FOR IMMEDIATE RELEASE CONTACT: Doug McGinn
October 13, 1999 (202) 225-3031

RYAN CALLS FOR MEDICARE REFORMS, JOINS IN UNVEILING LEGISLATION TO ASSIST WISCONSIN BENEFICIARIES AND PROVIDERS

"Our intent with this 15-point plan is to make Medicare work for all seniors throughout the country."
WASHINGTON - At a press conference today, First District Congressman Paul Ryan joined in unveiling Medicare reform legislation to assist Wisconsin beneficiaries and health care providers in maintaining and expanding choices in Medicare service plans. The legislation, the Medicare Balanced Budget Refinement Act, establishes a 15-point plan to adjust the current Medicare payment structure and provides incentives for expanded health service choices throughout the nation. Under current Medicare laws, Wisconsin health providers and beneficiaries enrolled in the Medicare+Choice plan are penalized by a geographical disparity that provides higher reimbursement rates to other parts of the country. As a result, Southern Wisconsin has witnessed the departure of two of its largest health services providers. This legislation attempts to correct this problem by providing financial incentives to health providers to maintain, reenter, and enhance the service options available to seniors.

Ryan had previously cosponsored legislation, the Medicare Fair Payment Plan Act, which sought to equalize the amount paid to Medicare+Choice providers in Wisconsin to that of other areas of the nation such as New York and Miami that currently receive higher payment amounts. Under the legislation introduced today, similar provisions were included at Ryan's insistence that called for increased funding for Medicare+Choice providers. In addition, Ryan fought successfully to include provisions that would allow Medicare+Choice providers who had discontinued health services plans to reenter markets where coverage was previously dropped. Under current law, Medicare providers who discontinue service are barred from reentering such markets for five years.

"I have heard from countless providers and beneficiaries throughout Southern Wisconsin about the disparities resulting from current Medicare laws," said Ryan. "From Medicare+Choice plans, skilled nursing facilities, rural hospitals, and others, the problems are rampant and need to be fixed. Our intent with this 15-point plan is to make Medicare work for all seniors throughout the country."

"As a result of this legislation, beneficiaries will hopefully have more options to choose from - from the traditional fee for services plan, to plans that offer expanded benefits such as eye care or dental care. In particular, I hope that the financial incentives for Medicare+Choice providers put forth in this legislation will possibly lure back some of those who have pulled out of local areas due to low reimbursement rates. I look forward to working with them in trying to make this a reality."

Attached is a summary of the 15-point plan. For additional information, or to schedule an interview with Congressman Ryan, please contact Doug McGinn at (202) 225-3031.

The Medicare Balanced Budget Refinement Act
15-Point Plan to Strengthen Medicare

FEATURES OF THE PLAN:

More Flexibility Through Medicare +Choice - The plan will offer incentives for health care providers entering counties that do not currently offer managed care plans or have lost such plans; allow plans to offer seniors more choices by varying benefit packages; allow Medicare+Choice beneficiaries an open enrollment period when they learn that their plan is ending its contract.

Strengthen Rural Hospitals - The refinement package increases flexibility in determining payment status and flexibility of rural hospital bed use (swing beds); extends the Medicare Dependent Hospital program for rural areas; provides financial relief to some sole community hospitals, and; modifies the existing Rural Hospital Flexibility Grant Program to permit rural hospitals to obtain computer software and staff training to accommodate changes to new payment Systems.

Critical Access Hospitals - The plan adopts a new average 96 hour length of stay for patients in rural areas; allows hospitals that closed or downsized within the last 10 years to convert to a critical access hospital, which provides intense outpatient medical care; eliminates co-payments by beneficiaries for lab services.

Improve Outpatient Rehabilitation Services - Provides for separate $1500 caps for physical and speech therapy services and exempts 1% of high-acuity patients for 2 years.

Maintain the Vitality of Teaching Hospitals - Permits rural hospitals to increase their Medicare resident numbers to better serve rural beneficiaries.

Preserve Hospitals' Ability to Better Coordinate Care - The plan requires HCFA to preserve hospitals' ability to coordinate care for patients and improve the accuracy in calculating Medicare payments to hospitals with a disproportionate share of beneficiaries (DSH).

Ensue Smooth Transition for Outpatient Hospitals Switching to New Payment System - Creates an "outlier" adjustment for high-acuity patients; adjusts payments for innovative medical devices, drugs and biologicals, including orphan and cancer drugs; and provides targeted incentives to increase hospital efficiency.

Ensure Availability of Home Health Care - Beneficiaries will receive increased access to home health care services through delaying 15 percent payment reductions to home health agencies until one year after implementation of the prospective payment system (PPS). The plan also assists agencies with added paperwork and record-keeping costs. The plan also calls on HCFA to waive interest on repayments to Medicare made by home health agencies.

Increase Care for Medically Complex SNF Patients - Skilled nursing facilities (SNF) caring for medically complex patients will receive adjustments in their payments. In addition, the plan increases the federal per diem rate for SNF "market baskets."

Increase Ability to Offer Prostheses, Cancer Fighting Drugs and Ambulance Services - Allows separate billing by skilled nursing facilities for certain prosthetic devices, chemotherapy drugs, and ambulance and emergency services.

Improving Graduate Medical Education (GME) - Freezes the Indirect Medical Education (IME) program for one year and adopts a more equitable structure for direct GME payments to teaching hospitals nationwide.

Provide Payment Updates for Renal Dialysis and Durable Medical Equipment - The plan improves beneficiaries' access to renal dialysis treatments and durable medical equipment such as wheelchairs.

Assisting Long-Term Psychiatric Hospitals - Adjusts the payment system for existing long-term and psychiatric hospitals through increased continuous improvement and bonus payments through FY2002. The plan also requires the Health and Human Services Secretary to develop and implement a payment system based on discharge of patients.

Maintain Risk Adjuster Payment Demonstration Project for Frail Elderly - The plan calls on the White House and HCFA to continue a demonstration project that will help those seniors with special needs.

Update Payments for Physicians Caring for Beneficiaries (Sustainable Growth Rate) - The plan modifies the way doctors are paid for treating patients, based on a sustainable growth rate (SOR) that stabilizes Medicare payments to physicians.