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HHS RESCINDS MEDICAID REGULATIONS!
MEDICAID NEWS
FOR IMMEDIATE RELEASE CONTACT:
CMS Media Affairs Office
Monday, June 29, 2009
(202) 690-6145
Department of Health and
Human Services (HHS) Secretary Kathleen Sebelius today announced that the
administration will rescind all or part of three Medicaid regulations that
were previously issued and delay
the enforcement of a fourth regulation. Each of these rules, in whole or in
part, had been subject to Congressional moratoria set to expire on July 1,
2009.
"These regulations, if left in place would have potentially adverse
consequences for Medicaid beneficiaries, some of our nation’s most
vulnerable people," said Secretary Sebelius. "By rescinding these rules, we
can expect that children will continue receiving services through their
schools, beneficiaries will be able to access all available case management
resources to help them better manage their health care, and outpatient
hospital and clinic services can continue to
be covered in the most efficient manner."
"The actions we are taking today are necessary to ensure that the states
have the flexibility they need to fully serve Medicaid-eligible
individuals," said Secretary Sebelius.
The Centers for Medicare & Medicaid Services (CMS) and HHS today are:
・ Rescinding a final rule, published December 28, 2007, that
would have eliminated reimbursement for school-based administrative
costs and costs of transportation to and from schools. The rescission
reflects concern that the rule could limit the Medicaid administrative
outreach activities of schools, and that the overall budgetary impact on
schools could potentially impact their ability to offer Medicaid
services to students.
・ Rescinding a rule, published November 7, 2008, that would have
limited the outpatient hospital and clinic service benefit for Medicaid
beneficiaries to the scope of services recognized as an outpatient
hospital service under Medicare. This rule was rescinded because CMS
became aware that coverage beyond that scope could not be easily moved
to other benefit categories, resulting in great impact than previously
anticipated.
・ Rescinding provisions of an interim final rule published
December 4, 2007, which would have restricted beneficiary access to case
management services. These provisions appeared to, in practice, restrict
beneficiary access to needed covered case management services, and limit
state flexibility in determining efficient and effective delivery
systems for case management services.
・ Delaying until June 30, 2010, the enforcement of portions of a
regulation that clarified limitations on health care related tax
programs so that CMS could determine whether states need additional
clarification or guidance. CMS may also further review the potential
impact of the regulation, and give additional consideration to
alternative approaches.
San Francisco Unified
School District Sues State of California Over Free Care
May 29, 2009
Click
here for the School District press release and copy of the pleadings.
Click here for the correspondence from
CMS that is the basis for the State's action.
What a Difference a
Day Election Makes!
Center for Children
and Families Director Mann Appointed
by Obama
Administration to
Direct Medicaid and CHIP
May 29, 2009
Secretary of Health and Human Services
Kathleen Sebelius announced today that Georgetown University Center for Children
and Families Director Cindy Mann has been appointed Director of the Center for
Medicaid and State Operations at the U.S. Department of Health and Human
Services (CMSO). CMSO oversees Medicaid and the Children’s Health Insurance
Program (CHIP) at the federal level. Mann will assume her new position on June
8. CCF is an independent, nonpartisan policy center based at Georgetown
University’s Health Policy Institute whose mission is to expand and improve
health coverage for America’s children and families.
Mann was an original cofounder of CCF along with Deputy Directors Joan Alker and
Jocelyn Guyer. In the four years since CCF began, it has become a nationally
recognized and respected voice on issues related to health coverage for children
and families at both the federal and state levels. Accomplishments include
serving as a key resource to policymakers, state and national organizations, and
the media during the reauthorization of CHIP and advising state-level
policymakers, program administrators and advocates on coverage and enrollment
policies.
Cindy Mann, J.D., is a research professor at Georgetown University, Health
Policy Institute and the executive director of the Center for Children and
Families at the Institute. Her work focuses on health coverage, financing, and
access issues affecting low-income populations. She has written extensively on
these issues -- and on how they relate to the Medicaid and CHIP, in particular
-- and has worked closely with state and federal policymakers and program
administrators on the design and implementation of Medicaid and CHIP. From
1999-2001, Ms. Mann was the director of the Family and Children's Health Program
Group at the Health Care Financing Administration (HCFA), now the Centers for
Medicare & Medicaid Services. In that capacity, she directed, at the federal
level, the implementation and oversight of the Medicaid program with respect to
families, children, and pregnant women, and oversaw the implementation of CHIP.
Prior to her work at HCFA, Ms. Mann led the Center on Budget and Policy
Priorities' federal and state health policy work. She also has extensive
state-level experience, having worked on health care, welfare, and public
finance issues in Massachusetts, Rhode Island, and New York. She holds a law
degree from New York University School of Law.
On May 1, 2009, the Federal Register
contained the following posting regarding a
proposed new final rule:
This rule proposes to rescind the
December 28, 2007 final rule entitled “Elimination of Reimbursement Under
Medicaid for School Administration Expenditures and Costs Related to
Transportation of School-Age Children Between Home and
School”; the November 7, 2008 final
rule entitled “Clarification of Outpatient Hospital Facility (Including
Outpatient Hospital Clinic) Services Definition”; and certain provisions of the
December 4, 2007 interim final rule with comment period entitled
“Optional State Plan Case Management
Services.”
In plain language, this new rule would
rescind CMS-2287-P2, the regulation that would have eliminated Medicaid
reimbursement for school-based administrative and transportation services;
portions of the Targeted Case Management regulation [CMS 2237-P]; and the
regulation dealing with hospital outpatient services [CMS-2213-P2]. And,
since it only calls for a thirty day public comment period, it would go into
effect before the June 30 expiration of the current moratorium. For those
of you in the school community, that means that reimbursement for administrative
and transportation services will continue.
The regulation also solicits public
comment. Please consider submitting comments of your own or those of your
organization, pro or con.
Take that, Dreadful Dennis!
Call to Action: Live
Webcast with CDF* President Marian Wright Edelman
May 1, 2009
Momentum is building—the next few weeks provide our nation with an unprecedented
opportunity to make critical changes to our broken health care system. Our goal
is to provide affordable, comprehensive health coverage to everyone this
year—especially children.
Join CDF President Marian Wright Edelman and other child advocates for a live
webcast and learn how you can step up and take action at this crucial time for
our nation. Mrs. Edelman's speaking engagements are powerful experiences that
change lives. Don't miss this exciting event!
*The Children's Defense Fund's Leave No
Child Behind® mission is to ensure every child a Healthy Start, a Head Start, a
Fair Start, a Safe Start, and a Moral Start in life and successful passage to
adulthood with the help of caring families and communities.
Sebelius, Napolitano, Besser to Host Webcast on Swine
Flu, Answers Questions from the American People
April 29, 2009
Health and Human Services Secretary Kathleen Sebelius, Homeland Security
Secretary Janet Napolitano and Acting Director of the Centers for Disease
Control and Prevention, Dr. Rich Besser will host a Webcast to answer questions
and provide information directly to the American people regarding the 2009 H1N1
flu on Thursday at 1:00 p.m. EDT. The Webcast
can be viewed at
www.hhs.gov and
www.cdc.gov.
"At times like this, clear accurate information is one of the most powerful
tools we have and we look forward to answering questions and speaking directly
to the American people," said Secretary Sebelius. "Our administration believes
in using new methods to engage the American people and ensure they can speak
directly to their public officials. This Webcast is an important part of that
effort."
"It's imperative that the American people know exactly what their government is
doing, and exactly what they can do themselves to mitigate the spread of this
virus," said Secretary Napolitano. "Everyone has a part to play in this, and
it's important that the lines of communications are open."
Questions for the officials can be submitted by emailing
hhsstudio@hhs.gov. Additional information regarding the Webcast is
included below.
WHAT: Webcast regarding 2009 H1N1 flu virus
WHEN: Thursday, April 30, 2009
1:00 p.m. EDT
WHERE: Watch the Webcast live at
www.hhs.gov or
www.cdc.gov. Submit questions for the Webcast by emailing
hhsstudio@hhs.gov. Registration for the Webcast is not required.
Please note, you will need Flash (http://www.adobe.com)
installed on your computer in order to view the live video stream. You can test
your ability to view the Flash video stream starting at 10 a.m. EDT on Thursday
by visiting
www.hhs.gov or
www.cdc.gov.
NOTE: Networks can access the Webcast via outbound fiber from VYVX:100355
Sebelius Confirmed as HHS Secretary
April 28, 2009
The Senate approved the nomination
of Kathleen Sebelius to head the Department of Health and Human Services,
filling the final seat in President Obama's Cabinet on the eve of his 100th
day in office.
