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Capitol Hill Watch | House Budget Committee Approves FY 2007 Budget Plan Without Medicare, Medicaid Cuts

The House Budget Committee on Wednesday voted 22-17 along party lines to approve a $2.8 trillion fiscal year 2007 budget resolution that does not call for mandatory spending reductions to Medicare or Medicaid, CQ Today reports. President Bush in his budget proposal last month outlined $65 billion in spending reductions from Medicare and other mandatory programs over five years. The House resolution includes $6.8 billion in spending reductions to mandatory programs, but it “spar[es] politically sensitive programs such as Medicaid and Medicare,” CQ Today reports (Dennis, CQ Today, 3/29). Budget Committee Chair Jim Nussle (R-Iowa) and other House committee chairs “are still figuring out how to meet the $6.8 billion mandatory spending cut goal,” CongressDaily reports (Cohn, CongressDaily, 3/29). The House resolution adopts Bush’s proposed $873 billion cap on discretionary spending, which would increase 3.6% over last year (Dennis, CQ Today, 3/29). The plan includes a 7% increase in the core defense budget, not including war costs, meaning that domestic programs such as health research and education face tightened budgets (Seattle Times, 3/30). Under the discretionary spending cap, “nonsecurity spending would rise by a negligible amount for a near-freeze over FY06 levels,” CongressDaily reports (CongressDaily, 3/29).

Health Plans Don’t Fear 2007 Medicare Advantage Rates, See Positive Long Term

CMS is expected to issue final 2007 Medicare Advantage (MA) payment rates April 3. But some established Medicare managed care organizations aren’t holding their breath: They anticipate satisfactory reimbursement for next year’s MA product lines….

Visit AISHealth to read the entire story.

CMS Takes Steps To Clean Up Enrollment

Last week CMS notified Medicare prescription drug plan sponsors of the process for reconciling plan enrollments to ensure that all beneficiaries who have elected to change plans are appropriately disenrolled from their initial plan by April 30, 2006. To ensure that all enrolled beneficiaries would have access to prescription drug coverage in the early days of the new program, particularly for dual-eligible beneficiaries who switched plans later in the month, CMS advised plans in January to delay processing certain disenrollments. By early February, most plans began processing disenrollments. As a result of the January CMS instruction and some plans’ decision to continue delaying disenrollments into February or March, certain beneficiaries have had access to coverage under more than one plan: the initial plan that continued coverage, and a subsequent plan chosen by the beneficiary or an agent acting on their behalf (the Medicare “plan of record”). As the startup of the drug benefit progresses, CMS is now taking steps to ensure that all beneficiaries who changed plans are appropriately disenrolled from their initial plan by April 30, 2006. This process of reconciling plan enrollments will assure consistent coverage, allow appropriate tracking of out-of-pocket costs, permit payments to be fully reconciled between plans, and most importantly, ensure that each beneficiary continues to receive drug coverage smoothly and consistently. Please find attached a one-pager that further describes this process. The standard letters sent to affected beneficiaries on CMS letterhead are also attached for your reference.

DEADLINE: PDPs, MA-PDs, Cost, and PACE 2007 Applications

Today is the deadline for all PDPs, MA-PDs, Cost, and PACE 2007 applications.

Details on the CMS website.

Market Responce: Get the Word Out Tours

Private providers are hoping to clear up the confusion over the new Medicare Prescription Drug Plan with road trips to enroll new members and by offering information to consumers about competing plans.

Representatives for Humana, one such provider, will answer questions for the public from its “Let’s Talk” tour bus, which will be at Wal-Mart stores on the East Side today and in Northeast El Paso on Tuesday.

Ross McLerran, spokesman for Humana in San Antonio, said the company’s 10 mobile units began the nationwide tour last year. The tour is set to end on April 1, after stops at 1,187 Wal-Mart stores, and senior and community centers in 408 U.S. cities.

“We had 200,000 visitors as a result of the tour so far,” McLerran said.

MORE

Bush Says He Opposes Extending Deadline for Medicare Enrollment

Bloomberg is reporting, President George W. Bush said he opposes extending the deadline to sign up for a new Medicare prescription drug benefit even though some of the people who are eligible may be confused about the program.

Surprise CMS Move Will Cost Hospitals for Multiple Push Injections of Same Drug

AISHealth and the 3/6/06 Report on Medicare Compliance are reporting Hospitals are about to lose money for intravenous push injections because of a surprise move by CMS, experts say.

CMS said recently that hospitals can’t charge Medicare for more than one IV push injection of the same drug during the same patient encounter (HCPCS code C8952C), according to new guidance on billing for drug administration under the outpatient prospective payment system (OPPS). Only multiple injections of different drugs can be charged separately, according to the guidance, which comes in the form of answers to frequently asked questions (FAQs) and was posted on the CMS Web site in mid-February.

This is the latest in a series of OPPS drug administration changes to cause revenue and/or compliance challenges for hospitals.

MMA 2003 Update

The Medicare Modernization Update (MMU) was updated on Wednesday, March 1, 2006.

For your convenience, we offer the following topics and links that this office maintains. Please update your bookmarks and favorites accordingly.

Subject area on the web site Link
Medicare Modernization Update (MMU) http://www.cms.hhs.gov/MMAUpdate/
Quarterly Provider Update (QPU) http://www.cms.hhs.gov/QuarterlyProviderUpdates/
CMS Manuals http://www.cms.hhs.gov/Manuals/IOM/list.asp
CMS Transmittals http://www.cms.hhs.gov/Transmittals/
Office of the Attorney Advisor http://www.cms.hhs.gov/OfficeAttorneyAdvisor/
FOIA http://www.cms.hhs.gov/AboutWebsite/04_FOIA.asp
Advisory Committees http://www.cms.hhs.gov/FACA/
SBA Ombudsman Liaison http://www.cms.hhs.gov/CMSSmallBusAdminOmbuds/
CMS Rulings http://www.cms.hhs.gov/Rulings/
eComments http://www.cms.hhs.gov/eRulemaking/
Paperwork Reduction Act (PRA) http://www.cms.hhs.gov/PaperworkReductionActof1995/

Continue reading MMA 2003 Update…