WASHINGTON – Ways and Means Health Subcommittee member Jim Ramstad (R-MN) today introduced a bill to promote the coverage of frail elderly Medicare beneficiaries enrolled in innovative Medicare+Choice programs.

"Everyone recognizes the need for innovative health care options for seniors," said Ramstad. "Programs that have already proven successful in Minnesota should not be threatened by arbitrary, bureaucratic decisions."

Specifically, Ramstad’s bill will exempt certain innovative programs specifically designed for the frail elderly living in nursing homes from being impacted by the new risk-adjusted payment methodology designed by the Health Care Financing Administration (HCFA) during its phase-in period.

"While the concept of a risk-adjusted payment methodology would actually be beneficial for such programs, the interim methodology is limited in scope and is primarily based on hospital encounter data," explained Ramstad. "This focus on hospitalizations will put unique programs that are designed to provide care in non-hospital settings at a distinct disadvantage."

"One such program is EverCare, an innovative health care program for the frail elderly in Minnesota and other states, said Ramstad. "A recent study by the Long Term Care Data Institute (LTCDI) concluded EverCare’s revenue alone will decrease 42% under this new methodology. The program could not continue with such dramatic cuts."

"I was pleased HCFA recognized EverCare and programs like it may be adversely impacted by the new methodology and granted certain programs limited exemptions," said Ramstad. "And while HCFA acknowledged additional steps may be necessary, I am concerned almost five months have passed and we have not seen action on the part of HCFA to develop such a methodology. In addition, HCFA has not addressed similar programs facing other comparable dilemmas."

"I have heard from EverCare enrollees from all over the country and spoken with nursing home staff at town meetings," said Ramstad. "All of them sing the praises of these innovative programs, so I would hate to see them jeopardized simply because Washington is slow to act."

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