Democrats had sought a quick vote on the
Kansas governor as Congress moves ahead with health-care reform this summer, but
Republicans slowed Sebelius's advancement because of her record in favor of
abortion rights. GOP procedural objections faded with the recent outbreak of
swine flu and the threat of a global pandemic. Sebelius was confirmed by a 65-31
vote this afternoon.
Lewin Group Study of Impact of CMS Regulations Begins
April 22, 2009
Last year, as part of Congressional
action on the seven regulations proposed by CMS, the agency was required to
contract with an independent company to produce a report on the fiscal impact
and utilization of several of those regulations. That report was to be
presented to Congress in April, 2009. The Lewin Group was selected to
complete the study, and that process has just begun.
A copy of the draft questionnaire being used by Lewin is attached.
More on this story to follow.
Sebelius Confirmation Could Occur as Early as Tuesday
April 22, 2009
The Senate could vote as early as
Tuesday on the nomination of Kansas Gov. Kathleen Sebelius to be Secretary of
Health and Human services. Senate Majority Leader Harry Reid announced
that up to eight hours of debate on her nomination is scheduled to begin at 10
a.m. Tuesday. She will need 60 votes for confirmation.
At the urging of conservative religious
groups, some Senate Republicans have opposed Sebelius because of her support for
abortion rights. However, one of her strongest supporters has been fellow
Kansan, Republican Sen. Pat Roberts, who is an ardent opponent of abortion. The
Senate Finance Committee endorsed her selection on a vote of 15-8.
If the Senate approves her nomination,
Sebelius will become the final member of President Obama's cabinet to be
confirmed. The lack of an HHS Secretary has slowed progress filling several
other critical posts, including Director of the Centers for Medicare and
Medicaid Services.
Obama
Selects Kansas Governor Sebelius for Secretary of
HHS
March 2, 2009
WASHINGTON -
Making it official, President Barack Obama says he
has chosen Kansas Gov. Kathleen Sebelius for health
and human services secretary. He also has
picked Nancy-Ann DeParle as the director of the
White House Office for Health Reform. The
president's announcement comes just days before he
holds a White House summit on health care.
Lawmakers from both parties and representatives of
major interest groups, from insurers to drug
companies to consumers, will attend.
President Barack Obama said that his
administration would move more than $15 billion in federal Medicaid dollars to
states on Wednesday, a move meant to help stem a healthcare crisis in the face
of rising unemployment and growing ranks of uninsured people.
“That means by the time most of you get home, money will be waiting to help 20
million vulnerable Americans in your states keep their healthcare coverage,”
Obama told governors in Washington today at the National Governors Association
annual winter meeting.
In his White House speech, the president reiterated that the funding—part of the
much larger economic stimulus package—“is not a blank check.” Obama said that
the dollars are “intended to go directly toward helping struggling Americans
keep their healthcare coverage.” Several of the nation’s governors have said
that the infusion of federal money into their Medicaid coffers, more than $87
billion over the next three years, could free up state dollars previously marked
for the program to instead go to other programs outside of the healthcare arena.
FMAP
State Allocations In the ARRA*
February 22, 2009
The Federal
Medical Assistance Percentages (FMAPs) are used in
determining the amount of Federal matching funds for
State expenditures for assistance payments for
certain social services, and State medical and
medical insurance expenditures. The Social Security
Act requires the Secretary of Health and Human
Services to calculate and publish the FMAPs each
year.
Daschle
Withdraws Nomination for Health and Human Services
Secretary
1:25 PM, EST
Tom Daschle
has withdrawn his nomination for health and human
services secretary, and President Obama has
accepted.
resident
Obama stood by Daschle Monday, telling reporters
that he "absolutely" supports the former South
Dakota senator. But the president accepted Daschle's
withdrawal Tuesday morning.
It was unclear whether Daschle, with his deep
network of ties in the Senate stemming in part from
his time as majority leader, would have been able to
weather the criticism in confirmation.
Senators were reluctant to state publicly any
opposition to Daschle's nomination in recent days.
But that started to crack Tuesday morning, as
Republican Sen. Jim DeMint called for Obama to
withdraw the nomination -- becoming the first
senator to say that the former majority leader's tax
problems are disqualifying.
DeMint told FOX News that Daschle's failure to pay
$134,000 in federal taxes reflects a "problem with
integrity" that the government cannot afford to
tolerate. DeMint spoke out against Daschle as a
number of prominent newspapers, including The New
York Times, called for the South Dakota Democrat to
drop his bid.
DeMint said he came to that conclusion after it
became "obvious" that Daschle knew about the tax
problems long before his nomination and did nothing
to make it right.
"The average American would likely face criminal
charges with tax evasion of this size, yet he did
not address the issue until he was nominated," he
said.
Daschle has since paid $146,000 in back payments and
interest, and apologized on Monday for what he
called income tax errors.
The New York Times, in its editorial, complained
that Timothy Geithner was already confirmed as
treasury secretary despite his tax problems. "It
would send a terrible message to the public if we
ignore the failure of yet another high-level nominee
to comply with the tax laws," the Times
wrote. Several other newspapers, including the
Chicago Tribune, Philadelphia Inquirer, Boston
Globe, and Pittsburgh Post-Gazette, also have called
for Daschle to withdraw.
But Democratic Sen. Chuck Schumer earlier said
Daschle's own admission that he had failed to pay
the taxes was reason enough to forgive his sin.
"Clearly it was a bad mistake, and Daschle was the
first to come up with this in June 2008," Schumer
said. "It wasn't discovered by the administration's
vetting team but rather by Daschle himself much
earlier and he brought it to the attention of the
administration's vetting team when he was chosen as
a potential nominee for HHS."
New Administration Halts Pending Bush Regulations
January 20, 2009
From the AP
Newswire: One of President Barack Obama's first acts as
president was to order federal agencies to halt all
pending regulations until his administration can review
them. The order went out Tuesday afternoon, shortly after
Obama was inaugurated president, in a memorandum signed by
new White House chief of staff Rahm Emanuel. The notice of
the action was contained in the first press release sent out
by Obama's White House, and it came from deputy press
secretary Bill Burton.
This may or may not
affect CMS 2287 and 2237 (case management). Stay
tuned.
A number of credible sources reported
today that the House version of the new economic stimulus legislation contains
language extending the moratoria on the six CMS regulations from April 1,
2009, to October 1, 2009. Official confirmation/language will be
posted here as soon as it is available.
Updated 1/16/09 - Click
here for the official news
release from the House and herefor the first official printing of the House version. You will
not find the moratoria extension language in this version, as it is not in final
form.
CMS Provides Written Answers to Questions From the NAME Conference
January 5, 2009
At the National Alliance for Medicaid in
Education, Inc. (NAME) 2008 Annual Conference, the Centers for Medicare and
Medicaid Services (CMS) conducted a panel presentation regarding Medicaid
services provided in schools. Conference participants submitted both
written and oral questions to the CMS panel. Due to time constraints, CMS
was unable to answer all of those questions. NAME recently received
written answers from CMS and they are
posted on the NAME site.
You can obtain further information about
NAME and the benefits of membership by clicking
here.
Reaching Out on Health Care
Daschle Visits Indiana for Grass-Roots Forum
December 31, 2009
Even before taking office or introducing
concrete policy proposals, the administration-in-waiting is moving to build
public support around the broad notion that the U.S. health system needs an
overhaul. To Washington veterans, the approach may seem backward, or even naive,
but Obama is betting that the energetic, technology-savvy supporters who fueled
his candidacy will act as a potent counterbalance to the traditionally powerful
special interests that have defeated similar reform efforts.
Full story here.
CDF Releases State of America's Children 2008® Report
December 25, 2008
The Children’s Defense Fund recently
released its State of America's Children 2008 report, a compilation of the most
recent and reliable national and state-by-state data on poverty, health, child
welfare, youth at risk, early childhood development, education, nutrition and
housing. The report provides a statistical compendium of key child data showing
epidemic numbers of children at risk: the number of poor children has increased
nearly 500,000 to 13.3 million, with 5.8 million of them living in extreme
poverty, and nearly 9 million children lack health coverage, with both numbers
likely to increase during the recession. The number of children and teens killed
by firearms also increased after years of decline.
President-elect
Obama Nominates Arne Duncan as Secretary of Education
December 16, 2008
President-elect Barack
Obama has nominated superintendant of Chicago schools Arne
Duncan as Secretary of Education.
