Medicare Compliance & Reimbursement

There should be little legislation before New Year's '05, but then everything changes.

Congress will be unable to pass all its fiscal year 2005 appropriations legislation before the November elections and will finish the job in an end-of-year lame-duck session, Sen. Gordon Smith (R-OR) said in a September 8 address to the Academy of Molecular Imaging's Washington Symposium.

On the prospects for congressional health-care action in 2005, Smith echoed remarks made earlier that morning by Liz Fowler, Democratic staff director for the Senate Finance Committee: Health-care issues including Medicare and help for the uninsured might make it onto the 2005 legislative agenda, but the one sure bet is "deficit reduction" - read, cuts to Medicare.

No matter who wins the presidential election, the 2005 legislative schedule on health is murkier than at any time in the recent past, said Fowler.

If Democratic candidate Sen. John Kerry (MA) prevails, then some major retooling of the health-care system to expand coverage and trim costs might be in the works, but only if legislators sense strong voter demand during this year's election cycle, she suggested. A Kerry win would also encourage congressional Democrats to call more strongly for significant changes to last years' Medicare bill, such as allowing the government to negotiate directly for drug prices.

However, the only sure bets are that Congress will work on a deficit-reduction package that will include Medicare cuts, revisions to the Medicare physician-payment formula that would rein in payments to aid deficit reduction and reimburse more accurately, and a technical-corrections bill for the 2003 Medicare legislation, said Fowler. Such measures will be launched in 2005 no matter who wins the presidency this fall, she said.

A Medicare-law corrections bill is "clearly going to happen in the 109th Congress," which will convene in January, Smith agreed.

Physician-payment changes likely will be included in a Medicare technical-corrections bill, as "the biggest thing in it," he said.

As for 2004, it's "possible," though not at all probable, that appropriations bills will clear Congress before the elections, said Smith. What's likely is that Congress will return for a lame-duck session late in the year to pass whatever spending bills remain, he said. In addition, chances are that the always contentious Labor/Health and Human Services/Education spending measure will be linked to the must-pass Homeland Security appropriations bill in order to get through, according to Smith.

Other rank-and-file Republicans also have said recently they expect a lame-duck session to finish the spending bills, although Senate Majority Leader Bill Frist (R-TN) apparently isn't backing off his assertion that the bills will be completed in time for Congress to adjourn before the November 2 elections.