RISOPS Legislative News
View the AOA's March 2008 Legislative Bulletin
View the AOA's 2007 Year-End Legislative Report
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DO Washington Update - March 24, 2008
MedPAC Presents Annual Report to Congress
In early March, the Medicare Payment Advisory Commission (MedPAC) released its annual report to Congress. The report provided recommendations on Medicare fee-for-service (FFS) payment policy for the upcoming year as well as recommendations regarding Medicare Advantage (MA) plans. This year's report made special note of growing concerns amongst the Commission regarding long-term sustainability of the Medicare program. Specifically, the report provides policy recommendations to limit updates to providers as an incentive for greater efficiency, to reward quality, and to modify payments to private plans to ensure parity in payment.
Medicare Payment Policy:
MedPAC acknowledges that the downfall of the Medicare program has been increasing volume for specialized services, while not necessarily improving health outcomes or efficiency. The Commission has encouraged quality based payments, measurement of physician resource use, and utilizing comparative effectiveness, but there are still underlying problems with the current payment system that must be addressed.
While beneficiary access to physicians on a national level remains stable, beneficiaries are reporting difficulty making timely appointments with their current physician as well as difficulty finding new primary care physicians, partly due to decreasing physician payments. Therefore, MedPAC recommends that the physician payment update for 2009 be 1.5 percent (projected change in input minus productivity). The Commission's eventual goal is to base physician payments, at least in part, on resource use. That goal will not be realized for several years.
Medicare Private Plans:
The Commission supports private plans under the Medicare program, thus providing beneficiaries with greater choice. Further, the Commission supports financial neutrality between payments to traditional fee-for-service (FFS) Medicare and Medicare Advantage (MA) plans in order to spur efficiency and innovation. MA payments upwards of 113 percent of FFS, as well as lesser efficiency of MA plans when compared to FFS, are contributing to the worsening sustainability of the entire Medicare program.
Ray Quintero (rquintero@osteopathic.org )
The "Physician Activities Guidelines for Americans Act"
On March 12, Sens. Tom Harkin (D-IA) and Sam Brownback (R-KS), along with Reps. Mark Udall (D-CO) and Zach Wamp (R-TN) introduced legislation aimed at improving the health and wellness of Americans. The "Physical Activities Guidelines for Americans Act" would direct the Department of Health and Human Services (HHS) to prepare and promote physical activity guidelines based on the latest scientific evidence, similar to current dietary and nutritional guidelines.
Citing that more than half of Americans do not get enough daily exercise to maintain proper health, the "Physical Activities Guidelines for Americans Act" will establish guidelines for children, adults, seniors and people with disabilities, to ensure Americans understand how much exercise they should be getting. It would also require federal agencies to promote the guidelines when carrying out any federal health program. The legislation has been endorsed by more than 35 organizations
Cate Blankenburg (cblankenburg@osteopathic.org)
March is National Nutrition Month
Please join with the Centers for Medicare and Medicaid Services (CMS) in promoting increased awareness of nutrition, healthful eating, and the medical nutrition therapy (MNT) benefit covered by Medicare.
Approximately 8.6 million Americans, at least 60 years or older, are diagnosed with diabetes or acute renal failure. MNT provided by a registered dietitian or nutrition professional may result in improved diabetes and renal disease management and other health outcomes and may help delay disease progression.
Medicare provides coverage of medical nutrition therapy (MNT) for beneficiaries diagnosed with diabetes and/or renal disease (except for those receiving dialysis) when provided by a registered dietitian or nutrition professional who meets the provider qualification requirements. The beneficiary's treating physician must provide a referral and indicate a diagnosis of diabetes or renal disease. Medicare provides coverage for 3 hours of MNT in the first year and 2 hours in subsequent years. Additional hours may be covered in certain situations.
CMS has developed a variety of educational products and resources to help health care professionals and their staff become familiar with coverage, coding, billing, and reimbursement for all preventive services covered by Medicare.
- The MLN Preventive Services Educational Products Web Page - provides descriptions and ordering information for Medicare Learning Network (MLN) preventive services educational products and resources for health care professionals and their staff.
- Diabetes-Related Services Brochure - This tri-fold brochure provides health care professionals with an overview of Medicare's coverage of diabetes screening tests, diabetes self-management training, medical nutrition therapy, and supplies and other services for Medicare beneficiaries with diabetes.
