Clinton’s budget plan to shape health care debate
April 1, 2000 2 minutes read
Clinton’s budget plan to shape health care debate
Program targets Medicare payments, fraud
Republicans declared President Clinton’s final Medicare reform budget dead on arrival, but it still will frame much of this year’s health care debate. According to an analysis by the Medical Group Management Association in Englewood, CO, the budget proposal would:
• create a new Medicare preferred provider option (PPO) in which beneficiaries pay less out of pocket when using providers in the PPO network. The proposal also would introduce competitive bidding and pricing negotiations in setting payment rates for Part B services (except physician services);
• reduce payment updates for durable medical equipment, parenteral and enteral nutrition, and prosthetics and orthotics by the consumer price index minus 1%;
• reduce laboratory payments by 30% for four common lab tests for which data show Medicare overpays compared to the private sector;
• eliminate Health Professional Shortage Area payments for nonprimary care physicians in urban areas;
• allow Medicare to institute a $1 fee on any claim not submitted electronically, which could be waived due to compelling circumstances;
• permit the imposition of a fee for duplicate or unprocessable claims submitted by providers;
• authorize the collection of fees from Medicare+Choice managed care plans to cover the costs associated with initial registrations and annual renewals to the Medicare program;
• double funding to $80 million for the Children’s Hospitals Graduate Medical Education Program.
Among the initiatives to control waste, fraud, and abuse in federal health programs, the budget package would:
• eliminate the physician mark-up for outpatient drugs by limiting Medicare payments to 83% of the average wholesale price;
• impose civil monetary penalties when a phy s ician falsely certifies the need for partial hospitalization services;
• require private insurance companies to provide Medicare Secondary Payer information;
• provide $680 million for the Medicare Integ rity Program, a $50 million increase over the fiscal year 2000 level;
• propose $182 million for the Health Care Fraud and Abuse Control Program, a $24 million increase over fiscal year 2000 funding;
• provide $48 million to improve Medicare contractor internal controls and financial accounting, enhance federal performance measuring and monitoring, and establish a structure for overall federal oversight;
• set a goal of reducing provider bad debt payments by 45%.
The administration’s proposed budget also would do the following:
• authorize a $3,000 tax credit to provide support for Americans who care for a disabled or elderly relative;
• institute a variety of credits to small businesses to offer health insurance;
• expand Medicaid and the State Children’s Health Insurance Program by accelerating the enrollment of uninsured children by increasing efforts in schools, simplifying eligibility, and allowing states to cover the parents of children eligible in those programs;
• enable Americans ages 62 to 65 and vulnerable displaced workers ages 55 and older to buy into Medicare;
• allow contributions to COBRA for Americans ages 55 and older whose companies eliminate their retiree health benefits.
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