Question. The sites will apparently be allowed to advertise and utilize special marketing inducements to attract patients and referrals from other facilities, practices that currently do not appear to be allowable under Medicare. What specific inducements and practices would you allow? Are you concerned about setting a bad precedent by allowing special privileges and inducements for a procedure which is widely practiced and 95 percent effective? The Answer. HCFA will not conduct any direct marketing on behalf of demonstration providers. extent of HCFA representation in marketing or advertising will be to allow designated providers to identify themselves as "Medicare Designated Cataract Surgery Providers," characterizing them as highly efficient providers who are subject to rigorous utilization and quality review. To assure designated providers do not engage in unduly aggressive or misleading marketing practices, all marketing plans and materials used by demonstration providers to promote availability of services under the demonstration will be subject to HCFA's prior approval. Designated providers remain free to offer the same program benefits to prospective cataract surgery patients as non-demonstration providers. However, because designated providers are able to offer cataract surgery services to beneficiaries at a lower total cost to Medicare, beneficiaries may benefit from these efficiencies in the form of lower out-ofpocket costs. This may be accomplished under the demonstration's authority by permitting designated providers to waive beneficiary deductibles and coinsurance if they so desire and at their own expense. In addition, physicians and facilities practicing as designated providers may offer program benefits such as prompt forwarding of surgical records to the patient's primary care physician, and more coordinated pre- and post- surgical service delivery. REDUCTION OF COSTS THROUGH SHARED ARRANGEMENTS Question. What have you been able to accomplish to reduce administrative costs through shared computer maintenance and processing arrangements? Answer. In the last three years we have actively encouraged contractors to adopt shared processing and shared maintenance arrangements. In FYS 1990 and 1991, a total of $31 million in savings is expected from shared maintenance and shared processing arrangements. In FY 1992, we estimate that nearly $8 million dollars in savings will result from shared processing arrangements alone. FURTHER LEGISLATION FOR SHARED ARRANGEMENTS Question. Is legislation still needed to bring about further savings in this area? Answer. Under its current statutory authority, HCFA cannot mandate any shared systems arrangements. Although new legislation may not be required, strengthening HCFA's ability to provide powerful incentives to contractors to participate in shared systems, shared claims processing and shared systems maintenance arrangements is still perceived as necessary if savings are to be maximized. RURAL HEALTH CARE TRANSITION GRANT PROGRAM AND HOSPITAL/PRIMARY CARE HOSPITAL PROGRAM Question. Your budget zeros out two programs important to helping ensure health care services in rural areas, the Rural Hospital [Health] Transition Grant program and the Essential Access Community Hospitals program. These programs were funded at $24,398,000 and $9,759,000 respectively in 1991. I have a lot of praise for these programs and the important job they do in helping rural hospitals survive and become viable. Is your proposal to eliminate these two programs a budget gimmick or do you really believe the programs are ineffective? Answer. HCFA's decision not to include funds in our FY 1992 budget request for the Rural Health Care Transition Grants Program (RHCTGP) is based on our belief that before additional funds are sought to continue this program, an assessment/evaluation of the program is needed. It is still too early to judge the impact of the RHCTGP on the financial viability of rural hospitals and access to care by beneficiaries in rural areas. Hospitals that received grants in FY 1989 have just completed their first year under the program, with many having just completed the planning phase of their project. will use this year to evaluate the program. We HEARINGS AND APPEALS BACKLOG Question. Is it acceptable to you to have a backlog of 6.9 million cases and to take nine months for an appeals hearing? Answer. The prospect of having a backlog of this magnitude is not acceptable. However, given the current budgeting constraints, funds available for hearings and appeals are limited, and maintaining prompt claims processing and payment safeguard activities remain higher priorities. Nonetheless, we are examining several alternatives to minimize the impact of such a large backlog on beneficiaries and providers. ACCEPTABLE HEARINGS AND APPEALS BACKLOG Question. What is