Medicare Physician Payment Fairness Act of 2001

H.R.4954/H.RES.465:To amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize and reform payments and the regulatory structure of the Medicare Program. H.R.2073: To amend title XVIII of the Social Security Act to waive the part B late enrollment penalty for military retirees who enroll by December 31, 2002, and to provide a special part B enrollment period for such retirees. H.R.179:To restore health care coverage to retired members of the uniformed services. S.1707: A bill to amend title XVIII of the Social Security Act to specify the update for payments under the medicare physician fee schedule for 2002 and to direct the Medicare Payment Advisory Commission to conduct a study on replacing the use of the sustainable growth rate as a factor in determining such update in subsequent years S.278:A bill to restore health care coverage to retired members of the uniformed services.Directs the Secretary of Defense to enter into an agreement with the Office of Personnel Management to provide FEHBcoverage to the following eligible beneficiaries: (1) a member or former member entitled to military retired or retainer pay; (2)an unremarried former spouse who was married to a member for at least 20 years, during which such member performed at east 20 years of retirement-creditable military service; (3) a dependent of a deceased qualifying member or former member;(4) a dependent of a living member or former member; and (5) a family member.

Client expense: $80,000 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Internal Revenue Service (IRS), President of the U.S., SENATE

H.R. 3351/S.1707-Medicare Physician Payment Fairness Act. Appropriations Issues (Veterans Administration, AHRQ, NIH,CDC). H.R.4954 - Medicare Modernization and Prescription Drug Act of 2002. H.R. 4200 - Health Act 2002. Issues related to proposed reform of the A.W.P. drug pricing methodology.

Client expense: Not reported · Firm income: $60,000

The Medicare Physician Payment Fairness Act of 2001, S. 1707 and HR 3351, introduced by Senator James Jeffords and Rep. Michael Bilirakis to reduce an across the board cut of 5.4% in Medicare payments to physicians and set the conversion factor (update) for payments under the Medicare physician fee schedule for 2002 at 0.9 percent less than the conversion factor for 2001. The bills also direct the Medicare Payment Advisory Commission (MedPAC) to study and report to Congress on replacing the use of the sustainable growth rate as a factor in determining the update for such payments with a factor that more fully accounts for changes in the unit costs of providing physicians' services. Modification of Medicare physician fee schedule geographic work adjustor. HR 3569, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 1953, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. S. 2752 by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. S. 2555, the “Revitalizing Underserved Rural Areas and Localities (RURAL) Act of 2002” introduced by Senator Baucus with provisions to increase the geographic adjustment of physician reimbursement in low payment areas. The Medicare Modernization and Prescription Drug Act (HR 4954) introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 2% Medicare Part B conversion factor update in 2003, 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; and delaying “Lock-in” requirements for one year; establishing competitive bidding for certain Part B services. The Medical Excellence Demonstration Program Act of 2001 (S. 1756 introduced by Senator Jeffords, and HR 3746 introduced by Rep. Houghton) to establish demonstration projects to examine health care delivery factors that encourage improved quality of care. The conference report on HR 3448 the Public Health Security and Bioterrorism Preparedness and Response Act changed the Medicare+Choice “lock-in” provisions governing marketing and enrollment in M+C plans. The new provisions would postpone for three years limits determining when Medicare beneficiaries can switch health plans. These provisions also set limits on the period when M+C enrollment could be marketed to beneficiaries. Full reimbursement of Medicare Allowed Costs under Medicare Part B. Acceleration of Risk Adjustment implementation under Medicare+Choice. Preservation of floor payments in rural areas under Medicare+Choice. Waiver and or delay of Medicare+Choice “lock-in” enrollment limitations for 2002-2005. Extension of the New Entry bonus under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. HHS Initiative on Rural Communities, DHHS Secretary Thompson's call for a department-wide examination of federal health programs and how the federal programs respond to the needs of rural areas. Regulatory reform of CMS, through select provisions of the Medicare Education and Regulatory Fairness Act (S. 452, H.R. 858), H.R. 3046, the Medicare Regulatory, Appeals, Contracting, and Education Reform Act (The Medicare RACER Act) and the H.R. 2768, the “Medicare Regulatory And Contract Reform Act of 2001,” and H.R. 3391, The Medicare Regulatory and Contracting Reform Act” HR 3584, “The Medicare+Choice Improvement and Stabilization Act of 2001” legislation that would revise the payment structure of the Medicare managed care program for the year 2003 and make other changes to the program basing M+C payment on 100 percent of fee-for-service costs for 2003 only. Plans would then be paid based on whichever option was greatest: 100 percent of fee-for-service; a modified blend that re-weights the national average using M+C enrollment; floor payments as enacted in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000; or a 2 percent minimum increase. The bill would also delay the onset of the “lock-in” period by one year and enable demonstration projects for preferred provider organizations and disease management programs. Save this template.Issue Template Text ACC accounting Or S. 3018, by Senators Baucus and Grassley, the Beneficiary Access to Care and Medicare Equity Act of 2002. Provisions calling for a statutory increase in medicare physician payments for 2003-2005; provisions equalizing payments for physicians in rural areas for 2003?2005 by implementing a floor of 1.0 for the geographic adjustment of physician work, holding all other areas harmless. Incentive payments for physicians in underserved areas. Provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, HR 5661. Section 412. HHS will be required to conduct a Physician Group Practice Demonstration to test, and expand the use of incentives to health care groups participating under Medicare. Section 429. BIPA requires GAO to study and submit a report to Congress and the Secretary on the reimbursement for drugs and biologicals and related services under Medicare. On September 27, the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Medicare reimbursement for recovery care center services. Medicare Evaluation and Management Documentation Coding. Clarification of Medicare Formatting of Advance Beneficiary Notices. Medicare coverage of injected drugs HR 5063, a bill extending unemployment benefits, but also including a provision written by Ways and Means Committee Chairman Bill Thomas (R-CA) granting the Centers for Medicare and Medicaid Services (CMS) immunity from “retroactive lawsuits” for Medicare+Choice overestimates and accounting mistakes made in 1998 and 1999 in the calculation of Medicare physician fees.

