The Medicare Prescription Drug, Improvement, and Modernization Act , also called the Medicare Modernization Act or MMA , is United States federal law, enacted in 2003 This results in Medicare's biggest improvement in 38 years of public health program history.
MMA was signed by President George W. Bush on December 8, 2003, after passing in Congress by a close margin.
Video Medicare Prescription Drug, Improvement, and Modernization Act
Benefits of prescription drugs
The feature most heralded by MMA is the introduction of the right benefits for prescribed medicines, through tax breaks and subsidies.
In the years since the creation of Medicare in 1965, the role of prescription drugs in patient care has improved significantly. When new and expensive drugs begin to be used, patients, especially the elderly who are targeted by Medicare, have found more difficult recipes to buy. MMA is designed to address this problem.
The benefits are funded in a complex way, reflecting the diverse priorities of lobbyists and constituents.
- This provides subsidies for large companies to prevent them from removing personal recipe coverage to retired workers (AARP's primary objective);
- It prohibits the federal government from negotiating discounts with drug companies;
- This prevents the government from formulating a formulary, but does not prevent private providers such as HMOs from doing so.
Basic prescription drug coverage
Beginning in 2006, the benefits of a prescription drug called Medicare Part D are available. Coverage is only available through insurance companies and HMOs, and is voluntary.
Applicants pay the following initial fee for initial benefit: minimum monthly premium of $ 24.80 (premium may vary), $ 180 to $ 265 deductible annual, 25% (or flat copay estimate) of full drug charges up to $ 2,400. Once the initial coverage limit is met, the period commonly referred to as the "Donat Hole" begins when an enrollee may be responsible for the price negotiated by the drug insurance company, less than the retail price without insurance. The Affordable Care Act, also known as " Obamacare ", modifies this size.
Maps Medicare Prescription Drug, Improvement, and Modernization Act
Medicare Advantage Package
With the passing of the Balanced Budget Law of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through a private health insurance plan, not through the Original Medicare plan (Parts A and B). These programs are known as "Medicare Choice" or "Part C" plans. Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, compensation and business practices for insurance that offer this plan change, and the "Medicare Choice" plan is known as the "Medicare Advantage" (MA) plan. In addition to offering comparable coverage for Parts A and Part B, Medicare Advantage plans may also offer Part D coverage.
Changes to plan
With MMA, a new Medicare Advantage plan is created with several advantages over previous Medicare Choice plans:
- list of applicants for a full year
- maintenance can be restricted to provider networks
- formularies can be used to limit the choice of prescribed drugs
- prescription coverage may be suspended to the patient or Medicare prescription plan Part D
- treatments in addition to emergency care can be restricted to certain areas
- federal reimbursement can be adjusted with applicant's health risk
Health savings account
MMA drafted a New Health Savings Account law that supersedes and extends the previous Medical Savings Account law by extending the allowable contribution and employer participation. After the first 10 years more than 12 million Americans are enrolled in HSAs (AHIP; EBRI).
Other conditions
While almost all agree that some form of prescription drug benefit will be included, another provision is the subject of prolonged debate in Congress. Complex laws also change Medicare in the following ways:
- requires a six-city court of a partially privatized Medicare system (in 2010)
- it gave an additional $ 25 billion to a rural hospital (at the request of congressional representatives in the rural West)
- it costs more than the richer senior
- it adds a pre-tax health savings account to people who work
- Required Medicare Part D plans to support electronic prescribing, with a planned execution date in April 2009.
Administration of medicare claims
In addition, the law requires a major overhaul of how claims Part A and Part B are processed.
