When President Clinton signed the $520 billion fiscal 1999 federal budget bill into law last week, he gave the OK to hundreds of healthcare pork-barrel projects-from a new building for a hospital in Israel to millions of dollars for telemedicine programs in Alaska.
The bill, called the Omnibus Consolidated and Emergency Supplemental Appropriations Act of 1999, also includes a number of provisions sought by healthcare provider groups.
A requirement that the General Accounting Office study how the U.S. Justice Department is applying the federal False Claims Act to alleged cases of Medicare billing fraud by providers. Providers say the department uses the act and its severe penalties to extort large monetary settlements from providers, which have said that billing problems were not the result of intentional fraud. The GAO must submit its findings to Congress on two dates, Feb. 1, and Aug. 2, 1999.
An overhaul of the new Medicare home health payment system. The change increases both the per-enrollee and per-agency limits implemented as part of last year's balanced-budget law. The limits took effect Oct. 1. Home health agencies have complained that because the limits were based on historical costs, inefficient providers were being paid more than efficient agencies.
The bill also delays for one year a 15% across-the-board cut in Medicare home health reimbursements that was to have gone into effect Oct. 1, 1999.
The nearly $1.7 billion cost of the changes will be financed by reducing the annual Medicare home health update by 1.1 percentage points from 2000 to 2003. That saves Medicare nearly $1 billion. The remaining cost will come from nonhealthcare-related cuts.
An increase to 17 from 15 in the number of commissioners on the Medicare Payment Advisory Commission. MedPAC advises Congress on Medicare matters. The new seats are designated for an osteopath and a rural healthcare provider.
The bill also contains a number of provisions opposed by providers.
For example, Sen. Alfonse D'Amato (R-N.Y.) was successful in adding a measure that requires health plans to cover reconstructive surgery for breast cancer patients.
Health plans decried the mandate, which they said would increase the cost of insurance and set a dangerous precedent.
"This unleashes the possibility of continued body-part legislation," said Charles Kahn, president-designate of the Health Insurance Association of America.
The real stars of the nearly 4,000-page spending bill are the thousands of pork-barrel projects inserted into the measure by lawmakers, mostly during the final few days of furious negotiations between congressional leaders and the Clinton administration. Many are healthcare-related.
The original Senate appropriations bill included $30 million for healthcare-related capital projects. The House had no such provision. A House aide who requested anonymity said that when the Senate insisted on its $30 million measure, the floodgates opened for a wave of healthcare spending. The final total for capital projects alone ballooned to more than $65 million.
Rep. John Porter (R-Ill.), chairman of the House Appropriations Committtee's HHS subcommittee, is concerned that the hospital largess in the spending law will set a precedent for future years, said a GOP staff member.
But it is a windfall for hospitals that managed to get their projects included.
Most of the healthcare facilities receiving funds are in districts or states that have lawmakers on the House and Senate appropriations committees with jurisdiction over the spending package.
For example, Sen. Arlen Specter (R-Pa.), who ultimately voted against the bill, is chairman of the Senate Appropriations Committee subcommittee that oversees HHS. Not surprisingly, enough Pennsylvania facilities received pork to open a scrapple factory.
Among the recipients of federal grants for various projects are the University of Pennsylvania School of Dental Medicine; Magee-Womens Hospital of Pittsburgh; Philadelphia College of Osteopathic Medicine; Fulton County (Pa.) Medical Center; and Mercy Health System of Philadelphia.
Mississippi, home of Sen. Thad Cochran, the second-ranking Republican on the Appropriations Committee, and Senate Majority Leader Trent Lott, also had a disproportionate share of recipients. Among those are the Delta Health Center of Mound Bayou, Miss., and Jackson-Hinds Comprehensive Health Center, Jackson, Miss.
Among the dozens of other hospitals and healthcare facilities receiving funds for a variety of projects are: Montefiore Hospital, New York City; Northwestern Memorial Hospital, Chicago; National Jewish Hospital, Denver; Rush-Presbyterian-St. Luke's Medical Center, Chicago; Children's Hospital, Washington; White Plains (N.Y.) Hospital; Memorial Hospital Southwest, Houston; and Englewood (N.J.) Hospital and Medical Center.