Medicare and Medicaid Fee-for-service Payments
On 22 November 2003, the House of Representatives voted 220 to 215 to approve the conference report on H.R. 1, the Medicare Prescription Drug, Improvement, and Modernisation Act of 2003. The Senate, on November 24th, voted 54 to 44 to approve the conference report. The bill was signed by the President in a ceremony on December 8th. The legislation adds a prescription drug benefit to Medicare and replaces the existing Medicare+Choice program with a new Medicare Advantage program that establishes managed care payments based on a system of bids and benchmarks. The bill also contains numerous provisions that would generally increase fee-for-service payments within Medicare's Part A and Part B program (also known as traditional Medicare), especially for rural health care providers; numerous regulatory and administrative practices will also be modified. This book discusses the fee-for-service (FFS) provisions of the legislation, those affecting Medicaid as well as the Medicare cost containment provisions. It compares the provisions in the bill as enacted with those in the Medicare reform bills that were originally passed by the Senate and the House. through VIII; some FFS provisions are included in Titles VIII through X as noted. The cost containment provisions are in Title VIII and the Medicaid and other provisions are in Title X. CONTENTS: Preface; Introduction; Changes to Medicare's Fee for Service Program; Index.
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Page 6 - Bryan (Editor) anticipated $200 million from FY2004 thought FY2008 and by $600 million from FY2004 through FY2013. • Certain teaching hospitals with high per resident payments will not receive a payment increase from FY2004 through FY2013; this provision was scored by CBO as a reduction in Medicare spending of $500 million from FY2004 through FY2008 and $1.3 billion from FY2004 through FY2013. • For 18 months from the date of enactment, physicians will not be able to refer Medicare patients to...
Page 9 - Secretary is required to conduct a 2-year demonstration where payment is made for certain drugs and biologicals that are currently provided as "incident to" a physician's services under Part B. The demonstration is required to provide for cost-sharing in the same manner as applies under Part D of Medicare. The demonstration is required to begin within 90 days of enactment and is limited to 50,000 Medicare beneficiaries in sites selected by the Secretary.
Page 7 - В drags from selected entities awarded contracts for competitively biddable drag products under a newly established competitive acquisition program. Selected Provisions Affecting Other Providers and Practitioners The follow provisions affecting other providers and practitioners are included in the legislation: Ambulatory Surgical Centers Payments to ambulatory surgical centers (ASCs) are expected to be lower by $800 million from FY2004 through FY2008 and by $3.1 billion from FY2004 through FY2013...
Page 7 - Blood clotting factors and other blood products, drugs or biologicals (drug products) that were not available for payment by April 1, 2003, covered vaccinations, drug products furnished in during 2004 in connection with renal dialysis services, drugs provided through covered durable medical equipment will be paid at a higher rate during 2004.
Page 6 - Although physicians will receive a 1.5% update in 2004 and 2005 which is expected to increase spending by $2.8 billion from FY2004 through FY2007; subsequently, from FY2008 through FY2012, the provision is expected to result in a decline of $2.8 billion in Medicare spending.
Page 9 - Set (OASIS) data on private pay (non-Medicare, non-Medicaid) until the Secretary reports to Congress and publishes final regulations regarding the collection and use of OASIS. Selected Fee-for Service Demonstration Projects The legislation establishes numerous demonstration projects for the Medicare program.