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ask.heather@mail.house.gov
In Washington DC 442 Cannon House Office Building Washington, DC 20515 202-225-6316 Phone 202-225-4975 Fax |
In Albuquerque 20 First Plaza NW Suite 603 Albuquerque, NM 87102 505-346-6781 Phone 505-346-6723 Fax | ![](/congress110th/20081217051203im_/http://wilson.house.gov/Media/Photos/best.jpg) |
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Congresswoman Heather Wilson, First Congressional District of New Mexico
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Domenici & Wilson Confirm That Final Package Will Include Increased Medicare Choice Reimbursements |
December 14, 2000 |
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WASHINGTON -- U.S. Senator Pete Domenici and Congresswoman Heather Wilson today confirmed that the Congress and White House have agreed on a Medicare and Medicaid reimbursement package to help ensure that thousands of New Mexico seniors do not lose the health care benefits offered through Medicare-HMO plans.
The Congress has set a goal of adjourning this week and giving final passage to a variety of bills. Wilson and Domenici have continued to push the Clinton administration and the congressional leadership to support and enact a Medicare and Medicaid reimbursement adjustment package to make up funding shortfalls in a number of health care programs that are important to New Mexico, preeminent among them, the Medicare Choice program. Without additional funding, as many as 15,000 New Mexico seniors will be among 1.7 million Americans who will lose benefits offered by Medicare HMO programs.
Domenici and Wilson today confirmed that both houses of Congress are expected to pass the Medicare Choice reimbursement package as part of an omnibus budget package on Friday.
“I think we may finally be reaching the apex of our efforts to try to preserve health care benefits for thousands of New Mexico seniors,” Domenici said. “The agreement that Congress could finally approve this week will work to end the discrimination reimbursement rates that penalize states, like New Mexico and Oregon, that deliver health care in an efficient manner. I hope providers in our state will now take a second look at their decision to withdraw from Medicare Choice programs.
“I met earlier this year with hundreds of New Mexicans affected by HMOs scaling back their Medicare Choice programs,” Wilson said. “And since then I`ve heard from hundreds more about the devastating effect losing their coverage will have on them. Deborah Wagner, a single mom who is disabled and relies on Medicare, just can`t afford to be in limbo. She`s been waiting
for months to find out what Congress and the President agree on. Behind the numbers and the formulas and the statistics are real live faces and people. I sincerely hope the President will agree that it`s important to fix this for people like Deborah.”
In October, negotiators agreed to increase the Medicare Choice Minimum Payment Floor to $525 a month per beneficiary in 2001 for all Metropolitan Statistical Areas (MSA’s) with populations exceeding 250,000. The health care providers in the Albuquerque MSA are currently reimbursed at $430 per beneficiary. Under the deal, the Albuquerque area would see an increase of $95 ($430 to $525) per beneficiary per month, resulting in at least an additional $34 million for New Mexico in FY2001.
In addition, the agreement would increase the Payment Floor for Rural Areas from the current $415 to $475 in 2001.
The final reimbursement rates closely mirror the levels advocated by both Domenici and Wilson in legislation they introduced this year. In July, Domenici introduced the Medicare Geographic Fair Payment Act of 2000 (S.2937) to increase reimbursement rates and keep Medicare-HMO benefits available to at-risk seniors. Wilson, who introduced the Fair Care for Seniors Act (H.R.5001), was instrumental in gaining House Commerce Committee approval for a plan that increased Medicare Choice reimbursements to the $475 and $525 levels. A bill (HR.2614) that included Wilson`s Medicare Choice provisions passed in the U.S. House on Oct. 26, 2000 by a vote of 237-174.
The Health Care Finance Administration (HCFA) this summer reported that nearly 1 million seniors could lose their Medicare Choice coverage by 2001, possibly forcing them to return to the traditional Medicare Fee-for-Service program. Over the past three years, more than 1.7 million seniors have already been forced out of Medicare Choice plans because of unfair reimbursement rates.
Of the at-risk seniors, an estimated 15,000 of the 45,000 New Mexico seniors enrolled in Medicare Choice programs could lose coverage. In July, Presbyterian Healthcare Services, Lovelace Health Systems, QualMed Plans for Health and St. Joseph Healthcare in New Mexico informed HCFA of their intention to withdraw from the Medicare Choice program.
Under HCFA’s administration, reimbursement rates around the country have varied widely, with private health maintenance organizations dropping out of the Medicare Choice program in communities where reimbursement rates are lowest. For example, while patient care reimbursement rates are now $814 for Staten Island and $794 for Dade County, Fla., they are only $430 for Albuquerque and $453 for Portland, Ore., for the same senior services.
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