Live National Conference on Medicaid in the Schools!
May 5, 2008
LEAnet will host a live national conference on May 21st from one to three pm, EST. You can participate in the conference on the Web. Participation requires only a broadband connection to the Internet and a piece of free software called Quicktime. Speakers will include Sara Rosenbaum from the Center on Public Health Law at George Washington University; Bruce Hunter, Legislative Affairs Director from the American Association of School Administrators; Dr. Luann Purcell, Executive Director of the International Council of Administrators of Special Education; John DiCecco, who manages a number of federal reimbursement programs for the Los Angeles Unified School District; and Greg Morris, Executive Director of LEAnet. Attendance is limited to the first one thousand applicants. This is your chance to get the latest news on Congressional action to protect reimbursement for Medicaid in the schools, potential impact on school programs, an overview of the Medicaid program as it applies to school programs, and efforts by LEAnet to build and maintain a national coalition to oppose CMS program funding cuts, and to plan for post-moratorium action.
It will be possible to submit questions by phone or email during the conference.
To register and for additional information, click HERE
Please join us for this innovative and informative national event
To protect and enhance school-based health services for all children
LEAnet is a growing coalition of Local Education Agencies dedicated to the protection and enhancement of school health programs. This is organization is intended to support current LEA initiatives and offer resources for new ones.
Recent federal action has created serious challenges to the continued existence of school programs that rely on Medicaid funding, and our current focus is the prevention of cuts in federal Medicaid reimbursement for administrative and transportation services.
Membership is open to any LEA or any other entity involved in the delivery of health services programs to children in the education environment. For additional information, contact us at fightback@theleanet.com or 916-760-7018.
Click Here to Download a Membership Brochure and Application - We Need Your Help
News of the Day
Stunning Defeat for the President !!
H.R. 5613 Passes in the House, 349 to 62
The bipartisan House bill imposing moratoria on the CMS regulations (H.R. 5613)
passed the House by a vote of 349 -62!! This is more than
enough votes to overturn the Administration's threatened veto. This happened
despite last minute opposition from the Republican leadership. The roll call
vote is pasted below -- please thank Republican members, especially, for their
votes.
The issue now moves on to the Senate.
FINAL VOTE RESULTS
(Democrats in roman; Republicans in italic; Independents underlined)
---- YEAS 349 ---
|
Abercrombie |
Gonzalez |
Nunes |
---- NAYS 62 ---
|
Akin |
Garrett (NJ) |
Paul |
---- NOT VOTING 20 ---
|
Andrews |
Etheridge |
Royce |
House Energy and Commerce Committee Passes
H.R. 5613 on a Roll Call Vote of 46 - 0
April 17, 2008
A roll call vote means that each Member's name was called and her/his vote was recorded. Next stop is a vote by the entire House.
We are all deeply indebted to Chairman Dingell and his principal cosponsor, Representative Murphy of Pennsylvania and to Representative Joe Barton of Texas, ranking minority (Republican) member of the committee. Mr. Barton, once again, demonstrated that he is a man of his word and has the political courage to do what he thinks is right.
Smith to Leave CMS
Dennis Smith, currently Director of Medicaid and State Operations, will be leaving CMS tomorrow, April 11. Herb Kuhn will be appointed as the Acting Center Director. Mr. Kuhn is currently the Deputy Administrator under Kerry Weems. More on Mr. Kuhn.
Did You Miss the Energy and Commerce Health Subcommittee Hearing on H.R. 5613 Last Week?
