omnibusappropriationsact2000

MEDICARE CHANGES: OMNIBUS APPROPRIATIONS ACT - 2000

On November 29, 1999, President Clinton signed into law "The Omnibus Appropriations Act for Fiscal Year 2000,@ Pub.L.No.106-113. Title VII, Section I, the "Medicare, Medicaid, SCHIP Balanced Budget Refinement Act,@ contains numerous changes to the Medicare program. The entire Appropriations Act may be found at http://www.thomas.loc.gov. What follows is a summary of the pertinent Medicare changes.

Skilled Nursing Facilities. (1) Payments are increased by 20% for six months in 2000 for 15 categories of "high cost@ Medicare patients. Payments for all patients are increased by 4% in fiscal years 2001 and 2002. (2) Starting April 1, 2000, ambulance services for end-stage renal disease patients, certain chemotherapy drugs, and certain prostheses are excluded from the consolidated billing requirement which means that the SNF will receive separate payments for these services and items.

Hospital Outpatient Services. The amount for which a beneficiary can be billed for a hospital outpatient procedure is limited to the Medicare inpatient deductible ($776 in 2000).

Cap on Outpatient Therapy Services. For years 2000 and 2001, the Act eliminates the annual cap of $1500 for outpatient physical and speech therapies and the $1500 cap for outpatient occupational therapy.

Home Health Services. (1) The Act delays the planned 15% reduction in payment rates for home health services until one year after implementation of the prospective payment system (PPS) and requires the DHHS Secretary to report within 6 months of implementation of the PPS on the need for the 15% or other reduction. (2) The Act provides $10 per beneficiary payments to home health agencies in fiscal year 2000 for administration of the Outcome and Assessment Information Set (OASIS), a standardized assessment tool HHAs must use for their patients. (3) Durable Medical Equipment, including oxygen, is excluded from the consolidated billing requirements under PPS.

Medicare + Choice Program. (1) Starting January 1, 2000, a request to enroll in or disenroll from a M + C plan made after the 10^th of a month becomes effective two months later, rather than the following month. (2) Incentive payments will be made to organizations that offer plans in areas without plans (3) Plans may vary premiums, benefits and cost-sharing across individuals enrolled in the plan if charges to enrollees are uniform within each separate service area.

Immunosuppressive Drugs. Medicare coverage of immunosuppressive drugs following a covered organ transplant is extended from 36 months for an additional 8 months in 2000 and a minimum of eight additional months in 2001. The Department of Health and Human Services (DHHS) is to determine additional coverage in 2002 through 2004.