“The Balanced Budget Act of 1997 (BBA) fundamentally changed the delivery of quality health care to the nation’s seniors and disabled,” said Rep. Kolbe, an original sponsor of the legislation.   “The BBA expanded coverage of preventive benefits, cracked down on fraud and abuse, and extended the life of Medicare for future beneficiaries.  Unfortunately, some of the changes promulgated by Congress have been implemented poorly and, at times, counter to Congressional intent,” stated Kolbe. 

The bill includes several provisions that will benefit Medicare providers and patients in Southern Arizona.  Specifically, the bill: 

• Strengthens rural hospitals.  This bill will protect low-volume, rural hospitals by letting them choose between current reimbursement levels (which benefit small rural hospitals who serve a low volume of patients), and the new PPS system (which is better for larger rural hospitals).  It will create an alternative Medicaid payment system specifically for community health centers and rural health clinics -critical providers of health care services in rural areas.  It will expand Graduate Medical Education opportunities in rural settings and permit rural hospitals in "urban" areas to be recognized as rural for purposes of Medicare payments.

• Provides additional funds for physical therapy and speech therapy.  Under current law, Medicare places a$1,500 cap on physical and speech therapy, combined.  This bill would provide a separate $1,500 cap for each and would crate a special pool of funds for “high cost” cases.

• Improves women’s health.  This bill would increase access to and reimburse for annual pap tests to ensure that senior citizens benefit from new cervical cancer screening technologies.

• Increases funding for teaching hospitals.  Payments to teaching hospitals would rise and hospitals would be permitted to increase their Medicare resident numbers to better serve rural populations.  In addition, the bill would adopt a national average method of calculating Graduate Medical Education payments and would delay for one year, the one-percent reduction in Indirect Medical Education payments.

• Extends Medicare’s coverage of immunosuppressive drugs.  Currently, there is a three-year limitation on Medicare coverage for immunosuppressive drugs.  All organ donor recipients must take these medicines daily for the rest of their lives to prevent rejection of the donated organ - costs which average $1,000 a month. This bill would provide $200 million to extend the Medicare coverage of immunosuppressive drugs. 

• Continues the Medicare Community Nursing Organization demonstration project.  This bill would provide a two-year extension of the CNO demonstration project, otherwise known as the Healthy Seniors program.  This project tests the ability of nursing organizations to provide quality health care services in home and community-based settings, without requiring beneficiaries to join HMOs. The program includes not only Medicare-covered benefits of home care and medical equipment and supplies, but it also includes expanded coverage for physical, speech and occupational therapy, health education, patient education, routine assessments and case management services.

• Creates incentives to expand Medicare+Choice options for seniors.  This bill would increase payments to Medicare+Choice plans. It would also allow a Medicare+Choice plan to offer continuing coverage to seniors even if the plan withdraws from their immediate county.  Lastly, the bill would establish more flexible enrollment options for the frail elderly.

“Not only will this bill allow our hospitals and physicians to deliver better care to our nation’s senior citizens and disabled, but it will provide targeted relief to rural health care providers who supply critical medical care to senior citizens in Southern Arizona,” said Kolbe. 

For a complete summary of the bill click here.