Connect to the Archived Video Webcast of this Hearing or Download
Be sure to listen to Mr. Dingell's opening remarks
Good News from The Hill
April 8, 2008
|
SENATORS PRESS TO REVERSE ADMINISTRATION REGULATIONS THAT WOULD CUT ACCESS TO HEALTH CARE FOR MILLIONS OF AMERICANS ~Bipartisan Legislation Also Offers $12 Billion in Targeted State Fiscal Relief~ April 3, 2008 Washington, D.C. – A bipartisan group of Senators today filed legislation aimed at reversing a number of misguided Bush Administration directives that threaten health care access to our nation’s most vulnerable populations -- seniors, pregnant women, individuals with disabilities and children. Senators Jay Rockefeller (D-WV), Olympia Snowe (R-ME) and Edward Kennedy (D-MA) introduced the Economic Recovery in Health Care Act of 2008 (S. 2819), legislation that would implement a one-year moratorium on proposed regulatory changes to Medicaid and CHIP and provide states in need with federal relief. “Children don’t stop getting sick and seniors don’t suddenly stop needing long-term care services just because the economy slows,” Senator Rockefeller said. “Instead, the need for access to Medicaid and CHIP grows during times of economic uncertainty. In order to prevent the same kind of health care crisis that working families experienced during the 2001-2003 recession, we must provide states with federal relief – and postpone the draconian Medicaid and CHIP regulations.” “This is the wrong time to impose regulations that will shift additional financial burdens to states that cannot afford it,” Senator Snowe noted. “Rather than identifying the ways in which we can work more efficiently and better serve those who rely on Medicaid – our states are faced with the prospect of being forced to implement regulations that will cause them to fall through the cracks.” Senator Kennedy said, “Every day brings new evidence of the intense financial pressures facing states. Tragically, the first to suffer when states cut their budgets are families with the fewest resources and the greatest needs. Particularly at risk are patients enrolled in Medicaid, who have nowhere else to go for help when states cut enrollment. The legislation we introduce today will help families who need help the most, and delay the implementation of harsh new policies from the Bush Administration that deny patients the care they need." Over the past year, HHS has issued a number of proposed regulations that would reverse long-standing Medicaid policies aimed at ensuring coverage to our nation’s poorest citizens. According to the Congressional Budget Office, the regulations recently proposed by the Administration would reduce federal Medicaid matching payments by approximately $18 billion over 5 years and $42 billion over 10 years. However, state reports to the House Oversight Committee indicate that the cost shift to states could be far greater. These administrative regulations would further aggravate the impact of the economic downturn on states and working families. The Economic Recovery in Health Care Act will preserve access to Medicaid during the economic downturn by temporarily extending – through April 1, 2009 – the Medicaid moratoria on payments to public providers, graduate medical education, school-based services, and rehabilitative services that Congress has already enacted. The legislation will also delay – through April 1, 2009 – implementation of the following additional Medicaid regulations, which are already in effect or scheduled to go into effect in the near future: targeted case management, allowable provider taxes, outpatient clinic and hospital services, and the Departmental Appeals Board rule. Additionally, the legislation also delays implementation of the so-called August 17 CHIP directive, which threatens access to the program for thousands of low-income children across the country. Along with addressing the proposed Medicaid and CHIP regulations, the Economic Recovery in Health Care Act also provides timely, targeted, and temporary state fiscal relief. According to the National Governors Association, the recent economic downturn has left 18 states with budget shortfalls totaling $14 million in 2008, and 21 states project shortfalls totaling more than $32 million in 2009. If the current downturn follows the path of most recessions, between 35 and 40 states will face severe budget shortfalls in 2009. Compounding the problem is that by law, 49 states have balanced budget requirements – and without help from the federal government, states will be forced to reduce spending, often through cuts to Medicaid. The bill introduced today will provide $12 billion in targeted state fiscal relief – with $6 billion in additional Medicaid assistance and $6 billion in general revenue-sharing grants to states . However, unlike the state fiscal relief enacted in 2003, each state must meet certain criteria in order to qualify for relief payments under the bill. The criteria would be based on the average of state ranks in unemployment, food stamp participation, and foreclosures. These three economic indicators closely align with state budget deficits and would allow us to more appropriately target relief to the states with the most need. (A detailed bill summary and description of the targeted relief provisions is set out in full below). Senator Rockefeller is Chairman of the Senate Finance Committee Subcommittee on Health Care. Senator Snowe also serves on the subcommittee. Senator Kennedy is Chairman of the Senate Health, Education, Labor and Pensions Committee. Over the past year the Center for Medicare and Medicaid Services (CMS) has proposed 7 new regulations dealing with Medicaid that go beyond Congressional intent and would shift billions of dollars in costs to states. Many states are already experiencing budget shortfalls and these regulations would result in significant cuts to services and supports for individuals with disabilities and other vulnerable populations. The Congressional Budget Office (CBO) estimates that the regulations will cut Medicaid spending by $21 billion over five years. State Medicaid directors estimate the impact of the cuts will be deeper, approximately $50 billion over five years. Advocates are asking for a moratorium that would prevent CMS from implementing these 7 regulations. House Energy and Commerce Committee Chairman Dingell (D-MI) and Representative Murphy (R-PA) have introduced a bill (H.R. 5613) that would place a moratorium on these 7 Medicaid regulations until April 2009. Senators Rockefeller (D-WV), Snowe (R-ME), and Kennedy (D-MA) have introduced the Economic Recovery in Health Care Act of 2008 (S. 2819). The bill includes a similar one-year moratorium on the 7 Medicaid regulations. The bill also includes a moratorium on a CMS SCHIP directive issued last year that limits the ability of states to cover children in families above 250% of the federal poverty level. In addition, the bill includes $12 billion in targeted Medicaid fiscal relief to states -equally split between a temporary increase in the Medicaid matching rate and grants to states. ------------------------------------------------------ Summary of the Economic Recovery in Health Care Act of 2008 jointly sponsored by Senators Jay Rockefeller (D-WV), Olympia Snowe (R-ME), and Edward Kennedy (D-MA)
Background Medicaid is a critical safety-net for working families. Medicaid is also the economic foundation of our health care infrastructure through its support of hospitals, doctors, community health centers, and nursing homes in every state throughout the nation. During the last economic downturn, the number of uninsured Americans would have been millions more if Medicaid and the State Children’s Health Insurance Program (CHIP) had not responded to the twin challenges of an economic downturn and a sharp drop-off in private health insurance coverage.
