Scrambling to adjourn before Thanksgiving, the House passed a huge government spending package last week that includes $15.1 billion in increased Medicare provider payments over the next five years.
Passage by the Senate may not take place until this week because several senators are objecting to measures unrelated to the Medicare relief.
In a final compromise maneuver, Congress agreed to include in the spending legislation clarifying language that would avert an estimated $3.6 billion reduction in Medicare payments to hospitals for outpatient care over five years beginning in 2000.
The outpatient payment cut was one of the last issues remaining in negotiations between Congress and the White House over legislation to reverse payment restraints imposed under the Balanced Budget Act of 1997.
The cut to outpatient department payments resulted from HCFA's interpretation of how to reduce beneficiary copayments without increasing government expenditures.
Members of Congress contended that they did not intend for that cut to be imposed. HCFA said it was bound by its interpretation and needed Congress to clarify its intent in the legislation, but congressional leaders feared President Clinton would characterize such a maneuver as draining money from Social Security.
In a letter last week, John Podesta, Clinton's chief of staff, promised that the White House would not accuse congressional Republicans of abusing Social Security revenues if the clarifying language was included.
Under that agreement, neither the White House Office of Management and Budget nor the Congressional Budget Office will include the $3.6 billion in new outpatient booty in their estimates of the final cost of the Medicare package.
"It's victory-lap time," said Thomas Scully, president and chief executive officer of the Federation of American Health Systems. Although he said he sees the need for further aid to hospitals next year, "I think the odds of us coming back (for additional relief) are one in four. Congressional sympathy for additional (money) comes not from Washington lobbyists but from direct political pressure at home."
Among other payment increases, the legislation would:
* Freeze scheduled reductions in Medicare payments to teaching hospitals for the indirect costs of teaching medical students at 1999 rates for 2000. It reduces the rate slightly for 2001 and then drops it to the reimbursement rate called for in the balanced-budget law in 2002, a year later than originally scheduled.
* Freeze reductions in extra Medicare payments for hospitals serving a disproportionately high number of low-income patients and instruct HCFA to collect data to refine the payment formula as recommended by the Medicare Payment Advisory Commission.
* Increase skilled-nursing facility payments 20% for patients requiring more-intensive services beginning April 1, 2000, unless HCFA can draft a refined PPS that provides better reimbursement for those patients.
* Delay a scheduled 15% reduction in home-health payment limits until after HCFA can implement a prospective payment system.
* Phase in Medicare+Choice risk adjusters, which result in higher capitation payments to managed-care plans that enroll higher-acuity beneficiaries.