Kaiser Daily Health Policy Report Highlights Recent Medicare Developments

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• Dialysis: The Corporate Health Care Coalition has launched a lobbying campaign against lawmakers who are seeking to extend by one year the length of time employers providing benefits must cover dialysis treatment for Medicare-eligible employees, The Hill reports. The shift, which would require employers to pay for 42 months of dialysis services before Medicare would begin to pay, would reduce Medicare spending by $1.2 billion over 10 years. However, the coalition maintains the proposal would increase their costs by more than $2 billion because private health plans pay a higher fee for dialysis treatment and drive up health insurance premiums for other employees. The coalition contends that it is unfair to ask corporations to spend more so that Congress can fund other priorities, such as reversing a scheduled 10% cut in Medicare physician payments (Young, The Hill, 10/5).
  
  
• Medicare payments: The AP/Houston Chronicle on Monday examined how the "maneuvering over Medicare has been a quiet presence in recent weeks and is certain to flare when Democrats turn anew to the issue." When House Democrats attempted to use revisions to Medicare to fund an expansion of SCHIP, "[p]ublicly, all sides trumpeted their concern for older people in the U.S. and scarcely mentioned their own financial and political self-interests, if at all," according to the AP/Chronicle. The AP/Chronicle reports that groups in favor of revisions to Medicare "stand ready to renew the battle this fall, all the while previewing possible lines of attack for the 2008 elections," noting that the "fight" over Medicare "is far from over" (Espo, AP/Houston Chronicle, 10/8).
  
  
• MedPAC: The Medicare Payment Advisory Commission has begun to examine in greater detail outlays for hospice care, CQ HealthBeat reports. Medicare spending on end-of-life care increased from about $3 billion in 2000 to $8.2 billion in 2005. MedPAC staffer James Mathews said that among the issues being researched are whether the current payment system is adequate; what implications there are for the payment system in the evolving mix of beneficiaries receiving hospice care; whether a better definition for a hospice visit is needed; and if the maximum benefit cap should be revised (Reichard, CQ HealthBeat, 10/5). In related news, MedPAC said it is "weeks, if not months," away from making a formal recommendation about "special needs plans," which provide benefits for Medicare's sickest and lowest-income beneficiaries. However, commission members at a meeting on Wednesday "appeared headed toward a recommendation that Congress extend the current authority for the plans to operate, as long as they prove they are providing extra value," CQ HealthBeat reports (Reichard, CQ HealthBeat, 10/4).
  
  
• Part D Overpayments: CMS said it would recover $4 billion in overpayments to Medicare prescription drug plan providers in 2006, the Hartford Courant reports. According to CMS, drug costs were lower than expected in 2006 because of a more widespread use of generic drugs. The overpayment recovery is an annual process to reconcile advanced payments to drug plans with the actual cost of providing drug coverage, CMS said (Hartford Courant, 10/6).
  
  
• Transparency: Consumer representatives say that "corrective action plans" posted on CMS' Web site for 39 private companies that market Medicare prescription drug or Medicare Advantage plans are not helpful to beneficiaries because the data are complex and located in large documents that require a lot of computer power, CQ HealthBeat reports (Reichard, CQ HealthBeat, 10/5). A New York Times review of 91 audit reports posted on the Web site found that insurers improperly terminated coverage for people with HIV/AIDS, had a large number of claims backlogs and complaints and failed to answer telephone calls from customers, physicians and pharmacists. CMS officials said that the violations mostly involved marketing abuses, particularly in the sale of MA plans, and the handling of appeals and complaints related to quality of care. CMS since March has imposed fines totaling more than $770,000 on 11 companies. Making the violations public is part of acting CMS Administrator Kerry Weems' pledge to increase transparency within the agency (Pear, New York Times, 10/7). However, Deane Beebe, a spokesperson for the Medicare Rights Center, said, "To say [the information] is now 'public' is not exactly meaningful," adding that the data are "not accessible or understandable." Beebe said CMS should integrate the data into its Medicare plan finder that helps beneficiaries compare plans, as well as into report cards CMS will issue this year on Medicare drug plans and MA plans. Weems said there are no immediate plans to add the data to the plan finder. A CMS spokesperson said, "The Web site posting of this substantial amount of information is a work in progress and indeed, we welcome comments and suggestions that would make the corrective plans more user-friendly" (CQ HealthBeat, 10/5).

Opinion Piece
"Restoring the balance" between payments to traditional Medicare plans and MA plans "will make it possible for Congress to stop cuts to doctors who care for Medicare patients and to add important new benefits such as preventive care and help for low-income Medicare patients -- all without raising Medicare premiums," Ronald Davis, president of the American Medical Association, and William Novelli, CEO of AARP, write in a Detroit Free Press opinion piece. According to Davis and Novelli, the House has "voted to level the playing field between payments to private health plans under Medicare Advantage and traditional Medicare," and "[n]ow the Senate must act." They conclude, "The Senate has a choice: Keep this country's long-term commitment to keep Medicare strong -- or keep subsidizing big insurance. Seems like an easy call to us" (Davis/Novelli, Detroit Free Press, 10/8).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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