According to the National Governors Association, the recent economic downturn has left 18 states with budget shortfalls totaling $14 million in 2008, and 21 states project shortfalls totaling more than $32 million in 2009. If the current downturn follows the path of most recessions, between 35 and 40 states will face severe budget shortfalls in 2009. By law, 49 states are required to balance their budgets and, in times of economic downturn, this task becomes significantly more difficult. Without help from the federal government, states will be forced to reduce spending, often by cutting Medicaid. The administrative regulations recently proposed by the Administration would reduce federal Medicaid matching payments by approximately $18 billion over 5 years and $42 billion over 10 years according to the Congressional Budget Office. However, state reports to the House Oversight Committee indicate that the cost shift to states could be far greater. These administrative regulations would further aggravate the impact of the economic downturn on states and working families. Preserving Access to Medicaid and CHIP During the Economic Slowdown * Extension of Existing Moratoria on Medicaid Regulations Our bill will preserve access to Medicaid for seniors, pregnant women, individuals with disabilities, and children during the economic downturn by temporarily extending – through April 1, 2009 – the Medicaid moratoria that Congress has already enacted: Cost Limit for Public Providers Final Rule (72 Fed. Reg. 29748) – The proposed rule imposes new restrictions on payments to providers operated by units of governments. Final rule issued May 25 and published May 29, 2007. Congress acted to delay implementation for one year through Section 7002 of P.L. 110-28. However, the current moratorium expires May 25, 2008. Payments for Graduate Medical Education (GME) Proposed Rule (72 Fed. Reg. 28930) - The proposal would no longer allow Medicaid funding to be used for GME. Proposed rule published May 23, 2007. Congress acted to delay implementation for one year through Section 7002 of P.L. 110-28. However, the current moratorium expires May 25, 2008[1]. Rehabilitative Services Proposed Rule (72 Fed. Reg. 45201) – This proposed rule would prohibit federal matching funds for rehabilitative services furnished through a non-medical program (e.g., foster care, adoption services, education, juvenile justice). Proposed rule issued August 13, 2007. Congress acted to delay implementation for one year through Section 206 of P.L. 110-173. However, the current moratorium expires June 30, 2008. Payments for Costs of School Administration, Transportation Final Rule (72 Fed. Reg. 73635) – This rule eliminates longstanding federal policy by prohibiting federal matching funds for (1) administrative activities by school employees or contractors and (2) transportation of school-aged children from home to school and back. Final rule issued December 28, 2007. Congress acted to delay implementation for one year through Section 206 of P.L. 110-173. However, the current moratorium expires June 30, 2008. * Additional Moratoria on Medicaid Regulations and CHIP Guidance The Economic Recovery in Health Care Act would also preserve access to Medicaid by delaying – through April 1, 2009 – implementation of the following additional Medicaid regulations, which are already in effect or scheduled to go into effect in the near future: Optional Case Management Services Interim Final Rule (72 Fed. Reg. 68077) – This rule narrows Medicaid payment policy for covered case management services – referred to as Optional State Plan Case Management Services or, more commonly, Targeted Case Management (TCM). Interim final rule issued December 4, 2007. Effective March 3, 2008. The Senate voted to adopt an amendment to the Indian Health Care Improvement Act Amendments of 2007 (S.1200) that delays implementation of this regulation until April 1, 2009. Allowable Provider Taxes Final Rule (73 Fed. Reg. 9685) – The regulation imposes more stringent language in applying the hold harmless test and affords CMS broad flexibility in identifying relationships between provider taxes and Medicaid payments. Final rule issued February 22, 2008. Effective April 22, 2008. Revised Outpatient Clinic and Hospital Services Proposed Rule (72 Fed. Reg. 55158) - CMS seeks to limit the funding that states pay for outpatient visits to hospitals and clinics by restricting costs, including GME, that can be counted in the upper payment limit, which is the maximum a state can pay for these services. Proposed rule published September 28, 2007. Departmental Appeals Board (DAB) Proposed Rule (72 Fed. Reg. 73708) – This rule would allow the Secretary of HHS to overturn or remand independent Board decisions on Medicaid, TANF and Head Start; exclusions from federal health care programs; civil penalties on Medicare Advantage or Prescription Drug Plans under Medicare Parts C or D; and decisions on whether providers meet conditions of