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Executive Summary

Medicare coverage of self-administered EPO by patients at home is a legislative priority for the Senate Finance Committee during the second session of the 101st Congress, committee staffers said. The Finance Committee also has asked the Bush Administration to comment on EPO coverage provisions included last year in budget reconciliation legislation passed by the committee. The EPO provision was one of dozens that were stripped from the committee-passed bill because they did not directly affect the budget deficit. Under the 1989 provision, self-administered EPO would have been covered by Medicare for individuals receiving home dialysis "subject to utilization controls deemed appropriate" by HHS. The Health Care Financing Administration announced Medicare coverage of EPO on June 1. Since program rules disallow coverage of self-administered drugs, home coverage of EPO was denied. In a report accompanying the 1989 provision, the Finance Committee noted: "Erythropoietin may be administered at the same time a kidney patient is dialyzing. Excluding Medicare coverage for erythropoietin administered by the patient at home will compel many kidney patients who receive dialysis at home to travel to facilities to receive treatment with the drug." The Medicare program encourages home dialysis to reduce treatment costs. Another legislative priority for the Senate Finance Committee is a long-term health care bill, which is expected to include some smaller "technical" provisions repealed along with the catastrophic care act last year. Described as a "little long-term care bill" by one staffer, the legislation could mandate Medicare coverage changes, such as eliminating the 210-day limit on hospice coverage and clarifying the definition of intermittent care for home care coverage, staffers say. In a break from past legislative cycles, the committee is planning to package Medicare policy provisions, such as the EPO and long-term care measures, as separate bills. For the past several years, almost all Medicare policy measures were included as provisions in budget reconciliation legislation. Staffers to the committee said Chairman Bentsen (D-Tex.) always has been a "reluctant suitor" in using the budget bill for Medicare legislation. Activities planned by the committee include confirmation hearings for HCFA administrator candidate Gail Wilenksy and HHS Assistant Secretary for Planning and Evaluation candidate Martin Gerry, the consideration of child care and a review of the Bush Administration's FY 1991 budget.

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