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• W1970833703 abstract "Last year came to an anti-climactic end as Congress failed to approve a broad Medicare package. Instead, on December 29, the President signed into law the SCHIP Extension Act, which did not include any end-stage renal disease (ESRD) provisions. This created a temporary fix for the scheduled reduction in Medicare physician payments. The bill also reauthorized SCHIP through March 2009 and included roughly $1.6 billion in additional funding to prevent the projected shortfalls. Early in the second session of the 110th Congress, President Bush submitted his budget proposal for the 2009 fiscal year to Congress. The proposed budget included $200 billion in reductions over five years for Medicare and Medicaid, including a $1 billion reduction in ESRD spending over five years. The $1 billion reduction would be implemented through a bundled payment system. The President's budget also proposed to extend the Medicare Secondary Payer provision for ESRD from 30 to 60 months, but the savings would not kept in the ESRD program. In addition, the proposed budget requested authority for CMS to reinstate the revisit user fee program, which expired at the end of 2007. Reinstatement of user fees would require action by Congress. Other provisions in the budget proposal included a two or three year freeze followed by a permanent 0.65% reduction to the market basket updates for hospitals, skilled nursing facilities, hospice, inpatient rehabilitation facilities, long-term care hospitals, outpatient departments, ambulance services and ambulatory surgical centers. The reductions would generate $117 billion in savings over five years. Congressional democrats have roundly condemned the magnitude of the Medicare cuts in the President's budget, calling the proposal “dead on arrival.” Once again, the renal community faces a very difficult legislative year; members seek to oppose cuts to the ESRD program in an environment fraught with uncertainty. The CHAMP Act remains the House position on Medicare. It is expected to will be the foundation of House conference negotiations with the Senate. The CHAMP Act contained numerous ESRD provisions. It also lowered erythropoiesis stimulating agent payments for large dialysis organizations to average sales price (ASP) + 2%, leaving organizations with fewer than 300 facilities at ASP + 6%. It is unclear at this time whether the Congress will move the Medicare package in a larger budget reconciliation bill. The sources of revenue for the physician fee fix remain problematic, with the administration continuing its opposition to Medicare Advantage cuts. Another factor adding to the legislative complexity this year is a requirement in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) that whenever general revenue funding for Medicare is projected for two consecutive years to exceed 45% of the total expenditures within a seven-year period, the President must submit a proposal to Congress to reduce the general revenue share of Medicare funding to 45% or less. The President's proposal must be given expedited consideration in the House and it is subject to special procedural rules in the Senate. To fill this requirement, the President's budget contains a proposal requiring a four-tenths of a percent reduction in all payments to Medicare providers, including dialysis facilities in FY 2009, which would increase by fourtenths of a percent each fiscal year that the shortfall continues to occur. Increased use of electronic health records, publishing of price and cost information, and “value-based” payments to providers; Medical malpractice reforms, including limiting non-economic and punitive damages; and Income relating the Medicare Part D premium subsidy. The first of these proposals has attracted congressional interest, being similar to proposals long supported by Democratic healthcare leaders. The second two have been called “dead on arrival.” It is unclear at this time what, any, response to the “trigger” will be forthcoming from Congress. Once again, the renal community faces a very difficult legislative year. In addition to gearing up to support an update and an annual update mechanism, dialysis providers and patient groups will be seeking to oppose cuts to the ESRD program in a legislative environment fraught with uncertainty." @default.
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• W1970833703 date "2008-04-11" @default.
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• W1970833703 title "Congressional Action on Medicare Reform Expected" @default.
• W1970833703 doi "https://doi.org/10.1002/dat.20214" @default.
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