participation in Medicare or Medicaid. Proposed rule published December 28, 2007. Our bill would also preserve access to CHIP for low-income children by implementing a one-year moratorium on the August 17 CHIP guidance. * Targeted Countercyclical Funding to States The Economic Recovery in Health Care Act would also provide countercyclical funding to states that is timely, temporary and targeted. Leading economists have found that targeted state aid would generate increased economic activity of $1.36 for each dollar of cost. Our legislation provides approximately $12 billion in targeted state fiscal relief, equally divided between an increase in federal Medicaid matching payments and targeted grants to states. In order to qualify for an increase in federal matching payments and the targeted grants, each state must meet certain criteria. The criteria would be based on the average of state ranks in the following: 1. Reduction in employment. (Year-to-Year based on latest Bureau of Labor Statistics Current Employer Statistics Survey) 2. Increase in food stamps participation. (Year-to-Year based on average of monthly participation according to most recent USDA Food and Nutrition Service Data) 3. Increase in the foreclosure rate. (Year-to-Year based on most recent Mortgage Bankers National Delinquency Survey, as published in "Recent Foreclosure Trends Report for all States") There will be two rounds of targeted relief – Round One and Round Two. States that qualify will continue to be qualified throughout the period of fiscal relief. For states that qualify for Round One, that period is April 1, 2008 – June 30, 2009. States newly qualifying after April 1, 2008 will begin receiving state fiscal relief payments in Round Two, which begins in the first quarter of federal fiscal year 2009 (October 1, 2008) and lasts through June 30, 2009. Detailed Summary of Targeted Countercyclical Funding Provisions Included in the Economic Recovery in Health Care Act of 2008 Senators Jay Rockefeller (D-WV), Olympia Snowe (R-ME), and Edward Kennedy (D-MA) The Economic Recovery in Health Care Act would also provide countercyclical funding to states that is timely, temporary and targeted. Leading economists have found that targeted state aid would generate increased economic activity of $1.36 for each dollar of cost. Our legislation provides approximately $12 billion in targeted state fiscal relief, equally divided between an increase in federal Medicaid matching payments and targeted grants to states. In order to qualify for an increase in federal matching payments and the targeted grants, each state must meet certain criteria. The criteria would be based on the average of state ranks in the following: 4. Reduction in employment. (Year-to-Year based on latest Bureau of Labor Statistics Current Employer Statistics Survey) 5. Increase in food stamps participation. (Year-to-Year based on average of monthly participation according to most recent USDA Food and Nutrition Service Data) 6. Increase in the foreclosure rate. (Year-to-Year based on most recent Mortgage Bankers National Delinquency Survey, as published in "Recent Foreclosure Trends Report for all States") There will be two rounds of targeted relief – Round One and Round Two. States that qualify will continue to be qualified throughout the period of fiscal relief. For states that qualify for Round One, that period is April 1, 2008 – June 30, 2009. States newly qualifying after April 1, 2008 will begin receiving state fiscal relief payments in Round Two, which begins in the first quarter of federal fiscal year 2009 (October 1, 2008) and lasts through June 30, 2009. I. Round One of Countercyclical Funding to States Round One will begin on April 1, 2008 and last for five quarters. A state with an average rank in the top 28 states for the three criteria listed above, based on the most recent data available as of April 1, 2008, would qualify for its increase in the FMAP/hold harmless and its calculated share of the per capita block grant. Amount of Relief • In Round One, at least $4 billion will be available for the FMAP increase and $5 billion will be available for the targeted grants to states. Hold Harmless for Falling Medicaid Matching Rates · For a Round One qualifying state that has a federal unadjusted Medicaid matching rate for FFY 2007 that is higher than the matching rate for FFY 2008, then the qualifying state would get the higher FFY 2007 matching rate. Effective for the last two quarters of FFY 2008 (April 1, 2008 through September 30, 2008). · If the qualifying state’s federal unadjusted Medicaid matching rate for FFY 2008 is higher than the matching rate for FFY 2009, then the qualifying state would get the higher FFY 2008 matching rate. Effective for the first three quarters of FFY 2009 (October 1, 2008 through June 30, 2009). Across-the-Board Matching Rate Increase · Each Round One qualifying state would receive a 1.667 percentage point increase in its federal Medicaid matching rate, after