Outgoing House Speaker John Boehner and the Obama Administration have reached agreement on a two-year, $80 billion budget/debt-ceiling deal that includes Medicare and Medicaid “offsets” to finance other spending. For instance, while the budget would provide $80 billion in discretionary spending sequestration relief over two years, it would extend Medicaresequestration for an additional year, through 2025. The deal also would: 

  • Extend inflation-based Medicaid drug rebates currently paid on brand drugs to generic drugs.
  • Pay new provider-based off-campus hospital outpatient departments (those located more than 250 yards from the main hospital campus that enter into a Medicare provider agreement after the date of enactment) under the ambulatory surgical center prospective payment system or the Medicare physician fee schedule, rather than the hospital outpatient prospective payment system (OPPS). Existing provider-based off-campus hospital outpatient departments would continue to be paid under the OPPS.
  • Require civil monetary penalties to be updated for inflation since their last update prior to 1996 (with certain exceptions, and capped at a 150% increase), with inflation adjustments applied annually thereafter.
  • Repeal an Affordable Care Act provision that requires employers with more than 200 employees to automatically enroll new full-time equivalents into a qualifying health plan if offered by that employer, and to automatically continue enrollment of current employees.
  • Protect Medicare beneficiaries from a substantial jump in Medicare Part B premiums for 2016.

The fate of the agreement is still up in the air, but it could come up for a House vote later this week.