With a 70-29 vote, the Senate today ended a filibuster against the Medicare bill led by Sen. Edward Kennedy (D-Mass.).
Senate Minority Leader Thomas Daschle (D-S.D.), then made a point of order against the bill, claiming it violates the 2004 budget resolution that allocates $400 billion over 10 years for Medicare reform and the addition of a prescription drug benefit.
Speaking with reporters this morning about his strategy, Daschle says, "I have come up with an approach that I think meets the concerns of many of those who don't want to unnecessarily delay the legislation, who want some finality with regard to the bill, but are not comfortable with a straight up-or-down vote. If our points of order are sustained, I think it's back to the drawing board on Medicare next year."
The blocked filibuster, however, indicates final passage is imminent.
In a 220-215 vote early Saturday morning, the House narrowly passed the $400 billion, 10-year Medicare reform bill that would add a prescription drug benefit, create a bigger role for private health plans and create new tax-advantaged healthcare savings accounts.
Reported out of conference last week after five months of negotiation, the bill blocks the CMS-scheduled 4.5% reduction in Medicare reimbursement to physicians for 2004 and replaces it with a 1.5% increase in 2004 and 2005.
It also calls for an 18-month moratorium of the self-referral exemption for new specialty hospitals (see related story).
Other physician-related provisions in the Medicare conference agreement include:
- Incentive grants for small, rural and low-volume practices instead of mandating that all providers use electronic prescribing technology; the issuance of final eRx standards from HHS by April 1, 2008; and physicians prescription drug plans can pay higher fees to doctors who reduce medical errors, improve formulary compliance or reduce adverse drug reactions.
- Price reform for drugs administered in physicians' office: average wholesale price (AWP) minus 15% in 2004, average sales price (ASP) plus 6% in 2005, and competitive bidding as an option for physicians in 2006; a transitional payment increase of the practice expense reimbursement for drug administration in 2004 and 2005 and a required MedPAC review of the affect of payment changes for oncologists by January 2005 and for other specialties by January 2006.
- A 1% reduction in payment to ambulatory surgical centers beginning in April 2004; a five-year freeze in ASC payment rates from 2005 through 2009, with HHS to develop a new payment system following a study by the General Accounting Office.
- The floor of the work geographic payment adjuster in the payment formula brought to 1.0 in 2004 through 2006, which means all doctors would be paid 100% of the national average.
- Bonus payments of 5% to physicians in scarcity areas in 2005 through 2007.
- Regulatory relief that includes due process for physicians, provider education and technical assistance, repayment plans and written responses from carriers.
- Special funding for rural healthcare, medical training programs and certain preventive care.