Baucus introduces Medicare reform bill / Senate blocks debate on Baucus' Medicare reform bill

CAL/AAEM News Service calaaem_news at yahoo.com
Tue Jun 24 08:51:14 PDT 2008


Medicare: Senate blocks debate on Baucus' Medicare reform bill

Source: Medical Economics ( http://medicaleconomics.modernmedicine.com )
Date: Jun 13, 2008


A Medicare reform bill introduced by Senate Finance Committee Chairman Max Baucus failed June 12 to obtain the 60 votes needed to invoke cloture and begin debate on the measure, which would, among other things, block payment cuts to physicians of over 10% that will otherwise go into effect July 1.

The Medicare Improvements for Patients and Providers Act of 2008 (H.R. 3101) contains several controversial provisions, including cutting payments to Medicare Advantage (MA) plans.

Meanwhile, Senate Finance Committee Ranking Member Charles Grassley (R-IA) unveiled a separate version of Medicare reform legislation June 11. The Preserving Access to Medicare Act of 2008, like Baucus’ bill, would maintain the current 0.5% increase in physician reimbursement rates through the remainder of 2008 and provide a 1.1% update in 2009.

In announcing his alternative package earlier in the week, Grassley said “the most critical difference” between the two proposals is that his bill “can be signed into law.”

The White House issued June 12 a Statement of Administration Policy threatening to veto Baucus’ bill. “This legislation unnecessarily expands the Medicare program” and “pays for these spending increases, in part, with inappropriate reductions in Medicare Advantage payments,” the statement said.

“We all know what this vote was about, and it wasn't about what’s best for American seniors. The White House doesn't want overpaid private plans in Medicare to lose a single dime,” said Baucus in a statement following the failed 54-39 vote on the cloture motion for H.R. 3101.

Grassley, however, blasted Democratic leaders for “wast[ing] time and taxpayers’ money” on a bill they knew would fail and refusing to allow a vote on his alternative measure. “Now, Congress has 18 days left to make sure doctors serving Medicare patients don’t get hit with a draconian cut that would put them in the position of not being able to serve seniors,” he said after the vote.

The two proposals contain a number of similar provisions, including extending the Physician Quality Reporting Initiative (PQRI) through January 1, 2011, increasing bonuses under the PQRI to 2% for 2009 and 2010, and providing financial incentives for e-prescribing in 2009 through 2013.

The two measures also would implement a delay of the competitive bidding program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), which is set to begin July 1. Although Baucus did not originally include a delay of the DMEPOS competitive bidding program in his measure, he later announced he would amend his bill to that effect, citing reports from “suppliers who believe they were wrongly disqualified” and concerns about the impact on beneficiaries.

Later in the week, House Ways and Means Health Subcommittee Chairman Pete Stark (D-CA) and Ranking Member Dave Camp (R-MI) introduced a bill that would delay the DMEPOS competitive bidding program for 18 months.

Given the failure to advance either proposal in the Senate this week, lawmakers will have to restart negotiations to hammer out a measure that will garner enough votes and avoid the looming physician reimbursement cut.

Medicare Advantage

One area that is a major sticking point is Baucus’ proposal to trim MA payments by $12 billion over five years. Baucus has long argued that MA payment rates should be in line with traditional fee-for-service Medicare.

Grassley’s legislation does not contain the payment reductions to MA plans contemplated under Baucus’ measure, but would remove $1.3 billion from the MA stabilization fund for regional preferred provider organizations in 2013, according to a summary.

Among the reforms included in Baucus’ package are eliminating a special network exemption for private fee-for-service plans (PFFS) by 2011; requiring PFFS plans to report on quality measures by 2010; and eliminating a “double payment” with respect to the indirect medical education (IME) adjustment to MA rates.

Notably, Grassley’s bill does call for phasing out the inclusion of payments for IME in MA payments. His proposal would reduce the MA payment rate by 0.6% each year until the amount accounted for by IME is exhausted. The bill also would require PFFS plans to submit data for quality analysis and reporting.

