104th
Congress: Democratic Perspectives 103rd-107th
Congress Committee Activity As introduced, H.R. 1791 clarified that certification by a medical specialty board recognized by the American Osteopathic Association would be sufficient to qualify a family practitioner, pediatrician, or obstetrician to receive Medicaid reimbursement for delivering care to children under 21 or pregnant women, respectively. In addition, H.R. 1791 as introduced would have clarified that physicians delivering care to children or pregnant women in the emergency departments of hospitals participating in Medicaid could qualify for Medicaid payments. These clarifications were thoughtful, constructive, and consistent with the prudent expenditure of Federal funds.
During Committee consideration, a provision was added allowing physicians serving children and pregnant women also to qualify for Medicaid payments so long as they are `certified by the State in accordance with policies of the Secretary.' This provision was adopted to avoid disruption in implementation of the underlying provision. In adopting this provision, I posed a question to the majority to receive assurance that this action in no way was intended to weaken the quality protections of current law. I received assurances that this was the case. Therefore, it is clear to me that, in implementing this option, the Secretary should assure that the policies established meet the basic goal of the underlying provision: assuring quality services for children and pregnant women.
Historically, in order to participate in Medicaid, a physician (other than one excluded for fraud or abuse) was only required to be licensed in the State in which he or she practiced. The assumption was that State licensure would protect Medicaid beneficiaries from poor quality providers. As a result of oversight hearings conducted in the 101st Congress by the Government Operations Subcommittee chaired by the late Ted Weiss, we learned that this assumption was not always well-founded. The Weiss Subcommittee hearings demonstrated how `Medicaid mills' thrived financially (mostly at Federal expense) by providing poor quality care even though staffed by licensed physicians.
In order to protect children and pregnant women from poor quality physicians, whether in Medicaid mills, managed care plans, or other settings, and in order to prevent Federal Medicaid funds from financing substandard care in these settings, this Committee in 1990 authored a provision that set a higher standard than State licensure for physician participation. Specifically, the Committee required that, in order for Federal Medicaid matching funds to be made available for payment for services provided by a physician to children under 21, the physician must meet just one of the following criteria: (1) hold admitting privileges to a hospital participating in Medicaid; or (2) be certified in family practice or pediatrics by an appropriate specialty board; or (3) have a formal consultation and referral arrangement with a certified pediatrician or family practitioner; or (4) be employed by, or affiliated with, a Federally-qualified health center; or (5) be a member of the National Health Service Corps; or (6) be certified by the Secretary as qualified to deliver care to children.
Similarly, in order to protect pregnant women from substandard physicians, the Committee required that, in order to qualify for Federal Medicaid matching funds, physician services delivered to pregnant women had to be delivered by practitioners who meet just one of the following criteria: (1) hold admitting privileges to a hospital participating in Medicaid; or (2) be certified in family practice or obstetrics by an appropriate specialty board; or (3) have a formal consultation and referral arrangement with a certified obstetrician or family practitioner; or (4) be employed by, or affiliated with, a Federally-qualified health center; or (5) be a member of the National Health Service Corps; or (6) be certified by the Secretary of HHS as qualified to deliver care to pregnant women.
These minimum Federal quality standards were sensible then and remain sensible now.
This bill merely corrects an oversight--failure to explicitly acknowledge that certification by a specialty board recognized by the American Osteopathic Association should qualify an osteopath to be treated like a physician for Medicaid purposes. This, in fact, is HCFA's practice, and the Committee wanted to confirm the view that osteopaths provide the same quality care as physicians.
The bill also recognizes that emergency room physicians need separate recognition because of their unique circumstances.
Finally, in regard to inclusion of State certification in accordance with the Secretary's policies, I fully expect the Secretary to carry this out in such a way as to maintain the intent of assuring quality that forms the basis for the current law and to fashion policies that will assure that children and pregnant women do not receive poor quality care at the hands of licensed physicians practicing in Medicaid mills or substandard managed care plans that are financed with Federal taxpayer funds. To do otherwise would be contrary to the intent of this Committee in adopting this legislation.
HENRY A. WAXMAN.
104th
Congress: Democratic Perspectives
103rd-107th
Congress Committee Activity