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Medicare “Givebacks” Approved by House; Veto Threat Looms

Despite veto threats by the President, the House leadership pushed through legislation to provide additional Medicare payments to health care providers. The legislation would provide $28 billion over five years in Medicare reimbursements for health care providers. The President issued a veto threat saying that the bill provided too much money for managed care organizations.

The House Ways and Means and Commerce Committees approved separate versions of the legislation earlier this month (see The Source, 10/6/00, p. 7). While Sen. William Roth (R-DE) unveiled a similar package, the measure was not considered by the Senate Finance Committee or the full Senate. Rather, the three versions were negotiated with the White House and added to a conference report for a bill (H.R. 2614) pertaining to a Small Business Administration loan program. The House approved the conference report on October 26 by a vote of 237-174. The Senate began debate on the conference report on October 27, but no vote is expected by the end of the day.

The 105th Congress enacted the Balanced Budget Act (BBA) of 1997 (P.L. 105-33), which reduced spending on Medicare by $115 billion over five years and reduced spending on Medicaid by $12 billion over five years. These reductions were primarily achieved by decreasing reimbursements to health care providers. Since that time, certain health care providers have been more adversely impacted than others, forcing them either to close their practices or to reduce their services. Lawmakers attempted to rectify the situation last year during the appropriations process, when they included more than $16 billion in additional Medicare payments over five years as part of the FY2000 omnibus spending bill (P.L. 106-113). Still, health care providers have indicated that last year’s “givebacks” were not enough.

The final measure would provide for biennial coverage for screening Pap smears and pelvic exams. Currently, Medicare covers a Pap smear once every three years. Women who are at risk of developing cervical cancer and those who have had an abnormal Pap smear in the past three years are currently eligible for a yearly Pap smear. Under the House Ways and Means bill, coverage would have been extended to all women on an annual basis for three years. If during that three-year period the tests were negative, then Medicare would have covered screening Pap smears and pelvic exams every three years.

The final measure also would increase the payment limit for new technologies applied to screening mammography. Under the bill, beginning in 2002, two new payment rates would be established: one for technologies that directly take digital images and another for technologies that convert standard images to digital images. For technologies that directly take digital images, the payment rate would be equal to 150 percent of the payment for bilateral diagnostic mammography. Additionally, the Secretary of Health and Human Services would be required to determine if a new code is necessary. The provisions are similar to the House Ways and Means Committee version. For technologies that convert images, the payment rate would be increased by $15. The provision is similar to one included in the House Commerce Committee bill.

The final measure would extend Medicare coverage for medical nutrition therapy services for beneficiaries with diabetes and renal disease as provided under the House Ways and Means bill. Under the final version, coverage would be effective January 1, 2002, and the Secretary of Health and Human Services would be required to report to Congress on the effectiveness of providing these services. The Commerce Committee bill would have created a five state, five-year demonstration project to examine the cost-effectiveness of providing medical nutrition therapy services for all Medicare beneficiaries. The Commerce Committee provision was similar to a broader bill (H.R. 1127) sponsored by Reps. Nancy Johnson (R-CT) and Sherrod Brown (D-OH), which is one of the legislative priorities of the Congressional Caucus for Women’s Issues.

The final measure also includes House Ways and Means Committee language pertaining to racial and ethnic minorities. Both provisions were authored by Rep. John Lewis (D-GA). One provision would establish cancer prevention and treatment demonstration projects for ethnic and racial minorities. The other provision would expand the Medicare+Choice quality assurance programs to include a separate focus on racial and ethnic minorities. Additionally, the Secretary of Health and Human Services would be required to report to Congress on how quality assurance programs under Medicare+Choice focus on racial and ethnic minorities.

Under the final bill, the national limitation amount for a new clinical laboratory test would be equal to 100 percent of the national median for such tests. This provision would apply to new Pap tests. The language is similar to a provision included in the House Commerce Committee bill. The House Ways and Means Committee included language directing the Secretary of Health and Human Services to establish procedures for coding and payment determinations for new clinical laboratory tests.

Finally, the measure would increase the authorization for the Maternal and Child Health Block Grant from $705 million to $850 million. Additionally, the bill includes a provision to conduct a series of studies to identify preventive interventions in primary care for older Americans.

A number of provisions approved by the House Commerce Committee were not included in the final measure. One provision would have allowed states to provide optional coverage under Medicaid and the State Children’s Health Insurance Program for pregnant women and children who had been lawfully residing in the United States for two years. Another provision would have allowed additional sites to review and determine children’s eligibility for Medicaid. A third provision would have extended the Transitional Medicaid Assistance (TMA) program, which was created to help families transition from welfare-to-work by extending Medicaid coverage for up to one year as the families make the transition. The TMA program is set to expire in September 2001.

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