Copyright 2000 Journal Sentinel Inc.
Milwaukee
Journal Sentinel
October 15, 2000 Sunday FINAL EDITION
SECTION: NEWS; Pg. 13A
LENGTH: 687 words
HEADLINE:
Bill increases benefits for Medicare patients;
Cost of outpatient care for
beneficiaries would be cut
BYLINE: ROBERT PEAR New York
Times
BODY:
Washington -- Medicare recipients will
receive several new benefits under legislation sailing through Congress with
bipartisan support.
The bill improves coverage of mammography, Pap
smears and pelvic examinations for women; expands coverage of colonoscopies to
detect colon cancer and authorizes payment for tests for glaucoma. In addition,
the bill promises to reduce the cost of outpatient care for beneficiaries, a
goal long sought by AARP, formerly known as the American Association of Retired
Persons.
The new benefits are included in a bill that also increases
Medicare payments to health maintenance organizations, hospitals, nursing homes
and home care agencies. Republicans said they had decided to provide new
Medicare benefits for two reasons. First, they said, the benefits, especially
coverage for preventive health services, can prolong the lives of older
Americans. Second, they said, the benefits serve an important political purpose,
showing that members of Congress care about older voters even as lawmakers
respond to the pleas of lobbyists for the health care industry.
Overall,
the legislation will cost $26 billion to $28
billion over five years. Health care providers will receive two-thirds of the
money.
One of the most significant features of the bill is a provision
limiting the amounts that can be charged to beneficiaries for outpatient care at
hospitals. Because of a quirk in the Medicare law, patients in recent years have
been forced to pay a rapidly growing share of the cost for outpatient services,
like cataract surgery and hernia operations. Patients sometimes pay more than
60%.
Under the legislation, the patient's share of outpatient bills may
not exceed 60% next year, 55% in 2002 and 2003, 50% in 2004, 45% in 2005 and 40%
in 2006. The Congressional Budget Office estimated that these limits would save
beneficiaries $1.8 billion in the next five years.
Under another provision of the bill, Medicare would cover colonoscopies
for all beneficiaries. Under current law, it covers such procedures only for
people who have a high risk of developing colon cancer, because of their family
history or other factors.
Medicare has not covered routine screenings
for glaucoma, but under the legislation, it would cover such examinations for
people with a high risk of glaucoma, including people with a family history of
the disease and people who have diabetes.
The legislation would also
expand coverage of Pap tests, to help detect cervical cancer.
In most cases, Medicare now pays for a Pap
smear and a pelvic examination once every three years. Under the legislation, it
would pay for the test and the examination every two years.
Under the
bill, Medicare would, for the first time, cover " medical nutrition therapy
services" for some patients. The benefit would become available next year to
Medicare patients with diabetes or kidney disease. The government would study
whether coverage should be extended to other groups.
Congress also has
decided to increase payments for certain types of mammography that use new
computer technology to help detect breast cancer in women with no symptoms. The
payment for such a test, which now averages $84, could be
increased by 50%.
Medicare pays for some organ transplants and for the
drugs needed to prevent rejection, but coverage of the drugs is generally
limited to 44 months. The bill would eliminate the time limit on coverage of the
drugs.
Republicans have also agreed to increase payments to HMOs. The
monthly payment on behalf of a Medicare beneficiary now ranges from a low of
$402 in some rural areas to a high of $814 in
parts of New York. The bill would establish a minimum payment of
$525 a month for beneficiaries in any metropolitan area with a
population of more than 250,000. In rural areas, the minimum payment would be
raised to $475.
KEY PROVISION
Under legislation
that has bipartisan support in Congress, a Medicare patient's share of
outpatient care bills from hospitals may not exceed:
60% in 2001
55% in 2002 and 2003
50% in 2004
45% in 2005
40%
in 2006
LOAD-DATE: October 15, 2000
