Medicare Compliance & Reimbursement

Plus: Scrutiny of Medicare QIOs intensifies.

Just as the much-debated budget reconciliation bill is under consideration in the Senate, an influential hospital organization and a senator took a last stand against the legislation's provisions for Medicaid "benefit flexibility" and cost-sharing--and they won.

Many safety net providers and the patients they serve "would be especially at risk if states were to impose new cost-sharing on Medicaid recipients, make premiums and co-payments enforceable or provide reduced Medicaid benefits," the American Hospital Association wrote in a Dec. 12 letter to the Senate Finance Committee and the Energy and Commerce Committee Chairmen.

According to the Congressional Budget Office, "three quarters of the House bill's Medicaid savings come from provisions that increase costs, cut benefits or impair access to services for low-income individuals," Sen. Max Baucus (D-MT) said in a Dec. 13 floor statement. Baucus offered a motion to instruct the legislation's conference committee members to turn down the budget reconciliation bill's cost-sharing and reduced benefits provisions.

Baucus--the Senate Finance Committee's ranking member--is opposed to his colleagues on the committee, including Chairman Sen. Charles Grassley (R-IA), who praised the bill. But Baucus says his motion to warn conferees will help "to set the record straight on Medicaid cuts."

"Taken together, these provisions could eliminate coverage for certain beneficiaries, increase uncompensated care for safety net providers and ultimately jeopardize the ability of patients to receive the full scope of needed services," the AHA warns. And the Senate agreed. On Dec. 14, senators voted 75 to 16 in favor of Baucus' motion to warn budget reconciliation bill conferees not to produce a final report that increases Medicaid co-payments and skims benefits to save dollars.

The conference committee members (appointments pending) will create a single, final version of the House and Senate bills. Baucus' motion should help sway conferees to choose more Medicaid provisions from the Senate bill--which derives savings from curbing government overpayments to Medicare and Medicaid providers--than from the House bill. Grassley Wants To See How Far Down The QIO 'Rabbit Hole' Goes The boards of directors of several Medicare quality improvement organizations have come under fire for hefty travel expenses and exorbitant pay checks. Sen. Grassley's latest inquiry furthers his hard-hitting investigation into QIOs' effectiveness and costs to Medicare.

The Finance Committee Chairman began scrutinizing QIOs after a series of July 2005 articles in the Washington Post questioned whether they "limit patient access to medical information and have a more than cozy relationship with physicians," Grassley wrote in a recent letter to a New Jersey QIO called PRONJ.

When Grassley received information he requested from the Centers for Medicare & Medicaid Services about 15 QIOs' contracts, travel expenses, board compensation and performance audits, he asked PRONJ for additional information. Specifically, the [...]