DEMOCRATS MAKE MAJOR IMPROVEMENTS IN REPUBLICAN-PASSED MEDICARE/MEDICAID 'GIVE-BACKS' BILL

The alternative includes the provisions which passed the House in H.R. 2614, AND makes the following changes and additions, many of which are provisions included on a bipartisan basis in the Commerce Committee bill, or sponsored by various bipartisan coalitions of Members:

Full Hospital Prospective Payment System Update for Two Years: The Republican bill had only a one-year full update, and cuts in the next two years. Hospitals reeling from BBA cuts need two years of full inflation adjustment.

Graduate Medical Education Payments, two year freeze at 6.5%, compared to Republican-passed one year freeze, and a cut in the second year. Provides help to the nation’s premier teaching and research hospitals.

Rural Disproportionate Share Hospitals: In addition to the provisions in the Republican-passed bill, provides for a higher level of reimbursement for rural hospitals serving low income individuals.

Nursing Home Staffing and Quality: Includes bipartisan proposals to provide an additional $1 billion/5 years to assist nursing homes in improving staffing. Recent studies show that many homes need to make major improvements in staffing levels.

Home Health Agencies: Provides a two-year delay in the 15% cut in payments instead of the Republicans one-year delay.

Rural home health agencies, provide a 10% bonus for service in rural areas to compensate for the high cost of travel, lower volume of patients seen per hour.

Hospice, full two year update, in lieu of the Republicans one-year update. Hospices need increased payments to deal with soaring cost of pharmaceuticals.

Puerto Rico Hospitals, Improved Payments: Includes the Ways and Means Health Subcommittee and Senate Finance Committee proposal to increase Puerto Rican hospital payments, which was dropped in the Republican-only negotiations.

Medicare+Choice Program: Retains the payment improvements in the Republican-passed bill, but provides increases only as the plan stays in a community with a defined package of benefits over a three-year period.

Medicare Coverage for Individuals with ALS (Lou Gherig’s disease): Waives 24-month waiting period for individuals diagnosed with ALS so that they can become eligible for coverage under Medicare immediately. This is a bill by Rep. Capps cosponsored by 282 House Members.

Medicare Appeals Provision: Makes the provision in the Republican-passed bill workable and similar to the Patients’ Bill of Rights protections for Medicare beneficiaries.

Provides needlestick safety for workers in public hospitals.

Permits nursing homes and home health agencies to seek geographic reclassification to a more advantageous payment area (helps rural and suburban facilities near large urban centers who must compete for workers at the same price as is offered in the urban center).

Improves Medicare Work Incentives Act provisions passed by Congress last year by adding two years of Medicare coverage to the existing policy.

MEDICAID AND CHIP PROVISIONS

Medicaid Disproportionate Share Hospital (DSH) Increased Payments: Freeze Medicaid DSH cuts at 2000 levels. Annual update of DSH allotment for inflation beginning in 2001 and thereafter, and eliminates the ‘cliff’ in FY 2003 allotments that was in the Republican bill.

Optional Coverage of Legal Immigrant Children and Pregnant Women in Medicaid and CHIP: States may extend coverage to legal immigrant children and pregnant women who lawfully reside in the US. Sponsors of immigrants would not incur a debt for cost of Medicaid benefits provided and would not be asked to repay the value of medical care for these people.

Improved/Expanded Outreach Sites for Enrollment in Medicaid and CHIP: State option to allow additional entities to determine children ‘presumptively eligible’ for health insurance in Medicaid or CHIP.

Improving Welfare to Work Transition: Extends Transitional Medicaid Assistance (TMA) program for one additional year. This program provides Medicaid health insurance for up to one year for families (up to 185% of poverty) who are transitioning from welfare to work. Gives states the option to simplify requirements for reporting eligibility. Gives states that already cover individuals up to 185% the option to be exempt from TMA requirement.

Improved Outreach/Enrollment in Cost-Sharing Assistance Programs for Low-Income Medicare Beneficiaries: Secretary of HHS to consult with states, beneficiary groups to develop a simplified application form for applying for Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) programs. Secretary would make form available in all Social Security offices, as well as other sites frequented by seniors.

Health Insurance for Disabled Children: Democrats include the Family Opportunity Act which allows working families with incomes above the Social Security limit to buy-in to Medicaid coverage.

Medicaid Coverage of Physician Assistant (PA) Services for purposes of reimbursement.