Medicare Reform Still in the Sights of Key Legislators

House Budget Committee Chairman Paul Ryan (R-WI) recently reiterated his intent to push for Medicare reform, regardless of the Medicare trustees’ report that extended the solvency of the program for another two years. However, the prospects that the House budget resolution containing such reforms will become the basis for a House-Senate budget deal appears to be less and less likely as the FY 2013 budget deficit declines due to the sequestration and unanticipated level of tax receipts. Nonetheless, in the Senate another bipartisan effort is underway to craft Medicare changes that focus on helping reduce the spiraling costs of chronic care according to Senators Ron Wyden (D-OR) and Johnny Isakson (R-GA). While the House budget resolution also would transform Medicaid into a block grant program, the Arkansas Surgeon General testified at a House Energy and Commerce Health Subcommittee hearing that the current law is sufficient to give states flexibility to contain Medicaid costs through new delivery mechanisms, such as the state’s private option given the okay by HHS. Rep. Joe Pitts (R-PA), the subcommittee chair, said that HHS/CMS should allow states to modernize their Medicaid programs through consumer driven mechanisms, such as coordinated care.

House Members Call for Delay in DME Bidding Process

Reps. Glenn Thompson (R-PA) and Bruce Braley (D-IA) said they have about 226 House members who support their efforts to ask the Centers for Medicare and Medicaid Services (CMS) to delay the July 1st start of Round Two of the durable medical equipment (DME) bidding program until year-end. They said they are concerned about what they say is a lack of transparency and binding bids under the program.

MedPAC Report on MD Cuts, Bundling and Payment Rates

The Medicare Payment Advisory Commission (MedPAC) released its annual report to Congress, Medicare and the Health Care Delivery System, which finds that Medicare payment rates often vary significantly for the same ambulatory services across practice/hospital-outpatient settings. The commission suggests that payment rates in different settings for the same patient services should be equalized, particularly given that physician services are shifting to more expensive hospital outpatient settings. MedPAC also found that Medicare fee-for-service payment rates vary significantly in post-acute care settings. The commission suggests that the bundling of payments for post-acute-care in-home and in skilled nursing, long-term care hospitals (LTCH) and inpatient rehabilitation facilities would result in the more efficient use of resources. The commission did not specify one design as the preferred means for payment bundling and said demonstration projects could help determine the best venue. In related news, the House Ways and Means Health Subcommittee held a hearing on other proposals to reform Medicare post-acute care payments included under the President’s FY 2014 budget and other bipartisan proposals. Chairman Kevin Brady (R-TX) said the goal is to come up with details for creating site neutral payments, reducing readmissions for nursing homes and creating bundled payments. MedPAC also included several recommendations to reform Medicare outpatient therapy benefit payments to improve accuracy, by: lowering the level of the caps; collecting additional patient data; reducing the certification period to improve physician oversight of the plan of care; and developing guidelines for therapy services. The report also discussed how federally qualified health centers (FQHCs) and community health centers (CHCs) could be better used to coordinate care for Medicare/Medicaid dual-eligibles. Of note, MedPAC also announced that Medicare physician payments will be cut by 24.4% in 2014 unless Congress again intervenes. In other news, the Medicaid and CHIP Payment and Access Commission issued its semiannual report to Congress recommending, among other things, the need to improve maternity services to help control costs while ensuring healthy birth outcomes.

Medicare Coverage for Certain PET Scans

CMS issued a final Medicare coverage decision under which three fluorodeoxyglucose positron emission tomography (PET) scans will be covered during a patient’s lifetime after initial anti-cancer therapy is completed.

Upcoming Hearings and Markups on Health-Related Legislation

House Energy and Commerce Oversight and Investigations Subcommittee: will hold a hearing titled “Continuing Concerns Over BioWatch and the Surveillance of Bioterrorism;” 10:00 a.m., 2322 Rayburn Bldg; June 18.

Senate Finance Committee: will hold a hearing titled “High Prices, Low Transparency: The Bitter Pill of Health Care Costs;” 10:00 a.m., 215 Dirksen Bldg; June 18.

Senate Appropriations Agriculture, Rural Development, FDA, and Related Agencies Subcommittee: will mark up draft legislation that would make FY 2014 Ag/FDA appropriations for programs under its jurisdiction; 10:00 a.m., SD-192 Dirksen Bldg; June 18.

Senate Appropriations Military Construction, Veterans Affairs and Related Agencies Subcommittee: will mark up draft legislation that would make FY 2014 appropriations for programs under its jurisdiction. 10 a.m., SD-124 Dirksen; June 18.

Senate HELP Primary Health and Aging Subcommittee: will hold a hearing titled “Reducing Senior Poverty and Hunger: The Role of the Older Americans Act;”10:00 a.m., 430 Dirksen Bldg; June 19.

Senate Appropriations: Defense Subcommittee: will hold hearings on proposed FY 2014 appropriations for agencies, programs and activities under its jurisdiction. 10 a.m., 192 Dirksen; June 19.

Senate Appropriations Committee: will markup draft legislation that would make FY 2014 appropriations for various agriculture programs as well as legislation that would make FY 2014 appropriations for military construction-veterans affairs programs. The committee will also vote on 302(b) subcommittee spending allocations. 10:30 a.m., 106 Dirksen; June 20.

House Ways and Means Health Subcommittee: will hold a hearing on the 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds; 9:30 a.m., 1100 Longworth Bldg; June 20.

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