Pending Legislation that Affects all ICU Professionals
CMS Publishes Proposed Rule on 2005 Physician Fee Schedule The Centers for Medicare & Medicaid Services (CMS) published the Proposed Rule on the 2005 Physician Fee Schedule on August 5, 2004 in the Federal Register. This rule establishes the 1.5% increase mandated by the Medicare Prescription Drug, Improvement and Modernization Act (MMA), and provides additional evidence for a permanent fix before 2006. The rule predicts payment cuts from 2006 to 2011 to “balance” the modest increases of the past three years.
Access to the completed rule can be found on the Society of Critical Care Medicine’s (SCCM) Coding and Billing Web page1. The Society anticipates additional information from CMS briefings in the coming months, and will release regular updates.
Increased Funding Sought for Controversial Trauma Care Systems
The Society joined other professional organizations in urging Congressional appropriators to increase funding for state trauma care systems planning and development. The Trauma – Emergency Medical Services Systems Program, which is administered by the Health Resources and Services Administration, facilitates the development of effective and comprehensive state trauma systems. Although this program has been funded at $3.5 million in recent years, half of the states still lack statewide trauma care systems. In 1995, the total direct and indirect cost of traumatic injury in the United States was estimated at $260 billion. Trauma is the leading cause of death of Americans between 1 and 44 years of age.
U.S. Reps. James Greenwood, R-Penn., and Gene Green, D-Texas, introduced a bipartisan Trauma Research and Access for Urgent Medical Attention (TRAUMA) Act (H.R. 3999) to improve federal support for the development of trauma systems. The TRAUMA Act updates and reauthorizes the Trauma Systems Planning and Development grant program, which was originally authorized in 1990. The act will help states to improve and increase access to trauma systems. These funds can be used to increase access to pre-hospital care, develop protocols for the transportation of seriously injured patients, expand communications systems, and increase education, training and technical assistance.
The bill also encourages trauma care research at the Department of Health and Human Services (HHS).
It has been reported, however, that the American Academy of Pediatrics and allied specialty societies fear that passage of the TRAUMA Act could undermine an existing federal program that funds the development of emergency medical services and related health programs for children. If the TRAUMA Act becomes law, the current Emergency Medical Services for Children program would be folded into the proposed new trauma funding program, which would fund the development of trauma systems for both children and adults.
The Society will continue to monitor this issue closely to ensure that quality trauma care for adults does not compromise the equally vital need for similar pediatric care.
Senators Seeking Increased Support for OIG Activities
In response to letters from the HHS Office of Inspector General (OIG) expressing concern about the adequacy of funding for OIG, Sens. Chuck Grassley, R-Iowa, and Max Baucus, D-Mont., are reported to be considering ways to allocate part of the $1 billion set aside for implementation of the new Medicare legislation to OIG. The Office has told lawmakers that it will need at least $25 million to carry out duties mandated by the new law and to oversee the programs created under the law. Funding for the OIG’s largest program, the Health Care Fraud and Abuse Control Program, has been capped at 2003 levels, forcing the Office to cut more than 40 staff positions in recent years.
Patients’ Rights Bill Before Congress Again
Legislation providing for a federal “patients’ bill of rights” is the subject of renewed interest on Capitol Hill, following a recent U.S. Supreme Court decision limiting patients’ rights to sue their HMOs in state court. In the 9-0 decision announced on June 21, the Court opined that the state lawsuits were brought “only to rectify a wrongful denial of benefits promised under ERISAregulated [health] plans” and that the federal Employee Retirement Income Security Act (ERISA) law “completely pre-empted” the state law claims.
The following day, Sens. Edward Kennedy, D-Mass., John Edwards, D-N.C., and John McCain, R-Ariz., renewed their support for the bipartisan patients’ rights bill that they first introduced last November, pending before the U.S. Senate Committee on Health, Education, Labor, and Pensions (HELP). In the House, Rep. John Dingell, D-Mich., introduced a companion bill, which has been sent to three House Committees for consideration. Several other similar pieces of legislation also have been introduced.