Senate May Not Take Up Medicare ‘Giveback’ Package This Week

The Senate does not have any immediate plans to address the Finance Committee's $41 billion Medicare package, CongressDaily/AM reports. The committee was expected to introduce the package Sept. 30, but a spokesperson for Senate Majority Leader Tom Daschle (D-S.D.) said the Senate's agenda this week is "dominated" by other issues, including a resolution authorizing military action against Iraq (Fulton, CongressDaily/AM, 10/1). Aides did say, however, that the package could be added to the Senate's schedule this week, CongressDaily reports (CongressDaily, 9/30). According to an outline, the $41 billion, 10-year "giveback" package includes "smaller-than-planned" cuts for hospitals and increases in payments for rural physicians, hospitals and home health agencies. Medicare+Choice plans reportedly would receive a boost in payments of 4% in 2003 and 3% in 2004. The bill also would reverse the expiration of $1.7 billion in temporary Medicare funding for nursing homes (Kaiser Daily Health Policy Report, 9/27). The temporary funding is set to expire Oct. 1 (Washington, Washington Times, 10/1). The package also would expand a pilot program that uses competitive bidding for durable medical equipment nationwide. The plan also is expected to allow Medicare to cover immunosuppressive drugs for organ transplants and renew a five-year program that helps low-income seniors pay their Medicare premiums. The plan also includes a two-year delay of payment caps for physical and occupational therapy and expands coverage of cholesterol and lipid level tests. The package also includes additional funding for Medicaid and state CHIP programs (Kaiser Daily Health Policy Report, 9/27).

Package's Path
The Finance Committee is not expected to mark up the bill, and aides said the package could face a "rocky floor fight" from senators attempting to add in a prescription drug benefit. The package also faces objections from CMS Administrator Tom Scully, who in a letter to committee members said, "Many of the well-intentioned provisions of the bill will codify administrative initiatives that CMS has already undertaken, thereby reducing future management flexibilities and constraining our ability to manage taxpayer dollars efficiently." Scully instead urged the committee to draft legislation that focuses on "benefits and contractor reform," CongressDaily/AM reports (CongressDaily/AM, 10/1).

Appealing Coverage Decisions
In other Medicare news, the House Ways and Means Committee on Sept. 27 sent a letter to HHS Secretary Tommy Thompson and Scully expressing concern about an administration proposal for a coverage appeals process for beneficiaries (House Ways and Means Committee release, 9/30). Congress in December 2000 passed a law that required CMS to create an appeals process for blanket coverage decisions, mandating that the process be in place by October 2001. Three beneficiaries and three advocacy groups sued CMS over its failure thus far to implement the appeals process (Kaiser Daily Health Policy Report, 8/7). Under a proposed process, beneficiaries would be permitted to appeal coverage decisions, but the outcome of the appeal would be applied only to that beneficiary and not all Medicare beneficiaries. In the letter, committee members said the administration's proposed rule "directly contravenes clear congressional intent" to create an appeals process that would "create policy for others" in the event of a successful appeal by an individual beneficiary. The letter asks Thompson and Scully to "reflect both the letter and spirit of the law" when revising the proposed regulation (Ways and Means letter text, 9/27).