The 2003 Medicare Modernization Act
Medicare Prescription Drug, Improvement, and Modernization Act
The Medicare Prescription Drug, Improvement, and Modernization Act, also called the Medicare Modernization Act or MMA, is a federal law of the United States, enacted in 2003. It produced the largest overhaul of Medicare in the public health program's 38-year history.
What is the Medicare Modernization Act?
On December 8, 2003, the President signed into law Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. This new law amended section 1144 of the Social Security Act to require the Commissioner of Social Security to conduct additional outreach efforts to identify individuals entitled to benefits ...
What is the legislative history of Medicare?
· The 2003 Medicare Modernization Act (MMA) is considered one of the biggest overhauls of the Medicare program. It established prescription drug coverage and the modern …
When was the Medicare Prescription Drug Act passed?
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) requires that these individuals receive their prescription drug coverage through Medicare, not their state's Medicaid program. A small copayment for each prescription is required; however, nursing home residents are exempt from the copayment. Low-income subsidies
What would a modernized Medicare look like?
· Public Law No: 108-173 (12/08/2003) Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Title I: Medicare Prescription Drug Benefit (Sec. 101) Amends …
What was the biggest change to Medicare brought about by the 2003 Medicare Modernization Act quizlet?
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was enacted in November 2003 and became effective on January 1, 2006. Two major changes occurred. A prescription drug benefit is now available for seniors and younger persons with disabilities who are covered by Medicare.
Why was Medicare Prescription Drug Improvement and Modernization Act passed?
In an attempt to relieve patients of some of the financial burden of prescription drugs, the government has enacted a law that provides new prescription drug coverage under Medicare: the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003.
When was the Medicare Modernization Act implemented?
On December 8, 2003, the President signed into law Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003.
Which was created by the Medicare Prescription Drug Improvement and Modernization Act to identify and recover?
Medicare Part D Prescription Drug benefit The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) made the biggest changes to the Medicare in the program in 38 years. Under the MMA, private health plans approved by Medicare became known as Medicare Advantage Plans.
What was notable about the Medicare Modernization Act of 2003 quizlet?
5. What was notable about the Medicare Modernization Act of 2003? The revision included a prescription drug benefit.
Who introduced the Medicare Modernization Act of 2003?
Speaker Dennis HastertThe bill was introduced in the House of Representatives early on June 25, 2003 as H.R. 1, sponsored by Speaker Dennis Hastert.
What was the purpose of the Durham Humphrey Amendment?
This amendment established the distinction between so-called legend (prescription) drugs and over the counter (nonprescription) drugs. The amendment also authorized the taking of prescriptions verbally, rather than in writing, and the refilling of prescriptions.
What is the purpose of the Deficit Reduction Act of 2005?
The Deficit Reduction Act of 2005 (DRA) grants states flexibility to modify their Medicaid programs in ways that could negatively affect children and families' access to care. On the other hand, some of the provisions allow states to expand eligibility and thus access to services.
What is the Medicare Integrity Program?
The Medicare Integrity Program (MIP) provides funds to the Centers for Medicare & Medicaid Services (CMS--the agency that administers Medicare--to safeguard over $300 billion in program payments made on behalf of its beneficiaries.
When was Medicare Part D added to the Medicare benefit package what services did it add?
Medicare did not cover outpatient prescription drugs until January 1, 2006, when it implemented the Medicare Part D prescription drug benefit, authorized by Congress under the “Medicare Prescription Drug, Improvement, and Modernization Act of 2003.”[1] This Act is generally known as the “MMA.”
When did Medicare Part D become mandatory?
January 1, 2006The benefit went into effect on January 1, 2006. A decade later nearly forty-two million people are enrolled in Part D, and the program pays for almost two billion prescriptions annually, representing nearly $90 billion in spending. Part D is the largest federal program that pays for prescription drugs.
What is one innovation in healthcare that was established through Medicare?
Since its introduction in 1965, Medicare has caused a dramatic expansion in hospital infra- structure, increased medical device patenting, and led to the diffusion of imaging technologies.
When was Medicare Modernization Act enacted?
Signed into law by President George W. Bush on December 8, 2003. The Medicare Prescription Drug, Improvement, and Modernization Act, also called the Medicare Modernization Act or MMA, is a federal law of the United States, enacted in 2003. It produced the largest overhaul of Medicare in the public health program's 38-year history.
When did Medicare Advantage start?
Medicare Advantage plans. With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the Original Medicare plan (Parts A and B).