Under the new law, FIs and operators will be replaced by Medicare Administrative Contractors (MAC), serving Parts A and B, and will be consolidated into fifteen Jurisdictions:
- Jurisdiction 1 - California, Hawaii, and Nevada, plus American Samoa, Guam and Northern Mariana Islands
- Jurisdiction 2 - Alaska, Idaho, Oregon, and Washington
- Jurisdiction 3 - Arizona, Montana, North Dakota, South Dakota, Utah, and Wyoming
- Jurisdiction 4 - Colorado, New Mexico, Oklahoma, and Texas
- Jurisdiction 5 - Iowa, Kansas, Missouri, and Nebraska
- Jurisdiction 6 - Illinois, Minnesota, and Wisconsin
- Jurisdiction 7 - Arkansas, Louisiana, and Mississippi
- Jurisdiction 8 - Indiana and Michigan
- Jurisdiction 9 - Florida, plus Puerto Rico and the US Virgin Islands
- Jurisdiction 10 - Alabama, Georgia, and Tennessee
- Jurisdiction 11 - North Carolina, South Carolina, Virginia, and West Virginia
- Jurisdiction 12 - Delaware, District of Columbia, Maryland, New Jersey, and Pennsylvania
- Jurisdiction 13 - Connecticut and New York
- Jurisdiction 14 - Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont
- Jurisdiction 15 - Kentucky and Ohio
Four "Special MAC Jurisdictions" are also created to deal with durable medical equipment and health/hospital claims:
- Jurisdiction A - made up of all states within Jurisdictions 12, 13, and 14
- Jurisdiction B - consists of all states in Jurisdiction 6, 8, and 15
- Jurisdiction C - consists of all states and territories in Jurisdiction 4, 7, 9, 10, and 11
- Jurisdiction D - consists of all states and territories in Jurisdiction 1, 2, 3, and 5
Finally, the underlying contract will be subject to competition, and will also be subject to the requirements of the Federal Accounting Standards and Acquisition Regulations.
Legislative history
According to the New York Times December 17, 2004 editorial W.J. "Billy" Tauzin, the Louisiana Republic who headed the Energy and Commerce Committee from 2001 to 4 February 2004 is one of the chief architects of the new Medicare law. In 2004, when Tauzin was appointed chief lobbyist for Pharmaceutical Research and Manufacturing America (PhRMA), trade associations and lobbying groups for the drug industry with "reported salary of $ 2 million per year," draws criticism from a Washington-based company. Public Citizen, a consumer advocacy group. They claim that Tauzin "may have negotiated for lobbying work when writing Medicare laws." Tauzin is responsible for including provisions that prohibit Medicare from negotiating prices with drug companies.
It is a sad commentary on politics in Washington that a congressman who pushed most of the legislation in favor of the drug industry, got the job leading the industry.
Democratic House Speaker Nancy Pelosi said,
I think if seniors want to know why pharmaceutical companies are doing so well at their expense, all they have to do is look at this. This is the abuse of power. This is a conflict of interest.
The bill was debated and negotiated for almost six months in Congress, and finally passed in the midst of an unusual situation. Several times in the legislative process, the bill appears to have failed, but each time it was saved when some members of Congress and Senators changed positions on the bill.
The bill was introduced in the House of Representatives on June 25, 2003 as Hr.1, sponsored by Chairman Dennis Hastert. All that day and the next bill was debated, and it was clear that the bill would be very divisive. On the morning of June 27, a vote on the floor was taken. After the initial electronic vote, the count reached 214 yeas, 218 no.
Three Republican representatives then changed their voices. One of the opponents of the bill, Ernest J. Istook, Jr. (R-OK-5), changed his voice to "present" after being told that CW Bill Young (R-FL-10), who is absent due to death in the family, will vote "aye" if he is already present. Furthermore, Republicans Butch Otter (ID-1) and Jo Ann Emerson (MO-8) turned their votes to "aye" under pressure from party leaders. The bill was passed by one vote, 216-215.
On June 26, the Senate passed the bill version, 76-21. The bill was put together in the conference, and on November 21, the bill returned to the House for approval.
The bill came to a vote at 3 am on November 22. After 45 minutes, the bill was defeated, 219-215, with David Wu (D-OR-1) not voting. Speaker Dennis Hastert and Majority Leader Tom DeLay tried to convince some Republicans who did not agree to change their votes, as happened in June. Istook, who had always been a shaky voice, agreed quickly, yielding a count of 218-216. In a very unusual move, the House leadership held an open vote for hours as they searched for two more votes. Then-Representative Nick Smith (R-MI) claims he was offered a campaign fund for his son, who ran to replace him, in exchange for a change in his voice from "no" to "yes." After the controversy broke out, Smith clarified no explicit funding offer of the campaigns he made, but that he was offered "assertive and aggressive campaign support" assumed including financial support.
