House, Senate, White House Agree to Medicare Refinement Plan
WASHINGTON - House Ways and Means Chairman Archer (R-TX) and Senate Finance Committee Chairman William V. Roth, Jr. (R-DE) today announced that a tentative agreement has been reached on a plan to strengthen Medicare and improve seniors' access to health care. Negotiations among members from the House, Senate and the White House concluded last night on H.R. 3075, the Medicare Balanced Budget Refinement Act.
Highlights of the agreement are listed below, but the list is not comprehensive, and it should be noted that they are subject to change. Final cost estimates on the multi-billion dollar package will be available soon by the Congressional Budget Office (CBO).
"Not only will this plan help to strengthen Medicare, it will also reduce out-of-pocket costs for millions of seniors who are often on fixed incomes," said Chairman Archer (R-TX).
"With this legislation, we help ensure that America's seniors receive high quality health care they deserve by restoring needed funding to hospitals, nursing homes and other health care providers over the next five years without retreating from the important policy reforms that were enacted in the Balanced Budget Act. The agreement we have reached addresses the most significant problems resulting from BBA policies and focuses payment adjustments on areas in which we face demonstrated problems resulting from the 1997 reforms," said Chairman Roth.
"Congress and the Administration were partners in the Balanced Budget Act two years ago, and now we are partners again in refining the law to offer more and better care to our nation's 40 million seniors and disabled," said Ways and Means Health Subcommittee Chairman Bill Thomas (R-CA).
"I'm pleased we have reached an agreement which will improve health care for millions of Americans. It means more money for rural hospitals, more affordable health coverage for seniors, and increased drug coverage for organ transplant recipients," said House Commerce Chairman Tom Bliley (R-VA).
- A two page summary follows -
The Medicare Balanced Budget Refinement Act of 1999
REDUCES SENIORS' COSTS: Seniors' out-of-pocket costs for hospital outpatient care, which currently vary widely and often exceed Medicare's standard 20 percent co-pay, would be limited to the same amount as the deductible for inpatient care - $776 in 2000.
MEDICARE + CHOICE: Creates incentives to expand Medicare+Choice options for seniors by increasing payments to Medicare+Choice plans, slows down the phase-in of the risk-adjuster until system can be revised with more complete data and offers incentives to encourage plans to begin offering coverage to seniors in counties that do not currently have Medicare+Choice plan options available. The bill also allows plans to offer seniors more choices by varying benefit packages, allows a Medicare+Choice plan to offer continuing coverage to seniors even if the plan withdrawals from their immediate county of residence, and establishes more flexible enrollment options for the frail elderly.
ORGAN TRANSPLANT PATIENTS: Extends Medicare's coverage of anti-rejection drugs used after organ transplants beyond the current three-year limit.
REHABILITATION SERVICES: Under the agreement, annual rehabilitation therapy caps would be lifted entirely for two years but with safeguards to prevent fraud and abuse.
WOMEN'S HEALTH: Provides more access to pap smear tests and cervical cancer screenings.
RURAL HOSPITALS: Increases flexibility in determining payment status and flexibility of rural hospital bed use (swing beds); would extend the Medicare Dependent Hospital program for rural areas; would provide financial relief to some sole community hospitals, and; would modify the existing Rural Hospital Flexibility Grant program to permit rural hospitals to obtain computer software and staff training to accommodate changes to new payment systems.
CANCER HOSPITALS: Ensures that cancer hospitals will not face any reductions due to the new outpatient prospective payment system.
HOSPITALS: Ensures smooth transition for hospitals switching to Medicare outpatient prospective payment system (PPS) -by creating "outlier" adjustments to ensure continuing access to new technologies and drugs, including orphan/cancer drugs; and would provide targeted incentives to increase hospital efficiency and ease the transition to the new prospective payment system. Rural hospitals with less than 100 beds would receive additional protections as they transition to the new payment system.
NURSING HOMES: Skilled Nursing Facilities (SNFs) would get added help in caring for medically-complex patients and those seniors needing rehabilitation therapy.
HOME HEALTH: The 15 percent scheduled reduction in payment reductions to home health agencies would be delayed until one year after implementation of the prospective payment system (PPS). The plan would also assist agencies with added paperwork and record-keeping costs.
HOSPICE CARE: Increases payments to hospice facilities caring for terminally-ill patients.
TEACHING HOSPITALS: Ensures the vitality of teaching hospitals by maintaining Indirect Medical Education payments and implementing a more equitable structure for Graduate Medical Education (GME) payments to teaching hospitals nationwide.
MEDICAL EQUIPMENT: Increases seniors' access to durable medical equipment like wheelchairs and oxygen.
FEDERALLY QUALIFIED HEALTH CENTERS: Adds provisions to protect clinics from potential reductions in payments in order to maintain access to community health centers.
MEDICAID and CHILDREN'S HEALTH INSURANCE: Includes several provisions to improve the State Children's Health Insurance Program (SCHIP) for low-income children; more stability in SCHIP funding by creating floors and ceilings. In addition, corrections are made in the original formula to account for under-representation of the population in certain areas; Improves Medicaid DSH funding - While most hospitals are limited in how much Medicaid DSH they can receive to 100 percent of their uncompensated care, some are allowed up to 175 percent. This bill provides a permanent extension for those safety net hospitals. In addition, the bill allows certain states and the District of Columbia to correct for errors that they made in submitting information for calculating their Medicaid DSH allotments.
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