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Medicare News
Supreme Court Backs Medicare 'Clawback' Requiring
States Help Pay Drug Costs
House moves to
prevent Medicare from cutting physicians' pay
June 20, 2006 The Supreme Court yesterday upheld
the "clawback" provision in the Medicare drug bill that requires states
to reimburse the federal government for some of the drug expenditures on
"dual eligibles." But, in the House Ways & Means Committee the focus was
on preventing Medicare from cutting pay to physicians in 2007, according
to KaiserNet.org.
 Supreme Court Declines to Block Portion of
Medicare Law Requiring States to Contribute to Cost of Drug Benefit
The Supreme Court on Monday declined to hear a
lawsuit in which five states sought an injunction to block the
collection of state funds by the federal government to help finance the
Medicare prescription drug benefit, CQ Today reports (Schuler, CQ Today,
6/19).
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Medicare Patients Getting Better Care, Says Survey
Quality Improvement Organizations getting the
credit
June 20, 2006 - Three out of four stakeholders in
health care improvement agree that providers are providing better care
because of QIOs, according to a new independent survey of stakeholders
working closely with Quality Improvement Organizations (QIOs) to improve
care for Medicare beneficiaries.
Read more...
Medicare Campaign to Emphasize Preventive Care
'90%-plus of what we are spending is going for
the complications of chronic disease'
June 19, 2006 The Centers for Medicare & Medicaid
Services is planning a campaign for the summer to encourage greater use
of preventive services available through Medicare with a special effort
to reach minorities. To add to this national emphasis on preventive
care, the American Medical Association has just elected its first
president with a board certification in preventive medicine.
Read more...
Read more
Medicare News |
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The attorneys general of Texas, Kentucky, Maine,
Missouri and New Jersey in March requested permission to file the
lawsuit in the Supreme Court; states can file lawsuits against the
federal government with a lower court or with the Supreme Court, which
can refuse to hear such cases.
The current lawsuit challenges the "clawback"
provision of the Medicare prescription drug benefit. Under the
provision, Medicare assumes prescription drug costs for beneficiaries
eligible for both Medicaid and Medicare, but states must pay the federal
government as much as 90% of the estimated amount that they would have
spent for medication costs for dual eligibles under Medicaid (Kaiser
Daily Health Policy Report, 3/6).
The rate under the clawback provision will decrease
to 75% by 2015. According to the lawsuit, the clawback provision amounts
to a tax that "infringes on state sovereignty" and "interferes with
essential functions of state government" (CQ Today, 6/19). Attorneys
general of ten other states have filed amicus briefs in support of the
five states involved with the lawsuit (Washington
Times, 6/20). The Supreme Court declined to hear the lawsuit without
comment and referred the case to a lower court (Holland,
AP/Louisville Courier-Journal, 6/20).
Arguments
New Jersey Attorney General Zulima Farber said, "Our position is
that this is the first time Congress has expanded its power to include
direct taxation of the sovereign states" (Cohen,
Newark Star-Ledger, 6/20).
However, Solicitor General Paul Clement wrote in
arguments for the Bush administration, "The states cannot establish that
the (law) ... will cause them any financial hardship at all" (Washington
Times, 6/20).
He added, "By contrast, an injunction barring
implementation of the (the law) would deprive the Medicare Part D
program of an important source of the funding necessary to furnish
prescription drugs to" beneficiaries (Newark Star-Ledger, 6/20).
Comments
Kentucky Assistant Attorney General David Johnstone said, "We
realized it was a long shot for the court to take the case," adding, "In
the next couple of days, we'll meet in-house and discuss with the other
states involved where we go from here." Johnstone said that each of the
15 states involved likely will have to file separate lawsuits in lower
courts.
CMS Administrator Mark McClellan said, "We continue
to work to ensure that the millions of people with Medicare and Medicaid
will continue to get the drugs they need, at a much lower cost than had
been expected, while saving money for states" (Freking,
AP/Boston Globe, 6/19).
UnitedHealth Enrollment Numbers
In related news,
UnitedHealth Group officials on Monday said that the company has
enrolled 5.7 million Medicare beneficiaries in prescription drug plans,
with 4.5 million beneficiaries enrolled in stand-alone plans and 1.2
million enrolled in Medicare Advantage plans, Dow Jones reports.
According to UnitedHealth, 3.2 million of the
company's 5.7 million Medicare beneficiaries have enrolled in a company
stand-alone prescription drug plan branded by
AARP.
About 1.1 million of the company's Medicare
beneficiaries were automatically enrolled in UnitedHealth prescription
drug plans by the federal government, the company said (Dow Jones,
6/19).
Lawmakers To Pass Bill To Prevent Reduction in
Medicare Reimbursements for Physicians
House Ways and Means Committee Chair Bill Thomas (R-Calif.) and
other committee members have indicated that they plan to pass
legislation to prevent a reduction in Medicare reimbursement rates for
physicians scheduled to take effect in fiscal year 2007, CongressDaily
reports.
Under the Medicare Sustainable Growth Rate formula,
reimbursement rates for physicians will decrease by almost 5% in FY 2007
and by a total of 37% over the next nine fiscal years.
Some lawmakers who support legislation to prevent
the reduction in Medicare reimbursement rates for physicians in FY 2007
have "caveats," and they "probably will not go as far as the physicians'
lobby would like," CongressDaily reports.
Rep. Paul Ryan (R-Wis.) said that physicians should
have to participate in a voluntary system to report information about
the quality of care for Medicare beneficiaries as a condition of such
legislation. "We want to see how they comply and whether they're really
sincere before we go down that road," Ryan said.
In addition, although House Ways and Means
Health Subcommittee Chair Nancy Johnson (R-Conn.) likely will
introduce such legislation at some point, the time remains uncertain
because of a lack of legislative vehicles this year, according to
CongressDaily.
Meanwhile, the
American Medical Association has begun to "kick their lobbying into
high gear," CongressDaily reports. AMA seeks permanent revisions to the
Medicare SAG formula or at least a 2.8% increase in reimbursement rates
for physicians in FY 2007. AMA "is telling lawmakers that without an
increase in payments, physicians might have to restrict services for
Medicare patients, limiting access to care for those patients,"
CongressDaily reports (Heil, CongressDaily, 6/19).
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