Senate Action on Medicare Creates Opportunities for NCCC Agenda
Geriatric Care Act of 2002 (S.2057) Summary
Geriatric Care Act of 2002 (S.2057)
Feingold Ammendment Summary
Feingold Amendment
We encourage anyone committed to chronic care reform to please call or
fax a letter to your Senators and express
your support for Senate 2057 (the Geriatric Care Act of 2002) and for
Senator Russ Feingold's (D-WI) amendment to improve M+C payments for
frail elderly. Ask them to contact Senators Max Baucus (Chairman of the
Senate Finance Committee), Chuck Grassley (Ranking Republican on
Finance), and Tom Daschle (Senate Majority Leader) to request their
assistance in getting these measures attached to the Medicare
legislation being considered by the Senate.
The Medicare legislation that passed the House last month and the
legislation being debated by the Senate this month, if passed, would
need to be reconsidered by both chambers this fall to reconcile
differences between the two measures. While it is widely held that these
Medicare bills are "election year tools" to give Members of Congress
cover during the August recess when they go home to campaign for the
fall elections, both measures are important to the NCCC agenda and will
provide a starting point for the "real" debate in the fall.
Geriatric Care Act of 2002 (S. 2057)
The NCCC has been working closely with the American Geriatrics Society,
the Alzheimer's Association, and the Partnership for Solutions on two
primary strategies to increase coverage for care management services.
These include S. 2057, the Geriatric Care Act of 2002, which was
introduced by Senators Blanche Lincoln (D-AR) and Harry Reid (R-NV), and
a narrower version of this legislation developed by the NCCC. S. 2057
would establish a new Medicare benefit covering geriatric assessments
and care management services for persons meeting functional impairment
criteria (i.e., impairments in two or more ADLs or the equivalent in
IADL impairments expected to at last least 90 days). The narrower
version would pay a monthly capitation for complex care management
services provided by a beneficiary's "principal care physician," the
physician responsible for the overall management of an individual's care
and who agrees to perform specific care coordination functions. While
this proposal is not as comprehensive as S. 2057, it could be more
viable politically in the end as it does not create a new Medicare
benefit, covers a narrower range of functions/services, and would be
much less costly than the Lincoln bill.
Recent conversations with staff from the Senate Finance Committee, the
majority leader's office (Senator Tom Daschle), and Senator Reid's
office suggest that we should continue pursuing S. 2057 during the
Medicare debate. The bill currently has 12 cosponsors, five of whom are
on the Finance Committee that has jurisdiction over Medicare, plus Harry
Reid who is in a key leadership position. Unless we hear differently, we
will continue to pursue action on the Lincoln/Reid legislation and keep
the NCCC's narrower proposal as a back-up in the event that S. 2057 is
deemed too broad or expensive.
M+C Payment Reform for Frail Elderly (Feingold Amendment)
Last year the Medicare Chronic Care Improvement Act was introduced in
the House and Senate by Congressman Pete Stark (D-CA) (H.R. 3188) and
Senator Jay Rockefeller (D-WV) (S. 1589). This bill included a provision
crafted by the Medicare Payment Coalition for Frail Beneficiaries
(MPCFB) to refine the M+C payment methodology for plans that exclusively
serve, or serve a disproportionate number of, frail, high-risk Medicare
beneficiaries. Senator Russ Feingold has agreed to lift this provision
with some modifications and offer it as an amendment to the Medicare
legislation being considered by the Senate this month. He has requested
Senator Wayne Allard of Colorado to join him in this effort so that it
can be offered as a bipartisan amendment. (We expect a decision by
Senator Allard today.) The Feingold proposal would: (1) require MedPAC
to identify frailty indicators and make recommendations to Congress for
improving M+C payment methods for frail and at-risk Medicare
beneficiaries; (2) direct the Secretary to refine the M+C risk
adjustment methodology to improve capitation rates for frail, high-risk
Medicare beneficiaries; (3) freeze payment formulas for Medicare
demonstration programs with special payment methods like the Social HMO
and dually eligible integration programs pending improvements to risk
adjustment for the frail; (4) freeze the current 90/10 blended PIP
payment structure for plans that exclusively serve institutionalized
members; and (5) establish a demonstration to test new payment methods
and clinical interventions for specialized plans for the frail elderly.
For More Information
View a list of U.S. Senators with phone numbers and email addresses (there is also an
option to view a list of Senators by state).
