Friday, February 3, 2012

Keeping Medicare Safe and Solvent

Members of the Democratic Party should encourage the repeal of the prohibition clause of the Federal 2003 Medicare prescription drug law which bans the Secretary of Health and Human Services from negotiating prices with pharmaceutical companies.

Other changes to Medicare which should be supported include provisions to stop paying private Medicare plans anything more than traditional Medicare, to include a drug benefit in traditional Medicare, and to lowering the age of Medicare eligibility.

In addition, we should support a clarification by CMS (Centers for Medicare & Medicaid Services) with regard to improper interpretation and erroneous implementation of an "improvement standard." This misinterpretation results in improper denial of coverage to Medicare patients with chronic conditions, including "people with Multiple Sclerosis, Alzheimer's disease, ALS (Lou Gehrig's disease), spinal cord injuries, diabetes, Parkinson's disease, hypertension, arthritis, heart disease, and stroke. Further, the erroneous standard disproportionately affects people who have low-incomes, as well as African-Americans and Hispanics." [1]

"Neither the Medicare statute nor its implementing regulations mentions or suggests an improvement standard in the context of diagnosis or treatment of illness or injury...The general statutory standard for Medicare coverage is one of medical necessity; that is, the standard is whether a given service is 'reasonable and necessary.' The same subsection of the law does use the word 'improve,' but only in the specific and limited context of authorizing Medicare coverage 'to improve the functioning of a malformed body member.' This use of 'improve' is the only reference to improvement in the statute...[T]here is no overarching improvement standard in the Medicare statute." [2]

In the absence of CMS action, the President should be encouraged to issue an Executive Order directing CMS to take appropriate steps.


1. Removing a Major Barrier to Necessary Care: The Medicare "Improvement Standard" Advocacy & Education Initiative

2. How the 'Improvement Standard' Improperly Denies Coverage to Medicare Patients with Chronic Conditions

Copies of this posting were sent as e-mails using Congress.org to President Barack Obama (D), Senator Al Franken (D-MN), Senator Amy Klobuchar (D-MN), and Representative Collin C. Peterson (D-MN 7th).

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