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THE NATIONAL ACADEMIES
Institute Of Medicine
Committee on Medicare Coverage Extensions
Committee on Nutrition Services for Medicare Beneficiaries
Committee on the Reimbursement of Services for Medicare Patients Enrolled in Clinical Trials

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Congressional Briefing
Tuesday, Dec. 14, 1999 - 1:30 p.m.
H-137 - The Capitol

on

EXTENDING MEDICARE COVERAGE AND REIMBURSEMENT

Three new reports from the Institute of Medicine (IOM) of the National Academies examine the extension of Medicare benefits for a number of services for which coverage or reimbursement is now excluded or limited. These services include nutrition therapy, dental services, skin cancer screening, routine care during clinical trials, and immunosuppressive drugs for transplant recipients.

As requested in the Balanced Budget Act of 1997 (PL105-33), these reports look at both the evidence for extending coverage and the cost to Medicare of doing so. Medicare emphasizes care -- especially hospital care -- for acute illnesses and injuries. Congress has broadened coverage to include, for example, some preventive services such as breast cancer screening and a few prescription drugs, but cost concerns have often limited further extensions.

The three reports are as follows:

EXTENDING MEDICARE COVERAGE FOR PREVENTIVE AND OTHER SERVICES -- This report discusses broad issues in coverage decision making and also reviews the evidence base related to skin cancer screening, dental services for seriously ill patients, and the current 3-year limit on coverage of immunosuppressive drugs. It will be presented by ROBERT L. LAWRENCE, M.D., Associate Dean for Professional Education and Programs, Johns Hopkins University School of Hygiene and Public Health and Chairman, Committee on Medicare Coverage Extensions, IOM.

THE ROLE OF NUTRITION IN MAINTAINING HEALTH IN THE NATION'S ELDERLY: EVALUATING COVERAGE OF NUTRITION SERVICES FOR THE MEDICARE POPULATION -- This report reviews the evidence related to nutrition therapy provided by trained health care professionals to manage health problems common among Medicare beneficiaries. It will be presented by LAWRENCE L. APPEL, M.D., M.P.H., Associate Professor of Medicine, Epidemiology and International Health, Johns Hopkins University Medical Institutions and Member, Committee on Nutrition Services for Medicare Beneficiaries, IOM.

EXTENDING MEDICARE REIMBURSEMENT IN CLINICAL TRIALS -- This report makes recommendations about reimbursement of routine care for Medicare beneficiaries enrolled in clinical trials. It will be presented by HENRY J. AARON, Ph.D., Senior Fellow in Economic Studies, Brookings Institution and Chairman, Committee on the Reimbursement of Services for Medicare Patients Enrolled in Clinical Trials, IOM.

Also available at this briefing will be copies of the recently released IOM report, DEFINITION OF SERIOUS AND COMPLEX MEDICAL CONDITIONS. In addition, staff will be in attendance to answer questions on its conclusions and recommendations.

This briefing was for members of Congress and congressional staff only. With the exception of "Definition of Serious and Complex Medical Conditions," which was released on an earlier date, these reports were publicly released on December 15, 1999. All can be found, in their entirety, on the Web site of the National Academies Press.