House Republicans Offer Proposals Clarifying HHS’s Authority To Adjust Medicare Physician Payment Formula
House Republicans have proposed to attach language to two bills "clarifying" that HHS has the legal authority to correct what they call a statistical error in the Medicare physician reimbursement formula, CongressDaily reports. The formula resulted in a 5.4% reduction in physician reimbursements this year and will lead to reductions of 17% by 2005. House Ways and Means Committee Chair Bill Thomas (R-Calif.) has reportedly asked House Appropriations Committee Chair Bill Young (R-Fla.) to include the clarification language in the fiscal year 2002 supplemental appropriations bill, scheduled for debate in the next few weeks (Rovner, CongressDaily, 5/14). In addition, House Energy and Commerce Committee Chair Billy Tauzin (R-La.) plans to add the language to the conference report of an anti-bioterrorism bill (Rovner, CongressDaily/AM, 5/15). Thomas and Rep. Nancy Johnson (R-Conn.) wrote in a letter to the administration in March that HHS has the legal authority to correct the formula. According to a legal analysis released Monday by the American Medical Association and 40 other groups, corrections to the Medicare formula could increase physician reimbursements by $62 billion. But the Bush administration has said that only Congress can address the problem, and "giving [HHS] the authority to make the changes ... does not mean the department will act," CongressDaily reports. Giving the administration responsibility for setting reimbursement rates would "take a lot of pressure off" Thomas and Tauzin to include a provision in the House Republican Medicare reform bill to increase physician reimbursements, according to a lobbyist for a provider group. The package, which includes a prescription drug benefit, has received criticism from several GOP House members and hospital groups, who say that increasing Medicare reimbursements to physicians would reduce them for hospitals (CongressDaily, 5/14).
Aides to Tauzin said that he also plans to add a provision to the anti-bioterrorism bill conference report to extend for an additional year the date by which managed care plans must announce whether they plan to remain in Medicare+Choice. The measure also would delay for one year a "controversial 'lock in' provision to limit how many times Medicare beneficiaries could switch managed care plans or switch" between Medicare+Choice and traditional Medicare. The anti-bioterrorism bill also includes a reauthorization of the Prescription Drug User Fee Act, under which drug makers pay the FDA additional fees for expedited reviews of new treatments (CongressDaily/AM, 5/15).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.