What is Medicare Part D?
Main article: Medicare Part D. The MMA's most touted feature is the introduction of an entitlement benefit for prescription drugs, through tax breaks and subsidies. In the years since Medicare's creation in 1965, the role of prescription drugs in patient care has significantly increased.
How many Americans were enrolled in HSAs in the first 10 years?
After the first 10 years over 12 million Americans were enrolled in HSAs (AHIP;EBRI).
When was the MMA signed?
The MMA was signed by President George W. Bush on December 8, 2003, after passing in Congress by a close margin.
When was the H.R. 1 bill introduced?
The bill was introduced in the House of Representatives early on June 25, 2003 as H.R. 1, sponsored by Speaker Dennis Hastert. All that day and the next the bill was debated, and it was apparent that the bill would be very divisive. In the early morning of June 27, a floor vote was taken. After the initial electronic vote, the count stood at 214 yeas, 218 nays.
Can formularies be used to restrict prescription drug choices?
formularies can be used to restrict prescription drug choices. prescription coverage can be deferred to the patient or a Medicare Part D prescription plan. care other than emergency care can be restricted to a particular region. federal reimbursement can be adjusted according to the health risk of the enrollees.
What Is the Medicare Modernization Act of 2003?
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 — also known simply as the Medicare Modernization Act (MMA) — is a sweeping piece of legislation that created a prescription drug benefit for millions of Medicare beneficiaries.
What Was the Impact of the Medicare Prescription Drug Improvement and Modernization Act?
The Medicare Modernization Act has impacted the program and its beneficiaries in significant ways. Perhaps the greatest impact is a massive enrollment shift to Medicare Advantage plans.
Medicare Modernization Act Pros and Cons
The Medicare Modernization Act expanded prescription drug coverage to millions of older and disabled Americans.
What is Medicare Modernization?
Medicare modernization: the new prescription drug benefit and redesigned Part B and Part C
When was Medicare created?
When Medicare was created in 1965 , its purpose was to protect seniors from the catastrophic costs of long hospital stays and expensive medical procedures (1–3). Since then, Medicare has expanded the scope of its benefits, the populations it covers, and, consequently, its costs.
What is CMS in healthcare?
The Centers for Medicare and Medicaid Services (CMS) administers all aspects of the Medicare program, including making decisions about covered services, determining payment rates and policies, administering claims, educating beneficiaries and health care providers, and conducting research on alternative health care delivery systems.
How much does Medicare pay for a drug?
For drug costs exceeding $5100, Medicare will pay 80%, the plan will pay 15%, and the beneficiary will pay 5%.
Why do Medicare Advantage plans have to bid?
The competitive bidding system is intended to encourage plans to compete to offer the best benefits at the lowest prices for beneficiaries.
How many parts are there in Medicare?
There are four distinct parts to the Medicare program: Parts A, B, C, and D. CMS organizes, funds, and administers each part separately.
How many therapeutic categories are there in the CMS?
The Model Guidelines, released on January 3, 2005, consist of 41 broad therapeutic categories based on similar groups of diagnosis codes; 137 pharmacologic classes generally based on similar mechanisms of action or chemical structure; and 146 unique therapeutic categories and pharmacologic classes. A plan's formulary must include at least two drugs in each therapeutic category or class. CMS may require more than two drugs per class when additional drugs offer unique and important efficacy and safety advantages.
What items were reduced in the 2005 Medicare payment?
Provides that for 2005 the payment amount for certain items, oxygen and oxygen equipment, standard wheelchairs, nebulizers, diabetic lancets and testing strips, hospital beds and air mattresses, will be reduced.
What is SSA Title 3?
Title III: Combatting Waste, Fraud, and Abuse - (Sec. 301) Amends SSA title XVIII to allow the Secretary to make a conditional Medicare payment if a primary plan has not made or cannot reasonably be expected to make prompt payment. Requires the payment to be contingent on reimbursement by the primary plan to the appropriate Medicare trust fund. Requires a primary plan as well as an entity that receives payment from a primary plan to reimburse the Medicare Trust Funds for any payment made by the Secretary if the primary plan was obligated to make payment. Makes other changes with regard to Medicare as a secondary payer to address the Secretary's authority to recover payment from any and all responsible entities and to bring action, including the collection of double damages, to recover payment under the Medicare secondary payer provisions.
