Senate Provider Package Introduced;
AAMC Expresses Support
October 4, 2002-Senate Finance Committee Chairman
Max Baucus (D-Mont.) and Ranking Member Charles Grassley (R-Iowa)
Oct. 1 introduced "The Beneficiary Access to Care and
Medicare Equity Act,"
S. 3018, which provides increases in Medicare payments
to hospitals, physicians, skilled nursing facilities and home
health agencies. The $43 billion over 10-year bill also contains
proposals for Medicaid/SCHIP as well as expanded benefits
for Medicare beneficiaries. The AAMC supports the
legislation and communicated
its support to Sens. Baucus and Grassley on Oct. 1.
The following provisions are of interest to teaching hospitals:
- An FY 2003 update of Market Basket (MB) minus 0.25 percent
and full MB updates in FY 2004 and beyond;
- An Indirect Medical Education (IME) adjustment of 6.5
from 5.5 in FYs 2003 and 2004 IME adjustment to 6.5 from
5.5 percent and an adjustment from 6.0 from 5.5 percent
in FY 2005;
- An extension, through FY 2005, of Medicaid Disproportionate
Share Hospital (DSH) provisions that otherwise expire this
year, thereby preventing state allotments from reverting
to Balanced Budget Act (BBA)'s FY 2002 levels (adjusted
by inflation). State Medicaid DSH allotments would continue
to increase annually by inflation, as initiated by Medicare,
Medicaid, SCHIP Benefits Improvement Act (BIPA) of 2000;
- An increase in Medicaid DSH allotments for those states
with Medicaid DSH programs totaling less than 3 percent
of their overall Medicaid spending. States would be allowed
to increase their Medicaid DSH allotments to 3 percent of
Medicaid spending;
- An increase in the standardized amount for rural and
other urban hospitals; and
- A decrease in the labor-related share for those hospitals
with a wage index below 1.0 for FYs 2003-2005.
The bill does not address any of the Direct Graduate Medical
Education (DGME) provisions included in House-passed Medicare
legislation
H.R. 4954 [see Washington
Highlights, June 28]. Under the Baucus-Grassley bill,
certain geriatric residencies would be exempt from a hospital's
resident cap for purposes of determining Medicare IME and
DGME payments.
For physicians, S. 3018 is intended to provide physician
payment increases similar to the H.R. 4954. H.R. 4954 sets
the CY 2003 physician update at 2 percent and modifies the
calculation of updates for CYs 2004 and 2005, subsequently
generating a 2 percent increase each year. In his statement
introducing the bill, Sen. Baucus acknowledged that the physician
payment fix to be temporary and stated that he is "committed
to working with [his] colleagues in the Congress and the Administration
to find a more reasonable solution." The bill also establishes
a 1.0 geographic practice cost index floor in the physician
work component in CYs 2003-05.
The proposal also includes a temporary 1.3 percent increase
in the Federal Medical Assistance Percentage (FMAP), or "Medicaid
match," for all states in FY 2003. If a state's FY 2003
FMAP is lower than its FY 2002 FMAP, the temporary increase
would apply to the FY 2002 amount.
According to Sen. Grassley's statement, the bill was introduced
under Rule 14, which allows the bill to be moved straight
to the floor instead of being referred to the Senate Finance
Committee. Stated Sen. Grassley, "Our action gives Senate
Majority Leader Daschle (D-S.D.) the ability to call the bill
up as early as Thursday." It is unclear whether Sen.
Daschle will move the measure through the Senate. A number
of Senators have already expressed concerns ranging from a
lack of a prescription drug benefit to the overall cost of
the legislation.
In its letter of support, AAMC President Cohen stated, "the
AAMC believes Senate passage of your package must take place
immediately" so that such legislation could be "conferenced
with the House, and signed into law before Congress adjourns
this year."
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Office of Governmental Relations
ldavisboyle@aamc.org
(202) 828-0526
Christiane Mitchell, Senior Legislative Affairs Manager
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
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