FOR IMMEDIATE RELEASE, Contact: (202) 225-3943
April 10, 1997
No. HL-10
Congressman Bill Thomas (R-CA), Chairman, Subcommittee on Health of the Committee on Ways and Means, today announced that the Subcommittee will hold a hearing on issues relating to Medicare's coverage policy. The hearing will take place on Thursday, April 17, 1997, in the main Committee hearing room, 1100 Longworth House Office Building, beginning at 1:00 p.m.
In view of the limited time available to hear witnesses, oral testimony at this hearing will be from invited witnesses only. However, any individual or organization not scheduled for an oral appearance may submit a written statement for consideration by the Committee and for inclusion in the printed record of the hearing.
BACKGROUND:
Under the Social Security Act, Medicare explicitly covers broad categories of benefits, but in general, does not specify coverage for individual items and services. As such, the Secretary of Health and Human Services has discretion to make coverage decisions for items and services determined to be "reasonable and necessary" for the diagnosis and treatment of an illness or injury, or to improve the function of a malformed body part. Historically, the Health Care Financing Administration (HCFA) has interpreted the definition of reasonable and necessary to be "safe and effective" by acceptable clinical evidence. In evaluating coverage decisions, HCFA considers several factors, including the potential for widespread use in medical practice, the level of disagreement about the technology's safety and effectiveness, and the variation among contractor decisions.
In 1989, HCFA issued a proposed regulation on Medicare coverage decisions that included in the criteria an analysis of "cost-effectiveness." Last year, HCFA indicated that it would issue final regulations on the 1989 proposed regulations. However, because of concerns raised about the seven-year gap between the proposed and final regulations, and serious concern that the use of cost-effectiveness as a criteria could preclude beneficiaries from receiving life-saving services, HCFA decided that it would no longer pursue its Medicare coverage policy through the regulatory process at this time. It is clear that questions remain about HCFA's current decision-making process and the impact of this process on patient access to advanced medical technology.
In announcing the hearing, Chairman Thomas stated: "With constant advances in medical sciences and changing practice patterns, we need to make sure Medicare beneficiaries have the most up-to-date and fair system for bringing state-of-the-art medicine to beneficiaries as quickly as possible. Beneficiaries deserve a system that encourages medical innovation while ensuring the safety of patients."
FOCUS OF THE HEARING:
The hearing will focus on Medicare's current coverage policy, beneficiary access to new medical technologies and procedures, the appropriate relationship among Federal agencies in Medicare coverage decision-making, interactions between coverage decisions and the private sector, and the impact of coverage decisions on beneficiary selection of Medicare managed-care plans.
DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:
Any person or organization wishing to submit a written statement for the printed record of the hearing should submit at least six (6) copies of their statement and a 3.5-inch diskette in WordPerfect or ASCII format, with their address and date of hearing noted, by the close of business, Thursday, May 1, 1997, to A.L. Singleton, Chief of Staff, Committee on Ways and Means, U.S. House of Representatives, 1102 Longworth House Office Building, Washington, D.C. 20515. If those filing written statements wish to have their statements distributed to the press and interested public at the hearing, they may deliver 200 additional copies for this purpose to the Subcommittee on Health office, room 1136 Longworth House Office Building, at least one hour before the hearing begins.
FORMATTING REQUIREMENTS:
Each statement presented for printing to the Committee by a witness, any written statement or exhibit submitted for the printed record or any written comments in response to a request for written comments must conform to the guidelines listed below. Any statement or exhibit not in compliance with these guidelines will not be printed, but will be maintained in the Committee files for review and use by the Committee.
1. All statements and any accompanying exhibits for printing must be typed in single space on legal-size paper and may not exceed a total of 10 pages including attachments. At the same time written statements are submitted to the Committee, witnesses are now requested to submit their statements on a 3.5-inch diskette in WordPerfect or ASCII format.
2. Copies of whole documents submitted as exhibit material will not be accepted for printing. Instead, exhibit material should be referenced and quoted or paraphrased. All exhibit material not meeting these specifications will be maintained in the Committee files for review and use by the Committee.
3. A witness appearing at a public hearing, or submitting a statement for the record of a public hearing, or submitting written comments in response to a published request for comments by the Committee, must include on his statement or submission a list of all clients, persons, or organizations on whose behalf the witness appears.
4. A supplemental sheet must accompany each statement listing the name, full address, a telephone number where the witness or the designated representative may be reached and a topical outline or summary of the comments and recommendations in the full statement. This supplemental sheet will not be included in the printed record.
The above restrictions and limitations apply only to material being submitted for printing. Statements and exhibits or supplementary material submitted solely for distribution to the Members, the press and the public during the course of a public hearing may be submitted in other forms.
The
Committee seeks to make its facilities accessible to persons with
disabilities. If you are in need of special accommodations, please
call 202-225-1721 or 202-225-1904 TTD/TTY in advance of the event
(four business days notice is requested). Questions with regard to
special accommodation needs in general (including availability of
Committee materials in alternative formats) may be directed to the
Committee as noted above.