Medicare Compliance & Reimbursement

Good question: Here's what a couple insiders had to say.

As Congress adjourned for its spring recess two weeks ago, the House had passed legislation seeking at least $20 billion in Medicaid cuts over the next ten years. The Senate had passed a bill that required no cuts but established a federal commission to seek longer-term solutions.

It's not at all clear whether congressional leaders can mesh the two very different measures into a single package that both houses of Congress will approve.

At a March 29 Medicaid conference, a Senate Republican aide suggested that GOP senators would like to see some of President Bush's modest specific proposals on Medicaid enacted, including trimming payments to pharmacies and making it harder for people to spend down assets to qualify for Medicaid long-term care coverage.

If Bush gets some of those proposals passed, a commission could "be a logical next step," the aide said.

A Democratic staffer said that Medicaid revisions this year are off the table for the minority, since there hasn't been enough discussion of what actual large-scale policy changes are needed.

The staffer acknowledged that if Congress agrees on a single reconciliation bill, committees would be forced by law to make entitlement cuts, ready or not. But in that case, the aide warned, "Medicaid will be on the table, and so will Medicare. We're going to be looking for savings in all areas."

Some Senate Republicans and Democrats agree on one change they'd like to see: More transparency, possibly including a 30-day public comment period, in the process by which the Centers for Medicare and Medicaid Services negotiates Medicaid waiver approvals with states.