Hospitals:
BBA: Reduces medical education for training physicians by 6%; provided a 4$ reduction in 2001 and 5% in 2002 for hospitals serving the poor

BBRA: Increases Medical education for training physicians to 6.5% in 2000; 6.25% in 2001 and 5.5% in 2002; reduced payments for hospitals serving the poor by 3% in 2001 and 4% in 2002

BIPA: Received a 1.1% increase in the market basket between 4/1/01 to 10/01/01. Other additions for reimbursement are: costs associated with blood and blood products will be included in the DRG. Reimbursement will be based on a case mix of patients with the DRG system. Medical education payments will increase. The Disproportionate Share Hospital payment will be reduced by 1% rather than 3%. Wages and salary reimbursement will be adjusted.

Long Term Stay and Psychiatric Hospitals:
BBA: reduced the payments 1% on 10/1/00; 2% on 10/1/01)

BBRA: Reduced the bonus and relief payments to 1.5% of cost reporting periods starting 10/1/00; 2% to 10/1/01

BIPA: Rehab hospitals will have patient assessment costs reimbursed at 98% in 2001 and 100% thereafter; the hospital can elect to go on PPS 30 days prior to the cost report due date; Psychiatric hospitals will get a 2% (rather than 3%) reduction in incentive payments; and long term care hospitals will increase the cap amount by 2% and go on PPS on 10/01/02.

Skilled Nursing Facilities:
BBRA: Increases payments for 15 Resource Utilization Groups (RUGS) for determining the level of care needed by 20% starting 4/1/00; Increases payments by 4% for skilled nursing facilities.

BIPA: Nursing Homes. The reduction in the prospective payment system will be .5% rather than 1% for FY 2002-03 with increases in 2001 market basket rates. Reimbursement for 4/01/01 to 10/01/01 will be increased by 1 percentage point over the BBRA. Changes The Budget Improvement and Protection Act of 2000 provided for a 16.66% increase in the nursing component after 4/1/01 and a 6.7% increase in RUG III. Other RUG reimbursements will also increase.

Inpatient Rehabilitation:
BBA: allowed for Prospective Payment System reimbursement on 10/1/00)

BBRA: Develop a discharge plan based on functional issues including impairment, age, co-morbidities, and capability of patients to improve.

BIPA:

Home Health
BBA: a) See coverages under Part A; b) Home health services unassociated with a hospital or skilled nursing facility stay will be gradually transferred from Part A to Part B. The transfer will phase in over a 6-year period, while the cost of the home health services transferred will phase in to the Part B premium over 7 years; c) No longer covers venipuncture (blood draws in the home) as of 2/7/98; eliminating this skilled service in the home has reduced the amount of home health aide and homemaker services that are allowed;

BBRA: pays each agency $10 per patient in 2000 to collect OASIS data; delays the 15% reduction until after PPS starts; delays any further reductions pending further study; reduces the surety bond limits to $50,000 or 10% of the business; provides for a 2% increase per beneficiary in FY 2000

BIPA: Reimbursement from 4/1/01 to 10/1/01 will increase 1 percentage point in addition to the increase in the Balanced Budget Refinement Act of 1999. Reduction in the prospective pay system to .5% instead of 1% for FY 2002-2003. The prospective payment system for home health agencies has been delayed until Fall 2001. Home health agencies are currently reimbursed on case mix of the population they serve. They will receive a 2.2% increase in payments from 4/1/01 to 10/01/01. Congress has also ordered a study on costs to home health agencies for non-routine medical supplies, ostomy supplies and so forth with a report due to Congress on 8/15/01.

Hospices:
BBA: reduced the payment by 1% from FY 99 through FY 02)

BBRA: Decrease the payment by 0.5% for FY 01 and .75% for FY 02

BIPA: Will receive 5% increase in reimbursement for FY 2001. The lump sum payment will increase based on the SMA in Wichita Kansas for FY 2000.

