Medicare

A group of Senate lawmakers are poised to press Senate leaders to strengthen the chamber's language on Medicare's cost contracting program.

Medicare cost contract plans -- HMOs reimbursed for the actual cost of care -- serve roughly 340,000 Medicare beneficiaries and are slated to expire at the end of next year. The Senate bill would extend the program through 2009 and apply Medicare+Choice (M+C) standards and protections to the cost contract program.

Medicare conferees are heading towards a compromise on specialty hospitals that stops short of the Senate bill's ban on physicians referring patients to new, so-called boutiques hospitals in which they have ownership stakes but goes beyond the House bill's call for further study of the issue, Sen. John Breaux (D-LA) told reporters today (Sept. 16).

Breaux, the author of the ban on physician self-referral, said he would accept a modification of his proposal but indicated some of it would survive conference.

As Medicare conferees take up controversial home health care provisions for the first time this week, home care advocacy groups are converging on Capitol Hill and their sympathizers in the Senate are stepping up internal lobbying efforts to get conferees to oppose the home care provisions in the House bill.

Members of the National Association of Home Care (NAHC) and the American Association for Homecare held a home health lobby day on Sept. 9. Members of the Visiting Nurse Associations of America will be lobbying on home health issues later this month as well.

As doubt over final passage of a Medicare prescription drug benefit percolates, advocacy groups pushing hard for drug coverage have upped the ante through vocal lobbying campaigns pressing Congress for action.

AARP members descended on Washington, DC last week to pressure Congress to "keep its promise," "finish the job" and "fix and pass" the benefit. The scene was played out at two similar AARP rallies across the country.

House Ways and Means Committee Chairman Bill Thomas (R-CA) this week backed off plans to hold controversial votes on key ideological principles dividing the two chambers' Medicare bills, but still faced renewed partisan tension over looming decisions on the private sector role in delivering Medicare benefits and Democrats' role in the negotiations.

Thomas told reporters after the conference he has no plans to hold votes on principles but will put controversial provider issues to a vote.

House and Senate Medicare conferees tomorrow (Sept. 9) are expected to hold a series of votes that may chart the course for future negotiations on major ideological differences between the rival Medicare prescription drug bills and resolve contentious provider issues, including how to set payments for rural physicians and hospital reimbursements, according to industry and congressional sources.

Three pharmacy trade groups are lobbying conferees charged with crafting a Medicare drug benefit compromise to strip Senate-passed language that would set up a one-year FDA pharmacy compounding advisory committee. The groups argue that state boards, not FDA, should examine compounding safety issues.

Oncologists are mounting increased pressure on Medicare conferees to radically scale back proposed cuts in drug reimbursement even as CMS last week put forward a proposed revision to the Average Wholesale Price (AWP) reimbursement system that heightens pressure on cancer physicians to reach a deal with the conferees.

Key pharmacy groups and certain drug manufacturers have teamed up to lobby Medicare conferees to ensure adoption of the Senate Medicare bill's non-mandatory language on electronic prescribing, after it is modified to include safeguards against interference with prescriptions and choice of pharmacy, Inside CMS has learned. The move comes as more than 40 medical groups have voiced opposition to compulsory electronic prescribing in the House Medicare bill, stating that it would represent an "unfunded mandate" on physicians.