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What a Deal: Senate Health Bill Will Pay Doctors Less for Medicaid Services, But Won't Let Docs Reduce Services

3:47 PM, Nov 19, 2009 • By JOHN MCCORMACK
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A doctor who's been following the health care debate closely writes in an email:

The Senate bill has a demonstration project, section 2074, that seeks to control costs in Medicaid by trying to create a fixed payment for doctors and hospitals for a given patient's stay in the hospital. The goal is to reduce costs but part 6 of the plan (page 541), copied below, states that one cannot reduce services as part of the project! So same services but less payment. Great demonstration. Great bill.

And by the way, the Secretary of HHS can change anything anytime he/she wants to.

(6) The Secretary and each State selected to participate in the demonstration project shall ensure that the demonstration project does not result in the Medicaid beneficiaries whose care is subject to payment under the demonstration project being provided with less items and services for which medical assistance is provided under the State Medicaid program than the items and services for which medical assistance would have been provided to such beneficiaries under the State Medicaid program in the absence of the demonstration project.

(c) WAIVER OF PROVISIONS.-Notwithstanding section 1115(a) of the Social Security Act (42 U.S.C. 1315(a)), the Secretary may waive such provisions of titles XIX, XVIII, and XI of that Act as may be necessary to accomplish the goals of the demonstration, ensure beneficiary access to acute and post-acute care, and maintain quality of care.