Both measures also include provisions that expand on a Centers for Medicare and Medicaid Services’ (CMS’) proposal for curbing abusive marketing tactics by MA plans.

Pharmacies

The Baucus bill includes provisions aimed at ensuing pharmacists get paid in a timely manner for drugs dispensed to Medicare beneficiaries.

Specifically, the bill would require Part D drug plans to pay pharmacies within 14 days for clean claims submitted electronically and within 30 days for claims submitted otherwise, according to a summary.

The bill would give pharmacies that are located in or contract with long term care facilities between 30 and 90 days to submit reimbursement claims to a drug plan.

Under the legislation, Part D drug plans would be required to update their prescription drug pricing standard at least every seven days starting on January 1 of each year.

H.R. 3101 also delays through September 30, 2009 a controversial Medicaid “drug rebate rule” issued in July 2007 (72 Fed. Reg. 39142) that uses Average Manufacturer Price for generic drugs.

The National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA) challenged several aspects of the final rule in court, arguing its impact on Medicaid reimbursements of generic drugs would spell dire consequences for community pharmacies and would reduce reimbursement rates below the level permitted by law.

On December 14, 2007, the district court judge in the case issued a preliminary junction halting implementation of the rule until a final decision on the merits of the lawsuit. National Ass’n of Chain Drug Stores v. Health and Human Servs., No. 1:07-cv-02017 (RCL).

In a statement, NCPA hailed H.R. 3101’s prompt pay provisions and the delay of the Medicaid drug rebate rule.

NCPA President Stephen L. Giroux said the provisions “end[] the deliberately slow payment of Part D claims that force community pharmacies to maintain cash flow by taking out huge loans” and “delay[] the implementation of a fundamentally-flawed Medicaid reimbursement formula that forces community pharmacies to be reimbursed below actual generic prescription drug cost.”

Other Differences

Grassley’s bill also lacks provisions included in H.R. 3101 that would reduce payments for power wheelchairs and oxygen equipment.

The Baucus bill would apply a similar rent-to-own method to power wheelchairs that already is in place for other durable medical equipment. Current law, according to the bill summary, allows the complete purchase of power wheelchairs through Medicare in the first month of use, “concentrating costs up front for the program and for taxpayers who fund it.”

H.R. 3101 also calls for reforms to how Medicare pays for oxygen equipment and oxygen, which is expected to save the program roughly $1 billion over five years.

In announcing his bill, Grassley emphasized that his measure, unlike the majority's proposal, “does not expand eligibility for low-income Medicare programs, which would increase long-term entitlement spending and expand coverage under an already unsustainable program.”

This material originally appeared in the June 13, 2008, issue of Health Lawyers Weekly, a publication of the American Health Lawyers Association.

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Baucus introduces Medicare reform bill 

Source: The American Hospital Association ( http://www.aha.org )
Date: June 9, 2008


Senate Finance Committee Chairman Max Baucus (D-MT) Friday introduced Medicare reform legislation (S. 3101), which is expected to move directly to the Senate floor within the next two weeks. The Medicare Improvements for Patients and Providers Act would block a July 1 physician payment cut and increase physician payments by 1.1% for the remainder of 2008 and in 2009. Among other changes, the bill would extend the Medicare Rural Hospital Flexibility grant program; provide rebasing for sole community hospitals; extend and expand the outpatient hold-harmless provision for small rural hospitals under 100 beds, and add sole community hospitals under 100 beds; extend Section 508 reclassification; repeal the competitive bidding demonstration project for clinical laboratory services; and allow critical access hospitals to receive 101% of reasonable costs for clinical lab services whether the specimen was taken at the hospital or off site. Co-sponsors include
 Sens. John Rockefeller (D-WV), Olympia Snowe (R-ME) and Gordon Smith (R-OR). Finance Committee Ranking Member Charles Grassley (R-IA) is expected to release a separate Medicare package this week with some Senate Republicans.


Abid Mogannam &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service
University of California, Irvine

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