INTRODUCTION
During the summer, the US House of Representatives and US Senate completed work on their Medicare reconciliation bills and named their conferences for the joint Conference Committee. The Conference Committee is responsible for negotiating the final Budget Resolution that will the become the latest Omnibus budget Reconciliation Act (OBRA). This act includes all the law changes needed to reach the savings specified in the Budget Resolution. The president's signature will then be required.
During the Conference Committee negotiations, provisions in both the House and Senate bills are not open for discussion. The differences, however, must be discussed to result in a negotiated bill.
Some of the differences affecting End-Stage Renal Disease (ESRD) Program include:
Reimbursement For Outpatient Drugs
The House bill recommends a reimbursement of 95% of the average wholesale price (AWP) while the Senate language limits reimbursement to 95% of AWP as indexed to the consumer price index. Since it saves more money, the Senate language will likely prevail.
Measurement of Quality
The House language calls for the development of a method to measure and report on the quality of dialysis services provided under Medicare in order to reduce payments for inappropriate of low-quality care. Chances are slim this language will survive the conference.
Audit Reports
The House has a provision requiring an audit of a sample of cost reports for dialysis providers for 1995 and for each third year thereafter. This was suggested by the Prospective Payment assessment commission (ProPAC) earlier this year. Although the House was quick to include it in its bill, the Senate has no such language in its version.
Study on Lifting Managed Care Ban
The House calls for a study on the feasibility and impact of lifting the ban on ESRD beneficiaries enrolling in Medicare managed care plans. This was not included in the Senate bill. It will be interesting to see if this provision makes it out of the conference since there is some confusion regarding its necessity with the implementation this year of the US Health Care Financing (HCFA) ESRD Managed Care Demonstration Project.
Medigap
The Senate's language extends guaranteed coverage to the
currently disabled, non-senior beneficiaries who enroll during a
six-month period. Estimates by the Congressional Budget Office,
however, led to this provision not applying to the ESRD population,
and the Conference language probably won't include ESRD
patients.
SAMPLE LETTER
OR
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The Honorable (full name) |
The Honorable |
Dear Representative or Senator (full name),
I am very concerned that the Stare Renal Plan/kidney disease prevention programs may be adversely affected unless funding is provided in this year's state budget. Because of diabetes and hypertension 1/4 of the population in the state of Michigan is at risk for kidney disease and kidney failure is increasing at a rate of 11% per year. These are alarming facts.
(Insert a short paragraph explaining how kidney disease/failure has affected your life. If you are not a patient, explain how it has affected the lives of people you know with kidney disease/failure. legislators need to understand that kidney disease/failure is a major life event affecting people's health care costs, employment and quality of life.)
I feel strongly that prevention programs begun last year by the National Kidney Foundation of Michigan should be continued and expanded in order to slow growth of kidney failure in Michigan. In order to assure implementation of the programs, please urge your colleagues on the Community Health Appropriations Conference Committee to keep $200,000 for the State Renal Plan/kidney disease prevention in the Department of Community Health budget bill that was passed by the Michigan House of Representatives.
Thank you for your time and consideration. Please let me know about your discussion with your colleagues on the Conference Committee. I look forward to hearing from you.
Sincerely,
Your name
Your address
Your phone #
