Medicare Plans May Get Cash ‘Infusion’

Published November 1, 2001

CongressDaily reports Thomas Scully, administrator for the Centers for Medicare and Medicaid Services (CMS), predicted on October 15 a “better than even chance” lawmakers would provide Medicare managed care plans with an additional “infusion of cash” before legislators adjourn for the year.

At the same time, Scully, speaking to the American Association of Health Plans, “backed away from earlier predictions” Congress might address “in a major way” a number of concerns prompting health plans to withdraw from the troubled Medicare+Choice program.

Scully said the FY 2002 budget “situation” and the “crush of other business” would make reforms a “tough call” for lawmakers. He reportedly said the administration would “continue to push” the pharmacy discount card program President Bush unveiled in July, despite a September court ruling that has blocked the program temporarily.

“We are very, very committed to getting this program in place,” Scully said, adding, “Getting seniors buying drugs in bulk to get discounts is the one common denominator” among Democrats and Republicans.

Closing a Loophole

CongressDaily also reported Scully’s plan to issue a regulation that will “further restrict” the Medicaid “upper payment limit.”

A loophole in that limit currently allows states to pay city- or county-owned health care facilities more than the actual cost of health services, thereby qualifying the state for additional federal matching funds from CMS. Some states pay the facilities a small fee for their participation in the Medicaid program, but the facilities are not required to spend that money on health care for low-income patients.

“It’s a scam,” Scully said. “We just have to draw the line. We can’t let every state come in and refinance their entire state government through the Medicaid program.”