applying the hold harmless provisions. Puerto Rico and the Territories would automatically qualify for Round One and receive an equivalent increase via a 3.334 percent increase in their federal Medicaid payment cap. Effective for the last two quarters of FFY 2008 and the first three quarters of FFY 2009 (April 1, 2008 through June 30, 2009). · The matching rate increase would not apply to DSH payments, Medicaid payments already receiving an enhanced matching rate, and other federal programs where federal payments are calculated based on the federal Medicaid matching rate. States may not use the increased Medicaid matching payments to increase their rainy day funds. · States may not reduce Medicaid eligibility levels below the levels effective as of December 31, 2007 in order to receive the across-the-board matching rate increase during the effective period. If a state does reduce eligibility levels, it can receive the across-the-board matching rate increase in the first calendar quarter in which it reinstates eligibility levels effective as of December 31, 2007. · States receiving the across-the-board matching rate increase that require local governments to contribute to the state’s share of Medicaid matching payments, cannot require local governments to pay a greater share of the state’s share of Medicaid matching payments than was effective as of December 31, 2007. Revenue Sharing Grants to States · Our legislation provides $5 billion in federal funding for targeted revenue sharing grants to states that qualify for Round One, available through June 30, 2009. The Secretary of Treasury shall provide payments to states and local governments under a program established within 45 days of enactment. $2.5 billion will be distributed in FFY 2008 and $2.5 billion will be distributed in FFY 2009 on a per capita basis. Minimum payments apply, with states each receiving at least one-half of one percent of the total funding made available and Puerto Rico and the Territories each receiving at least one-tenth of one percent of the total funding made available. · The grants are available for the following uses: (1) essential government services; (2) financing unfunded federal mandates; or (3) compensating for a decline in federal funding. States may only use these funds for the types of expenditures permitted in the most recent budget. States cannot use the general revenue sharing grants to add to their rainy day funds, and the grants must be expended within one year of date of receipt. States must also certify to the Secretary of Treasury that they are using the grants for the specified uses. II. Round Two of Countercyclical Funding to States Round Two will begin on October 1, 2008 and last for three quarters. A newly eligible state with an average rank in the top 38 states for the three criteria listed above, based on the most recent data available as of October 1, 2008, would qualify for its increase in the FMAP/hold harmless and its calculated share of the per capita block grant. Amount of Relief · In Round Two, a maximum of $2 billion will be available for the FMAP increase and $1 billion will be available for the targeted grants to states. Hold Harmless for Falling Medicaid Matching Rates · For a Round Two qualifying state that has a federal unadjusted Medicaid matching rate for FFY 2008 that is higher than the matching rate for FFY 2009, then the qualifying state would get the higher FFY 2008 matching rate. Effective for the first three quarters of FFY 2009 (October 1, 2008 through June 30, 2009). Across-the-Board Matching Rate Increase · Each Round Two qualifying state would receive a 1.667 percentage point increase in its federal Medicaid matching rate, after applying the hold harmless provisions. Effective for the first three quarters of FFY 2009 (October 1, 2008 through June 30, 2009). · The matching rate increase would not apply to DSH payments, Medicaid payments already receiving an enhanced matching rate, and other federal programs where federal payments are calculated based on the federal Medicaid matching rate. States may not use the increased Medicaid matching payments to increase their rainy day funds. · States may not reduce Medicaid eligibility levels below the levels effective as of December 31, 2007 in order to receive the across-the-board matching rate increase during the effective period. If a state does reduce eligibility levels, it can receive the across-the-board matching rate increase in the first calendar quarter in which it reinstates eligibility levels effective as of December 31, 2007. · States receiving the across-the-board matching rate increase that require local governments to contribute to the state’s share of Medicaid matching payments, cannot require local governments to pay a greater share of the state’s share of Medicaid matching payments than was effective as of December 31, 2007. Revenue Sharing Grants to States · This legislation provides $1 billion in federal funding for targeted revenue sharing