Federal lawmakers this week expect to take a second look at scaling back the Medicare Advantage program after provisions to rework the program were stripped out of a House billand shunned completely by the Senatein an effort to pass childrens health legislation.
On Oct. 16, the House Ways and Means subcommittees on health and oversight together will hold a hearing to look deeper into the $51 billion Medicare Advantage program, and already friends and foes of the private plans have dug deep in preparation for another go-around on Capitol Hill.
The debate comes just weeks after the CMS caused a stir by publicly posting the corrective action plans for 91 Medicare Advantage plans. In an audit of data from this year and last, the CMS found instances where beneficiaries had been wrongly dropped from coverage, lured out from traditional Medicare plans and discovered backlogs for appeals and other complaint processes.
Rep. Pete Stark (D-Calif.), chairman of the Ways and Means Health Subcommittee and a longtime Medicare Advantage critic, took the CMS to task for its lax oversight of the program. Mandated audits are not performed, and those that are performed are not used to make needed changes, costing beneficiaries and taxpayers millions in overpayments and lost benefits, he said in a written statement.
Karen Ignagni, president of Americas Health Insurance Plans, however, has criticized the governments handling of the data, saying it gives an incomplete and misleading picture of the data and implies that the plans have done certain things when they havent.
Our industry is very comfortable with the concept of transparency. We have never raised concerns about that, Ignagni said. What we have raised concerns for is putting this information on the Web site without any context.
In many instances, the corrective action plans represent less than one-half of 1% of all of the plans sales, Ignagni said.
Additionally, many of the corrective plans were largely cited for process issuesthe wrong paperwork, missed deadlinesnot systemic ones that denied beneficiaries care, she added.
Meanwhile, members from both sides of the Capitol are expected to step-up work on legislation that would carry a host of Medicare-related provisions that dictate hospital and physician payments, but also includes a host of other provisions for rural health, specialty hospitals and skilled-nursing and inpatient rehabilitation facilities.
Theres every expectation that there will be a Medicare bill by the end of the year, and the physician fix is one of the driving forces behind that, said one healthcare lobbyist, who added that the House and Senate views on the other provisions may not be the same.