Part B (Medical Insurance)

A. 2001 monthly premium of $50 is deducted from the individual's Social Security check (individuals enrolling after age 65 may pay a higher monthly premium)
B. Deductible is $100 per calendar year
C. The Balanced Budget Act of 1997 made the following changes in Part B. The changes made to these policies by the Balanced Budget Refinement Act of 1999 are also noted. (Note: If nothing is noted, the BBRA did not make any changes for that service). The Budget Improvement and Protection Act of 2000 made additional changes.

Physician Services:
BBA: 80% of the approved charges for doctor's services both in and out of the hospital outpatient with the patient paying 20% of the approved charge

BBRA: Stabilizes payments for physicians starting in 2001; changes the reimbursement rates; authorizes a GAO study to look at costs for cancer therapy

BIPA: Funds a study to determine the benefits of group practices for efficiency, liability, and funding

Nurse Practitioners:
BBA: Can directly bill 80% of the lesser of the actual charge or 85% of the physician fee schedule effective 1/1/98

Chiropractic:
BBA: Effective 1/1/2000, do not need an x-ray to demonstrate the need for subluxation; Prior to 2000, the x-ray was required, but Medicare did not pay for it

Emergency Room Services:
BBA: Are reimbursed on a prospective payment system starting 1/1/99 with a 20% co-payment by the patient

Hospital Outpatient Services:
BBA: Are reimbursed on a prospective payment system starting 1/1/99 with a 20% co-payment by the patient of the billed charge.

BBRA: allows for higher payments for high cost procedures; some drugs and medical devices can be paid at a higher rate than Medicare - 2.5% until 2004 and 2% thereafter; caps the patient co-payments at the dollar amount of the Part A deductible of $778 in 2000

BIPA: Reimburses services from 1/1/01 to 4/30/01 on a fee schedule; from 4/30/01 to 01/01/02 reimburses on a fee schedule plus .32% for implementation to the market basket update; clarifies that benefits are included in the PPS payment and what services can be charged additionally; included some drugs and biologics in the PPS

Therapy Charges:
BBA: Capped the annual limit on physical therapy and speech therapy at $1500 per person per year; capped the annual limit on occupational therapy at $1500 per person per year.

BBRA: Effective 1/1/00, there is no annual limit all outpatient physical therapy including speech/language pathology services and outpatient occupational therapy services (this includes some charges for evaluation and assessment) for the years 2000-2001, pending an evaluation of utilization for those two years.

BIPA: Extends the moratorium on therapy caps through 2002; continues focused medical reviews
Authorizes a study to eliminate the "in the room" requirement for therapy assistants; and study the elimination on the cap on PT with a report in 18 months

Durable Medical Equipment:
BBA: Medicare pays 80% of the approved charge; suppliers will not receive any increase in reimbursement for the years 1998 - 2002, effective 8/7/97;

BBRA: Increases the payments by 0.3% in 2001 and 0.6% in 2002

BIPA: For urban consumers, the percentage increase in the CPI ending June 2000 for 2001

Prosthetics and Orthotics:
BBA: Medicare pays 80% of the approved charge; suppliers will receive a 1% reduction for the years 1998 - 2002, effective 8/7/97

BBRA:

BIPA: For urban consumers, the percentage increase is the CPI ending June 2000 for 2001 plus a 2.6% transitional allowance; special payments are authorized for custom-made orthotics and prosthetics that are ordered by licensed practitioners such as therapists

Parenteral and Enteral Nutrients:
BBA: Medicare pays 80% of the approved charge; suppliers are reimbursed at 1995 levels for the years 1998 - 2002, effective 8/7/97

Oxygen and Oxygen Equipment:
BBA: Medicare pays 80% of the approved charge; Payments are capitated at the 1997 limit reduced by 25% for 1998 effective 1/1/98; For 1999 and each subsequent year, they are capitated at the 30% of the 1997 limit.