grants to states that qualify for Round Two, available through June 30, 2009. The Secretary of Treasury shall provide payments to states and local governments under a program established within 45 days of enactment. Minimum payments apply, with states each receiving at least one-half of one percent of the total funding made available and Puerto Rico and the Territories each receiving at least one-tenth of one percent of the total funding made available. · The grants are available for the following uses: (1) essential government services; (2) financing unfunded federal mandates; or (3) compensating for a decline in federal funding. States may only use these funds for the types of expenditures permitted in the most recent budget. States cannot use the general revenue sharing grants to add to their rainy day funds, and the grants must be expended within one year of date of receipt. States must also certify to the Secretary of Treasury that they are using the grants for the specified uses. _______________________________ [1] The legislative language relative to the GME provision appears separately from language on existing moratoria because there are differing opinions about whether the current moratorium fully addresses all the provisions in the GME proposed rule. |
New Bill Introduced to Stop CMS Cuts
March 17, 2008
On March 13, 2008, Representatives John Dingell (D-MI) and Tim Murphy (R-PA) introduced H.R. 5613, the "Protecting the Medicaid Safety Net Act of 2008." This legislation would impose a one-year moratorium on seven recent CMS regulations, including the one affecting administrative and transportation service reimbursement. In introducing the bill, Mr. Dingell said "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."
Letters of support for this legislation are important. If you are active in an organization that would be affected by this legislation - an LEA, a disability group or professional organization, for example - ask them to send a letter of support to:
Amy Hall
Committee
on Energy and Commerce
2125 Rayburn House Office Building
Washington, D.C. 20515
or email it to Hasan Sarsour at Hasan.Sarsour@mail.house.gov
A copy of the LEAnet letter of support can be found here, and other examples are available on the web. Support letters are valuable at any point during the legislative process.
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.
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.
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.
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.
Click here for an interactive map showing how the proposed regulations would impact each state.
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
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.
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.
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.
It isn't June 30th, it's September 1 - or Not, Depending on Your State's Fiscal Year
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.
Sharon Brown|
Administrative Claiming Team,
Division of Reimbursement and State Financing | Financial Management
Group |
Centers for Medicare& Medicaid Services | (: 410-786-0673 | *:
sharon.brown@cms.hhs.gov"
So much for the Georgia Medicaid letter. (See below)
Help on the 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, and this one, which shows the various regulations and the current (February 8, 2008) status of the moratoria.
Georgia Cuts Admin Claiming Program
February 7, 2008
Georgia has decided, apparently based on instructions from CMS Region IV, notify its schools that billing for administrative services will end on June 30. According to the attached letter, not only must all claiming cease by that date, but all distributions must be made by the same date. I can only hope that the school districts in that state continue to perform time studies and retain documents so that they will not lose any reimbursement dollars to which they are entitled when the dust settles. The is some evidence that indicate that the mandatory sixty day period before the rule goes into effect runs consecutively with the six month moratorium, giving a program termination date of August 28. This does not take into account a major effort on Capitol Hill to extend the moratorium. It also does not take into account the fact that current law - section 1132's timely claiming restrictions - provide states 2 years to claim. And, as we know, state claims are are paid quarterly.
I would certainly be pleased if someone could send me any communication from Region IV that supports the position taken in Georgia. My email is fightback@theleanet.com.
LEAnet Offers On-Site Presentations
Greg Morris, Executive Director of LEAnet, is available for public speaking engagements. As the battle to protect school health programs from cuts in federal reimbursement continues, LEAnet has assumed a leadership role. As our Director, Greg can provide a comprehensive update and analysis for your organization.
