Deadline pressure: Lawmakers zero in on Medicare bills.

Lawmakers zero in on Medicare bills

UNDER INTENSE PRESSURE FROM BENeficiaries and provider representatives, lawmakers at press time in early October appeared to be getting closer to agreement on a Medicare package that would provide much-needed relief for skilled nursing facilities.

Senate Minority Leader Thomas Daschle (R-S.D.) has introduced a BBA correction bill (S 1678) that calls for increases to 12 RUG categories and a repeal of the caps on physical, speech, and occupational therapies for three years. The bill would also carve out from PPS ambulance services, certain costly drugs, and other expensive services.

In addition, both Senator William Roth (R-Del.), chairman of the Senate Finance Committee, and Representative William Thomas (R-Calif.), chairman of the House Ways and Means Committee, were on the verge of announcing separate bills containing temporary adjustments to the prospective payment system for skilled nursing facilities.

Determined to make sure Congress does not leave town without giving nursing facilities some relief, the nursing home industry in September stepped up its intense lobbying campaign with a national TV and print campaign and a rally by caregivers, all challenging Congress and the administration to restore funding cut by the Balanced Budget Act of 1997 (BBA).

The calls for relief were bolstered in part by a recent report from the Department of Health and Human Services' Office of Inspector General, which concluded that the PPS appears to have made it more difficult for hospital discharge planners to place patients needing extensive services in nursing facilities.

While details of the bills were still being finalized at press time, Roth's Medicare package is expected to include elements of 5 1500, introduced by Senators Orrin Hatch (R-Utah) and Pete Domenici (R-N,M.), that would provide add-ons to 15 payment categories and eliminate a 1 percent reduction in the market basket update for fiscal years 1996 through 1998. The bill also is expected to provide for exceptions to the $1,500 therapy caps.

At press time, it was uncertain how extensive the adjustments might be. Senator Roth in September asked Majority Leader Trent Lott (R-Ms.) for $1 billion to $1.5 billion in fiscal 2000 for adjustments. The Thomas and Daschle bills were expected to be more costly.

Another key difference is that while Senator Roth's Medicare package was expected to address larger Medicare reforms, Representative Thomas planned to limit his bill to BBA corrections, according to Greg Crist, a spokesman for the House Ways and Means Committee.

Complicating the negotiations is a split between the nursing homes and hospitals over just which RUG III categories should be increased. While S 1500 would modify payment mostly for rehabilitation categories, hospitals prefer add-ons for the extensive, special care, and clinically complex categories. Ultimately, any kind of BBA correction package could end up being rolled into an omnibus reconciliation package along with unfinished appropriations bills. In any event, time for action is quickly running out. Congress was scheduled to adjourn for the year on October 29, but staff say they expect to be in session until at least mid-November.