	Introduction

On March 23, 2010, President Obama signed into law a comprehensive health care reform bill, the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148 ). The U.S. House of Representatives also passed an amendment in the nature of a substitute to H.R. 4872 , the Health Care and Education Affordability Reconciliation Act of 2010, on March 21, 2010. The Reconciliation bill includes two titles. The first title contains provisions related to health care and revenues. The second title includes amendments to the Higher Education Act of 1965, which authorizes most of the federal programs involving postsecondary education. The differences in projected Medicare savings are primarily due to changes that led to reductions in cost savings estimates for provisions related to disproportionate share hospitals and the Independent Payment Advisory Board together with cost increases associated with closing the coverage gap in the outpatient prescription drug benefit. Key Changes Made to PPACA by the Reconciliation Bill

The Medicare provisions in Subtitles B, D and E of Title I in the Reconciliation bill would make modifications to certain Medicare provisions in PPACA, as well as add several new provisions. 1105) would revise the additional adjustments to the market basket (MB) updates for the IPPS, OPPS, IPF, IRF and LTCH payment systems. Payment for Qualifying Hospitals

The Reconciliation bill as modified by the manager's amendment (Sec. Section 3135 of the PPACA changes the utilization rate assumption for calculating the payment for advanced imaging equipment from 50% to 65% for 2010 through 2012. Activities to fight health care fraud, waste, and abuse are funded by the Health Care Fraud and Abuse Control (HCFAC) account.
On March 23, 2010, President Obama signed into law a comprehensive health care reform bill, the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148), which would, among other changes, make statutory changes to the Medicare program. The U.S. House of Representatives also passed an amendment in the nature of a substitute to H.R. 4872, the Health Care and Education Affordability Reconciliation Act of 2010, on March 21, 2010 (referred to hereafter as the Reconciliation bill), which would amend the PPACA.
The Reconciliation bill includes two titles. The first title contains provisions related to health care and revenues, including modifications to PPACA's Medicare provisions. The second title includes amendments to the Higher Education Act of 1965, which authorizes most of the federal programs involving postsecondary education.
Medicare changes that would be made by the Reconciliation bill, as passed by the House on March 21, 2010, to the PPACA are summarized in this report. Among other changes, the Reconciliation bill would:
phase out the coverage gap under the Medicare prescription drug benefit and close it by 2020; change the methodology used to determine Medicare Advantage payments, and create an incentive system to reward high quality plans with higher payments; move up reductions in payments to disproportionate share hospitals to 2014, and reduce the cuts; revise the adjustments to annual updates for certain providers; change the qualifying date whereby an existing physician-owned hospital would be exempt from the self-referral prohibition; change the assumptions used to calculate Medicare reimbursement for advanced imaging services; and increase funding for the Health Care Fraud Abuse Control program and provide for enhanced oversight of DME suppliers.
This report will be updated as legislative activity warrants.