an acceptable backlog? Answer. Ideally, workloads received would be processed without generating backlogs. Such backlogs differ from cases kept at hand in order to maintain steady and efficient contractor operations. However, the reality is that backlogs will continue to exist and to exceed accepted volumes for workloads held at hand because of the need to develop cases for additional information, limitations relating to staffing capacities and the widely varied amounts of time required to process hearings, reviews and appeals workloads. The backlog of Part A workloads for FY 1990 was 20,779 cases, which represents 17.6% of the receipts for that year. For Part B, the backlog was 608,951 cases or 8.1% of the total received. BENEFICIARY SERVICES Question. What is going to happen with 21.8 million unanswered inquiries? Answer. Our projected workload is 30.4 million inquiries in FY 1992, and we expect to be able to process only 8.6 of these requests. However, this will not necessarily result in a total of 21.8 million unanswered inquiries. Since the majority of inquiries not received will be phone inquiries, it is believed that a significant number of these potential calls will not result in either written or walk-in follow-ups. To help minimize the impact of the funding limitations on telephone services, increased emphasis is being placed on the use of Audio Response Units (ARUS) for answering both beneficiary and provider inquiries. We are also considering other avenues for achieving savings. Question. How are beneficiaries supposed to find out about complex and ever-changing provisions of the Medicare program? Answer. There are several ways that beneficiaries can find out about the varied issues involving the Medicare program, including the Medicare Handbook and advocacy group publications. Another significant source is the EOMB (Explanation of Medicare Benefits) that beneficiaries receive after services are rendered by their providers. Funding is being provided in the FY 1992 budget to refine EOMBS. Question. Isn't it the contractors' responsibility to explain provisions of law, coverage of services, complicated payment rules, and the rights and responsibilities of beneficiaries? Answer. Yes, contractors are responsible for providing the information you noted. The EOMB (Explanation of Medicare Benefits) is a prime source for this information regarding medical services beneficiaries have received. Despite FY 1992 funding constraints, contractors will continue to provide information in response to all written and walk-in inquiries, and will process as many telephone inquiries as possible. USER FEES Question. Once again, you are proposing to offset your budget request by $341 million through collection of user fees to cover the cost of monitoring facilities such as nursing homes that receive funds from Medicare and Medicaid. These user fees were proposed last year and rejected by the Congress. Since this was rejected last year, why didn't you just request the funding for the mandated inspections? Answer. Medicare and Medicaid have historically subsidized the survey and certification costs of all payers. These costs should be a regular cost of doing business, to be equitably allocated among all of a provider's lines of business. Therefore, we believe that user fees are justified, and that our proposal should be enacted. Additionally, the user fee proposal builds on the precedent established by Congress in the Clinical Laboratory Improvement Act of 1988 (CLIA 88). HCFA is initiating discussions with the authorizing committees on this matter. We are hopeful that the merits of survey and certification user fees will outweigh any opposition to our proposal. We are sensitive to the concerns that are raised by proposals that cross jurisdictional boundaries. HCFA will do what it can to help address these jurisdictional concerns. Question. How do you plan to pay for monitoring work until user fees are collected? Answer. HCFA believes that the collection of CLIA user fees into the Survey and Certification Revolving Fund will begin in the summer of 1991. Collection of these funds will enable HCFA to pay for on-going survey and certification activities from the beginning of FY 1992. Until that point, we will use Survey and Certification funds appropriated to the Program Management account. Question. I understand that the fees would range from $1,700 to $16,000, with the fees going up for larger, more complex facilities. Is it true that the facilities can recoup these charges by billing Medicare and Medicaid for them as a cost of doing business? Answer. Yes. Some portion of the fees may be recouped. Medicaid provider payment rates are updated on a staggered basis, as a result we only expect about 50 percent of the fees to be recoverable in FY 1992. We expect this recoupment amount to be about $46 million. |