Budget

A White House budget proposal to save $140 million over 10 years through prepayment review or prior authorization for power wheelchairs came as a surprise to industry as CMS has already scrapped the prepay phase of a recently revived demonstration. The White House power wheelchair proposal, which an industry source tells Inside Health Policy is outdated, is one of 16 HHS policies estimated to save $3.6 billion over 10 years by reducing fraud, waste and abuse in Medicare and Medicaid.

The president’s budget proposal puts the 10-year cost of replacing the Sustainable Growth Rate (SGR) formula at $429 billion -- compared with the $316 billion estimate by the Congressional Budget Office -- which a physician lobbyist said indicates that the White House plans to increase Medicare physician pay and not just freeze it for a decade. The budget came out as House Republicans angered congressional Democrats by proposing to separate SGR talks from conference discussions on extending the payroll tax holiday, the latter which the GOP now says it would support without an offset.

The administration's FDA budget request includes more than $583 million in seven proposed new user fees, including two pending before Congress, with total industry fees funding 98 percent of the agency's $654 million increase over fiscal 2012 funding levels. The administration is also continuing its push to limit drug patent settlements between brand-name and generic drug makers and lower biologic exclusivity to seven years from the 12 years negotiated during health reform.

The Alliance for Quality Nursing Home Care is urging conferees hashing out a Medicare physician pay solution to phase in CMS' 11.1 percent Medicare pay cut to nursing homes and to avoid using nursing-home cuts to pay for overriding the Sustainable Growth Rate (SGR) formula.

Rep. Nan Hayworth (R-NY), a conferee negotiating on the Medicare physician payment fix, told Inside Health Policy that she is open to counting a reduction in war spending as an offset for permanently replacing the Sustainable Growth Rate formula.

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House Energy and Commerce health subcommittee Chair Joe Pitts (R-PA) said he wants to cut spending from the health overhaul law to pay for delaying for two to three years a 27.4 percent cut to Medicare physician payment, which would do away with the need for hospital-pay cuts that were included in the House-passed Sustainable Growth Rate formula two-year patch. Pitts opposes the idea of using war savings as an offset, although other Republicans appear to be warming to the idea.