HHS Secretary Leavitt Suggests Compromise On Medicaid Bill, Senate Support Unclear

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Women's Health / Gynecology
Article Date: 01 May 2008 - 5:00 PDT

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HHS Secretary Mike Leavitt on Tuesday suggested that the Bush administration is willing to reach a compromise on a bill (HR 5613) that would prevent seven new Medicaid regulations from taking effect until April 1, 2009, CongressDaily reports. The measure was approved last week in the House and could come up for a floor vote in the Senate at any time (Johnson, CongressDaily, 4/29). Leavitt said that if Congress allows five of the rules to go into effect, the administration would be willing to postpone implementation of the other two rules -- one limits Medicaid reimbursement to public hospitals and the other reduces federal Medicaid reimbursement for residents and interns at teaching hospitals (Wayne, CQ Today, 4/29).

The five rule changes the administration now wants implemented aim to restrict services covered by some states' case management plans; narrow federal Medicaid reimbursement eligibility for outpatient hospital services; bar federal reimbursement for transportation to school and school-based care for Medicaid-eligible children; restrict the types of "rehabilitative" services covered by federal funding; and limit taxes some states charge health providers. Critics have said the regulations could reduce health care coverage for pregnant women, low-income children, nursing home residents and other groups (Daily Women's Health Policy Report, 4/25).

"We're trying to put together a package where the five would remain" while the administration and Congress negotiate on the other two rules, Leavitt said, adding that if Congress cannot "find a solution" by August, the two rules would be postponed until March 2009.

Leavitt on Tuesday also reiterated the administration's intent to veto the measure if a compromise is not reached and the bill that delays all seven rules passes in the Senate. There are "ambiguities in the law that are being exploited" and that "need to be fixed," Leavitt said, adding that the administration is not "against legitimate use of these tools." Senate Minority Whip Jon Kyl (R-Ariz.) said he thinks that the administration's "proposal is reasonable" and that he hopes "it will lead the Congress to negotiate" on the measure (CongressDaily, 4/29).

Senate Support Unclear

Senate Republicans on Tuesday slowed action on the measure, leading Democratic leaders to consider attaching it to a supplemental war spending bill, CQ Today reports.

Senate Majority Leader Harry Reid (D-Nev.) Tuesday evening attempted to pass the bill by voice vote, but Sen. Tom Coburn (R-Okla.) objected, saying the rules "will make a difference" in addressing Medicaid fraud and abuse. Reid will need to file a cloture petition before bringing the measure up for a vote again, according to CQ Today.

Democratic aides said the party leaders might attempt to add the bill to another measure to avoid the cloture petition, although House Speaker Nancy Pelosi (D-Calif.) has made "no final decisions," according to Pelosi spokesperson Nadeam Elshami. An aide to Senate Finance Committee Chair Max Baucus (D-Mont.) said Baucus "will work to find another way and the next appropriate vehicle" to pass the measure.

It is unclear how many Senate Republicans would support the Bush administration's efforts to prevent the legislation from passing, according to CQ Today. Two letters have circulated among Senate Republicans that outline the party's concerns with the measure and the administration's offer to compromise, but it is unclear how many Republican senators have signed either letter. One of the letters -- dated April 23 and addressed to Senate Minority Leader Mitch McConnell (R-Ky.) -- says that passing the measure would be "irresponsible" and "would further undermine the fiscal integrity of the Medicaid program" (CQ Today, 4/29).

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