WASHINGTON WIRE
July 11, 2008
Issue 176
Senate Passes Veto-Proof Medicare Package
Universal Health Care Bill Reintroduced As Sponsors Push for Bipartisan Support
Medical Review of Hospital Claims Shifted From QIOs to Intermediaries, Contractors
CMS Looks to Expand Quality Reporting In Outpatient Proposed Payment Rule
CMS Notifies Labs Not to Bill Medicare For Technical Component of Certain Services
Hearings
Top Story
Senate Passes Veto-Proof Medicare Package
At the last minute this week, enough Republicans supported a "cloture" motion and final vote on the House-passed Medicare physician payment fix bill, H.R. 6331, that it passed by a veto-proof margin of 69-30. The bill included cuts to Medicare Advantage plans strongly opposed by the Bush Administration and many Republicans. The Senate voted two weeks after the House veto-proof vote of 355-49. At the time, the House vote derailed an anticipated Senate Finance Committee compromise which in turn caused the previous cloture vote to fail just prior to the July 4 recess.
Sen. Edward Kennedy (D-MA), in his first appearance on the Senate floor since being diagnosed with brain cancer, entered the Senate chamber to a dramatic standing ovation and proceeded to vote for the bill. Kennedy was absent two weeks ago when the Senate fell one vote short of the 60 votes needed for cloture.
The bill not only extends the 0.5% update for physicians through the end of 2008, it also provides a 1.1% update through 2009. Also, included in the bill was an 18-month extension of the therapy caps exceptions process, rural providers provisions, and a much sought after delay for the CMS durable medical equipment competitive bidding program which took effect July 1.
Notably, the next day the President announced he would veto the bill despite the veto-proof support displayed in both chambers. A quick veto-override vote is expected if the bill is vetoed.
Health Care News
Universal Health Care Bill Reintroduced As Sponsors Push for Bipartisan Support
On Wednesday, the Healthy Americans Act was reintroduced in the House by Rep. Debbie Wasserman Schultz (D-FL). The bill requires the purchase of private health insurance with premiums subsidized on a sliding scale. It would cover almost all Americans, except those covered by Medicare and the military health system (TRICARE) and would eliminate Medicaid and the State Children's Health Insurance Program. The bill also eliminates the current tax exclusion for employer coverage and replaces it with a standard deduction for those earning less than $125,000 a year. The bill and others will be early options under consideration as part of a probable healthcare reform debate expected in Congress early next year.
Medical Review of Hospital Claims Shifted From QIOs to Intermediaries, Contractors
On Wednesday, the Centers for Medicare & Medicaid Services (CMS) announced that it is transferring responsibility for medical review of hospital claims from Quality Improvement Organizations (QIOs) to fiscal intermediaries and administrative contractors which will review acute and long-term care hospitals claims starting this summer. QIOs will retain responsibility for quality oversight in all Medicare fee-for-service settings, provider-requested reviews of higher-weighted DRGs, review of cases under the Emergency Medical Treatment and Labor Act, provider education on quality of care issues and expedited determinations.
CMS Looks to Expand Quality Reporting In Outpatient Proposed Payment Rule
Last week, CMS issued a proposed rule to update payment rates for calendar year (CY) 2009 and improve quality of services provided in hospital outpatient departments and ambulatory surgical centers. The proposed rule includes a 3 percent annual inflation update to rates for most outpatient prospective payment system services. Additionally, CMS is proposing to make a single payment for imaging services when multiple services are provided in one hospital session. Also, CMS would continue a 2 percentage-point reduction to the CY 2010 hospital update for those not reporting quality measures. CMS is accepting comments on the proposed rule until September 2.
CMS Notifies Labs Not to Bill Medicare For Technical Component of Certain Services
On Monday, CMS indicated that independent laboratories may no longer bill Medicare for the technical component of physician pathology services furnished to beneficiaries in hospitals. Moratoriums had been in place through June 30 allowing labs and hospitals sufficient time to negotiate new arrangements regarding the technical component payment.
Upcoming Events
Hearings
Tuesday, July 15, 2008
Americans with Disabilities Act
Senate Health, Education, Labor and Pensions Committee
10 a.m., 430 Dirksen Bldg.
Instability of Health Coverage
House Ways and Means - Subcommittee on Health
10 a.m., 1100 Longworth Bldg.
Wednesday, July 16, 2008
Health Care
House Budget Committee
10 a.m., 210 Cannon Bldg.
Veteran Amputees
House Small Business - Contracting and Technology Panel
10 a.m., 1539 Longworth Bldg.
Childhood Obesity
Senate Health, Education, Labor and Pensions - Subcommittee on Children and Families
2:30 p.m., 430 Dirksen Bldg.
Thursday, July 17, 2008
Health Care Issues
Senate Finance Committee
10 a.m., 215 Dirksen Bldg.
For More Information
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