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Archive for July 8th, 2008

As some of you may be aware, Aetna offers a Training Certification Program which has been designed with the Producer’s learning certification needs in mind. Aetna’s Consumer Segment Learning & Performance Team has designed the program in an online format making it simple to access, complete and track.

This is to advise you that in order to prepare for the conversion from the 2008 to the 2009 Portal, the system will be down and unavailable on Thursday July 10th. (more…)

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Aetna has released it’s 2009 plans for agent use only.  If you are a licensed insurance agent and would like more information on Aetna’s proposed plans, please e-mail Craig.

As a reminder, this information is pending CMS approval and is not to be shared with any Medicare beneficiary.

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From various sources, The Hill and Kaiser  Daily Health Policy Report

From Craig, “Looks like this may come up again by the end of the day tomorrow.”

 Senate Finance Committee Chair Max Baucus (D-Mont.) on Monday said that a House-passed bill (HR 6331) that would delay a 10.6% reduction to Medicare physician fees that was scheduled to take effect last week might have enough votes in the Senate to gain cloture, even though it failed by one vote on June 26, CongressDaily reports (Edney, CongressDaily, 7/7). The House last month passed the measure by a veto-proof margin. The bill is similar to a measure (S 3101) proposed by Baucus, which also failed to receive enough votes for cloture (Kaiser Daily Health Policy Report, 7/7).

CMS provided Congress with more time to act on blocking the fee reduction, freezing rates until July 15 through an administrative measure, according to CQ Today. However, Jeff Nelligan, a spokesperson for the agency, on Monday said there would be no further extensions (Armstrong, CQ Today, 7/7). A spokesperson for Senate Majority Leader Harry Reid (D-Nev.) said that the Senate will again vote to invoke cloture on the measure as early as Wednesday (CongressDaily, 7/7).

The vote “will come after a recess week when outside lobbying groups, specifically physicians’ associations, have tried putting pressure on GOP senators who voted against the House bill in an effort to flip at least one of them,” according to CQ Today. However, “there’s no firm evidence yet that any Republicans intend to actually switch sides,” CQ Today reports. In the event the measure gains 60 votes for cloture, it still faces a veto from President Bush, which would take 67 votes to override. Baucus said, “We have a decent chance of getting cloture,” adding, “I can’t guarantee it, but it’s close” (CQ Today, 7/7). Baucus also rejected a proposal from some Republicans to extend the current physician pay rate for 31 days, saying it would be too confusing (CongressDaily, 7/7).

Republicans offered an extension so that Baucus and Finance Committee ranking member Chuck Grassley (R-Iowa) could finish negotiations on a compromise bill. “Frankly, we did not have an agreement,” Baucus said, adding, “The overwhelming House vote … changed the dynamics considerably, and I felt, and many others felt, it was best to bring up the House-passed bill” (CQ Today, 7/7). Baucus said that if the Senate passed the measure with a wide enough margin, the Bush administration might back down from its veto threat (CongressDaily, 7/7).

The Hill Examines AMA Ad Campaign
The Hill on Monday examined how the American Medical Association and other physicians’ groups are “risking a backlash from Republicans” by airing “noticeably partisan” advertising campaigns supporting the House bill that is largely backed by Democrats. According to The Hill, trade groups are typically wary of siding with one party, but “sometimes interest groups find themselves in a position where they have to risk future comeuppance for present gain.” In this case, the “immediate interests” of the AMA and other physicians’ groups “clearly lie with the Democrats,” The Hill reports.

Sen. Arlen Specter (R-Pa.), one of the senators targeted by the AMA ads, said, “I’m a little surprised when there are issues that are very important to the AMA, the shoe may be on the other foot,” adding, “I’ve been a very good friend of America’s doctors, so a little surprised to see one vote in this context the subject of media advertising” (Young, The Hill, 7/7).

The AMA ads ran in Pennsylvania, Mississippi, New Hampshire, Tennessee, Texas and Wyoming, “slamming lawmakers who voted against the House measure” and requesting voters to call their senators and urge them to change their vote, CQ Today reports. Meanwhile, America’s Health Insurance Plans launched its own ad campaign on July 1, asking lawmakers to vote against the bill (CQ Today, 7/7).

Other Medicare Services Affected by House Bill
Meanwhile, CQ HealthBeat on Monday examined other constituents — including Medicare beneficiaries who receive outpatient physical, occupational and speech therapy services and suppliers of durable medical equipment — who also are affected by the outcome of the House bill. The measure contains provisions to block for 18 months payment caps on physical, occupational and speech therapy services under Medicare. The physical, occupational and speech therapy services payment caps that would have gone into effect on July 1 were delayed under the CMS administrative measure.

Baucus in a July 2 letter to HHS Secretary Mike Leavitt said that about 700,000 beneficiaries would be affected by the payment caps. Francesca Fierro O’Reilly, senior director for legislative affairs at the American Health Care Association, said that in 2003 when the payment caps went into effect for three months, some beneficiaries declined treatment after reaching the maximum payment level instead of paying for it out of pocket.

The House measure also contains an 18-month delay of a competitive bidding program for DME. However, the bidding program was not covered by the 10-day freeze and went into effect as scheduled on July 1. The bidding program still could be retroactively delayed. House Ways and Means Health Subcommittee Chair Pete Stark (D-Calif.) on Monday said, “I don’t think there are any problems in just ending the bidding operations,” adding, “It was just a stupid plan” that “disenfranchised 70% to 80% of providers.” However, Ed Biggins — executive vice president of Ablecare Medical, which won contracts under the program — said the company will “aggressively seek … legal rights” if the program is halted. He said the company spent hundreds of thousands of dollars to ready itself to provide services to beneficiaries under the new contract (Reichard, CQ HealthBeat, 7/7).

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The debate of the excess funding of Medicare Advantage relative to the actual cost to care for a Medicare Beneficiary brings us to a fundamental question:  Is Medicare Advantage Good for America?

The Single-Payor agrument goes like this:  The cost of administering Medicare is 3.1% and the excess payment to Medicare Advantage companies is 12%.  So, if we eliminated the excess payment, we could save 9-12% (depending on your point of view) in Medicare costs on the 1 in 5 Medicare Beneficiaries who are enrolled in a Medicare Advantage plan.

However, there are a number of “indirect costs” which are not included in the widely quoted administrative cost of Medicare.  This comes from an AMA position paper on the subject of Public v. Private. (more…)

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