President-elect Obama
said, “In the next few years, the decisions we make about how to
educate our children will shape our future for generations to
come. When it comes to school reform, Arne is the most hands-on
of hands-on practitioners. For Arne, school reform isn’t just a
theory in a book – it’s the cause of his life. And the results
aren’t just about test scores or statistics, but about whether
our children are developing the skills they need to compete with
any worker in the world for any job. With his leadership, I am
confident that together, we will bring our education system –
and our economy – into the 21st century, and give all our kids
the chance to succeed."
Arne Duncan said:
"Whether it’s fighting poverty, strengthening the economy or
promoting opportunity, education is the common thread. It is the
civil rights issue of our generation and it is the one sure path
to a more equal, fair and just society. While there are no
simple answers, I know from experience that when you focus on
basics like reading and math, when you embrace innovative new
approaches to learning, and when you create a professional
climate that attracts great teachers -- you can make a
difference for children."
The official nomination
for Secretary of Education announced today is below:
Arne Duncan, Secretary
of Education
For the past seven years, Arne Duncan has served as the Chief
Executive Officer of the Chicago Public Schools, where he has
earned a solid reputation for confronting pressing issues in
public education, such as transforming weak schools and
increasing teacher quality. Prior to joining the public school
system, Duncan directed the the Ariel Education Initiative, a
program which seeks to create eductional opportunities for
inner-city children on the South Side of Chicago. In 2006, the
City Club of Chicago names Duncan Citizen of the Year. Duncan
comes from a family of educators; his mother founded and has run
a notable Chicago tutoring program for 48 years. Duncan
graduated magna cum laude from Harvard University.
President-Elect's Transition Website can be found
here. Policy updates, legislative goals, introduction of appointees,
etc. Your one-stop shop for the new administration
December 15, 2008
They're At It Again
December 6, 2008
From an Email originating from CMS:
From: Johnson, Donald N. (CMS/OL)
Sent: Friday, December 05, 2008 5:30 PM
Subject: HHS Releases Final Report to Congress on the Medicaid Regulations under
Section 7001(c)(1) of the Supplemental Appropriations Act of 2008
Importance: High
I am pleased to inform you of the release of the attached Department of Health
and Human Services report, “Final Report to Congress on the Medicaid Regulations
under Section 7001(c)(1) of the Supplemental Appropriations Act of 2008”. This
report was transmitted to the House Energy and Commerce and the Senate Finance
committees on December 3, 2008.
Required under Section 7001(c)(1) of the Supplemental Appropriations Act, 2008 (P.L.
110-252), this report discusses in detail the problems the Medicaid regulations
fully under moratoria were intended to address, how the design of the
regulations were intended to address these specific problems, and the Centers
for Medicare & Medicaid Services (CMS’) legal authority for each regulation. The
following four rules are addressed in this report:
·
Proposed rule, published January 18, 2007 – Medicaid Program; Cost Limit for
Providers Operated by Units of Government and Provisions to Ensure the Integrity
of Federal-State Partnership (CMS-2258-P)
·
Proposed rule, published May 23, 2007 – Medicaid Program; Graduate Medical
Education (CMS-2279-P)
·
Final rule, published December 28, 2007 – Medicaid Program; Elimination of
Reimbursement Under Medicaid for School Administration Expenditures and Costs
Related to Transportation of School-Age Children Between Home and School
(CMS-2287-F)
·
Proposed rule, published August 13, 2007 – Medicaid Program; Coverage for
Rehabilitative Services (CMS-2261-P)
A copy of the report in .pdf format can
be download here. With
regard to 2287, notice that CMS uses the same tired old GAO and OIG reports of
waste and abuse in school-based administrative and transportation services that
they always drag out to try to make their point. It is good to note that
the dates they use are the dates of the reports, not the dates of the alleged
events, many of which occurred before the 2003 MAC Guide, some as long ago as the
late 1990's. Apparently CMS would have us believe that, once having been
told they are not in compliance, school districts continue their non-compliant
behavior.
The report also makes reference to the
1997 Technical Assistance Guide, which mysteriously disappeared from the CMS
site nearly two years ago
Some of the provisions in the Baucus proposal with the most important
implications for children and their families are:
1. Expanding SCHIP Coverage. The Baucus plan proposes a notable
expansion of SCHIP by creating a new requirement that all states cover children
at least to 250 percent of the federal poverty level (FPL). As of October 2008,
twenty-six states have enacted eligibility levels at or above 250 percent of the
FPL.
o States currently below 250 percent of the FPL. The plan would require
all states that have not yet expanded coverage to 250 percent of the FPL to do
so. If they wanted to expand further up the income scale than 250 percent of
the FPL, they would continue to have the option to do so.
o States already at or above 250 percent of the FPL. States that already
cover children above 250 percent of the FPL could continue to do so.
o Possible changes to SCHIP Financing. The plan acknowledges that SCHIP’s
capped financing structure can cause states to cut back or freeze enrollment,
and that this is a potential problem in a world in which everyone must enroll in
coverage. It suggests that changes will be made to SCHIP’s financing structure
to address this issue, as well as the increased need for funds created by
expansions to 250 percent of the FPL and beyond, but does not provide any
details.
2. Strengthening Medicaid A central part of the Baucus proposal is to
strengthen and expand Medicaid, which has long been a cornerstone of the health
care system. It already serves more than 50 million Americans and will play an
even more important role in the months ahead as unemployment rises and more and
more families lose their only access to affordable healthcare coverage.
o Expansion of Medicaid to 100 percent of the FPL. While not directly
aimed at children, the Baucus plan includes a proposal to expand coverage to all
people below 100 percent of the federal poverty level. If adopted it would not
only offer help to millions of adults, but also would ensure that children
living in poverty can enroll in the same source of coverage as their parents.
When children are covered through the same source of insurance as their parents,
they are more likely to enroll in coverage and to secure necessary care. .
o Ensuring Medicaid’s stability during difficult economic times. With the
proposed health care system relying heavily on Medicaid, the Baucus plan
acknowledges the importance of ensuring that Medicaid remains stable and strong,
including during difficult economic times. To that end, the Baucus plan calls
for increasing the federal Medicaid matching rates of states when an economic
downturn occurs. It notes a variety of options that could be used to determine
when additional federal matching funds should be made available, but does not
offer a detailed proposal.
White Paper on Health Care Reform
November 12, 2008
This morning Senate Finance Committee Chairman Max Baucus released an executive
summary of his white paper on health care reform. The 100-plus page white paper
will be released later this week. Click
here for the
executive summary.
Here is a quick summary of the parts affecting Medicaid and SCHIP:
Medicaid
· Recommends setting a national minimum Medicaid eligibility level at 100
percent of the poverty level, essentially eliminating categorical eligibility
below this level. Senator Baucus estimates that this would cover an additional
7.1 million people.
- States that already offer Medicaid coverage above 100 percent of poverty
would be required to continue to do so and would continue to receive the same
federal financial participation for those groups.
- The plan does not specify how the expanded coverage below 100 percent of
poverty would be financed, but says that it would “invest new Federal resources
to help states, and is committed to findings ways for the Federal government and
the states to share responsibility for the costs associated with increased
Medicaid enrollment.”
- No individuals currently eligible for Medicaid coverage would lose
eligibility under the plan.
· Recommends developing simplified, uniform enrollment and renewal
processes, updating eligibility systems, and additional federal support for
outreach efforts.
· Recommends establishing a new, permanent counter-cyclical Medicaid
financing mechanism that would trigger an automatic increase in the federal
match rate for Medicaid during times of economic downturn. This would alleviate
the need for Congress to pass legislation to increase the FMAP each time the
nation faces an economic crisis.
· Recommends eliminating the five-year ban on legal immigrants’ eligibility
for Medicaid and CHIP.
· Encourages efforts to improve quality and access in Medicaid and CHIP.
CHIP (the Children’s Health Insurance Program)
· Recommends setting a mandatory minimum CHIP eligibility level at 250
percent of poverty (29 states currently have CHIP eligibility levels lower than
that and have no expansions pending).
- States that already offer CHIP coverage above 250 percent of poverty
would continue to receive the same federal financial participation they receive
today.
· Calls attention to the insufficiency of CHIP allotments in the past, and
calls for the federal government to help states with the costs associated with
increased CHIP enrollment. The plan does not provide details, but cites the CHIP
reauthorization bills of 2007 as examples of how this might be done.
