NATIONAL PATIENT ADVOCATE FOUNDATION

NPAF Sets Policy Agenda for 2002
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The NPAF 2002 federal policy agenda includes:

MANAGED CARE REFORM: PATIENT'S BILL OF RIGHTS

• Congress is urged to pass a meaningful and enforceable Patient's Bill of Rights.
• Legislation should include an internal and external appeals process that is binding upon the health plan.
• Reasonable health plan accountability provision should be included.
• Routine clinical trial patient costs should be a covered benefit.
• Congress is encouraged to include genetic non-discrimination for health insurance and employment.

MANAGED CARE OMBUDSMAN PROGRAM

• Health Care Consumer Assistance Fund should be included in final PBOR legislation.
• Case managers should have necessary qualifications.
• Nonprofit entities should be eligible to apply directly to HHS for funding.

RESPONSIBLE REFORM OF MEDICARE REGULATIONS

• Congress is encouraged to pass a Medicare regulatory reform bill this year.
• CMS should issue timely coverage information to patients and providers.
• Expedite coverage approval for new therapies and technologies.

MEDICARE PRESCRIPTION DRUG BENEFIT

• Should include private plans and CMS-sponsored safety net plan.
• 100% premium support for beneficiaries at or below 135% of poverty.
• Stop-loss protection should not exceed $4000.
• Patient access to out-of-network pharmacy if no network pharmacy available.

MEDICARE PART B COVERAGE OF ORAL ANTI-CANCER DRUGS

• Medicare benefits should include therapies for cancer available only in oral form.
• Congress is encouraged to pass H.R. 1624 and S. 913 this year.

BALANCED REFORM FOR MEDICARE CANCER CARE REIMBURSEMENT

• Medicare should neither overpay nor underpay for covered benefits.
• Balanced reform should not compromise access to cancer care.
• Reform to AWP and practice expense reimbursement implemented concurrently.

MEDICARE OMBUDSMAN PROGRAM

• Congress is encouraged to establish a Medicare patient and provider ombudsman program.
• Case managers should have necessary qualifications.
• Nonprofit entities should be eligible serve as Medicare beneficiary ombudsman.

MEDICARE HOSPITAL OUTPATIENT REIMBURSEMENT

• Congress should ensure that access to hospital outpatient care is not compromised.
• Reimbursement rate should reflect true cost of providing care to beneficiaries.

MEDICARE COVERAGE OF INJECTABLE THERAPIES

• CMS is encouraged to provide coverage directive to Medicare carriers and fiscal intermediaries to ensure a consistent reimbursement policy for all beneficiaries.
• CMS should follow Congressional intent outlined in Committee Report.

BIOMEDICAL RESEARCH FUNDING

• Congress is encouraged complete five-year plan to double funding for NIH.
• Congress should exercise restraint on restricting biomedical research funding.•