The American Geriatrics Society

President Signs Medicare Bill into Law

President Bush signed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 into law December 8, clearing the way for sweeping changes to the Medicare program that include prescription drug coverage for seniors and improved payments for providers. Calling the $400 billion overhaul the "greatest advance in health care coverage for America's seniors since the founding of Medicare," the president said the measure would give older Americans "better choices and more control over their health care, so they can receive the modern medical care they deserve. He also touted the other benefit enhancements to the elderly contained in the legislation in addition to drug coverage. "With this law, we are providing more access to comprehensive exams, disease screenings, and other preventative care, so that seniors across this land can live better and healthier lives," Bush stated.

The bill signing ceremony capped months of negotiations and partisan debate on Capitol Hill. The House of Representatives gave its final approval to the bill on Nov. 22 in a close 220-215 vote. Voting for the bill in the House were 16 Democrats and 204 Republicans. Voting against the bill were 189 Democrats, 25 Republicans, and 1 independent. Three days later on Nov. 25, the GOP led Senate overcame a Democratic filibuster as well as a budget challenge and passed the measure 54-44. Voting for the legislation were 42 Republicans, 11 Democrats, and 1 Independent, while 35 Democrats and 9 Republicans opposed it.

Geriatric Care Act Provisions Included in Legislation

The legislation signed by the President provides an exception to the initial residency period for geriatric residency or fellowship programs, giving the Secretary of HHS the authority to clarify that geriatric training programs are eligible for two years of fellowship support under Medicare.

In addition, the legislation bill a three-year Medicare Care Management Performance Demonstration, loosely based on another provision of the GCA that would have authorized Medicare to cover geriatric assessment and care coordination services. Under the bill, the HHS Secretary is required to set up projects in four sites, with at least two in urban areas and one in a rural area. One of the sites must be in a state with a medical school with a geriatrics department that manages rural outreach sites and is capable of managing patients with multiple chronic conditions, one of which is dementia.

Physicians who provide care to a specified minimum number of eligible beneficiaries may participate if they agree to use health information technology, report electronically on clinical quality and outcomes measures, and manage the care of patients. Payment would be made on a per beneficiary amount when performance standards are met or exceeded and when information technology is used; the amount of payment may vary based on different levels of performance or improvement.

Eligible beneficiaries must have one or more chronic medical conditions specified by the Secretary. The legislation does not include a GCA provision that would have provided a limited exception to the Medicare hospital specific cap for geriatricians nor does it provide a new geriatric assessment benefit.

Cut in Physician Update Blocked

In another victory for AGS, the legislation blocks a scheduled fee decrease of 4.5% that would have taken effect on Jan. 1, 2004, if Congress had not acted. Instead, physicians and other members of the interdisciplinary team paid under the physician fee schedule will receive a 1.5% update in 2004 and 2005. Other provisions of the bill boost payments to physicians practicing in rural areas.

AGS and the physician community lobbied hard for the fee update, arguing that further cuts in reimbursement threatened beneficiary access to care and particularly hurt the practices of geriatric health professionals due to their large numbers of Medicare patients.