Financing
· The plan does not list specific sources of financing for the plan, but
includes a discussion of the savings that could be derived from:
- Reducing fraud, waste, and abuse;
- Increasing transparency;
- Reforming medical malpractice;
- Extracting savings from Medicare Advantage plans;
- Increasing efficiency in long term care; and
- Making changes to the current tax treatment of health care.
· Overall, the plan also envisions achieving savings by covering all
Americans, increasing wellness and prevention, and investing in quality
improvement efforts.
The Orphan Regulation - The One With No Moratorium Protection
November 10, 2008
On
Friday CMS published the final rule on the Medicaid outpatient
reimbursement. The rule can be found
here.
As an increasing number of states suffer severe financial problems, budget cuts
have reached schools. A
recent report from the
Center on Budget and Policy Priorities notes that . . . "at least 14 states have
implemented or are considering cuts that will affect low-income children’s or
families’ eligibility for health insurance or reduce their access to health care
services. Programs for the elderly and disabled are also being cut. At least 11
states are cutting medical, rehabilitative, home care, or other services needed
by low-income people who are elderly or have disabilities, or significantly
increasing the cost of these services. At least 13 states are cutting or
proposing to cut K-12 and early education; several of them are also reducing
access to child care and early education, and at least 17 states have
implemented or proposed cuts to public colleges and universities."
These facts are powerful arguments for protection of federal reimbursement for
school based administrative and transportation services, and must be addressed
by the new Congress before the current moratorium protecting those programs is
lifted on April 1.
Senator Stabenow (D-MI) Introduces Bill to
Protect Rehab and Case Management
October 7, 2008
On September 26 Senator Debbie Stabenow of Michigan introduced S. 3611, a bill
to To amend title XIX of the Social Security Act to improve the provision of
rehabilitation services and case management and targeted case management
services under the Medicaid program, and for other purposes. Full text
here in .pdf format. You can track
the bill at www.thomas.gov
Names
Being Mentioned as Potential Appointees for HHS Secretary
October 7, 2008
For McCain
Mike Huckabee, former governor of Arkansas
Mark McClellan, former administrator of Centers for Medicare and Medicaid
Services
Bobby Jindal, Louisiana governor
For Obama
Rosa DeLauro, Connecticut congresswoman
Howard Dean, Democratic National Committee chairman
Kathleen Sebelius, Kansas governor
Coming Soon - the New and Improved GregontheWeb
September 29, 2008
Congress overrides Medicare payment bill veto
July 15, 2008
Congress on Tuesday rejected President Bush's veto of legislation protecting
doctors from a 10.6 percent cut in their reimbursement rates when treating
Medicare patients (H.R. 6331, the Medicare Improvements for Patients and
Providers Act of 2008). The override vote in the House was a lopsided 383-41,
easily meeting the two-thirds threshold needed to nullify the president's veto.
About an hour later, the Senate voted to override, 70-26.
The bill also extends protection to the Departmental Appeals Board, which had
been the subject of a disemboweling by CMS late last year. Details to follow.
The Fat Lady Finally Sang!
I'm writing to tell you that it's official
June 30, 2008
Over the weekend the President signed the War Supplemental funding bill with
moratoria on six Medicaid regulations. Congratulations to all of you who worked
on the campaign to move Congress. It shows you what a lot of will,
determination and team effort can accomplish. You should never forget what you
accomplished and should be very happy. I am proud to be a small part of your
team.
Thank You!
Who Knows What Evil Lurks in the Hearts of Men?
June 1, 2008
That reference is from a radio show called “The Shadow,” which few of you will
remember since it went off the air in 1954. Unfortunately for us, it is also a
question we should be asking about the Centers for Medicare and Medicaid
Services.
Let me explain. On December 28, 2007, CMS published the final version of
CMS-2287, which eliminates federal reimbursement for school-based administrative
services and most school-based transportation services. Normally this rule
would have been implemented sixty days after publication, or February 28, 2008.
A six month moratorium was imposed on the rule, however, which would have made
the implementation date August 28, or thereabouts (60 days + 6 months). Over
the course of the months of March and April, however, CMS sent a variety of
messages that established the implementation date as June 30, 2008; September
30, 2008, September 1, 2008, the first day of the 2008/2009 school year,
[another moving target] and, if you believe the State of Georgia, February 28.
After a series of increasingly confusing messages from CMS, they seemed to
settle on June 30 as the last day of the current reimbursement program, and that
is the date LEAs and Congress have been using. CMS has had ample opportunity to
advise both if the date was something other than June 30 but has not done so.
Last week, several states were notified in writing by their CMS regional offices
that the implementation date is now September 1, 2008, not June 30.
Attempts have been made by several interested parties, including Congressional
staff, to obtain clarification from CMS regarding this most recent shift. The
only response from CMS – and most inquires have met with stony silence – has
shed no light on the subject and mimicked this email from CMS on February 8,
2008 (emphasis added)
"The publication of the final school-based rule (CMS-2287-F) on December 28,
2007 does not affect the ability of States to submit claims for costs incurred
prior to the effective date of the rule; the rule will be applied prospectively.
However, as you know, there's a six-month moratorium on CMS' ability to enforce
the rule, due to legislation recently signed into law. This moratorium is
scheduled to end June 30, 2008.
Final regulations are typically effective 60 days after publication; however,
due to the moratorium, that 60 day period starts once the moratorium ends. As a
result, the implementation date for the rule will technically be September 1,
2008. CMS never intended States and Schools to be in compliance with the final
rule prior to the start of the 2008-2009 school year, so the moratorium really
has no effect on that timeline . . . . Finally, although I indicated [in an
earlier email] that CMS was considering developing some sort of additional
guidance to address questions surrounding implementation of CMS-2287-F, there
are no official plans to do so at the current time and no format specified for
any guidance that may ultimately be issued.
Because that communication was not entirely clear, I made contact with Ms. Brown
shortly after her February email. She was kind enough to respond by phone. She
left a message on my voice mail. Here it
is in its entirety.
(You will probably have to download it to play it.)
And if this date confusion weren’t enough, there is a second issue. This one is
far more troublesome.
· Regardless of the implementation date, the only thing the
moratorium really does is allow LEAs to continue to claim FFP for services
delivered before that date
· CMS will certainly retain the right to review those claims
· CMS has repeatedly demonstrated, in previous audits, that it will
audit administrative service programs for years prior to the May, 2003
Medicaid Administrative Claiming Guide rule changes even though the audits
have been conducted in the years after the 2003 guide. In some cases, they
have gone as far back as the 1990s to disallow claims
· If you follow this twisted logic, CMS could review claims made for
services delivered between December 8 and the date of the moratorium and
impose the conditions set out in 2287; e.g., disallowing most transportation
claims.
Stay tuned If you want to try for clarification on your own, the CMS contact
for public information inquiries is Jeff Nelligan, Director of Media Affairs,
Central Phone: 202-690-6145, Central Fax: 202-690-7159, E-mail:
OEABox@CMS.HHS.GOV
If that doesn’t work, you can find contact information for your Member of
Congress by clicking here.
Maybe she/he can find out.
Updated Chart on the State of CMS Cuts and Moratoria
May 29, 2008
Click here
for an updated chart on the Medicaid Regulations that reflect recent action by
the U.S. District Court for the District of Columbia.
Desperate People do Desperate Things
May 21, 2008
Fearful that a federal Judge was going to act on Friday to declare 2258 to be in
violation of existing moratorium, which would then require the Administration
to give a 60 day comment period before the regulation could be effective, the
Administration issued the following statement. This announcement is to make it
look like Administration is in control and at same time is give Republican
Senators an excuse to vote against the domestic amendment (which includes the
moratoria) on the Senate floor tomorrow. After all, "we have 60 days to
negotiate.”
----------------------------------
May 21, 2008
To: Republican Health Policy Staff
Fr: Andy Chasin
Re: Voluntary Extension of Moratorium on IGT and GME Rules
The Administration today announced that they would voluntarily extend for 60
days the moratorium on Medicaid rules related to intergovernmental transfers (IGT)
and graduate medical education (GME). The Administration has previously
indicated that it would consider staying its rules on intergovernmental
transfers and graduate medical education funding while negotiating changes to
these rules with lawmakers. Those rules represent $885 million of the $1.65
billion at issue for the seven Medicaid rules. Without further action the IGT
and GME rules will now go into effect August 1st instead of May 25th.
