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Finance Committee negotiations on how long employers must pay for employees' kidney dialysis have stalled after a business coalition opposed to adding to the employer's responsibility ran an ad in a Montana newspaper, according to a committee aide familiar with the negotiations. Finance Chairman Baucus had been considering removing language from a Medicare package that would extend the employer responsibility from 30 months to 42 months, which CBO says would save the government $1.2 billion over 10 years. Baucus was irritated at a recent ad in the Billings Gazette sponsored by the Employers Coalition on Medicare that asked him not to extend the employers' timeframe, making him less inclined to sympathize with their point of view, the aide said. The ad also ran in the Des Moines Register last week, home of Finance ranking member Charles Grassley. The Senate Medicare package, which would also stave off a scheduled 10 percent physician pay cut, is being completed this week.
The business coalition that ran the ad consists of employers and business associations such as the U.S. Chamber of Commerce, but a broader group that includes unions and healthcare advocates opposes expanding the employers' responsibility to pay for kidney dialysis and other treatment for end-stage renal disease. Medicare covers people with end-stage renal disease. Current law dictates that afflicted individuals with group health insurance receive the treatment on the private-sector dollar for 30 months before the government begins paying. Employers say the CBO score on this does not reflect actual private-sector costs, which would be closer to $3 billion-$4 billion over 10 years. (CongressDaily PM 12/03)
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CALL TO ACTION! Members of the Senate Finance Committee and Ways & Means must be contacted immediately to ensure that no additional cuts to oxygen and PMDs be included in the Medicare reform legislation / “doc” fix, set to be completed this week!
Don’t let the NY Times article, “Oxygen Suppliers Fight to Keep a Medicare Boon,” discourage you from taking action. For the sake of the beneficiaries, we must not dwell. We must focus on the Medicare reform legislation! Providers and beneficiaries need to call the members of both committees.
A list of committee members, broken down by state, and talking points are provided below.
Medicare Reform – The Medicare Physician Fee (“Doc”) Fix
To offset the "DOC FIX", Rep. Stark proposed additional cuts to oxygen and the elimination of first-month purchase option of PMD.
While the Senate managed to keep the Medicare provisions out of the SCHIP bill, Medicare cuts will be addressed again before the end of the year. We must call to ensure that cuts to DME are NOT included in any upcoming Medicare Reform Bill/ “Doc Fix.”
Concerns/Talking points for Oxygen cuts:-
Over the past ten years, Congress has already reduced Medicare reimbursement for oxygen therapy by nearly 50 percent.
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More cuts put more seniors at risk and could lead to unnecessary hospital admissions and ER visits due to improper oxygen saturation
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Most Medicare home oxygen patients need oxygen to treat a debilitating pulmonary disease such as the incurable Chronic Pulmonary Obstructive Disease
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A shorter cap on oxygen will force over half of Medicare's home oxygen patients to own their own equipment and thus be responsible for recalls, maintenance and service requirements, not to mention maneuvering heavy oxygen tanks.
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Patient choice will also be seriously curtailed. For example, if a patient's needs change after 13 months, they are stuck with the equipment they were forced to own at 13 months
Concerns/Talking points for PMD: -
Because many power wheelchairs are individualized for the patient, eliminating the first-month purchase option will dramatically reduce access for beneficiaries who suffer from long-term conditions such as multiple sclerosis, Lou Gehrig's disease, spinal cord injuries or paralysis.
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Power wheelchairs are uniquely configured for the individual beneficiary and are not interchangeable with other beneficiaries. It makes no sense to rent an item that is uniquely configured for an individual.
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Information from a CMS contractor, the SADMERC, indicates that virtually 100% of Medicare beneficiaries needing power wheelchairs purchase them on day one. Beneficiaries with severe disabilities use their PWCs daily and for the rest of their lives. There is little reason to rent these devices.
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Analysis from the American Association for Homecare shows that eliminating the first-month purchase option would result in the Medicare program paying 5 percent more for power wheelchairs than they currently pay.
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There are significant up front costs associated with providing power wheelchairs. These costs include, but are not limited to, assessing the beneficiary, fittings and adjustments, providing demonstration product, education and delivery as well as equipment acquisition costs, which are significant and are borne by the supplier prior to submitting a claim to Medicare.
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