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Medicare “Givebacks” Bill on Fast Track

Congress is headed toward enacting legislation that would increase Medicare payments to health care providers. The Medicare “givebacks” legislation was approved, 13-0, by the House Ways and Means Subcommittee on Health on October 3. The House Commerce Committee approved, by voice vote, its version of the bill (H.R. 5291) on September 26. Additionally, Senate Finance Committee Chair William Roth (R-DE) unveiled his version of the bill this week, although the Senate measure will not be marked up. Rather, lawmakers are negotiating the three versions of the bill with the White House and hope to attach a compromise to the conference report for the FY2001 Labor, Health and Human Services, and Education appropriations bill (H.R. 4577) prior to adjournment.

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.

Commerce Committee Bill The bill (H.R. 5291) approved by the House Commerce Committee last week would cost an estimated $20 billion over five years. As approved, the Beneficiary Improvement and Protection Act includes several provisions that would impact women and families.

The bill would create a five state five-year demonstration project to examine the cost-effectiveness of providing medical nutrition therapy services under Medicare. The bill would allocate $60 million per year for a total of $300 million for the project. The language is similar to a broader bill (H.R. 1127) sponsored by Reps. Nancy Johnson (R-CT) and Sherrod Brown (D-OH). H.R. 1127, one of the legislative priorities of the Congressional Caucus for Women’s Issues, would have required Medicare to cover medical nutrition therapy services. The provision was included after a 1999 Institute of Medicine study recommended that the provision of medical nutrition therapy services would benefit both Medicare and its beneficiaries. The study was commissioned under the 1997 BBA.

The Commerce Committee bill also would increase the payment limit by $15 for new technologies applied to screening mammography performed beginning in 2001.

Additionally, the bill would provide optional coverage for certain legal immigrants under Medicaid and the State Children’s Health Insurance Program (SCHIP). Pregnant women and children who have been lawfully residing in the United States for two years would be eligible to receive health care coverage under Medicaid. The provision is drawn from two more comprehensive bills (H.R. 827/H.R. 4707). H.R. 827 is sponsored by Reps. Diana DeGette (D-CO) and Connie Morella (R-MD) and H.R. 4707 is sponsored by Reps. Lincoln Diaz-Balart (R-FL) and Henry Waxman (D-CA). The bill also would provide optional coverage for permanent resident alien children under SCHIP.

In an effort to enroll eligible children in Medicaid and SCHIP, the bill would allow additional sites to review and determine children’s eligibility. According to committee documents, these sites would include elementary and secondary schools, state child support enforcement agencies, child care resource and referral agencies, organizations providing emergency food and shelter assistance, or an agency that determines eligibility for any public assistance or benefits.

H.R. 5291 also would extend 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, but H.R. 5291 would extend its authority until 2002.

Ways and Means Subcommittee Bill The House Ways and Means Subcommittee on Health approved the Medicare Refinement and Benefit Improvement Act (as-yet-unnumbered) that is estimated to provide more than $30 billion over five years in additional Medicare payments. Prior to approving the bill, the subcommittee accepted a substitute amendment by Subcommittee Chair Bill Thomas (R-CA) that made several changes to the bill.

The substitute amendment added language pertaining to screening mammography. The bill would restate current law, which requires Medicare to cover annual screening mammography for women aged 40 and older. Additionally, the bill would direct the Secretary of Health and Human Services, in consultation with the Director of the National Cancer Institute, to periodically review the appropriate frequency of screening mammography. The bill would increase the payment for new technologies applied to screening mammography by authorizing a payment equal to 150 percent of the current physician fee schedule. Also, the Secretary of Health and Human Services would be instructed to expedite the consideration of a new payment category for screening mammography that uses new technology. The language is slightly different from H.R. 5291. As approved, the measure would extend Medicare coverage for medical nutrition therapy services to beneficiaries with diabetes or renal disease. The provision is slightly different from H.R. 5291, which would create a demonstration project. Under the Ways and Means bill, coverage for screening Pap smears and pelvic exams would be extended. 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. The bill would allow Medicare coverage for annual screening Pap smears and pelvic exams for all women for three years. If during that three-year period the tests are negative, then Medicare would cover screening Pap smears and pelvic exams every three years. Similar language is not included in H.R. 5291.

During subcommittee consideration, Democrats offered a number of amendments. One, offered by Rep. Pete Stark (D-CA), would have added a prescription drug benefit under Medicare at a cost of $37 billion over five years. The amendment was defeated, 5-8.

Another amendment, offered by Rep. John Lewis (D-GA), would require the Department of Health and Human Services to report to Congress on how quality assurance programs under Medicare+Choice focus on racial and ethnic minorities. The amendment also would create nine cancer prevention and treatment demonstration projects for racial and ethnic minorities. The amendment was approved by voice vote.

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