Secretary Michael Leavitt released the following statement today:
"I reiterate the Administration's willingness to work with Congress and
Governors to discuss their concerns before the rules go into effect", Secretary
Leavitt said. "We will voluntarily refrain from making these rules effective
until August 1, 2008, more than 60 days after the moratorium expires. I invite
interested parties to sit down with me and my staff in the coming weeks to
ensure that we meet our mutual commitments to protect health care for low-income
individuals."
The two rules at issue are:
· Graduate Medical Education - CMS 2279 - proposed rule published on May
23, 2007. Cost: $115 million for the moratorium. For permanent repeal, $800
million over 5 years, and $1.9 billion over 10 years.
· Cost limit for Providers Operated by Units of Government and
Provisions to Ensure the Integrity of Federal-State Financial Partnership - CMS
2259-FC- final rule with comment period, published on May 29, 2007. Cost: $770
million for the moratorium. For a permanent repeal, $9.0 billion over five
years and $22.0 billion over 10 years.
FINANCE BRINGS UNEMPLOYMENT INSURANCE, MEDICAID SAFEGUARDS
TO 2008 SENATE SUPPLEMENTAL FUNDING BILL
For Immediate Release Contact: Dan Virkstis
May 21, 2008 (202) 224-4515
Baucus urges passage of bipartisan provisions for America
as funding bill moves to Senate floor
Washington, DC – Senate Finance Committee Chairman Max Baucus (D-Mont.) today
urged passage of key Finance provisions in the domestic spending portion of the
2008 supplemental funding bill, including measures that would extend
unemployment insurance (UI) for America’s workers and that would safeguard
Medicaid services for millions of low-income Americans. The Senate Finance
Committee put forward similar UI provisions in late January as part of the
economic stimulus package, and Baucus has been vocal in his opposition to
stringent Medicaid regulations issued by the Department of Health and Human
Services (HHS) to reduce federal funding to the Medicaid program.
“These provisions in the supplemental spending bill target some of today’s most
urgent domestic issues by providing additional assistance to those Americans who
have lost their jobs during this tough economic time, and by protecting Medicaid
coverage for millions who face being shut out of our health care system,” said
Baucus. “I urge my colleagues in the Senate to do what’s right for America’s
working families, and move these provisions in our supplemental funding bill.”
The UI provision would make 13 weeks of additional UI benefits available to
jobless Americans through the end of March 2009. Americans in high unemployment
states – with total unemployment rates of six percent or higher – would have 13
additional weeks of eligibility for a total of 26 additional weeks. Individuals
who have begun to receive either 13-week extension of benefits by the end of
March would be eligible to receive benefits for the remainder of that 13 weeks.
One provision related to Medicaid would suspend until April 1, 2009, seven
regulations issued by HHS to reduce federal funding to the Medicaid program by
nearly $20 billion, cutting millions of vulnerable Americans out of the health
care system. Specifically, the proposed rules would force cuts in school-based,
rehabilitation, and case management services, and limit the ability of states to
impose taxes on health care providers. They would also change the definition of
public provider, the definition of outpatient services, the policy on
intergovernmental transfers, and eliminate payment for graduate medical
education. These rules would shift millions of dollars in health care costs to
state and local governments at a time when they are already under tremendous
financial pressure. The National Governors’ Association has asked Congress to
block these proposed regulations.
The CBO cost
estimate
examines legislation (HR
5613)
that would place a one-year moratorium on seven new Medicaid regulations for
services supplied by public providers; graduate medical education, school-based
administration and transportation services; and rehabilitation services. CBO
estimates that the increases in spending under the bill would cost $1.8 billion
between 2008 and 2013, and the decreases in spending under the bill would save
$1.9 billion between 2008 and 2018, largely due to the required delays in
implementing the regulations. According to CBO, the legislation would not affect
federal revenues or discretionary spending (CBO cost estimate, 4/22).
The Governors Weigh In
April 24, 2008
WASHINGTON—The
National Governors Association released the following statement
today regarding the House vote on implementing the Medicaid
regulations issued by the Centers for Medicare & Medicaid Services:
The nation's governors commend today's action by the U.S. House of
Representatives to delay implementation of Medicaid regulations that
represent a shift of billions of dollars in federal costs to states.
According to states' own estimates, the impact of these regulations
could be up to four times the Administration's original five year
$13 billion estimate.
Governors believe that the issues raised by these regulations
deserve more thoughtful, detailed and collaborative discussions to
best serve their citizens. However, they maintain that Congress must
have sufficient time to act appropriately on them – more time than
is left in this year's congressional calendar.
"Today's strong bipartisan vote by House members is a critical step
in averting significant disruptions in coverage for vulnerable
populations. We urge the Senate to act on these issues
expeditiously."
Contact: Jodi Omear, 202-624-5346
Office of Communications
Today the House Energy & Commerce Committee is taking up consideration of
HR5613. This bill seeks to place a moratorium on seven Medicaid regulations
until the next Administration. I know some people have concerns with the CMS
Medicaid regulations.
Let me be clear: I’m not here to argue the regulations are perfect. I have
issues with some of them I’d like to see addressed. However, the regulations do
address areas where there are real problems in Medicaid.
Mr. President, Medicaid is a federal-state partnership that provides a crucial
health care safety net for some very vulnerable populations – low-income
seniors, the disabled, pregnant women, and children. They depend on Medicaid,
and it does generally serve them well.
Medicaid is also a program with a checkered history of financial challenges.
That’s the gentle way of putting it. A more severe way of putting it would be
that Medicaid has a history of states abusively pushing the limits of what
should be allowed to maximize federal dollars sent to them.
I’m not going to devote time in my remarks today to issues of fraud and abuse in
Medicaid. I’ll probably be back to do more on that later. Instead, I want to
focus on a very simple concept: Medicaid program integrity depends on CMS and
the states and providers and ultimately, beneficiaries having a clear
understanding of the rules of the road. When states don’t have clear guidance,
they could be inappropriately spending taxpayer dollars. Improper payments and
wasteful spending only increase the financial pressure on the safety net.
Mr. President, the Medicaid regulations HR5613 attempts to halt are efforts by
CMS to provide clearer rules of the road in critical areas where there have been
well documented problems. During the recent debate on the budget resolution, I
entered into the record a CRS memo that showed some of the issues that exist
under current law. I’m not going to go into them in detail today, but when CMS
doesn’t know how a state is billing for a service and states don’t have clear
guidance for how they should bill, neither Medicaid beneficiaries nor the
taxpayers are well served.
We should be talking about fixing the regulations so they better address real
problems in Medicaid, but instead the House is trying to kick the can to next
year.
So what does that mean for the taxpayer? HR5613 spends $1.7 billion to place
moratoriums on the regulations. This is only to delay the regulations until the
end of March of next year. I know supporters hope that the next administration
will completely cancel the regulations. What would it cost if we tried to
completely prevent these regulations from ever taking effect? Not $1.7 billion
that’s for sure. It would actually cost the taxpayers almost $20 billion over
the next five years and almost $50 billion over the next ten years.
It is an absolute farce for anyone to argue that all of those dollars are being
appropriately spent and that Congress ought to just walk away from these issues.
But that’s what HR5613 does. Now I know supporters of that bill will say they
just need more time. They say they haven’t had enough time to study the
regulations and respond.
That argument is starting to strain credibility. The public provider rule was
proposed well over a year ago. The rehabilitation services rule was proposed
nine months ago. Supporters of the bill have had plenty of time, if they wanted
to make new policy. But it is obvious by their actions, their only real interest
is making the regulations go away. This is unfortunate Mr. President, because
finding solutions is what we should be doing. When we start talking about the
integrity of the Medicaid program, clarity is what is most needed between CMS
and the states. If you don’t like the rules, fine. But there are ten of billions
of taxpayer dollars involved. Roll up your sleeves and get to work solving the
problems the regulations try to solve.
Mr. President, that’s what we should be doing for the taxpayers. Putting
moratoriums on all of the Medicaid regulations issues by CMS is not the right
answer.
"Apres moi, le deluge”
Let us Hope Not
Dennis Smith will be leaving CMS tomorrow. Herb Kuhn will be appointed as the
Acting Center Director. Mr. Kuhn is currently the Deputy Administrator under
Kerry Weems. More on
Mr. Kuhn.
An Editorial
April 10, 2008
“He who lives by the sword dies by the sword.”
Dennis Smith was a good soldier. Time and time again he carried the
Administration’s water on the spate of regulations affecting reductions in
health care coverage for pregnant women, low-income children, nursing home
residents and other groups.
From time to time, good soldiers are asked to fall on their swords. Smith,
described by the Wall Street Journal as the “architect of the rules,” did so.
