No Time Like the Present

It’s July, and Congress is knee-deep in its consideration of Medicare reform provisions and development of a Medicare prescription drug benefit. With 2004 elections just around the corner — at least in Washington terms — the Republicans in the House and the Senate have made significant headway on both of these important proposals.

After passing their respective prescription drug packages late on the evening of June 26, lawmakers took a break for the Fourth of July holiday. They were planning to return July 7 to reconcile the two packages in conference before the end of July. Now is the perfect time to make that lobbying visit or phone call you’ve put off for so long.

And, if you have not written President Bush about the Medicare-reform issue, this is the time to do so, because the Administration will have a significant say in what is in the final Medicare package.

Why lobby now? Let’s look at the facts:

In the Senate, the top Republican and Democratic lawmakers on the Senate Finance Committee announced in early June that they had reached agreement on a $400 billion Medicare prescription drug package. This package, called The Prescription Drug and Medicare Improvement Act (S.1) contains numerous Medicare provisions, including a seven-year consumer-price-index freeze for durable medical equipment reimbursement, a provision that all DME suppliers be accredited by 2006, and payment cuts to the average wholesale price reimbursement formula for Medicare-covered drugs.

The Senate Finance Committee approved the package June 17, and the package passed the full Senate by an overwhelming majority.

Meanwhile, in the House, the two health committees — Ways and Means, and Energy and Commerce — approved their own prescription drug and Medicare-reform packages. Each version of the Medicare Prescription Drug and Modernization Act of 2003 contained DME-related provisions, including a requirement that DME, and respiratory drugs used in conjunction with DME, be subject to competitive bidding.

By a slim vote, the House approved a reconciled version of these two bills.

Addressing Accreditation

While the industry should support the imposition of some real quality standards for Medicare DME providers, we only should do so with the assurance that accredited providers will receive some quid pro quo, such as reduced administrative costs (less paperwork, fewer DMERC audits, etc.). Why not require physicians to electronically prescribe — and complete certificates of medical necessity for — DME?

As far-fetched as it might sound, this is exactly what some senators have discussed as an option — real-time e-prescribing.

What are the Chances?

Let’s look at the possibilities. Any number of things could happen before the August recess.

The House and Senate Medicare and prescription drug packages could be too different to reconcile in conference. And, even if the two sides reach a comprimise, slim Republican margins in both chambers could mean that final approval is simply not possible. As a result, all attached Medicare provisions — including contractor reform, rural-provider relief, a DME CPI freeze and AWP reductions — would languish with the larger Medicare vehicle.

On the other hand, a compromise Medicare prescription drug vehicle could pass both the House and Senate. Attached to such a legislative vehicle could be DME competitive bidding, DME CPI cuts, AWP cuts and mandatory DME-provider accreditation.

You can only prevent the worst of all possibilities from happening if the Administration and members of Congress vividly understand the impact of these various proposals on you, your business and the patients you serve.

Make the calls and send the letters. You really can make a difference.

A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is an attorney with the law firm of Epstein, Becker & Green in Washington, D.C. Bachenheimer previously worked at the American Association for Homecare and the Health Industry Distributors Association. You can reach her by phone at 202/861-1825 or e-mail at [email protected].