Which title directs the Secretary to request the Institute of Medicine of the National Academy of Sciences to conduct an evaluation of the
Directs the Secretary to request the Institute of Medicine of the National Academy of Sciences to conduct an evaluation of the peer review program under SSA title XI.
When did the CCA program begin?
241) Directs the Secretary to establish a program for the application of comparative cost adjustment in CCA areas, to begin January 1, 2010, and last six years, and to test whether direct competition between private plans and the original Medicare fee-for-service program will enhance competition in Medicare.
Who conducts a study for a report to the Congress on the extent to which drug utilization and access to covered
Requires the Comptroller General to conduct a study for a report to the Congress on the extent to which drug utilization and access to covered part D drugs by subsidy eligible individuals differs from such utilization and access for individuals who would qualify as such subsidy eligible individuals except for application of the assets test.
What is MEDPAC report?
Requires a Medicare Payment Advisory Commission (MEDPAC) study and report to Congress with respect to authority regarding disapproval of unreasonable beneficiary cost-sharing.
What is the President's action on Medicare?
Today the President signed into law the historic Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which will help to create a modern Medicare system, allow for the biggest improvements in senior health care in nearly 40 years, and provide seniors with prescription drug benefits ...
When did Medicare cut drug costs?
Beginning in 2006, seniors without coverage would be able to join a Medicare-approved plan that would cut their yearly drug costs roughly in half, in exchange for a $35 monthly premium. In many cases, the savings will be even greater.
How much money would a senior save with no drug coverage?
Seniors with no drug coverage and monthly drug costs of $200 would save more than $1,700 on drug costs each year. Seniors with no drug coverage and monthly drug costs of $800 would save nearly $5,900 on drug costs each year.
How much does Medicare cover for seniors?
Seniors would be protected again high out-of-pocket costs with Medicare covering 95% of drug costs over $3,600 per year. Low-income seniors will receive additional help paying for their medicines. A $600 annual subsidy would be added to their drug discount card.
How many seniors are covered by Medicare?
For the first time in Medicare's history, a prescription drug benefit will be offered to all 40 million seniors and disabled Americans in Medicare to help them afford the cost of their medicines.
What percentage of Medicare subsidy is required by the Trustees?
For the first time ever, the legislation will require the Medicare Trustees to analyze the combined fiscal status of the Medicare Trust Funds and warn Congress and the President when Medicare's general fund subsidy exceeds 45 percent.
How does private sector competition affect Medicare?
Private sector competition will result in more innovation and flexibility in coverage. This will be a significant improvement over the way benefits are provided in Medicare today -where politicians and bureaucrats, rather than health care markets, dictate what is covered and what is paid.
What is the Medicare Modernization Act?
This article also probes whether or not the bill has been successful in meeting the needs of the elderly population to gain secure access to affordable prescription medicine as well as helping the federal government lower its spending. Based on available literature, the Modernization Act has a limited advantage to the people it seeks to serve, while giving private companies more money and business. The Medicare Modernization Act fails to answer the needs of the elderly population to have better access to prescription drug because. While it offers more services and benefits, the MMA does not answer the problem on cost related to medication.
Does Medicare cover disabled people?
The program also covers people under 65 years old who are disabled and are not capable of holding employment. Traditionally, the Medicare provides hospitalization and medical insurance to the elderly [1]. Later amendments allowed an individual to enhance the services by integrating a private health plan into Medicare for an additional cost.
Is Medicare Modernization Act a failure?
Those who believe that the Medicare Modernization Act is a failure have based their arguments on some points. For one, Medicare users can’t avail of the drug prescription benefit without getting involved with private health insurers and paying for monthly premiums. While this is not an issue for some, there are elderly people whose monthly stipends are meager. They could not afford the premiums. Although the MMA provides that this type of people can be accommodated and given prescription drugs for free, the question would lie on what type of drugs would they get, given that they are not paying for them? This would also imply that the MMA becomes discriminatory based on income. Those who can afford to pay get more, while those who cannot get less. This beats the very essence of Medicare being a social program.
When was Medicare Modernization Act enacted?
The Medicare Prescription Drug, Improvement, and Modernization Act, also called the Medicare Modernization Act or MMA, is a federal law of the United States, enacted in 2003. It produced the largest overhaul of Medicare in the public health program's 38-year history.
What does Congress do in the process of passing legislation?
Congress makes many decisions in the process of passing legislation, such as on the procedures for debating the bill, whether to change the bill before voting on passage, and even whether to vote on passage at all. You can learn more about the various motions used in Congress at EveryCRSReport.com.
