Senate Passes Medicare Bill by Veto Proof Margin

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Silver Spring, MD- Wednesday, the U.S. Senate passed the Medicare Improvements for Patients and Providers Act (H.R. 6331) by an overwhelming margin of 69-30. H.R. 6331 would enact a number of changes to current Medicare law. Most notably, it would reverse a 10.6 percent reduction in Medicare reimbursements for advanced practice registered nurses (APRNs) and physicians that took effect on July 1.

H.R. 6331 also contains a provision, advocated for by ANA, that would increase payments to APRNs and physicians who successfully implement electronic prescribing. These providers would receive an additional 2 percent payment increase in fiscal years 2009 and 2010. The bill also provides $16.6 billion dollars over the next ten years to help more beneficiaries become eligible for low-income assistance under the Medicare prescription drug benefit.

ANA had expressed concerns over a separate provision in H.R. 6331 that would allow Medicare to expand the current “medical homes” demonstration if it is determined that the project improves the quality of care without increasing costs to Medicare. The medical homes demonstration provides incentive payments to primary care physicians that coordinate care for high need Medicare beneficiaries. ANA has argued that this demonstration should be opened to APRNs and other health care professionals as well as physicians.

Additionally, the legislation removes the unique hospital deeming authority of the Joint Commission. Currently, JCAHO accreditation is accepted by Medicare to mean that the hospital meets all of the conditions for participation in the Medicare program. Under H.R. 6331, other accrediting bodies would be able to certify hospitals for Medicare participation, and the Join Commission would have to re-apply to Medicare for this authority. The Joint Commission has recently come under fire for failing to adequately enforce Medicare patient safety standards.

Wednesday’s vote marked the dramatic return of Senator Edward Kennedy (D-MA) who interrupted treatment for brain cancer to cast a deciding vote in favor of the legislation. The bill will now head to the President for his signature. President Bush and many Republican senators opposed the legislation, in part because it would cut federal payments to insurance companies that offer private Medicare Advantage plans, as an alternative to the traditional government-run program. H.R. 6331 had overwhelming bipartisan support in the House, where it was passed by a vote of 355 to 59 on June 24. That vote, combined with Wednesday’s Senate vote should be enough to override a threatened Presidential veto.

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