- The CMS website provides additional information about the MNT benefit.
- For information to share with your Medicare patients, visit http://www.medicare.gov
- For more information about National Nutrition Month, please visit http://www.eatright.org
Carol Monaco (cmonaco@osteopathic.org )
2009 Budget Resolution Adopted
On March 13 and 14, the House and Senate respectively adopted the FY 2009 budget resolution. This resolution is non-binding; but sets aggregate spending and revenue targets for the fiscal year. It offers Congress a way to outline broad policy goals separate from those of the President, who submitted his budget request last month.
The House adopted its resolution (H Con Res 312) by a vote of 212-207. Sixteen Democrats and all Republicans voted against the bill. The Senate adopted its budget resolution (S Con Res 70) by a vote of 51-44. Two Republicans - Sens. Susan Collins(R-ME) and Olympia J. Snowe(R-ME) voted for the proposal, Sen. Evan Bayh, (D-IN)., voted "no."
Both the House and Senate budget resolutions would allot more discretionary spending for the 12 annual appropriations bills than the $991.6 billion proposed by the president. The House plan calls for a $25.4 billion increase above Bush's request, while the Senate version would provide an additional $21.8 billion. Both numbers include funding for advanced appropriations provided in the resolutions but not "emergency" spending, which does not count against budget spending caps.
The House passed measure includes instructions that could be used to facilitate consideration of Medicare legislation, but the Senate measure does not. However, if the chambers agree on a final budget blueprint, it could include the House-approved instructions. That reconciliation language allows legislation to move in the Senate with protection against a filibuster if the measure reduces the federal deficit, needing only a simple majority to pass, not the currently required 60 votes. Conferences will meet when Congress returns on March 31.
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Congress Approves Six Month Delay in Meciare Payment Cuts
The United States Congress has approved the "Medicare, Medicaid, and SCHIP Extension Act of 2007" (S. 2499), legislation that prevents the scheduled 10.1 percent cut in Medicare physician payments and extends authorization for the State Children's Health Insurance Program (SCHIP). The Senate approved the legislation by voice vote [there were no recorded votes] on December 18. The House quickly approved the legislation on December 19 [see how your Members voted ]. President Bush is expected to sign the legislation into law later this week.
The final compromise bill falls far short of the policy objectives advanced by the American Osteopathic Association and other physician organizations over the past year and falls well short of the provisions included in the House-approved "Children's Health and Medicare Protection Act of 2007" (H.R. 3162). However, the legislation prevents the application of the largest single year cut in the history of the Medicare program. While we are disappointed with the final package, we are optimistic that we can build upon recent negotiations to advance more meaningful legislation in the first six months of 2008.
The following is a summary of the major provisions included in the "Medicare, Medicaid, and SCHIP Extension Act of 2007" (S. 2499):
- Physician Payment-Prevents scheduled 10.1% cut in Medicare physician reimbursements. Replaces scheduled cut with a 0.5% increase through June 30, 2008.
- SCHIP-Extends SCHIP funding through March 31, 2009. Imposes a six-month delay on implementation of proposed administrative regulations relating to school-based services and rehabilitation services.
- Work Geographic Adjustment-Extends the work geographic index (GPCI) floor of 1.0 through June 30, 2008.
- Medicare Scarcity Payments- Extends provisions that provide a 5% bonus payment to physicians practicing in physician shortage areas through June 30, 2008.
- PQRI-Extends the physician quality reporting system and revises the Physician Assistance and Quality Initiative fund (more details once we see legislative language)
- Therapy Caps-Extends exceptions to therapy cap through June 30, 2008.
- Medicare Advantage Stabilization Fund-Removes $1.5 billion in 2012.
- Inpatient Rehabilitation Facility (IRF) Services-Permanently freezes the inpatient rehabilitation services compliance threshold at 60%, effective for cost reporting periods starting July 1, 2006, and allows co-morbid conditions to count toward this threshold.
- Military Physicians-Permits physicians in the armed services to engage in substitute billing arrangements for longer than 60 days when they are ordered to active duty.
How to check the status of a bill in Rhode Island
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Double click “Bill Status/History” in the left-hand column. You will be on the “General Assembly Bill Status System” page. Double click on “Bill Status/ History” at the top.
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In the box entitled “Bills” enter the Bill Number. Bills are 4 digits in length, 0-4999 for Senate bills and bills starting with 5 or getter are house bills.