BBRA: increases the payments by 0.3% in 2001 and 0.6% in 2002

BIPA: no change in reimbursement for oxygen and oxygen equipment

Laboratory tests:
BBA: Freezes payment at 74% of the median of all fee schedules starting 1/1/98 through 12/31/2002

Ambulatory Surgical Centers:
BBA: Patient pays 20% of the approved Medicare charge. Allows an increase of 2 percentage points below the consumer price index for 1998 through 2002 effective 8/7/97

Drugs and Biologicals:
BBA: If the drug or biological is not paid on a cost or prospective rate basis, the payment will be equal to the lesser of the actual charge or 95% of the average whole sale price. A dispensing fee can be paid to a licensed pharmacy

BBRA:

BIPA: Changes to "those not usually self-administered" which is effective immediately. Allows the unlimited payment for immunosuppressive drugs for transplant patients. Paid at the assigned rate only

Ambulance Services:
BBA. Medicare pays 20% of the approved charge. Payments will be based on reasonable costs per ambulance trip and reasonable charges may not exceed costs or charges in 1997 level minus 1% for 1998, 1999 and 2000; this will change to a fee schedule effective 1/1/2000

BBRA

BIPA: Restored the CPI increase for 2001. Starting July 1, 2001 reimbursement will be 4.7%. Will pay mileage

Screening Mammography:
BBA: Pays for annual screening mammogram for all women age 40 and over starting 1/1/98; Waives Part B deductible

BBRA:

BIPA: Reduces the age to 35 from 40 for a mammogram; Payment can not be made more than every 11 months following the month in which a previous screening mammography was performed starting January 1, 2001. Pays for digital imaging without a film

Screening Pap Smear and Pelvic Exams:
BBA: Provides coverage every 3 years for a screening pap smear and pelvic exam (including a clinical breast exam); or annual coverage for women at high risk for cervical or vaginal cancer; Waives the Part B deductible;

BBRA: Increase the base reimbursement to $14.50 in 2001 with subsequent increases.

BIPA: Effective July 1, 2001, changes pap smears and pelvic exams to every 2 years from 3 years.

Prostate Cancer Screening:
BBA: Provides coverage for annual prostate cancer screening for men over age 50. Covered procedures include: a) digital rectal exam; and b) prostate-specific antigen (PSA) blood test effective 1/1/2000

Colecteral Screening:
BBA: Covers cancer screening including a) fecal-occult blood tests for persons age 50 and over; b) flexible sigmoidoscopy for persons age 50 and over c) colonoscopy for persons at high risk for colorectal cancer, and d) other procedures (including screening barium enema) as determined appropriate. Effective 1/1/98 with a 25% co-payment of Medicare approved amount

Diabetes Self-Management:
BBA: Provides training by physicians or other providers with a doctor's order effective 7/1/98; covers blood glucose monitors effective 7/1/98 and testing strips for all diabetics effective 1/1/98

Bone Mass Measurements:
BBA: Coverage to identify bone mass, detect bone loss, or determine bone quality for estrogen deficient women at risk of osteoporosis and persons a) with vertebral abnormalities, b) receiving long-term glucocorticoid steroid therapy, c) with primary hyperparathyroidism and d) being monitored to assess the response to, or efficacy of, an approved osteoporosis drug effective 7/1/98

Influenza and Pneumococcal Vaccines: BBA: Pays for the cost of the immunizations until 2002. Waives the Part B deductible

Renal Dialysis
BBA
BBRA
BIPA: Increase reimbursement by 4.2%; study whether there is sufficient access to renal dialysis services in the country with a report by 01/03

Glaucoma Screening
BBA

BBRA

BIPA: Done by a licensed optometrist or ophthalmologist for individuals who are at risk for glaucoma with family history or diabetes annually

Nutrition Therapy
BBA

BBRA

BIPA: For persons with diabetes, a registered dietician is paid 80% of the actual charge or 85% of the fee schedule for nutrition therapy effective January 1, 2001; study to see if beneficial to other Medicare populations

Colonoscopy
BBA

BBRA

BIPA: Makes colonoscopy available to everyone with a screening for individuals not at high risk every 119 months and every 48 months for a flexible sigmoidoscopy effective July 1, 2001

Ambulatory Surgical Centers
BBA

BBRA

BIPA: Delays the PPS until 01/01/02 with a four-year phase-in

Eileen Doherty, MS is Executive Director of Senior Answers and Services and the Colorado Gerontological Society. She has more than 20 years of experience in education and training, public policy, and clinical practice in gerontology. She can be reached at 303-333-3482