Medicare Compliance & Reimbursement

Responsible for revamping Medicare in two years, CMS is swamped.

Saying that their agency is swamped, officials of the Centers for Medicare and Medicaid Services have told some health plans to delay filing their intentions for participation in the Medicare Advantage program, AAHP-HIAA President Karen Ignagni said Feb. 3.

Ignagni said she didn't think a backlog this early signaled trouble for CMS in implementing the massive new Medicare law, but Health and Human Services Secretary Tommy Thompson said Feb. 2 that the administration had sought an additional $2 billion in administrative funding for the agency - double the $1 billion Congress provided.

Finance Chair Charles Grassley (R-IA) and senior Democrat Max Baucus (MT) wrote to Thompson Jan. 27 asking for an accounting by Feb. 10 of how CMS plans to spend that billion dollars. The two senators urged that State Health Insurance Assistance Programs receive "at least $41 million in each of 2004 and 2005, or approximately one dollar per beneficiary per year, to enhance their capacity to provide counseling and education to all Medicare beneficiaries."

They also urged funding increases for the HHS Office of Inspector General of at least $15 million in 2004 and $25 million in 2005 "to allow it to address the new oversight challenges posed by the new legislation."

Additionally, speaking Jan. 29 at a conference sponsored by AcademyHealth and Health Affairs, a Republican staffer stressed that Finance leaders would "be very watchful" over the multiple quality promotion initiatives that CMS began under former administrator Tom Scully. "We'll be making sure that in the huge, huge agenda before [CMS] ... that a lot of these things don't fall through the cracks," the aide said. "Even though we gave them a billion dollars to implement the [Medicare] legislation, we're a little bit worried that they don't have enough people and resources" to perform their traditional functions, develop the quality initiatives, and implement the new law, the staffer added.

In related news, one hundred and six applicants are seeking to offer Medicare-approved discount drug cards beginning in June, CMS announced Feb. 5. About a quarter of the applicants would offer cards in particular regions, a quarter would offer national cards, and the remaining half would offer cards to enrollees in particular Medicare Advantage managed care plans.