Over the course of the past two years or so, Mr. Smith increasingly lost
credibility with both parties in Congress. It was almost painful to watch him
testify before the various committees, where he was often asked valid questions
to which there were no reasonable answers. Reports demanded by Congress and
promised by Smith were almost always tardy or ignored, with excuses no better
than a child’s “The dog ate my homework.”
Smith’s sword was sharpened by the Administration’s abject miscalculation of the
furor the seven regulations (and the evisceration of the DAB) would have. The
battle is not over, by any means, but Smith has already had to pay the price.
We will see him again, perhaps on the staff of a Member of Congress already
troubled by the moratoria. Unfortunately for Dennis, his reputation as the
Administration’s voice will travel with him.
This is neither the time nor the place for an ad hominem attack on Mr.
Smith, but those who have worked with him in the past, including during his
tenure as Director of the Department of Medical Assistance Services for the
Commonwealth of Virginia, seem to believe that his personality and his mission
too often merged.
Dennis Smith was a good soldier. Let us hope for his sake - and for our own -
that he is not asked again to fall on his sword.
Interested in the Energy and Commerce Health Subcommittee
Be sure to listen to Mr. Dingell's opening remarks
The House Energy and Commerce Subcommittee on Health
Hearing on H.R. 5613
April 3, 2008
Full details will be posted here soon, including a link to the recorded video.
Here
is the link to the written testimony of the witnesses.
Markup of the bill is next week, with a floor vote the next week. Stay tuned.
The Congressional Research Service March 25 released a report that outlines how
a controversial Centers for Medicare & Medicaid Services final rule would affect
states' use of intergovernmental transfers to fund their Medicaid costs.
The report, Medicaid Regulation of Governmental Providers, explains that
intergovernmental transfers (IGTs) allow states to help fund their share of
Medicaid costs through contributions from local governments or other governments
entities. Some states have interpreted the term "public agency," which is
included in the lists of entities eligible to contribute to state costs, to
include providers that are not governmental but have a "public-oriented
mission," such as not-for-profit hospitals, according to the report.
However, the rule would tighten the definition of a government entity,
eliminating the term public agency and making some hospitals ineligible to
contribute to state Medicaid costs.
CMS contends that the rule is necessary because arrangements in which hospitals
participate in IGTs are "often repaid through Medicaid disproportionate share
hospital payments or through inflated Medicaid payment rates for which federal
matching amounts are claimed," according to the report.
In addition, states can make Medicaid payments to hospitals or another provider
which are then transferred back to the state through an IGT. The net effect,
according to the report is to "effectively raise the federal matching rate in
the state to levels beyond those specified in law."
The rule also would limit payments to governmentally operated providers to
amounts that do not exceed costs, although the limit would not apply to Indian
Health Services facilities, tribal facilities, or disproportionate share
hospital payments, according to the report. Another provision of the rule would
require government entities to document that they are making a certified public
expenditure when they contribute to state Medicaid costs.
The May 2007 rule (72 Fed. Reg. 29748) has drawn criticism from Congress,
states, provider groups and advocacy organizations who say its reduction in
payments to the states would be detrimental to Medicaid beneficiaries.
Congress enacted a moratorium prohibiting implementation of the rule until May
25, 2008, and pending legislation would extend it further. In addition, a
coalition of provider groups, which together represent most of the nation's
hospitals, have filed a lawsuit seeking a preliminary injunction prohibiting
implementation of the rule ((No. 48 HCDR 3/12/08) ..
See link
to new CRS report on IGTs and the Medicaid Public Provider Cost Limit Rule.
BNA
Volume 13 Number 59
Thursday, March 27, 2008
ISSN 1091-4021
Good News from The Hill
March 25, 2008
Senator Jay Rockefeller (D-WV), Chair of the Senate Finance Health Subcommittee,
is about to introduce legislation that would delay implementation of the seven
offensive CMS Regulations until April 2009. His bill will look like
Representative Dingell’s H.R. 5613, the Protecting the Medicaid Safety Net Act ,
but may also address an August 17 directive from CMS that attempts to limit
eligibility and expansion of SCHIP. That directive requires states to confirm
that the state children’s health insurance program (SCHIP) is serving 95 percent
of eligible Medicaid beneficiaries in families earning less than 200 percent of
the federal poverty level (FPL) before allowing coverage expansions to families
earning more than that.
Legislation imposing moratoria on CMS regulations has faced problems with cost
(CMS claims significant cost savings in the first year for most of its proposed
regs) but both the House and Senate budget resolutions include budget-neutral
reserve funds for moratorium legislation.
Both House and Senate bills would put off for one year the recent CMS
regulations affecting intergovernmental transfers; coverage of rehabilitation
services for people with disabilities; outreach and enrollment in schools;
specialized medical transportation to schools for children covered by Medicaid;
graduate medical education payments; outpatient hospital services; targeted case
management services; state provider tax limits, and appeals filed through the
HHS Departmental Appeals Board.
As Mr. Dingell pointed out in a press statement accompanying introduction of his
bill, “If the Administration’s proposed cuts move forward, those most in need
will pay the highest price. The restrictions the Administration is imposing on
Medicaid are harmful and will undoubtedly put the health of thousands of our
most vulnerable children at unnecessary, indefensible risk.”
Two recent reports indicate that, if implemented, the rules would have a
disastrous effect on states’ economies and their ability to provide services to
the most vulnerable beneficiaries.
House Oversight Committee Chairman Henry Waxman conducted a survey of State
Medicaid officials who estimated state losses could top $50 billion over five
years in reduced federal payments due to the regulations. This is nearly three
times CMS’ original estimate.
A recent report commissioned by First Focus, a children’s advocacy group, and
produced by Professor and attorney Sara Rosenbaum of George Washington
University’s School of Public Health, found that the rules would especially harm
low-income children with special needs and may violate a Medicaid provision
requiring access to the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
program.
Bruce Lesley, President of First Focus, points out that as states battle to
counteract the current economic downturn, the CMS regulations shift of Medicaid
costs to the states could saddle children most in need of health care with the
burden of paying for it themselves or going without treatment. The regs would
also cut billions of dollars from the budgets of public schools, which would
then be faced with the decisions to reduce funding for education and health
services or raise state and local taxes to pay for the reduction in federal
support.
Senator Charles Grassley (R-IA), meanwhile, warns that while the Medicaid regs
may be imperfect, ignoring the problems they are intended to solve would be bad
public policy. Senator Grassley would like Senate Finance to review all the
rules and replace them with “sound policy.”
Opposition to the CMS regs has come from a variety of sources, including some
that may not have been foreseen by the Administration. For example, former
Republican National Committee Chairman and current Mississippi Governor Haley
Barbour testified at the February 26th Waxman hearings that the regulations
banning intergovernmental transfers and graduate medical education payments
under Medicaid would devastate a number of providers in Mississippi and cost the
state upwards of one hundred million dollars.
Stay tuned. It’s just beginning to get interesting.
NEWS RELEASE
Dingell Highlights Report as Evidence that
Administration’s Medicaid Regulations
Violate Medicaid Statute, Weaken Health Services
Committee on Energy and Commerce
Rep. John D. Dingell, Chairman
For Immediate Release: March 14, 2008
Contact: Jodi Seth or Brin Frazier,
202-225-5735
Washington, D.C.
- Rep. John D. Dingell (D-MI), Chairman of the
Committee on Energy and Commerce, today pointed to a
new report as the latest evidence that the
Administration’s new Medicaid Regulations would
weaken health care for children with special needs.
The report titled,
“Medicaid Regulations: Implications for Children
with Special Health Care Needs,”
by Professor Sara Rosenbaum, a national Medicaid and
children’s health expert, was released by First
Focus, a non-partisan child health advocacy group.
The report finds many provisions of the Bush
Administration’s recently-published Medicaid
regulations in violation of the Medicaid statute
that guarantees health care for children with
special needs. These children, because of their high
reliance on Medicaid, either as a primary source of
coverage or as a means of supplementing limited
private health coverage, would be most hurt by these
actions.
“The evidence continues to mount that this
Administration’s is breaking the promise of health
care for our nation’s most vulnerable children,”
said Dingell. “This report provides the sobering
news that new CMS regulations will severely impair
the ability of Medicaid to perform its crucial
mission. Ultimately, low-income, seriously ill
children will pay the highest price.”
