October 14, 2009

Three More Wyden Amendments Included in America's Healthy Future Act; Ten Total

Provisions to Improve Home-Based Chronic Care, Speeding up Access to Important Tests and Raising the Bar for Medicare Advantage Included

Washington, D.C. - Three amendments written by U.S. Senator Ron Wyden (D-Ore.) were accepted to the final version of the America's Healthy Future Act of 2009. Ten Wyden-authored amendments are included in total.

The "Rewarding High Quality Medicare Advantage Plans" amendment will provide incentives for providing high-quality care by increasing payments for Medicare Advantage plans that voluntarily improve their services. The Centers for Medicare and Medicaid Services (CMS) score Medicare Advantage plans on a one to five scale. The best plans fall into the four and five star range. This amendment would boost payment rates by 1 percent to those plans that achieve a rating between four and five stars. This will entice a large portion of plans hovering in the three star range to increase quality and receive the higher payment rate. It also entices currently high scoring plans to maintain the quality of care they already provide.

The "Independence at Home" amendment will provide personalized, in-home care for Medicare patients suffering from multiple chronic conditions. House call teams, similar to those successfully used by the VA for decades, are available to provide one-on-one attention to patients and the personalized approach will cut down the costs associated with multiple hospital visits. This amendment specifically targets the 10 percent to 25 percent of Medicare Beneficiaries who account for 66 percent to 85 percent of Medicare spending, drastically reducing the cost of treating patients with multiple chronic conditions.

The "Protecting Patient Access to Personalized Medicine" amendment will remove unnecessary barriers between patients and the complex molecular diagnostic tests that can save their lives. Under current law, if a test is ordered less than 14 days after a beneficiary leaves the hospital, the hospital must bill for the laboratory service. These tests are often done by highly specialized labs that do not generally have agreements with an individual hospital and are required to wait until after the 14 day period is over before billing the hospital. This can lead to a delay in diagnosis and treatment for patients. This amendment allows the labs to bill Medicare directly for a two-year period in order to expedite the test results.

These seven amendments were included in the legislation and added during the first day of the bill's consideration in the Finance Committee:

The "Exchange Plans as Good As Members of Congress" amendment ensures that all Americans will be able to have a health insurance policy option available to them through their state exchange that is actuarially equivalent to the plans that their Members of Congress can choose. At least one plan in every exchange must meet the actuarial standard of the Blue Cross Blue Shield Standard Option in the Federal Employees Health Benefits Program.

The "Seamless Portability - No Need for COBRA" amendment will give Americans real health security by making it easier for those who have lost their jobs to qualify for Health Care Affordability Tax Credits. Instead of having the burden of using their previous year's tax return to prove they qualify for these credits, they will be able to use their enrollment for unemployment benefits as evidence of their eligibility.

The "Empowering States to be Innovative" amendment will free states to come up with their own methods of covering their residents if they can develop a health insurance plan that provides coverage as comprehensive as required by the final law. Similar to a provision in Senator Wyden's Healthy Americans Act, the amendment allows states to apply for a waiver through a process that mirrors that set up for Medicaid and CHIP. Once the waiver is applied for, the Secretary of Health and Human Services (HHS) must respond within a 180-day window. Congressman Dennis Kucinich added a similar amendment to the House's America's Affordable Health Choices Act of 2009 bill.

The "Amendment to Limit Insurance Rating Based on Age in the Individual and Group Markets" will protect late-middle aged Americans from being charged up to five times as much for their coverage as younger people. Age-rating is a policy that would make health coverage unaffordable for older individuals. While Wyden's original amendment would have limited age-rating to a 2:1 ratio, the revised amendment accepted into the bill lowers the ratio to 4:1. Wyden plans to continue pushing for his original 2:1 ratio goal.

The "Helping States with Extraordinarily Long Waiting Lists for Medicaid" amendment will make it easier for states that have long waiting times for residents to receive care through Medicaid by changing the legal definition of those on the waiting list to "newly eligible." This will help states like Oregon that have greater numbers of those in need to qualify for additional Federal funds and Medicaid.

The "Ensuring People in Hospice Do Not Have to Give Up the Prospect of a Cure" amendment will give those fighting life-threatening illnesses a better chance to survive. It will change the current discriminatory law that takes Medicare services and treatments away from anyone who enrolls in hospice care. The amendment creates a Medicare Hospice Concurrent Care (HCC) three-year demonstration program that would allow hospice patients to also receive Medicare coverage while in hospice. It would also direct the Secretary of HHS to establish 26 sites across the country - in both rural and urban areas - to examine the effectiveness of this delivery model and its ability to improve patient care, quality of life and cost-effectiveness.

The "Authorizing the Use of New Technologies that Empower Patients and Their Providers to Get More Value in Accountable Care Organizations" amendment will move America's health care system into the 21^st century by allowing Accountable Care Organizations to use the latest in technology to connect patients and their medical care providers. Innovations such as remote patient monitoring, which reduces the need for face-to-face office visits and allows physicians to use remote sensors to keep track of patients' vital statistics, have been proven to improve outcomes for patients with chronic diseases and cut health care costs.