Medicare Compliance & Reimbursement

The president wants to sign a Medicare prescription drug bill this year, and in the end he may not be too particular about details. Asked about administration preferences among provisions in two bills now being considered in a conference between the House and Senate, top administration officials at a July 22 briefing sounded the same note over and over again. "The president wants this bill passed very badly," said Health and Human Services Secretary Tommy Thompson. "The president really wants a drug benefit for seniors," said senior White House adviser on health care Doug Badger. The pair, joined by Centers for Medicare & Medicaid Services Administrator Tom Scully, did state a few administration preferences, as well as concerns about the current proposals: The administration would like to see the Senate's so-called fallback provision removed from the legislation. To assuage fears of some rural members that private drug-only plans may not show up in every area of the country, senators included a provision requiring the federal government to offer the coverage, through a contractor, in any area where two private drug-only plans don't appear. The problem with that approach, said Scully, is that "this is the way we run traditional Medicare," with the government alone bearing all insurance risk. And that's not the way to get private-sector entities to work hard at achieving efficiency. Better would be an approach in which all drug-only plans shared risk with the government, even though they might share only minuscule amounts of risk in the first few years, while they learned the Medicare ropes, he said. The administration wants the bill to include federal assistance for states on the matter of patients dually eligible for Medicare and Medicaid, but would like a final provision to bypass "some problems" officials see with the assistance plans in both current versions, according to Thompson. Remember the frenzy that engulfed Medicare's administrative staff after the Balanced Budget Act? When Congress passed the BBA in 1997, it imposed hundreds of tight implementation deadlines on CMS's predecessor, the Health Care Financing Administration, leaving officials and staff frantically scrambling to keep up a pace that virtually all commentators acknowledged was wildly unrealistic. HHS doesn't want to repeat that history. Administration officials hope to dissuade conferees from removing requirements for CMS action from current bills, and "to give us some time," said Thompson. For example, the bills would require CMS to reorganize itself into two separate agencies - one a major new office set up specifically to work with private plans that operate in Medicare - at the same time that the agency must bring new private plans into the program and implement the drug benefit. That could cause real difficulties, since "the [...]