Further BBA Relief Legislation To Be Marked Up By Mid-September

AdvaMed is working to ensure that portions of the Medicare Patient Access to Technology Act (HR 4395) will be incorporated into balanced budget act relief legislation by the time it is marked up in mid-September.

Introduced by Reps. Jim Ramstad (R-Minn.) and Karen Thurman (D-Fla.) on May 10, HR 4395 aims to streamline the Medicare coverage, coding, and payment processes for new devices and diagnostics by reforming the Health Care Financing Administration's reimbursement policies.

Realizing the measure is unlikely to stand on its own, AdvaMed has been working with hill staffers during the summer recess to try to blend certain portions of the bill into BBA relief measures. In the same vein, elements of a similar bill (S 1626) by Sen. Orrin Hatch (R-Utah) were incorporated into the Balanced Budget Refinement Act of 1999 (¹ (Also see "Congress Moves To Adopt $16 Bil. Medicare Funding Restoration Measure" - Medtech Insight, 22 Nov, 1999.)).

Several versions of a second-round BBA relief measure are currently circulating on Capitol Hill.

House Ways & Means/Health Subcommittee Chairman Bill Thomas (R-Calif.) has said that he will introduce a BBA relief package this fall that would cost $40 bil. over 10 years.

Rep. Thomas sent a letter to his House Republican colleagues July 27 stating his plans to use the August recess to address funding issues raised by various health providers and to develop appropriate solutions. The letter included a list of questions for members to ask providers in their districts seeking BBA-related financial relief.

Rep. Thomas' as yet unwritten legislation will need to move quickly through both houses in order for it to pass this session, staffers note. The bill likely will be marked up by mid-September; Congress reconvenes Sept. 5. Because members want time to campaign in their home states, Congress is aiming to break for recess in early October.

While Thomas has pledged to address health care providers' financial concerns this fall, he also reminded his colleagues to consider BBA refinements enacted in 1999 when talking to providers in their districts.

"You may wish to note that many of the provisions in last year's BBRA that add-back funds to Medicare do not take effect until FY 2001 and subsequent years," the letter points out. "As a result, some provider groups have yet to receive nearly $15 bil. in restored funds mandated by the BBRA."

Among the providers seeking BBA relief are hospitals, skilled nursing facilities and home health services. Both hospitals and nursing homes are asking for a full market basket update. In addition, the latter are seeking an additional $9.7 mil. to be restored to the baseline over 10 years. Home health providers have asked Congress to repeal the permanent 15% reduction mandated by the BBA.

Staffers say the California Republican's bill likely will mirror President Clinton's BBA relief proposal, which likewise would cost $40 bil. over 10 years. Forwarded June 20, the proposal would restore the market basket update to hospitals in FY 2001 but would not eliminate the 15% reduction in home health payments. Instead, the reduction would be delayed by one year.

The Administration's plan also would reserve $1 bil. over 10 years to "improve the sustainability of rural hospitals" and includes $11 bil. in "unspecified funds" that could go to Medicare +Choice plans.

Rep. Thomas' bill is one of several BBA relief packages slated for introduction soon after Labor Day. House Commerce Committee Chairman Thomas Bliley (R-Va.) or another committee member is also expected to introduce a Commerce relief package soon after Congress returns from the August recess, though details of the bill have not been finalized, staffers report.

On the Senate side, Minority Leader Tom Daschle (D-S.D.) and Sen. Daniel Patrick Moynihan (D-N.Y.) plan to introduce a relief bill that would restore $80 bil. over ten years. In addition, Senate Finance Committee Chairman William Roth (R-Del.) is said to have asked Moynihan to work with him in developing a ten-year, $30 bil. proposal for introduction in September.

While Congress will need to reconcile all of the different versions of further BBA relief legislation in a timely fashion this fall, staffers are already predicting that, of the different groups, hospitals are most likely to see the reforms they requested written into law.

Perhaps in recognition of the weight hospitals bring to the table, AdvaMed has been working with hospital groups throughout the summer to convey how incorporating the Ramstad/Thurman bill with further BBA reform legislation would benefit both hospitals and patients.

AdvaMed President Pamela Bailey has made patient access to medical technology a top legislative priority since joining the association slightly more than one year ago.

The Ramstad/Thurman legislation calls for across-the-board modification of current HCFA practice. For example, it would require the agency to provide quarterly updates of codes and allows for use of external data to improve the timeliness and appropriateness of reimbursement decisions.

By combining patient access language with further BBA relief, Congress would create legislation that would both provide a large degree of financial relief for institutions and expedite the introduction of new technology to Medicare patients, AdvaMed notes.

Other significant health-related measures also could receive congressional attention following the August recess.

Rep. Thomas' Medicare Patient Appeals Act (HR 2356) would allow beneficiaries to appeal Medicare decisions to not cover a technology or procedure. AdvaMed has urged Congress to include aspects of this bill in a broader Medicare package this fall. While it is possible that appeals language could show up in Thomas' BBA reform legislation, staffers say the reforms are unlikely to be part of the final version of the bill.

In June, AdvaMed urged the Senate to include reforms to the Medicare appeals process in its version of Medicare prescription drug legislation. While the Medicare Rx Act (HR 4680) is still viable, it appears unlikely that it will be taken up this year. Staffers predict that a prescription drug bill could be a major campaign issue in the 2002 congressional elections.

Before adjourning for the year Congress also will finalize appropriations for FY 2001. The Labor/HHS appropriations conference report was approved by a majority of conferees July 27. None of the Democrats on the conference committee signed the measure and the President is expected to veto the legislation.

The Senate passed its Labor/HHS spending bill (S 2553) June 30. The legislation was passed by the House June 14 (HR 4577).