Chart: Key Provisions Of The Medicare Improvements For Patients And Providers Act of 2008, H.R. 6331

Key Provisions Of The Medicare Improvements For Patients And Providers Act of 2008, H.R. 6331
After initially stumbling when introduced as S. 3101, MIPPA gained momentum when a slightly modified version, H.R. 6331, passed in the House by an overwhelming majority. Despite that, it still needed two more attempts at passage and the appearance of Sen. Ted Kennedy, D-Mass., to gain the needed veto-proof majority in the Senate. Congress overrode the president's veto during the week of July 14. Below are the measure's key pharma-related provisions, excerpted by "The Pink Sheet" from the bill text and committee summary documents.
	Provisions	Implementation Date
Part D drug coverage	Part D sponsors will be permitted to cover barbiturates used in the treatment of epilepsy, cancer or a chronic mental health disorder and benzodiazepines. (Sec. 175) Formalizes process under which changes can be made to list of classes that plans are required to cover "all or substantially all" drugs. Current list includes antineoplastics, antidepressants, antipsychotics, antiretrovirals, anticonvulsants and immunosuppressants. Beginning in 2010, HHS, through, rulemaking can modify the list. (Sec. 176)	Jan. 1, 2013
Pharmacy payment	Requires payment by Medicare Part D and MA-PD plans within 14 days of the receipt of clean claims (defined as having no defect or impropriety including any lack of any required substantiated documentation or particular circumstance requiring special treatment that prevents timely payment). If payment is not made in the 14-day window, PDP sponsor is required to pay interest. Clean claims submitted electronically are to be paid via electronic funds transfer if the pharmacy requests it. (Sec. 171)	Jan. 1, 2010
	If a PDP sponsor uses a payment standard for pharmacies based on the cost of a drug, prices are to be updated at least once every seven days beginning Jan. 1 of each year to accurately reflect the market price of acquiring a drug. (Sec. 173)	Jan. 1, 2009
Medicare plan marketing	Prohibits certain sales activities for Medicare Advantage and Part D prescription drug plans, including unsolicited direct contact (i.e. soliciting door-to-door, outbound telemarketing), cross-selling of unrelated products (i.e. annuities and life insurance), and providing meals during sales and marketing. (Sec. 103)	Jan. 1, 2009
	CMS will develop regulations limiting co-branding of MA and Part D plans, gifts to prospective enrollees, commissions paid to brokers, as well as rules requiring annual training and testing of agents, brokers and other third parties. (Sec. 103)	No later than Nov. 15, 2008
	MA and Part D plan sponsors will be allowed to use brokers and agents who have been licensed under state law to sell plans and must report to states when an agent or broker has been terminated. Sponsors must comply with state requests for information in a timely manner. (Sec. 103)	Jan. 1, 2009
Low-income subsidy enrollees	Increases amount of resources allowed when determining eligibility for the full LIS under Medicare Part D. (Sec. 112) Directs Social Security Administration to distribute LIS applications to those applying for Medicare benefits and train employees to assist in filling out application. (Sec. 113)	Jan. 1, 2010
	Waives the Part D late enrollment penalty for LIS-eligible enrollees. (Sec. 113)	January 2009
	Exempts life insurance policies and any in-kind support, such as that from a church organization or a family member, from income used to determine LIS eligibility. (Sec. 116)	Jan. 1, 2010
Part B drugs	Extends current "cost to charge" payment rules for brachytherapy and therapeutic radiopharmaceuticals through Dec. 31, 2009. (Sec. 142)
Electronic prescribing	Creates an incentive payment for the use of electronic prescribing. For 2009 and 2010, physicians receive a 2 percent increase on Medicare physician payments. For 2011 and 2012, they receive a 1 percent increase and for 2013, a 0.5 percent increase. Penalties for not adopting e-prescribing are: a 1 percent decrease in physician payments in 2012, a 1.5 percent decrease in 2013 and a 2 percent decrease in 2014 and beyond. HHS may exempt physicians if prescribing activities account for less than 10 percent of business, or other hardships prevent e-prescribing. (Sec. 132)	Various
	GAO to report on e-prescribing, including the percentage of eligible physicians using e-prescribing, and if that number is below 50 percent, recommendations to increase use; estimated Medicare savings from usage; reductions in avoidable medical errors; the extent to which privacy and security of personal health information is protected; and whether current law requires sufficient and appropriate oversight and audit capabilities to monitor the practice of prescription data mining. (Sec. 132)	Report due by Sept. 1, 2012
Medicare dialysis services	Increases composite rate for renal dialysis services provided to end-stage renal disease patients by 1 percent in 2009 and again in 2010 and creates a site-neutral composite rate for 2009. (Sec. 153)	Various
	HHS to implement a bundled payment system for dialysis products and services. The bundle will cover the composite rate for dialysis services as of Dec. 31, 2010, as well as erythropoiesis-stimulating agents and other drugs and biologics furnished to treat ESRD and diagnostic lab tests and other services. Bundle will include a case-mix adjustment that may take into account patient weight, body mass index, comorbidities, length of time on dialysis, age, race and ethnicity; an adjustment for high cost-outliers; an adjustment for low-volume facilities and other adjustments HHS deems appropriate. Bundled payments are to be phased in throughout a four-year period, with full implementation by Jan. 1, 2014, though a dialysis facility can opt out of the phase in and receive the bundled payment on Jan. 1, 2011. (Sec. 153)	Jan. 1, 2011
	HHS will annually update the ESRD market basket percentage increase for bundled payment system to reflect changes in the price of an appropriate mix of goods and services included in renal dialysis minus 1.0 percentage point. (Sec. 153)	Beginning in 2012
	GAO will report on ESRD bundling, examining the changes in ESA utilization rates, the mode of administering ESAs, analysis of payment adjustments and changes in other drug and biologic utilization rates. (Sec. 153)	No later than March 1, 2013
Comparative effectiveness and Medicare data sharing	Clarifies use of Part D claims data, stating it can be used to improve public health through research on utilization, safety, effectiveness, quality and efficiency of health care services and shall be made available to congressional agencies for oversight, monitoring, making recommendations and analysis. (Sec. 181)
	HHS will contract with the Institute of Medicine for a study on the methodological standards for systematic reviews of clinical effectiveness research on health and health care in order to ensure organizations conducting such reviews have information on methods that are objective, scientifically valid and consistent. A report is due in 18 months. (Sec. 304)
Medicaid	Delays implementation of rules through Sept. 30, 2009 that would reimburse pharmacies at 250 percent of the average manufacturer price for the least expensive drug in a multi-source group and delays to that date the publication of AMP data on a public Web site. (Sec. 203)