Medicare Compliance & Reimbursement

House and Senate Medicare negotiators are meeting this week to vote on tentative agreements reached by staff members during the August recess, conference committee and House Ways and Means chair Bill Thomas (R-CA) told reporters after Republican conferees met Sept. 4.

A spokesperson for conference vice chair Sen. Charles Grassley (R-IA) told CQ Today that Grassley had received a commitment that the conference committee would be discussing rural payment issues "right away." The Senate Finance Committee chair pulled his staff out of negotiations last month, in large part because he believed the committee was not promptly and adequately considering the issue of increasing payments to rural providers.

Thomas said that Grassley "had a commitment all along" that the Medicare legislation would increase payments to rural providers, but he focused on providers in general.

Conference negotiations have focused so far on relatively noncontroversial items like a prescription drug discount card for seniors and enhanced Medicare coverage of preventive health services, although even in these areas agreement has proven hard to come by. There is no indication that Republicans, even among themselves, are close to resolving more fundamental issues that divide the House and Senate bills, such as House language that would put traditional Medicare into direct competition with private plans, and Senate language that would provide government-run fallback drug coverage in areas where no private drug-only plans materialized for FFS beneficiaries.

Democratic conferees were not invited to the Sept. 4 meeting. "It's important for the Republicans to get their act together. They don't yet have a common position," Democratic conferee John Breaux (LA) told the New York Times.

Meanwhile, deficit projections continue to mount, potentially giving more credibility to those who argue that a broad-based Medicare drug benefit is too expensive, as well as constricting the resources available for other health care initiatives like covering the uninsured.