H.R. 2563 Bipartisan Patient Protection Act of 2001 S. 1052 Bipartisan Patient Protection Act S. 1738 Medicare Appeals, Regulating and Contracting Improvement Act of 2001 S. 358 Medicare PRescription Drug and Modernization Act of 2001 S. 1707 Medicare Physician Payment Fairness Act of 2001

Client expense: Not reported · Firm income: $90,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2563 Bipartisan Patient Protection Act of 2001 S. 1052 Bipartisan Patient Protection Act S. 1738 Medicare Appeals, Regulating and Contracting Improvement Act of 2001 S. 358 Medicare PRescription Drug and Modernization Act of 2001 S. 1707 Medicare Physician Payment Fairness Act of 2001

Client expense: Not reported · Firm income: $90,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.839/HR 1556, American Hospital Preservation Act of 2001:advocated for support; S.326/HR 975, Home Health Fairness Act of 2001: advocated for support and co-sponsorship; S.1707/HR 3351, Medicare Physician Payment Fairness Act: advocated for support;Proposed Rule (Centers for Medicare and Medicaid Services) entitled, "Medicaid Program;Medicaid Managed Care," 66 Fed.Reg. 43614 (August 20,2001):advocated and supported interpretation of rule which would allow state Medicaid programs to continue to make payments directly to teaching hospitals that are under contract with Medicaid managed care plans, to help offset the higher costs associated with the special missions of teaching hospitals (so-called direct graduate medical payments); monitored Medicare reform and Prescription Drug Benefit legislation; Monitored HR 4954, The Medicare Modernization and Prescription Drug Act of 2002.

Client expense: $140,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Medicare Modernization and Prescription Drug Coverage, Medicare Reform Act of 2001 (S.1135 and S.358) Medicare Physician Payment Fairness Act of 2001 (S.1707/H.R.3351) CMS Rule"FiveYear Review of work Related Value Units under the Physicians Fee Schedule Evaluation and Management(E/M)Services Emergency Medical Treatment and Active labor Act(EMTALA)

