October 14,1999

Roth, Moynihan Again Urge the Administration to Make Adjustments to the Medicare Program

WASHINGTON -- Senate Finance Committee Chairman William V. Roth, Jr. (R-DE) and ranking Democratic member Daniel Patrick Moynihan (D-NY) today, as a follow up to the Oval Office meeting, urged President Clinton to make administrative adjustments to the unintended consequences of the Balanced Budget Act of 1997 in the areas of hospital outpatient departments, Medicare + Choice risk adjustment, skilled nursing facilities and the disproportionate share hospital program.

In a letter to President Clinton, Senator Roth and Senator Moynihan stated "we remain hopeful that you will commit to the specific changes that could be made to ensure appropriate services for beneficiaries across the continuum of care."

This is the second letter to President Clinton requesting administrative adjustments to the Medicare program.

A copy of the letter is attached.

October 14, 1999
The Honorable William Jefferson Clinton
The White House
1600 Pennsylvania Avenue, NW
Washington, D.C. 20500

Dear Mr. President:

Thank you for the generous time you carved out of your schedule to discuss a number of issues with us last week. We wanted to share some additional thoughts on the matter of how we might work together to remedy some of the unintended consequences of the Balanced Budget Act of 1997 (BBA 97). As completion nears on a Chairman's mark developed in the Senate Finance Committee with bipartisan collaboration, we thought it would be best to revisit certain points.

As discussed in the Oval Office meeting, it would be extremely helpful and appropriate for the Administration to adjust downward its proposed 5.7 percent reduction in payments to hospital outpatient departments. We believe that the proposed reduction was an unexpected result of BBA 97 policies over which there is room for differences in interpretation. Of course, such an adjustment to the 5.7 percent reduction must be implemented in a way that protects the reduction in beneficiary coinsurance amounts scheduled to go into effect.

With the goal of achieving stability in the Medicare+Choice marketplace, we urge you to use your discretion to help ameliorate the negative impact of the Administration's current risk adjustment proposal on benefits and service areas offered by health plans. This is unequivocally within the Administration's authority and would demonstrate your commitment to the concepts of competition and choice in the Medicare program.

Our review of the skilled nursing facility prospective payment system suggests that treatment of medically-complex patients is inadequately reimbursed. Although the Chairman's mark would address certain aspects of this issue legislatively in the near future, we remain hopeful that you will commit to specific changes that could be made to ensure appropriate services for beneficiaries across the continuum of care.

Lastly, we understand an issue has very recently arisen with regard to the recovery of potential overpayments in the Medicare disproportionate share hospital program. We look forward to working with you to address this issue administratively. Thank you for your continued assistance as we work on the Senate Finance Committee to address these complex issues.

Sincerely,

____________________

William V. Roth, Jr.

____________________

Daniel Patrick Moynihan