At around 5:50 am, Otter and Trent Frank (AZ-2) were convinced to change their voices. With convincing parts, Wu chose yes too, and Democrat Calvin M. Dooley (CA-20), Jim Marshall (GA-3) and David Scott (GA-13) changed their voices to the affirmative. But Brad Miller (D-NC-13), and then, Republican John Culberson (TX-7), reversed their voices from "yes" to "no". The bill passed 220-215.
The Democrats shout violations, and Bill Thomas, chairman of the Committee on Means and Means of the Republic, challenged the results as a gesture to satisfy minority concerns. He then chose to face his own challenge; counting to the table is 210 ayes, 193 noes.
The Senate's consideration of the conference report was somewhat less heated, as the cloture was called in a 70-29 vote. However, the budget point of the order submitted by Tom Daschle, and choose. Since 60 votes are needed to set it aside, the challenge is actually considered to have a credible escape chance.
For a few minutes, the total vote stalled at 58-39, until Senator Lindsey Graham (R-SC), Trent Lott (R-MS), and Ron Wyden (D-OR) chose consecutively to qualify in the 61-39 vote. The bill itself was finally passed in 54-44 on 25 November 2003, and was signed into law by the President on 8 December.
Cost
Initially, the net cost of the program is projected at $ 400 billion for a ten-year period between 2004 and 2013. Administration official Thomas Scully instructed analyst Richard Foster not to say the Foster Congress's findings that the actual cost would be more than $ 500 billion. One month after passing, the administration estimates that the net cost of the program during the period between 2006 (the first year the program starts paying benefits) and 2015 will be $ 534 billion. As of February 2009, the projected net program cost over the period 2006 to 2015 was $ 549.2 billion.
Negotiate the price of prescribed medicines
Since the introduction of the Medicare Prescription Drug, Improvement and Modernization Act in 2003, only insurance companies that administer the Medicare prescription drug program, not Medicare, have the legal right to negotiate drug prices directly from drug manufacturers. Medicare Prescription Drug Drugs expressly prohibit Medicare to negotiate the price of prescription drugs. On January 31, 2017, President Trump, after his meeting with the CEO of a pharmaceutical company and chair of the American Pharmaceutical and Manufacturing Research, who had promised to let "Medicare negotiate a hefty discount in the price paid for prescription drugs," left his promise. On February 7, 2017, White House spokesman Sean Spicer confirmed that President Trump still likes medicare to negotiate prescription drug prices.
See also
References
External links
Government resources
- Medicare & amp; Medicaid Services (CMS)
- Medicare Modernization Act - including PDF files from actual legal text.
- Medicare.gov - the official website for people with Medicare
- Medicare Modernization Act at Medicare.gov
- Prescription Drugs Website at Medicare.gov - central location for Medicare web-based information on the benefits of Part D
- Sign up in the Medicare Prescription Medicines Plan at Medicare.gov - a web-based tool to sign up online under Part D plan
- Choice of Medicare Plan at Medicare.gov - basic information about plan options for Medicare beneficiaries, including Medicare Advantage Plans
- Medicare Personal Plan Finder at Medicare.gov - more details about Medicare Advantage Plans; including the ability to perform customized searches based on certain criteria
- Landscape plans - state breakdown of all plans available in an area, both the D-Standing D plan, as well as the Medicare Advantage plan
- Official Medicare Publications at Medicare.gov - including official publications on current Medicare benefits
- Medicare & amp; Your handbook for 2006 at Medicare.gov - includes information on current Medicare benefits
- Information about the 1-800-MEDICARE help line from Medicare.gov - 24X7 toll-free number where anyone can call with questions about Medicare
News articles
- "The Great Society Meets the 21st Century," by Michael Johns, Orthopedics Technology Review, January 2004.
- Based on the "- 60 Minutes Effect specifically on the influence of prescription drug lobbyists on the part of Medicare Bill
Other resources
- Read Congressional Research Service Report (CRS) on Medicare Prescription Drug Law
- "Medicare Q & amp; Weekly Columns", Kaiser Family Foundation
- http://webarchive.loc.gov/all/20090811041852/http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=22867
Source of the article : Wikipedia
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