Client expense: $1,060,000 · Firm income: Not reported

On November 1, the Centers for Medicare & Medicaid Services published in the Federal Register a final rule entitled, “Revisions to Payment Policies and Five-Year Review of and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 2002.” This final rule made significant changes affecting Medicare Part B payment to reflect changes in medical practice and the relative value of services including interim RVUs for new and revised procedure codes for calendar year (CY) 2002, and a revised physician fee schedule update for CY 2002 and a revised conversion factor for CY 2002. The Medicare Physician Payment Fairness Act of 2001, S. 1707 and HR 3351, introduced by Senator James Jeffords and Rep. Michael Bilirakis to reduce an across the board cut of 5.4% in Medicare payments to physicians and set the conversion factor (update) for payments under the Medicare physician fee schedule for 2002 at 0.9 percent less than the conversion factor for 2001. The bills also direct the Medicare Payment Advisory Commission (MedPAC) to study and report to Congress on replacing the use of the sustainable growth rate as a factor in determining the update for such payments with a factor that more fully accounts for changes in the unit costs of providing physicians' services. Modification of Medicare physician fee schedule geographic work adjustor. HR 3569, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 1953 Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. S. 2752 by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. S. 2555, the “Revitalizing Underserved Rural Areas and Localities (RURAL) Act of 2002” introduced by Senator Baucus with provisions to increase the geographic adjustment of physician reimbursement in low payment areas. The Medicare Modernization and Prescription Drug Act (HR4954) introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 2% Medicare Part B conversion factor update in 2003, 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; and delaying “Lock-in” requirements for one year; establishing competitive bidding for certain Part B services. The Medical Excellence Demonstration Program Act of 2001 (S. 1756 introduced by Senator Jeffords, and HR 3746 introduced by Rep. Houghton) to establish demonstration projects to examine health care delivery factors that encourage improved quality of care. The conference report on HR 3448 the Public Health Security and Bioterrorism Preparedness and Response Act changed the Medicare+Choice “lock-in” provisions governing marketing and enrollment in M+C plans. The new provisions would postpone for three years limits determining when Medicare beneficiaries can switch health plans. These provisions also set limits on the period when M+C enrollment could be marketed to beneficiaries. Full reimbursement of Medicare Allowed Costs under Medicare Part B. Acceleration of Risk Adjustment implementation under Medicare+Choice. Preservation of floor payments in rural areas under Medicare+Choice. Waiver and or delay of Medicare+Choice “lock-in” enrollment limitations for 2002-2005. Extension of the New Entry bonus under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. HHS Initiative on Rural Communities, DHHS Secretary Thompson's call for a department-wide examination of federal health programs and how the federal programs respond to the needs of rural areas. Regulatory reform of CMS, through select provisions of the Medicare Education and Regulatory Fairness Act (S. 452, H.R. 858), H.R. 3046, the Medicare Regulatory, Appeals, Contracting, and Education Reform Act (The Medicare RACER Act) and the H.R. 2768, the “Medicare Regulatory And Contract Reform Act of 2001,” and H.R. 3391, The Medicare Regulatory and Contracting Reform Act” HR 3584, “The Medicare+Choice Improvement and Stabilization Act of 2001” legislation that would revise the payment structure of the Medicare managed care program for the year 2003 and make other changes to the program basing M+C payment on 100 percent of fee-for-service costs for 2003 only. Plans would then be paid based on whichever option was greatest: 100 percent of fee-for-service; a modified blend that re-weights the national average using M+C enrollment; floor payments as enacted in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000; or a 2 percent minimum increase. The bill would also delay the onset of the “lock-in” period by one year and enable demonstration projects for preferred provider organizations and disease management programs. Provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, HR 5661. Section 412. HHS will be required to conduct a Physician Group Practice Demonstration to test, and expand the use of incentives to health care groups participating under Medicare. Section 429. BIPA requires GAO to study and submit a report to Congress and the Secretary on the reimbursement for drugs and biologicals and related services under Medicare. Section 437. BIPA requires GAO to conduct a study on the post-payment audit process for physicians services. The Comptroller General would also be required to conduct a study of the aggregate effects of regulatory, audit, oversight and paperwork burdens on physicians and other health care providers participating in Medicare. Medicare reimbursement for recovery care center services. Medicare Evaluation and Management Documentation Coding. Clarification of Medicare Formatting of Advance Beneficiary Notices. Medicare coverage of injected drugs

H.R. 2563 Bipartisan Patient Protection Act of 2001 S. 1052 Bipartisan Patient Protection Act S.1738 Medicare Appeals, Regulating and Contracting Improvement Act of 2001 S. 358 Medicare Prescription Drug and Modernization Act of 2001 S. 1707 Medicare Physician Payment Fairness Act of 2001

Client expense: Not reported · Firm income: $90,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1304 - Quality Healthcare Coalition Act H.R.4680 - Medicare RX2000 Acr. H.R.3351 and S.1707 - Medicare Physician Payment Fairness Act H.R.1759 - Kidney Patient Daily Dialysis Quality Act H.R.2290 - Kidney Dialysis Benefit Improvement Act H.R.868, S.452 - Medicare Education & Regulatory Fairness Act(MERFA) H.R.526, H.R.2563,S.283, S.1052 - Bipartisan Patient Protection Act

Client expense: Not reported · Firm income: $60,000

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

H.R.868,S.452 - Medicare Education & Regulatory Fairness Act(MERFA) H.R.526,H.R.2563,S.283, S.1052 - Bipartisan Patient Protection Act H.R.3351 and S.1707 - Medicare Physician Payment Fairness Act H.R.10,S.578,S.881-Legislation regarding confidentiality of Medical Records. Appropriations Issues(Veterans Administration,AHRQ)

