House Panel OKs Medicare Bills to Help Those With Special Needs

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By Mindy Yochelson

Republicans and Democrats on the House Ways and Means Committee joined together July 13 to unanimously approve legislation intended to enhance services for beneficiaries with particular health needs or who are low income.

Sponsors said the two bills would improve the quality of care provided to vulnerable beneficiaries.

H.R. 3168 would make managed care plans for beneficiaries who reside in institutions a permanent fixture of the Medicare program. These Medicare Advantage plans are one type of special needs plan. The other two types—for beneficiaries who are dually eligible for Medicare and Medicaid and for those with debilitating chronic conditions—would be authorized for five years. SNPs had been temporarily authorized for three-year stints since the program began in 2003.

H.R. 3178 would allow payments for home delivery of infusion services until a new program for these services begins in 2021. It also would allow payments for telehealth monitoring for beneficiaries with end stage renal disease, and would extend a demonstration that pays for home administration of intravenous immunoglobulin. It would make it easier for beneficiaries to get customized orthotics and prosthetics. Some claims had been held up because of missing information. This provision would allow alternative information to be used to support medical necessity.

In addition, several committee members praised a provision that would allow dialysis providers to seek outside accreditation from organizations approved by Medicare, in order to be able to bill for services. Problems getting the appropriate accreditation have led to centers being unable to serve beneficiaries in their areas, they said.

Bipartisan Support

The markup was generally a lovefest by members with just one partisan note.

Members beat back on party lines an amendment to H.R. 3178 by Rep. Lloyd Doggett (D-Texas) that would have imposed penalties on drugmakers that fail to report average sales price data for Medicare Part B drugs, which are administered in doctors’ offices and outpatient facilities. The Democrat said it was ironic that lawmakers would consider Part B legislation that didn’t address the soaring costs of drugs.

Special Needs Plans

H.R. 3168 would strengthen integration requirements between Medicare and Medcaid for SNPs for dual eligibles, including establishing procedures that would unify grievances and appeals procedures between the two programs. It would allow traditional MA plans and SNPs to offer individualized benefits to chronically ill enrollees.

“Over the past decade SNPs have become critical coverage options for a growing high cost, high need population who need access to specialized care management tools as well as enhanced home and community-based services,” the Better Medicare Alliance, an MA support group, said in a statement on the bill. “This legislation received bipartisan support today because Medicare Advantage is increasingly recognized as the bright spot in care for patients with complex conditions.”

To contact the reporter on this story: Mindy Yochelson at

To contact the editor responsible for this story: Brian Broderick at

For More Information

H.R. 3168 is at

H.R. 3178 is at

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