October 19, 2001

Energy and Commerce Health Subcommittee Approves Medicare Regulatory Reform Bills

The House Energy and Commerce Health Subcommittee Oct. 17 unanimously passed Chairman Michael Bilirakis' (R-Fla.) substitute in the nature of an amendment to H.R. 3046, the "Medicare Regulatory, Appeals, Contracting, and Education Reform Act" (Medicare RACER Act). The RACER Act is one of several bills introduced this year that attempts to streamline Medicare regulations, assure provider rights during audits, and create a competitive process for selecting Medicare contractors.

While it maintained much of the original RACER bill provisions, Rep. Bilirakis' amendment also established limits on the recoupment of Medicare overpayments during an appeal and addressed the use of peer review organizations. It also established a process for requesting exceptions to national coverage decisions that deny coverage of services for serious or life-threatening illnesses. Additionally, the Bilirakis amendment established a process for determining payments for clinical diagnostic lab tests that receive a new or revised HCPCS code after Jan. 1, 2003.

Several other Subcommittee members offered and then withdrew amendments, including Rep. Charles Norwood (R-Ga.). Rep. Norwood's amendments would have reduced contractors' administrative liabilities, repealed a prohibition on treating family members, and required that peer reviews be conducted by physicians in the same or similar specialty as the provider under review. Rep. Norwood also proposed limiting the use of extrapolation to cases of sustained or high levels of error (similar limits appear in the Ways and Means regulatory relief bill MRCRA).

Other amendments offered and withdrawn include:

• Medicare Physician Payment Update: Subcommittee Ranking Member Sherrod Brown (D-Ohio) proposed eliminating or reconfiguring the sustained growth rate (SGR) methodology.
• Upper Payment Limit (UPL): Rep. Anna Eshoo (D-Calif.) sought to preserve the 150 percent UPL for non-state-government-owned public hospitals.
• EMTALA: Rep. John Shadegg (R-Ariz.) offered provisions to establish an EMTALA advisory committee to review and advise on EMTALA regulations, guarantee peer review for providers facing the loss of Medicare certification because of EMTALA violations, and mandate notifying affected providers that an EMTALA investigation has closed.

Information: Chris Mitchell, AAMC Office of Governmental Relations, 202-828-0526.