Joint Panel on Medicare Agrees on One Part of Reform Bill

Meeting in public for only the second time, the congressional conference committee on Medicare reached unanimous agreement Thursday on regulatory reforms designed to make the program more “user-friendly” for beneficiaries and health-care providers alike.

Members of the House-Senate committee congratulated themselves on achieving bipartisan agreement on a significant, if largely technical, portion of the Medicare reform bill. And they expressed hope that agreement on the more substantive and contentious elements of the bill -- how any prescription-drug benefit should be structured and whether Medicare should have to compete with private health plans -- would soon follow.

Although the regulatory reforms have received little public attention, given the focus on a new Medicare drug benefit, the House and the Senate have worked on similar issues for longer than three years.

The reforms “will have as much impact on people’s lives as any [other] section of the bill,” said Rep. Nancy L. Johnson (R-Conn.), a committee member.

“Medicare has become a program that is asphyxiating the small provider,” she said, adding that the reforms are about “fairness.”

Despite Thursday’s agreement, certain aspects of the regulatory-reform provisions remain unresolved.

Sen. Charles E. Grassley (R-Iowa), vice chairman of the committee, called attention to what he said was one “major flaw” in that section of the bill: “There are no real resources in it,” he said.

“We have to put real money on the table,” Grassley said. “Otherwise, we’re setting up Medicare to fail.”

But if that issue and several minor matters are settled, and if the committee members are able to work through major philosophical differences and agree on a final Medicare reform bill, the provisions approved Thursday would likely change in practical ways how patients, doctors, hospitals and other providers use Medicare.

Many physicians have dropped out of the program in recent years, leaving seniors and people with disabilities in some states struggling to find doctors who will treat them.

Doctors complain that their payments from Medicare are too low, that the program’s paperwork burden is too great and that regulatory oversight leaves them worried that they will be accused of trying to overcharge the government or otherwise cheat the system.

Some of the provisions lawmakers agreed on Thursday would:

* Establish an ombudsman for Medicare beneficiaries.

* Transfer Medicare administrative law judges from the Social Security Administration to the Department of Health and Human Services, and “ensure their independence.”

* Set up a central toll-free telephone number beneficiaries could use to get answers to Medicare questions.

* Provide new outreach and education services to help health-care providers better navigate the system.

* Streamline the appeals process to make it easier for beneficiaries to appeal Medicare’s denial of a claim.

* Revise the process for reviewing doctors’ billing records.

* Make it easier for providers to correct billing mistakes, appeal actions against them and repay Medicare in cases of overbilling.

The committee chairman, Rep. Bill Thomas (R-Bakersfield), hailed the broad agreement but acknowledged, “Nothing’s final until everything is final.”

Thomas also laid out an ambitious schedule for the committee.

It calls for the members’ staffs to spend four of the next five weeks working on the thorny differences between the House and Senate bills. It also sets aside just eight weekdays in September for lawmakers to reach agreement.