WASHINGTON WIRE

In this issue, you'll find:

• House Leaders Postpone Budget Vote
• Congressional Leaders Clarify DRA
• Medicare Part D Updates for 2007
• CMS Release Final Rule on Power Wheelchairs
• Senate Republican Health Week: May 1-5, 2006
• Congress in Recess Until April 24, 2006

Top Story

House Leaders Postpone Budget Vote

House Leaders on Thursday announced the postponement of a vote on the fiscal year (FY) 2007 budget resolution, as they were unable to reach a compromise among House Republicans.

House Majority Leader Boehner (R-OH) had anticipated a vote on the measure by the end of this week, before Congress adjourns for it two-week spring recess. Yet, many moderate Republicans vowed to vote against the budget unless funding for health and education programs increased, while conservative Republicans remained committed to the President's proposed discretionary spending cap. Additionally, appropriators, led by Committee Chairman Jerry Lewis (R-CA), refused to support a provision in the budget that would require approval from the Budget Committee to exceed $4.3 billion in non-defense, emergency spending.

Although the House leadership has not surrendered hope for a budget this year, earlier this week Majority Leader Boehner questioned the rationale for a passing a budget after the recess. Additionally, the statutory deadline for the House-Senate conference agreement technically expires on April 15, 2006.

Failure to pass a budget will force Congress to pass "deeming resolutions" setting discretionary spending levels for the coming fiscal year. However, no budget resolution would mean that there would not be reconciliation legislation this year. The Senate budget resolution, approved in March, did not contain reconciliation instructions to committees with jurisdiction over Medicare, Medicaid and other health-related programs. However, the House Budget Committee's resolution did instruct the Ways and Means Committee to find $4 billion in saving over the next five years. While lawmakers indicated that, if passed, those savings would not come from the Medicare program, over which the Committee has partial jurisdiction, many speculated that the program could remain a target for cuts.

Health Care News

Congressional Leaders Clarify DRA

On Wednesday, March 29, 2006 in a letter issued to the Centers for Medicare and Medicaid Services (CMS), Senate Finance Committee Chairman Charles Grassley (R-IA) and House Energy & Commerce Committee Chairman Joe Barton (R-TX) clarified Congress’s intent on the Deficit Reduction Act of 2005 (DRA).

In their letter, the Senators state that despite the DRA giving states increased flexibility with Medicaid coverage and cost-sharing, Congress did not intend for the states to neglect pre-existing cost-sharing safety measures for Medicaid beneficiaries at or below 100 percent of the federal level of poverty. States may not charge those beneficiaries unlimited cost-sharing requirements. The Chairmen also noted that it was not Congress’s intent to make any changes to Early and Periodic Screening Diagnostic and Treatment (EPSDT) coverage and states must provide coverage to children up to the age of 19, with an option to cover individuals up to 21. While the DRA does give states the option of benchmark standards of coverage, EPSDT must be included. CMS is expected to release directions to states within the next few weeks.

Medicare Part D Updates for 2007

On Wednesday, April 5, 2006, the Centers for Medicare and Medicaid Services (CMS) announced an increase in Medicare Part D deductibles for the standard Medicare prescription drug beneficiaries in 2007. Deductibles will increase approximately 7 percent from 2006.

CMS used the National Health Expenditures prescription drug data and the Consumer Price Index annual percentage increase to calculate the updates. CMS stated that the increase to the standard benefits package should not affect most Medicare Part D beneficiaries as most Part D beneficiaries have plans with low or no deductible, pay a flat fee for medications and receive coverage while in the “donut hole.”

CMS Release Final Rule on Power Wheelchairs

The Centers for Medicare and Medicaid Services (CMS) published its final rule on the prescription of power wheelchairs and power operated vehicles (POV) on Wednesday, April 5, 2006.

The rule finalized many modifications to the prescription of power mobility devices under Medicare, originally put into place with an interim final rule in August, 2005. However, instructions to postpone the implementation of the interim final rule's changes were included in appropriations legislation late last year. The instructions resulted from lawmakers' and advocates' concerns with the rule's vague guidance to prescribing physicians, tight time frames for physicians and suppliers, and restricted opportunity for public input.

Among other changes, the final rule enforces the interim final rule's removal of the controversial certificate of medical necessity (CMN), the "check-list" document used by prescribing physicians to determine medical need. While most stakeholders did not contest the elimination of the CMN, groups in August and again this week expressed concern with the "lack of guidance" regarding the documentation now required of prescribing physicians.

The final rule also implements Medicare's face-to-face examination requirement for the prescription of power mobility devices as established in the Medicare Modernization Act of 2003 (MMA). The interim final rule required that the physician provide the supplier with the necessary documents and prescription within 30 days of a face-to-face appointment with the patient. However, during the public comment period on the interim final rule, many physicians, suppliers and consumer groups stated that this timeframe was unrealistic given the new documentation requirements and the often complicated assessment process. In the recent final rule, CMS increased the face-to-face timeframe to 45 days.

The final rule goes into effect on June 6, 2006.

Senate Republican Health Week: May 1-5, 2006

Senate Republicans announced that Health Week, a week focusing on improving health care and health policy, will be the first week in May. Planned topics include medical malpractice cap reform, health savings accounts and legislation on small business insurance coverage.

Upcoming Events

Congress in Recess Until April 24, 2006

For More Information

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