It's July, and Congress is knee-deep in its consideration of Medicare reform provisions and development of a Medicare prescription drug benefit. With
by Cara C. Bachenheimer, Esq.

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

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

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

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