WASHINGTON WIRE
September 12, 2008
Issue 180
SENATE PASSES BILL TO EXPAND, CLARIFY AMERICANS WITH DISABILITIES ACT
ADVOCATES PUSH TO PASS MENTAL HEALTH PARITY LEGISLATION
LAWMAKERS POISED TO INTRODUCE CHRONIC CARE LEGISLATION
HOSPICE GROUP SUES TO BLOCK PAYMENT CUT
OIG REPORTS POTENTIAL MEDICARE OVERPAYMENT TO PSYCHIATIC FACILITIES
PHYSICIANS BALK AT NEW ANTI-MARK UP RESTRICTIONS, SUPPORT MORE FREEDOM FOR GAINSHARING
Top Story
SENATE PASSES BILL TO EXPAND, CLARIFY AMERICANS WITH DISABILITIES ACT
On Thursday, September 11, the Senate approved by unanimous consent the ADA Amendments Act of 2008, a bill meant in part to address several Supreme Court rulings in the past decade that have narrowed the application of the original ADA. Critics of those decisions, including original ADA sponsor Sen. Tom Harkin (D-IA), said that the Supreme Court had misinterpreted the intent of the ADA.
The Supreme Court ruled that certain individuals were ineligible for protection under the ADA because medical treatments - such as prosthesis- improved their conditions. But Harkin and others argue that the rulings punished individuals with disabilities for seeking medical treatments that helped them become more self sufficient. On the floor of the Senate Thursday, Harkin said that this was a fundamental flaw in the Supreme Court interpretations, and that the current legislation "rejects" those interpretations.
The Senate bill would also expand the number of conditions that qualify as disabilities and authorize the Equal Employment Opportunity Commission, the attorney general, and the secretary of Transportation to issue new ADA regulations.
According to press reports, House Majority Leader Steny. Hoyer (D- MD) scheduled a Sept. 17 vote to clear the bill and send it to the White House.
Health Care News
ADVOCATES PUSH TO PASS MENTAL HEALTH PARITY LEGISLATION
Both the House and Senate have approved mental health parity bills that are more comprehensive than the mental health parity provision in MIPPA. Compromise language has been negotiated, but questions remain about how the $3.8 billion bill will be paid for. Advocates expect Congress to take up the compromise this month, although it is unclear what stance the Administration will take. President Bush originally supported the Senate version of the bill and expressed opposition to the House version.
There are several differences between the House and Senate bills, including a House provision that would require employers to cover all illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition. Press reports say the compromise jettisons the House DSM-IV language and includes an out-of -network coverage provision.
According to a coalition of parity supporter organizations, the new law will:
prohibit insurance discrimination against mental health and substance use disorder benefits for over 113 million Americans, requiring full parity coverage with physical health benefits;
Extend to all aspects of plan coverage, including day/visit limits, dollar limits, coinsurance, copayments, deductibles and out-of-pocket maximums;
Preserve strong state parity and consumer protection laws while extending parity protection to 82 million more people who cannot be protected by state laws; and
Ensure parity coverage for both in-network and out-of-network services.
LAWMAKERS POISED TO INTRODUCE CHRONIC CARE LEGISLATION
Lawmakers in the Senate and House are expected to introduce legislation this month that would establish a three-year, multi-state demonstration program to reimburse physicians for coordinating at-home care for some of Medicare's sickest beneficiaries.
The Independence at Home Act (IHA) proposes treating certain Medicare beneficiaries suffering from multiple chronic conditions at less expensive treatment settings, such as their residences, under a plan of care developed by a physician or nurse practitioner. The bill is meant in part to address the reality that Medicare spends a disproportionate amount of funding on a small subset of the beneficiary population.
The bill mandates that participating providers save the government at least 5 percent of what would otherwise have been spent.
IHA would provide access to chronic care coordination services by Medicare beneficiaries suffering from specific multiple chronic conditions including congestive heart failure, diabetes, chronic obstructive pulmonary disease, ischemic heart disease, peripheral arterial disease, stroke, Alzheimer's disease and other dementias, pressure ulcers, and hypertension.
HOSPICE GROUP SUES TO BLOCK PAYMENT CUT
On Sept. 5, the National Hospice and Palliative Care Organization (NHPCO) filed for a preliminary injunction against a CMS rule that, when effective this fall, will cut reimbursement rates for hospice care.
In its rule, CMS proposed to stop using the budget neutrality adjustment factor (BNAF) in the calculation of the hospice wage index. The BNAF would be phased out over three years. At the end of the three-year BNAF phase out, cuts will total 4.1 percent.
Hospice provider advocates are also anticipating legislative action on the rule this month.
OIG REPORTS POTENTIAL MEDICARE OVERPAYMENT TO PSYCHIATIC FACILITIES
On September 10, the Office of Inspector General reported that Medicare might have made $9 million in overpayments to psychiatric facilities in 2005. In that year, HHS was changing its prospective payment system, and the OIG found discrepancies with 62 of 100 sample claims for transition stays - stays that began under one payment system and concluded under the new payment system.
CMS agreed with OIG's findings and recommendations, which included reviewing information on the additional 2,100 stays excluded from the sample and post-payment data for claims submitted after the OIG's audit.
PHYSICIANS BALK AT NEW ANTI-MARK UP RESTRICTIONS, SUPPORT MORE FREEDOM FOR GAINSHARING
Physicians are fighting CMS' attempts to limit how doctors can bill Medicare for diagnostic tests performed in their offices or within their group practices. In the agency's 2009 physician fee schedule, CMS proposes applying anti-mark up rules to interpretations of diagnostic test results and tests performed in-house. A coalition of seven cardiologist groups, including the American College of Cardiology, oppose this portion of the rule.
The American Medical Association is in favor of certain gainsharing proposals in the fee schedule. These proposals loosen restrictions on hospitals giving cash incentives to physicians for better quality and higher cost-savings.
Upcoming Events
Hearings
Tuesday, Sept. 16
Health Care Delivery System Incentives
Senate Finance Committee
10 a.m., 215 Dirksen Bldg.
Wednesday, Sept. 17
Medical Device Advertising
Senate Special Aging Committee
10:30 a.m., 562 Dirksen Bldg.
Thursday, Sept. 18
Need for Changes in Health System
House Energy and Commerce - Subcommittee on Health
9:30 a.m., 2123 Rayburn Bldg.
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