October 25,2000

House and Senate Agree to Medicare Refinement Plan

WASHINGTON - House Ways and Means Chairman Archer (R-TX), Senate Finance Committee Chairman Bill Roth (R-DE), House Commerce Chairman Tom Bliley (R-VA), Health Subcommittee Chairman Bill Thomas (R-CA), and Commerce Health Subcommittee Michael Bilirakis (R-FL) today announced that an agreement has been reached between the House and Senate on a plan to strengthen Medicare, Medicaid and the Children's Health Insurance Program (SCHIP). Final Congressional Budget Office (CBO) cost estimates on the multi-billion dollar package will be available soon.

"This package addresses urgent needs within the Medicare program. We improve seniors' access to hospitals, lower their out-of-pocket costs and crack down on Medicare fraud that robs seniors of the care they need," said Ways and Means Chairman Archer.

"This House-Senate compromise not only addresses improving funding for health care services, but also makes a significant step forward in improving prevention benefits for Medicare beneficiaries and reduces their out-of-pocket costs for hospital services. I am also equally pleased that this compromise addresses funding matters in Medicaid and the State Children's Health Insurance Program to ensure maximum benefits are delivered under those programs," said Finance Chairman Roth.

"Today's agreement means improved health care for millions of Americans. It means more money for community health centers and hospitals -- especially those in rural areas and in areas with large uninsured populations. And, we increase drug coverage for patients with life threatening diseases, and make health coverage for all seniors more affordable," said House Commerce Chairman Bliley.

"This package makes Medicare stronger than it has ever been. We lower out-of-pocket costs, put more doctors in emergency rooms, more ambulances in rural areas, and more heath aides in seniors' homes," said Ways and Means Health Subcommittee Chairman Thomas.

"The 1997 Balanced Budget Act saved Medicare from bankruptcy, but the real-life effects of that law were far greater than expected or intended. This agreement will restore vital health care funding for providers and the patients they serve. It will also increase preventive health benefits for seniors, including screenings for glaucoma and colon cancer, medical nutrition therapy, and Pap smear screenings and pelvic exams," said Commerce Health Subcommittee Chairman Bilirakis.

- A two page summary follows -

Medicare, Medicaid and SCHIP Benefits
Improvement & Protection Act


Lowers Seniors' Out-of-Pocket Hospital Costs - The plan accelerates the reduction of high co-payments Medicare beneficiaries pay for outpatient hospital visits. Currently, Medicare patients pay as much as 70 percent on certain co-pays for outpatient hospital care.

Improved Benefits for Medicare Seniors - The plan creates and expands important new preventive benefits for seniors and the disabled. In addition to lowering out-of-pocket outpatient hospital costs, the plan also offers coverage of:

• Bi-annual pap smear screenings and pelvic exams;
• Medical nutrition therapy for patients with diabetes or renal disease;
• Glaucoma screenings;
• Colon cancer screenings for all Medicare patients; and
• Calls for Congressional study of expanding Medicare coverage of thyroid screenings.

Additional Beneficiary Assistance - Additional provisions improve access to Medigap coverage; permit Medicare+Choice plans to give beneficiaries cash rebates of Part B premiums; protect access to immunosuppressive, cancer, hemophilia and other drugs; and conduct new outreach initiatives to promote enrollment in programs designed to provide cost-sharing assistance to low-income Medicare beneficiaries.

Creates New Protections Through Medicare Patient Bill of Rights - Gives Medicare beneficiaries access to an external review process and expands the rights of Medicare patients to appeal coverage decisions.

Strengthens Rural Hospitals - The refinement package provides equitable treatment for rural disproportionate share hospitals (DSHs) caring for a disproportionate share of poor Medicare patients; extends the Medicare Dependent Hospital program for rural areas; updates target amounts for all sole community hospitals; and increases rural patients' access to emergency and ambulance services.

Boosts Medicare Anti-Fraud Provisions - Prevents drug companies from manipulating Medicare reimbursement levels for covered drugs which result in Medicare overpayments. Establishes fairer pricing system for Medicare reimbursable prescription drugs and related services. The package also re-authorizes an expired Office of Inspector General (OIG) advisory opinion provision, and creates stricter new standards for prosthetic device fraud.

Gives Rural Seniors Access to Best Medical Care Through Telehealth Services - Increases Medicare access to telehealth medicine in rural areas where medical specialists are not readily available. As a result, Medicare patients will now have access to the world's best doctors and medical care regardless of where they live.

Improves Beneficiaries' Access to New Medical Technologies - Modernizes Medicare's coding and payment procedures so that beneficiaries can have more rapid access to new technologies.

Improves Access to Hospitals and Strengthens Teaching Hospitals - Ensures access to hospital services nationwide by providing a full inflation update for 2001. The plan also ensures the financial stability of teaching hospitals by increasing payments related to physician training.

Offers Beneficiaries More Flexibility Through Medicare +Choice - Stabilizes and improves funding for beneficiaries electing to enroll in privately-offered Medicare+Choice plans, with special attention to rural communities; and provides additional assistance for disabled and rural beneficiaries. Assistance has also been targeted to immediately help those communities at greatest risk of losing their M+C plans. The plan also ensures that health disparities do not occur between different racial/ethnic groups served by M+C plans, and also makes it easier for employers providing retiree coverage to coordinate coverage with M+C plans.

Strengthens Critical Access Hospitals - Eases out-of-pocket costs for beneficiaries getting clinical lab tests done in critical access hospitals (CAHs). Gives rural hospitals more flexibility in exempting swing beds from the PPS, thus providing more flexibility to better care for patients with varying medical needs. Expands access to ambulance services furnished by CAHs as well as increased access to emergency room on-call physicians. The plan also provides hospitals with assistance so they can attract more doctors to isolated rural areas.

Home Health and Hospice Provisions - Protects funding for home health services by delaying a scheduled 15% cut in payments in addition to other payment increases. Provides for full medical inflation update for home health. Hospice provisions also improve funding for end-of-life care. The plan also enhances the use of telehealth medicine in delivery of home health care services.

Increases Access to Care for Nursing Home Patients - Maintains access to therapy services, and reduces regulatory burdens by eliminating some parts of consolidated billing. In addition, the plan increases the Federal per diem rate for SNF "market baskets."

Provides Payment Updates for Renal Dialysis and Durable Medical Equipment - The plan improves beneficiaries' access to renal dialysis treatments and durable medical equipment such as wheelchairs.

Boosts Care in Long-Term, Rehabilitation and Psychiatric Hospitals - Adjusts payments for existing long-term, rehabilitation, and psychiatric hospitals.

Boosts Patient Access to Federally Qualified Health Centers - Adds provisions to protect clinics from potential reductions in payments in order to maintain access to community health centers.

Strengthens and Expands Access to Medicaid and Children's Health Insurance - Establishes policies for the retention and redistribution of unspent SCHIP funds; adds funding for Medicaid's disproportionate share hospital (DSH) program.