Debate About Funding for the Next Fiscal Year (FY 2012) Has Begun
One day after passing the budget for FY 2011, the House passed Budget Committee Chairman Paul Ryan’s FY 2012 budget resolution. Representative Ryan’s resolution is a sweeping budget plan that reduces spending from $1.91 trillion to $1.019 trillion for FY 2012 (a difference of $891 billion). In comparison, the President’s FY 2012 total budget request is $1.121 trillion (a reduction of $789 billion).
In addition to reducing federal spending, the budget resolution also calls for major changes to the Medicare system for those under 55 years of age. In his plan, Rep. Ryan calls for a shift to a voucher system, providing an average of $11,000 to elderly and disabled Americans to purchase a private, Medicare-approved health insurance plan. Rep. Ryan’s proposal also converts the funding of Medicaid from its current system of the federal government matching state dollars to a block grant system. The new system would provide states with a fixed amount of money to spend on Medicaid services, with a federal spending cap focusing on cutting Medicaid costs by $770 billion over 10 years. Even though Rep. Ryan’s resolution passed the House, it is not expected to be adopted by the Senate.
Bill to Permanently Repeal the Medicare Therapy Cap Introduced
On April 14, Rep. Jim Gerlach (D-PA) and Sen. Benjamin Cardin (D-MD) introduced bills to permanently repeal the Medicare therapy cap. Rep. Xavier Becerra (D-CA) and Rep. Andre Carson (D-IN) signed on as cosponsors to the House version of the bill, the “Medicare Access to Rehabilitation Services Act of 2011” (H.R. 1546). A bipartisan group of nine Senators signed
on as cosponsors to the Senate version (S. 829).
Originally passed with the Balanced Budget Act of 1997, the therapy cap limits the amount of money that Medicare can pay annually for speech and physical therapy combined and for occupational therapy. The cap is currently set at $1,870 per year.
Congress prevented the implementation of the provision until an exemption process was developed in 2006, which allowed patients who had reached the cap to receive additional therapy if the services are determined to be medically necessary. Congress has approved the exemption process each year since 2006, with the current exemption expiring on December 31, 2011. Both H.R. 1546 and S. 829 would permanently repeal the cap, instead of requiring the exemption process to be approved each year.
Bill Introduced to
Allow Medicare to Cover Drugs for Off-Label Uses
Rep. Mac Thornberry (R-TX) introduced a bill (H.R. 1055) on
March 11 that would allow Medicare participants of Part D
to receive coverage for the use of “off-label” medications if the usage has
been supported by clinical evidence in peer-review publications and meets guidelines
to be established by the Secretary of Health and Human Services.
When the Food and Drug Administration (FDA) approves a drug
for use, the approval comes with a list of specific purposes for the drugs’ usage,
but physicians are free to prescribe drugs for any use. Doctors commonly
prescribe drugs for off-label purposes, particularly with older, generic drugs.
However, Medicare does not cover prescriptions for off-label purposes, with the
exception of cancer treatments. Rep. Thornberry’s bill would allow Medicare to
expand its coverage of off-label prescriptions.
"Doctors and patients should be able to choose the
safest and most effective medications for their treatments," Rep. Thornberry
said. "Right now, the requirements for coverage of the off-label use of a
drug are burdensome and often result in Medicare patients not being able to get
the drug coverage they need. Our bill helps fix that problem."
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