When was the MMA signed?
It produced the largest overhaul of Medicare in the public health program's 38-year history. The MMA was signed by President George W. Bush on December 8, 2003, after passing in Congress by a close margin. This summary is from Wikipedia. Source: Wikipedia. Show More Summary Show Less Summary.
Summary
On December 8, 2003, the President signed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, P.L. 108-173. On November 22, 2003, the House of Representatives voted 220 to 215 to approve H.R. 1, the Medicare prescription drug and modernization conference agreement.
Overview
On December 8, 2003, the President signed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Earlier, the House of Representatives voted 220 to 215 to approve H.R. 1, the conference agreement, on November 22, 2003. The Senate voted 54 to 44 to approve the conference agreement on November 25.
Prescription Drugs
Overview. The legislation establishes a new Voluntary Prescription Drug Benefit Program under a new Part D of Title XVIII of the Social Security Act. Effective January 1, 2006, a new optional benefit will be established under a new Part D.
Medicare Advantage
The Act establishes the Medicare Advantage (MA) program under Part C of Medicare, to replace the Medicare+Choice program. MA local plans continue to be offered as coordinated care and other plans on a county-wide basis.
Cost Containment
The Act requires the President to propose and Congress to consider legislation to address Medicare spending any time general revenue funding (6) of Medicare is projected to exceed 45% in two consecutive years.
Administration of Medicare Part C and Part D
The Medicare program is administered by the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS). Both the House and Senate bills would have established a new agency to administer Medicare Advantage, and Part D, prescription drugs within HHS but separate from CMS.
Appeals, Regulatory, and Contracting Provisions
The Act contains numerous provisions addressing Medicare appeals, regulatory relief, and contracting reform.
Overview
The Medicare Prescription Drug, Improvement, and Modernization Act, also called the Medicare Modernization Act or MMA, is a federal law of the United States, enacted in 2003. It produced the largest overhaul of Medicare in the public health program's 38-year history.
The MMA was signed by President George W. Bushon December 8, 2003, after …
Prescription drug benefits
The MMA's most touted feature is the introduction of an entitlement benefit for prescription drugs, through tax breaks and subsidies.
In the years since Medicare's creation in 1965, the role of prescription drugs in patient care has significantly increased. As new and expensive drugs have come into use, patients, particularly senior citizensat whom Medicare was targeted, have found prescriptions harder to afford. The …
Medicare Advantage plans
With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insuranceplans, instead of through the Original Medicare plan (Parts A and B). These programs were known as "Medicare+Choice" or "Part C" plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the compensation and business practices for insurers that offer these plans changed, a…
Health savings accounts
The MMA created a new Health Savings Account statute that replaced and expanded the previous Medical Savings Account law by expanding allowable contributions and employer participation. After the first 10 years over 12 million Americans were enrolled in HSAs (AHIP;EBRI).
Other provisions
While nearly all agreed that some form of prescription drug benefit would be included, other provisions were the subject of prolonged debate in Congress. The complex legislation also changed Medicare in the following ways:
• it mandated a six-city trial of a partly privatized Medicare system (by 2010)
• it gave an extra $25 billion to rural hospitals (at the request of congressional representatives in the rural West)
Legislative history
According to the New York Times December 17, 2004 editorial W.J."Billy" Tauzin, the Louisiana Republican who chaired the Energy and Commerce Committee from 2001 until February 4, 2004 was one of the chief architects of the new Medicare law. In 2004 Tauzin was appointed as chief lobbyist for the Pharmaceutical Research and Manufacturers of America(PhRMA), the trade association and lobby group for the drug industry with a "rumored salary of $2 million a year," dr…
Costs
Initially, the net cost of the program was projected at $400 billion for the ten-year period between 2004 and 2013. Administration official Thomas Scullyinstructed analyst Richard Foster not to tell Congress of Foster's finding that the cost would actually be over $500 billion. One month after passage, the administration estimated that the net cost of the program over the period between 2006 (the first year the program started paying benefits) and 2015 would be $534 billion. As of F…
Bar to negotiation of prescription drug prices
Since the enactment of Medicare Prescription Drug, Improvement, and Modernization Act in 2003, only insurance companies administering Medicare prescription drug program, not Medicare, have the legal right to negotiate drug prices directly from drug manufacturers. The Medicare Prescription Drug Act expressly prohibited Medicare from negotiating bulk prescription drug prices. The "donut hole" provision of the Patient Protection and Affordable Care Actwas an attem…