Rural Act of 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 (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.

Client expense: $122,924 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Council of Economic Advisers (CEA), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), SENATE

Fiscal Year 2003 Budget Resolution S.839,H.R.4954,H.R.1556 The American Hospital Preservation Act S.885,H.R.4954,H.R.1609 The Rural & Small Community Hospital Area Wage and Base Payment Improvement Act S.2547 The Hospital Outpatient Fair Payment Act of 2002 S.2555 The Revitalizing Under-Served Rural Areas and Localities Act S.2615,H.R.4515 The Rural Community Hospital Assistance Act S.326,H.R.4954,H.R.975 The Home Health Payment Fairness Act S.2490,H.R.4954 Medicare Skilled Nursing Beneficiary Protection Act of 2002 S.812,H.R.3414,S.2110 State Budget Relief Act of 2001 S.J.Res.37/H.J.Res.92 Resolution of Disapproval--Overturn Medicaid Upper Payment Limit Reduction S.1745,H.R.3360 Delay in Medicaid Upper Payment Limit Reduction S.572,H.R.854 Medicaid Safety Net Hospital Continued Preservation Act H.R.287 Prompt Payment of Health Benefits Claims Act H.R.4600 Helping to Ensure Affordable, Low-Cost, Timely Health Care Act of 2002 S.706,H.R.1436 The Nurse Reinvestment Act H.R.1897 The Nurse of Tomorrow Act S.705,H.R.3292 The Health Information Technology and Quality Improvement Act/Medication Errors Reduction Act of 2001 S.548,H.R.4954,H.R.1354 Assure Access to Mammography Act S.582,H.R.1143 The Immigrant Children's Health Improvement Act of 2001 S.2449 Federal Responsibility for Immigrant Health Act S.169,H.R.519 Local Medical Emergency Reimbursement Act S.1715,H.R.3448 Public Health Security and Bioterrorism Response Act of 2001 HHS Emergency Readiness Funding for Health Care Providers Disaster Relief Funding for Health Care Providers Medicare Prescription Drug Coverage & Provider Payment Increase Legislation Inpatient, Outpatient, Skilled Nursing Facility and Long Term Care Hospital (LTCH) PPS Regulations Continuation of Agriculture Department's J-1 Visa Program CMS Seventh Scope of Work for Quality Improvement Organizations CMS Outcomes-based Qulaity Improvement in Home Health Care CMS Proposed Expansion of Post-Acute Care Transfer Payment EMTALA Regulations Provider-based Regulations Corporate Compliance Department of Labor Regulations on Benefit Claim Appeals HHS Regulatory Reform Efforts IRS Intermediate Sanction Rules Upper Payment Limit Rules HIPAA Rules

Client expense: $320,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), Office of the Vice President of the United States, SENATE

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

Client expense: $119,489 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Council of Economic Advisers (CEA), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), President of the U.S., SENATE, White House Office