MANAGED CARE March 1996. ©1996 Stezzi Communications
Like the seasons, fiscal cycles are inexorable. No sooner had feuding Republicans and Democrats more or less decided to cool it on Medicare/Medicaid reform until after the election than the president sent the
1997 budget to the Hill — where it presumably will be tossed on top of its FY 1996 predecessor, which has yet to pass. In November, of course, Mr. Clinton vetoed the 1996 budget bill containing drastic Medicare/Medicaid reforms.
For '97, the Office of Management and Budget didn't crank out its customary forklifts full of budget documents. Instead, it Frisbeed the Hill a relative pamphlet called a "thematic document" purporting to balance the budget by 2002 and containing more than $100 million in tax cuts and spending slowdowns in Medicare.
For a while, the conservative House Democrats known as "Blue Dogs" have been saying that the biggest obstacle to turning Medicaid over to the states has been guaranteeing a minimum level of care. The GOP would have converted Medicaid into block grants to be spent at the discretion of each state. President Clinton would have maintained the program's overall structure but instituted capitated payments to slow program growth.
Seizing the initiative, the governors hammered out a compromise at their national meeting in February. Their plan would guarantee payment for hospital, physician and nursing facility services, home health care, family planning services, lab and X-ray services, pediatric and nursing facility services and diagnostic services for children. States would have "complete flexibility" to determine the amount, duration and scope of services and could use "all available" health care delivery systems without obtaining federal permission.
Don't count Medicaid reform out yet.
Meanwhile, many members of Congress don't want to report back to the voters in November with all health reforms stalemated. Still on the table are a simple portability bill in the House and the broader Senate bill introduced by lame-duck Republican Nancy Kassebaum of Kansas, co-sponsored by Massachusetts Democrat Edward M. Kennedy and approved unanimously by the Labor and Human Resources Committee last summer. The bill would assure access to insurance for workers laid off or taking early retirement if they had paid premiums for at least 18 months. It would limit pre-existing condition exclusions, prevent insurers from dropping coverage when a family member becomes ill and help companies form purchasing pools to cut insurance costs.
After some February horse trading there is good news and bad. The good is that the Senate is expected to debate Kassebaum-Kennedy in late April. The bad news is that unlimited amendments will be allowed, opening the door to riders from both sides of the aisle.
The National Committee for Quality Assurance released the Medicaid version of the Health Plan Employer Data and Information Set on Feb. 1. Although the Health Care Financing Administration is devising a single set of quality standards for both Medicare and Medicaid managed care plans, the joint standards will not be released until 1997. In the meantime, among other changes, plans using Medicaid HEDIS will now collect information on prenatal care utilization, but will no longer track cholesterol screening. For details, call NCQA at (202) 955-3500... Medicare plan-to-plan comparisons also being developed by HCFA are slated to be ready by Oct. 1, according to Bruce Fried, director of the office of managed care.
— Jean Lawrence