Over the last year, this Administration has issued a
number of regulations in an effort to redefine what
constitutes a federally permissible Medicaid health
care and program administration expenditure, which
according to the report “not only draws no support
from the law itself but directly contradicts the law
in numerous respects.” These regulations affect
rehabilitation services, services provided through
school and hospital settings, and case management --
all of which ensure children can access the health
services they need.
“Stopping this assault on health coverage for
children must be a top Congressional priority this
year,” noted Dingell. “Of particular concern is the
assault on Medicaid’s critical children’s benefit,
Early Periodic Screening Detection and Treatment, or
EPSDT. This key benefit must be protected.”
Medicaid’s EPSDT benefit, which has been an integral
part of children’s care since 1967, ensures that
children can access medically necessary services and
requires States to guarantee that children actually
receive needed care. It includes none of the benefit
exclusions found in commercial insurance coverage,
making Medicaid a lifeline for children with special
needs who otherwise would not receive essential
care.
New Report Highlights Damage to Critical Children's Health
Programs
as a Result of Federal Medicaid Cuts
March 14, 2008
First Focus commissioned a report by Sara Rosenbaum, Chair
of Health Policy at The George Washington University School
of Public Health and Health Services, regarding the series
of regulations and administrative changes for Medicaid and
the State Children’s Health Insurance Program (SCHIP) as to
the legal implications of the changes and the impact they
will have on children, particularly children with special
health care needs. The report and a summary can be found
here.
First Focus is a bipartisan advocacy organization that is
committed to making children and their families a priority
in federal policy and budget decisions. To learn more visit
www.firstfocus.net.
No, it isn't just the schools who have been victimized by
CMS
March 11, 2008
Hospitals File Lawsuit Over Medicaid
Groups representing most of the nation's hospitals announced Tuesday they were
suing federal health officials to block the enactment of regulations that some
hospitals claim threaten their survival. The regulations would restrict federal
Medicaid payments so they don't exceed the cost of providing care. But hospital
officials said the rules would make it harder to offset the expense of treating
the uninsured. Find the full story here.
Participants in the lawsuit include the American Medical Association, the
National Association of Public Hospitals and Health Systems, and the Association
of American Medical Colleges.
Federal action "sneaky, mean, shortsighted"
[yes, I know I originally posted this back in February, but it is fun to read
again, isn't it?]
February 13, 2008
Hey, I didn't say that. The Bakersfield Californian did. Read the whole column
here.
You Had Your Chance, CMS
March 5, 2008
In response to a series of reports presented Monday by Representative Henry A.
Waxman, Chairman of the Oversight and Government Reform Committee, showing the
terrible fiscal impact of the CMS regulatory cuts, CMS spokesman Jeff Nelligan
said that the committee's report is "not credible." According to Mr. Nelligan,
"The committee paper fails to provide any reliable information such as the
assumptions, expenditure reports, the knowledge of how states will respond, and
budget forecasts necessary to substantiate any of the numbers contained in the
paper."
Mr. Waxman asked for this information weeks ago and CMS would not or could not
make it available to him. He then went directly to the states and got responses
from more than forty of them. Is CMS suggesting that the states were all lying
or inept?
(The complete reports from Mr. Waxman's Committee can be found below)
It Had To Happen - TCM Rule Goes To Court
NEWS RELEASE
February 29, 2008
Today, Maine Attorney General Steve Rowe announced the filing
of a lawsuit
against the United States Department of Health and Human Services (US DHHS) and
Michael Leavitt in his capacity as Secretary of US DHHS. The Complaint, filed in
the United States District Court for the District of Columbia, challenges a
certain agency rule that would adversely impact many of Maine's Medicaid
recipients and cost the State's general fund more than 16 million dollars in
fiscal years 2008 and 2009. Maine joins with Maryland, New Jersey, and Oklahoma
in this litigation. The states allege that portions of the revised rules violate
the 2005 Deficit Reduction Act and parts of the Social Security Act.
The US DHHS promulgated an Interim Medicaid Program Final Rule on December 4,
2007 relating to Medicaid case management and targeted case management.
In the complaint, Maine and three other states allege that portions of the
Interim Final Rule promulgated by the US DHHS are arbitrary, capricious, an
abuse of discretion and not in accordance with the 2005 Deficit Reduction Act or
any of the provisions of Title XIX of the Social Security Act. The complaint
also alleges that the US DHHS violated the rule making requirements of the
federal Administrative Procedure Act (APA) and that the Interim Final Rule does
not provide a reasonable transition period for Maine to modify its case
management programs.
Rowe said that many of the provisions in the Interim Final Rule will jeopardize
the health and safety of Medicaid beneficiaries, limit the state's flexibility
to provide case management in the most effective and efficient manner and result
in a substantial reduction in federal funds for Medicaid case management
services.
"This federal rule will abruptly cut off funding that helps protect the health
and safety of our state's most vulnerable citizens. The rule is not only unfair
to States and Medicaid beneficiaries, it is also illegal. We are confident that
the federal court will find that the Secretary of Health and Human Services
exceeded the authority given to him by Congress." Rowe said. "States derive no
pleasure from suing the federal government. However, in this case, we must do so
to protect the health and safety of our citizens."
Joining Maine in this lawsuit are Maryland, New Jersey and Oklahoma.
This suit seeks injunctive relief, which is a court-ordered act or prohibition
against an act or condition which has been requested, and sometimes granted, in
a petition to the court for an injunction. Such an act is the use of judicial
(court) authority to handle a problem, and is not a judgment for money. Whether
the relief will be granted is usually argued by both sides in a hearing rather
than in a full-scale trial, and the overall process is much quicker that a
trial. There are normally three stages in this form of injunctive relief;
first, a temporary restraining order, which is intended to prevent immediate
harm; second, a preliminary injunction, which could be granted after arguments
are heard by the Court; and finally, a permanent injunction, which is just what
it sounds like.
If You Were Waiting for Mr. Waxman's Next Step . . .
March 3, 2008
Today Representative Henry A. Waxman, Chairman of the Oversight and Government
Reform Committee of the House released a new report: The Administration’s
Medicaid Regulations: State-by-State Impacts.
The report details the state-by-state impacts of seven regulations issued by the
Centers for Medicare & Medicaid Service (CMS) that would make major,
wide-ranging changes in Medicaid, the nation’s largest low-income health care
program.
“As the economy tips into recession, the last thing we should be doing is taking
federal funds from states, especially funds that are supposed to help people
with their health and medical expenses,” said Chairman Waxman. “The Bush
Administration has proposed drastic changes in the Medicaid program, without
even attempting to understand the financial impact on states, localities, and
the people they serve. The Governors have opposed these proposals on a
bipartisan basis. With this report, we can really see why. I hope that the
Administration will reconsider these misguided regulations.”
Although Medicaid is the largest health care program operated by the states, the
Administration has failed to provide any estimates of the state-specific impacts
of its regulations. After several unsuccessful attempts by the Committee to
obtain these important state estimates from CMS, the Committee requested an
analysis from Medicaid State Directors on the impact of the CMS regulations on
their state.
The report finds that the state estimates of the fiscal impact of the CMS
regulations are significantly higher than the $15 billion impact projected by
the Administration for next five years. States estimated that the regulations
would reduce federal payments to them by nearly $50 billion over the next five
years, more than three times the Administration’s estimate.
The large discrepancy between the state estimates and the CMS estimates is
evidence that the regulations are likely to have a much larger fiscal and
programmatic impact on state Medicaid programs and state budgets than people
realize.
The report also finds:
The combined effect of the reductions in federal funds from all seven
regulations represents a major fiscal blow for many states;
The regulations will reduce federal spending by shifting costs, not
through greater efficiencies;
The regulations will disrupt existing systems of care for fragile
populations; and
The regulations threaten the financial stability of the hospitals,
emergency rooms, and clinics that treat Americans without health
insurance.
Documents and Links
Press
Release
(102 KB)
Feature:
The Administration's Medicaid Regulations: State-By-State Impacts
Report:
The Administration's Medicaid Regulations: State-By-State Impacts
(305 KB)
Summaries
of State Responses
(179 KB)
Progress in Saving School Services Reimbursement:
Medicaid Moratorium Could Be Extended
March 3, 2008
The Senate Budget Committee has set aside enough money to keep the school-based
Medicaid reimbursement program in operation well into 2009. For the funds to
become available, however, the authorizing committees which oversee the Health &
Human Services Department must approve a change in the law.
