CMS Releases 2006 Physician Fee Schedule
Despite the grassroots advocacy efforts of AGS members and others in the physician community, Congress has yet to pass legislation that would block the scheduled 4.4% cut in Medicare payments to physicians. As a result, the final physician fee schedule issued by the Centers for Medicare & Medicaid Services (CMS) on November 2 reduces reimbursement by 4.4%, effective January 1, 2006. The reduction is the result of the sustainable growth rate (SGR) formula that takes into account growth in services in prior years. Under the final rule, the conversion factor for calendar year (CY) 2006 is $36.1770. As this issue of the Journal went to press, Congress was considering legislation that would block the 4.4% cut.

Despite repeated requests by the AGS, other physician groups, and members of Congress, CMS did not remove Part B drugs from the SGR formula, stating that it does not have the authority to do so. Taking drugs out of the SGR administratively would reduce the legislative cost of repealing the payment formula.

CMS decided to put off adoption of proposed changes to the practice expense Relative Value Unit (RVU) calculations because of an error in the way it calculated the practice expense RVUs in the proposed rule. Instead, the agency will use the CY 2005 practice expense RVUs to value services for CY 2006, with some exceptions.

The final rule extends the glaucoma screening benefit to include Hispanic-Americans aged 65 years and older; provides for supplemental payments to federally qualified health centers (FQHCs) that contract with Medicare Advantage (MA) plans; adopts a modified approach to reforming payment for multiple imaging procedures performed on a beneficiary at one session; and revises payment for inhalation therapy and end-stage renal disease (ESRD) treatment. It also expands the list of Medicare telehealth services to include certain medical nutrition therapy services, which will enable greater access to these services for beneficiaries in rural areas, CMS reported.

CMS is also establishing a new cancer quality demonstration that focuses on treatment provided to beneficiaries for any of 13 cancers listed as a primary diagnosis. This demonstration, which will be conducted throughout CY 2006, will use the CMS billing system to generate information on coordination of care, treatment design, and patient monitoring, the agency reported.

Medicare Payments to Home Health Agencies to Rise 2.8% Next Year
Medicare payments to home health agencies will increase 2.8% next year, CMS announced November 2. According to the agency, the increase will bring an estimated extra $370 million in payments to home health agencies next year.

“This payment increase will continue to help home health agencies provide high-quality care to beneficiaries,” said CMS Administrator Mark McClellan, MD, PhD. “Rural home health agencies will experience an estimated 3.4% increase in payment, while urban agencies will see a 2.5% increase in payments.”

To qualify for Medicare home health visits, a Medicare beneficiary must be under the care of a physician, have an intermittent need for skilled nursing care, physical therapy, or speech therapy, or continue to need occupational therapy. The beneficiary must be homebound and must receive home health services from a Medicare-approved home health agency.

Final Rule Requires Facilities to Post Staffing Information
In a final rule published October 28, CMS established new data collection, posting, and recordkeeping requirements for skilled nursing facilities (SNFs) and nursing facilities (NFs). On a daily basis for each shift, SNFs and NFs must post nurse staffing data for the licensed and unlicensed staff directly responsible for resident care in the facility.

CMS said its objective in finalizing the rule, proposed February 27, 2004, is to make staffing information available to assist the public in making informed decisions when choosing health care providers.

The rule finalizes provisions in Section 941 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA). It is effective December 27, 2005. For a copy, visit: http://a257.g.akamaitech. net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/05-21278.htm.

President Signs Medicare Premium Assistance Bill
On October 20, President Bush signed into law legislation (H.R. 3971) extending the “Qualified Individual” or “QI” program, for two years. Under the QI program, state Medicaid programs help low-income seniors pay Medicare Part B premiums. The bill extends the program until September 30, 2007.

AGS and 34 other members of the Leadership Council of Aging Organizations (LCAO) had urged Congress to approve reauthorization of the QI-1 program. “Over 161,000 people nationwide currently rely on the QI-1 program and could not afford Medicare coverage without this assistance,” they noted in a letter to all members of Congress.