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Medicare contractor reform bill advances in House

The House Energy and Commerce Committee Wednesday approved without dissent its version of a Medicare contractor reform and regulatory relief bill that will now be merged with a companion bill reported earlier this month by the Ways and Means Committee.

As approved by voice vote, the measure included some significant changes from the version approved Oct. 17 by the Energy and Commerce Health Subcommittee.

Among them were two changes aimed at helping program beneficiaries. One would allow patients to find out in advance if Medicare will cover a questionable service or procedure and the other would delay by one year a requirement now scheduled to take effect in January that would limit beneficiaries to changing health plans once in a calendar year.

Both beneficiary groups and managed care companies have complained that the "lock in" provisions would hurt the already struggling Medicare+Choice program, although Ways and Means Chairman Bill Thomas, R-Calif.--who helped get the provision added to the 1997 Balanced Budget Act in the first place--is likely to fight to keep the requirement intact.

Energy and Commerce ranking member John Dingell, D-Mich., was among those who fought for the inclusion of the other beneficiary provision, to establish a process by which patients can find out in advance if care will be covered.

"Currently, the only way a beneficiary can find out of Medicare would cover the item is to risk potentially thousands of dollars to get the service, then hope the claim gets paid," he said.

Beneficiary groups say the requirement often deters patients from obtaining needed care out of fear of being stuck with the bill.

Other changes were aimed more squarely at providers. Rep. John Shadegg, R-Ariz., got language included that would help hospitals deal more easily with requirements that they treat patients who arrive for care in emergency rooms, while Rep. Charlie Norwood, R-Ga., got several provisions changed, including one that would make it more difficult for auditors to use "extrapolation" to determine how much physicians may owe the government because of Medicare overpayments.

Norwood, a dentist by profession, said that he still wants more movement to exempt Medicare contractors from liability under the False Claims Act, and to make it easier for dentists who do not participate in Medicare to get official claims denials so patients can collect from secondary insurers.

A committee aide said he hoped that the Ways and Means and Energy and Commerce bills could be merged and sent to the floor "in the coming weeks."

Both committees are working under an agreement that the measure will be revenue neutral. That has proved difficult as last-minute changes were made in the Energy and Commerce Committee, the aide said, because CBO--whose offices are in the still-closed Ford building--has not been able to do its usual work.