Members of Congress with control over HHS are well aware of and sympathetic to
concerns on the Medicaid reimbursement program’s proposed termination by the
Centers for Medicare & Medicaid Services in HHS. As a result, expect a bill to
be introduced in each chamber next week to extend -- into March of 2009 -- the
current moratorium, which expires June 30. There
has been pressure
from Members of the Senate and a number of Governors to continue this
moratorium, as well as others affecting a variety of Medicaid programs.
In preparation for the bills, the House Oversight and Government Reform
Committee will be releasing a report on Monday, March 3, on the impact that
reimbursement termination would have on each of 41 states surveyed.
Who Do They Think They are Kidding?
February 25, 2008
In its attempts to explain the effective date for 2287 (administrative and
transportation services reimbursement), something it has yet to accomplish with
any clarity, CMS has repeatedly claimed that it is trying to “avoid disruption
to the 08/09 school year.” At best, the agency is being disingenuous. The
disruption has already occurred, as LEAs attempt to cope with the budget cuts
2287 will cause. As one example, most states require school districts to notify
teachers no later than March 15th if they will not be reemployed in the fall.
Pink slips will be falling like autumn leaves. No, wait. A better metaphor
would be that they will descend like a late and especially bitter snowstorm.
Current Status of the CMS Regulations
February 25, 2008
With sincere thanks to Judy Chesser, New York City Health and Hospitals
Corporation. This
document
says it won't print within the margins, but it does.
Critics Say New Medicaid Rules Will Hurt States During Economic Downturn
Feb 20, 2008
Critics of Medicaid
regulations
[TCM] that will begin to take effect on March 3 contend that implementing the
rules during an economic downturn "will only worsen the fiscal situation for
already strapped state budgets," CQ
HealthBeat
reports. Speaking at a forum sponsored by the Alliance
for Health Reform
and the Kaiser
Family Foundation's
Commission on Medicaid and the Uninsured,
Barbara Edwards of the National
Association of State Medicaid Directors
said that as the economy weakens, more workers are becoming unemployed and some
are enrolling in Medicaid because they have no alternatives for coverage. At the
same time, state revenues are declining, and states are faced with more demands
for Medicaid services and fewer resources, Edwards said, adding that the timing
"almost couldn't be worse for states for many reasons."
However, Dennis Smith, director of CMS'
Center
for Medicaid and State Operations,
at the forum said that timing is not the only consideration. "In good times
people say, 'Don't rock the boat.' In tougher times they say, 'Oh no, not now,'"
adding, "We think that these are good regulations that help preserve the
integrity of the program" (Johnson, CQ HealthBeat, 2/19).
[Excerpted from the Kaiser Family Foundation Report of this date]
American Public Human Services Association Analysis of TCM Regulation
February 21, 2008
The American Public Human Services Association and its affiliates, the National
Association of State Medicaid Directors and the National Association of Public
Child Welfare Administrators has assembled an excellent side-by-side comparison
of the Deficit Reduction Act provisions covering TCM and the CMS proposed CMS
regulation on the same issue. You can find it here,
along with their cover
letter.
Federal action sneaky, mean, shortsighted
February 13, 2008
Hey, I didn't say that. The Bakersfield Californian did. Read the whole column
here.
It isn't June 30th, it's September 1
(Or Maybe it isn't. Standby. More CMS Memos are Flying)
February 8, 2008
From an email from CMS regarding CMS-2287:
"The publication of the final school-based rule (CMS-2287-F) on December 28,
2007 does not affect the ability of States to submit claims for costs incurred
prior to the effective date of the rule; the rule will be applied prospectively.
However, as you know, there's a six-month moratorium on CMS' ability to enforce
the rule, due to legislation recently signed into law. This moratorium is
scheduled to end June 30, 2008.
Final regulations are typically effective 60 days after publication; however,
due to the moratorium, that 60 day period starts once the moratorium ends. As a
result, the implementation date for the rule will technically be September 1,
2008. CMS never intended States and Schools to be in compliance with the final
rule prior to the start of the 2008-2009 school year, so the moratorium really
has no effect on that timeline.
With respect to claims for prior periods, all such claims must meet the
timeliness requirements specified at 45 Code of Federal Regulations (CFR) 95.7.
In addition, Section 1132(a) of the Social Security Act requires that a claim
for federal financial participation (FFP) must Be filed within a two-year period
that begins on the first day of the calendar quarter immediately following the
quarter in which the expenditure was made. The implementing regulations for
timely filing
Are at 45 CFR Subpart A and provide specific guidelines for determining when an
expenditure is said to have been made, so as to initiate the two-year filing
period.
Finally, although I indicated that CMS was considering developing some sort of
additional guidance to address questions surrounding implementation of
CMS-2287-F, there are no official plans to do so at the current time and no
format specified for any guidance that may ultimately be issued.
Hope this helps. Let me know if you have additional questions.
Thank you.
OK, so here is what I think this all means - the rule (CMS2287) goes into effect
the last day of the current (07/08) school year. CMS is trying to make the case
that this is October 1, 2008. That might be true if your state uses the federal
fiscal year. Most don't, but rather end their fiscal year on June 30. That
would then become the operative date for 2287. Confused? Stand by for more,
including some serious attempts to extend the moratorium. Don't stop keeping
your time sheets. This is FAR from over. Hell, she hasn't even come onstage
yet.
Help on the CMS Regs from the Kaiser Family Foundation
February 7, 2008
If you are confused by the multiple CMS regulations of the past nine months, you
will appreciate
this analysis
done by the Kaiser Family Foundation.
The Evisceration of the Departmental Appeals Board
January 28, 2008
The Departmental Appeals Board (DAB) provides impartial, independent
review of disputed decisions in a wide range of Department programs
under more than 60 statutory provisions. The DAB generally issues
the final decision for the Department, which may then be appealed to
federal court. The DAB may issue a recommended decision for action
by another official. The DAB has three broad areas of jurisdiction
each with its own set of judges and staff. The DAB also has a
leadership role in implementing Alternative Dispute Resolution (ADR)
across the Department since the DAB Chair is the designated Dispute
Resolution Specialist under the Administrative Dispute Resolution
Act of 1996. DAB staff include trained mediators and facilitators.
The DAB's ADR responsibilities include providing ADR services and
training and coordinating and facilitating negotiated rulemaking
committees.
The DAB resolves disputes with outside parties such as state
agencies, Head Start grantees, universities, nursing homes, doctors,
and Medicare beneficiaries. In a single year, disputes heard by the
DAB may involve as much as $1 billion in federal grant funds.
As a part of its ongoing attempt to dismantle the Medicaid program,
CMS has proposed
significant changes
in the operation of the Board. A response to those proposed changes
can be found
here.
.
Supreme Court Case Law Library
There are a number of Supreme Court cases that directly affect the issues of
FAPE and "related services." They are now posted on this site in the Case Law
Library.
I will soon post a brief summary of each case for your convenience. The cases
currently in the library are BROWN v. BOARD OF EDUCATION; BOARD OF EDUCATION OF
THE HENDRICK HUDSON CENTRAL SCHOOL DISTRICT; WESTCHESTER COUNTY v. ROWLEY;
IRVING INDEPENDENT SCHOOL DIST. v. TATRO; and CEDAR RAPIDS COMMUNITY SCHOOL
DISTRICT v. GARRET F. I especially recommend that you read the last two.
To gain access to any of the documents in the left hand margin, click on the
document title. Some of these documents are in Adobe format, and will require
Adobe
Reader
to open. If you do not have a copy of this program, you can download one for
free by clicking on the link above.
To submit questions, comments or suggestions for the website, click on the
e-mail address below:
Please feel free to use the information posted here in your efforts to expand
access to Federal Medicaid funding for special education.
Any summary or analysis of any state or federal law or regulation is transmitted
for informational purposes only and not for legal advice. Users should not act
upon this information without seeking the professional advice of a lawyer in the
applicable jurisdiction. An effort has been made to provide useful information,
but the information is not necessarily complete, may be inaccurate, and may not
reflect current legal developments. The provider does not warrant that the
information is complete or accurate and disclaims all liability to any person
for any loss caused by errors or omissions in any summary.
Welcome: This site was originally intended as a place for me to post materials
that were handouts for a national presentation I made in Boston nearly two years
ago. Since that time I have expanded the site to include a library of important
government documents (and this site is searchable by key word, by the way), a
library of relevant Supreme Court cases, regular (well, maybe not so regular, as
I try to keep up with the news as it happens) news updates, and the occasional
editorial. The site also has a new threaded discussion feature. Most of the
links you will need are in the left margin. Enjoy, use and reproduce
materials, and refer freely. Email me with questions, requests, etc.