Time growing short on prescription bill.

Charged with the task of cracking bedrock disagreements about health policy, a 17-member joint House-Senate conference committee is doggedly, determinedly working to resolve differences between the Senate-passed Prescription Drug and Medicare Improvement Act and the House-passed Medicare Prescription Drug and Modernization Act of 2003.

The bills, passed by both chambers in late June, are complicated, Book-like, and seeded with legislative dynamite, such as a provision that would reduce Medicare funding for cancer treatment and another that the AARP claims would open the door for companies to easily drop health coverage for older retirees.

Both bills give beneficiaries who choose a drug benefit the option of staying in traditional free-for-service Medicare or switching to a private plan. The House bill would eventually give private plans a much larger role in Medicare.

President Bush said earlier this summer that he'd like to sign a prescription drug bill this fall. With the 2004 elections on the horizon, his congressional allies want to give him the chance.

But some conferees aren't sure it can happen. During conferees' Sept. 9 public meeting, Montana's Democratic Sen. Max Baucus noted the complexity of the bill, the battle lines drawn over provisions and said what other members of Congress were undoubtedly thinking, "No bill is often better than a bad bill."

At that meeting, conferees did approve a four-age list of provisions they described as "non controversial." They are Row stepping carefully through the minefields of costly provider provisions, including financial help for low-income beneficiaries receiving the prescription drug benefit and eligibility, enrollment and information dissemination procedures for the benefit.

Among the explosive provisions to be faced is a plan for premium support Praised by House conservatives, disliked by Senate Democrats and a few moderate Republicans, this provision is expected to be test for whether a majority of lawmakers can agree on final legislation produced by the conferees. Strongly backed by conference committee chairman Rep. Bill Thomas of California, the provision authorizes a subsidy to help beneficiaries purchase private health insurance that could co-exist with Medicare.

Many House conservatives say they will not support a drug benefit unless Medicare is fundamentally changed from an insatiable, big government insurance program into a more privatized system. Premium support would be a step toward change.

Most Democrats distrust a program that would not be completely government run. They claim that a co-existing program, shored up by premium support, would leave Medicare only the sickest, poorest patients and drive up government costs.

Help for long Term Care

Providers of long term care note provisions of particular interest in the prescription drug bills. "We are very supportive of a provision that would return the moratorium barring caps on how much physical, occupational and speech therapies that Medicare recipients can receive in a nursing home," said Susan Feeney, a spokesperson for the American Health Care Associations." The moratorium was only lifted on Sept. 1, and it should be put back."

The American Association of Homes and Services for the Aging is also pressing for the moratorium." CMS has begun enforcement of the caps that limit Medicare reimbursement to $1,590 annually for physical and speech therapy combined and another $1,590 for occupational therapy," AAHSA policy expert Barbara Gay said.

These caps will be devastating to victims of strokes, fractures and other disabling conditions if they are unable to get the therapy needed to fully recover, critics note. Although these caps were enacted in 1997, Congress has never before allowed them to go into effect, recognizing that arbitrary coverage limits would cause hardship for beneficiaries in the greatest need of therapy.