Client expense: Not reported · Firm income: $60,000

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Medicare Modernization and Prescription Drug Coverage, Medicare Reform Act of 2001 (S.1135 and S.358) Medicare Physician Payment Fairness Act of 2001 (S.1707/H.R.3351) CMS Rule"FiveYear Review of work Related Value Units under the Physicians Fee Schedule Evaluation and Management(E/M)Services Emergency Medical Treatment and Active labor Act(EMTALA)

Client expense: $1,060,000 · Firm income: Not reported

On November 1, the Centers for Medicare & Medicaid Services published in the Federal Register a final rule entitled, “Revisions to Payment Policies and Five-Year Review of and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 2002.” This final rule made significant changes affecting Medicare Part B payment to reflect changes in medical practice and the relative value of services including interim RVUs for new and revised procedure codes for calendar year (CY) 2002, and a revised physician fee schedule update for CY 2002 and a revised conversion factor for CY 2002. The Medicare Physician Payment Fairness Act of 2001, S. 1707 and HR 3351, introduced by Senator James Jeffords and Rep. Michael Bilirakis to reduce an across the board cut of 5.4% in Medicare payments to physicians and set the conversion factor (update) for payments under the Medicare physician fee schedule for 2002 at 0.9 percent less than the conversion factor for 2001. The bills also direct the Medicare Payment Advisory Commission (MedPAC) to study and report to Congress on replacing the use of the sustainable growth rate as a factor in determining the update for such payments with a factor that more fully accounts for changes in the unit costs of providing physicians' services. Modification of Medicare physician fee schedule geographic work adjustor. HR 3569, the Rural Equity Payment Index Reform Act (REPAIR) would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas Full reimbursement of Medicare Allowed Costs under Medicare Part B. Acceleration of Risk Adjustment implementation under Medicare+Choice. Preservation of floor payments in rural areas under Medicare+Choice. Waiver of Medicare+Choice enrollment limitations for 2002 and 2003. Extension of the New Entry bonus under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. HHS Initiative on Rural Communities, DHHS Secretary Thompson's call for a department-wide examination of federal health programs and how the federal programs respond to the needs of rural areas. Regulatory reform of CMS, through select provisions of the Medicare Education and Regulatory Fairness Act (S. 452, H.R. 858), H.R. 3046, the Medicare Regulatory, Appeals, Contracting, and Education Reform Act (The Medicare RACER Act) and the H.R. 2768, the “Medicare Regulatory And Contract Reform Act of 2001,” and H.R. 3391, The Medicare Regulatory and Contracting Reform Act” HR 3584, “The Medicare+Choice Improvement and Stabilization Act of 2001” legislation that would revise the payment structure of the Medicare managed care program for the year 2003 and make other changes to the program basing M+C payment on 100 percent of fee-for-service costs for 2003 only. Plans would then be paid based on whichever option was greatest: 100 percent of fee-for-service; a modified blend that re-weights the national average using M+C enrollment; floor payments as enacted in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000; or a 2 percent minimum increase. The bill would also delay the onset of the “lock-in” period by one year and enable demonstration projects for preferred provider organizations and disease management programs. Provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, HR 5661. Section 412. HHS will be required to conduct a Physician Group Practice Demonstration to test, and expand the use of incentives to health care groups participating under Medicare. Section 429. BIPA requires GAO to study and submit a report to Congress and the Secretary on the reimbursement for drugs and biologicals and related services under Medicare. Section 437. BIPA requires GAO to conduct a study on the post-payment audit process for physicians services. The Comptroller General would also be required to conduct a study of the aggregate effects of regulatory, audit, oversight and paperwork burdens on physicians and other health care providers participating in Medicare. TITLE VI. Sections 601-609. BIPA improves funding for beneficiaries in Medicare+Choice plans. Minimum payment rates for Medicare+Choice (M+C) Organizations have been increased to $475/month in rural areas. Minimum M+C updates have been increased to 3% in 2001. The phase in period for risk adjustment has been modified. The new entry bonus (5%) where no plans are available would be extended to 2001. Section 702. Protects Federally Qualified Health Centers from potential reductions in payments, by installing a cost-based system for calculating payment for FQHC's and rural health centers in 2001. The provision would create a new Medicaid prospective payment system for FQHCs and RHCs beginning in January of FY2001. S. 358. Medicare Prescription Drug and Modernization Act of 2001, Title III--Medicare+Choice Competition Program, SEC. 301. (a) Payments to Medicare+Choice Organizations based on risk-adjusted bids- Prescription drug benefits would be offered through existing Medicare+Choice plans and private insurers. Medicare reimbursement for recovery care center services. Medicare Evaluation and Management Documentation Coding. Clarification of Medicare Formatting of Advance Beneficiary Notices.