Medicare diabetes self-management services coverage included in budget agreement.
Executive Summary
MEDICARE DIABETES PREVENTION COVERAGE INCLUDED IN BALANCED BUDGET AGREEMENT reached between the White House and Congress. The Medicare budget includes "coverage for diabetes self management," a summary of the agreement states. In addition, negotiators have agreed to pay for expanded mammography coverage, coverage for colorectal screenings and "higher payments to providers for preventive vaccinations to the extent it will lead to greater use by beneficiaries." The agreement calls for spending of "$4 bil. over five years (and $20 bil. over ten years) to limit beneficiary copayments for outpatient services unless there is a more cost-effective way to provide such services to beneficiaries as mutually agreed."
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MEDICARE DIABETES PREVENTION COVERAGE INCLUDED IN BALANCED BUDGET AGREEMENT reached between the White House and Congress. The Medicare budget includes "coverage for diabetes self management," a summary of the agreement states. In addition, negotiators have agreed to pay for expanded mammography coverage, coverage for colorectal screenings and "higher payments to providers for preventive vaccinations to the extent it will lead to greater use by beneficiaries." The agreement calls for spending of "$4 bil. over five years (and $20 bil. over ten years) to limit beneficiary copayments for outpatient services unless there is a more cost-effective way to provide such services to beneficiaries as mutually agreed." Rep. Furse (D-Ore.) told the National Community Pharmacists Association annual legislative conference in Washington, D.C. May 19 that she expects legislation (HR 58) authorizing Medicare coverage of diabetes outpatient self-management training services and diabetes blood- testing strips to pass this year. The diabetes bill, which Furse introduced with Rep. Nethercutt (R-Wash.), "needs to go through subcommittee. We hope that will happen very soon," she said. Furse told NCPA that she will continue to push for further expansion of Medicare diabetes coverage, including coverage of oral antidiabetics, after the preventive care language is enacted. "We are going to move...piece by piece," Furse said. We "want to get our bill [HR 58] passed this session, then move forward. But...I think we do need those oral medications covered" to prevent diabetes complications, Furse maintained. Rep. Johnson (R-Conn.) introduced legislation May 15 to mandate Medicare coverage of routine patient costs during cancer clinical trials. The Medicare Cancer Clinical Trial Coverage Act would establish a five-year demonstration project in which Medicare would cover the care costs of patients in cancer clinical trials approved by the National Institutes of Health, FDA, the Veterans Administration, the Department of Defense or "a qualified nongovernmental research entity identified in the guidelines issued by the National Institutes of Health for cancer support grants." Co-sponsored by Rep. Cardin (D-Md.), the bill is the companion to S 381, sponsored by Sens. Mack (R-Fla.) and Rockefeller (D-W.Va.) and introduced Feb. 27. A Congressional Budget Office analysis of the bill estimated that Medicare's FY 1998 cost for covering cancer clinical trials would be $450 mil. Johnson said the estimate was based on "false assumptions." The sponsors believe Medicare already inadvertently covers more patients in trials than CBO assumes and have asked the General Accounting Office to estimate the current rate of coverage. |