Greg is an attorney and professional public speaker who has presented on school Medicaid reimbursement and special education issues in national, regional, and state forums. He has been a featured speaker at four national conferences of the National Alliance for Medicaid in Education and has also presented at the national conventions of the Council for Exceptional Children and the Council of Administrators of Special Education. In 2007 he was the principal speaker at state events in Rhode Island, Massachusetts, Connecticut, Indiana, California, Minnesota, and South Carolina.
During his career Greg has served as a consultant with more than half a dozen Medicaid billing companies and two state-wide groups involved in rebuilding their school Medicaid billing programs. In Wyoming, he assisted in drafting the state's first Medicaid in the schools billing program and the enabling legislation. He has been called upon as an expert by large law firms and school consortia. Greg is viewed as a valuable resource by the media and specialists in the field and is regularly called upon for his expert advice and insights. He currently serves on the Steering Committee of a large, Washington D.C. based, ad hoc group organized to fight the CMS cuts.
Here are some recent comments from his audiences:
“His presentation was informative, entertaining, and inspirational”
“Probably the most well-informed person on Medicaid in the schools in the entire country”
“His passion for the subject is captivating and contagious”
“Energetic, funny, and very informative”
“Greg pulls no punches. He tells it like it is”
“We left the room energized, motivated, and very well-informed”
Contact LEAnet at fightback@theleanet.com or 916-760-7018 for fee information and details
HHS Issues a Notice of Proposed Rulemaking that Eviscerates the Departmental Appeals Board, Giving the HHS Secretary Authority Over its Rulings
January 13, 2008
On December 28, 2007, the Department of Health and Human Services published a Proposed Rule in the Federal Register, which would revise the procedures for the Departmental Appeals Board (DAB).
The Proposed Rule would require that the DAB not only follow
Federal statutes and regulations in hearings and appeals procedures, but
also follow published guidance issued by the Secretary of the Department
of Health and Human Services (Secretary) to the extent such guidance is
not inconsistent with applicable statutes or regulations. The Proposed
Rule would also provide the Secretary with the authority to review DAB
decisions for errors in the application of statutes, regulations and
interpretative policy.
According to the Secretary, the Proposed Rule is needed to ensure consistency in decision making and to ensure that the Secretary's policies are being correctly implemented.
In its current form, the Proposed Rule does not include a process for
either party to request the Secretary's review or address briefing
procedures. Instead, the Proposed Rule seeks to "maintain flexibility"
so that the Secretary can tailor the review process to the needs of a
particular case. However, the Proposed Rule does solicit comments on
whether the regulations should specify procedures for the Secretary's
review. One can only presume such comments will be given the same
careful consideration demonstrated by HHS/CMS in the recent past.
The changes contemplated by the Proposed Rule would impact various
appeals procedures, including: (i) the review of certain determinations
under 42 C.F.R. Part 498 and impacting certain provider's participation
in the Medicare program; (ii) disputes governed by 42 C.F.R. Part 1005
and concerning the imposition of exclusions, civil monetary penalties
and assessments related to health care fraud and abuse; and (iii)
appeals governed by 42 C.F.R. Parts 422 and 423 and involving civil
monetary penalties imposed on Medicare Advantage organizations and
Medicare prescription drug sponsors.
The deadline for submitting comments on the Proposed Rule is January 28,
2008. Get those PCs humming.
Implementation Date for 2287 is August 28th
January 8, 2008
From an email from CMS:
"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.
Sharon Brown | Administrative Claiming Team, Division of Reimbursement
and State Financing | Financial Management Group | Centers for Medicare
& Medicaid Services | (: 410-786-0673 | *: sharon.brown@cms.hhs.gov"
CMS 2287 Final Rule Published This Morning
December 28, 2007
This rule modifies 42 CFR Parts 431, 433, and 440. A .PDF copy of the rule can be found here.
To: Congressional Health Staff
From: Carleen Talley
Director, Congressional Affairs Group
Office of Legislation
Centers for Medicare & Medicaid Services
Re: CMS Issues Final Rule on Medicaid Reimbursement for School-based
Administration and Transportation
Today, the Centers for Medicare & Medicaid Services (CMS) placed on display at
the Office of the Federal Register a final rule (CMS-2287-F) regarding Medicaid
reimbursement for school-based administration and transportation. Improper
billing by school districts for administrative costs and transportation services
under the Medicaid program is a longstanding concern of the Department of Health
and Human Services (HHS). Both HHS’ Office of the Inspector General (OIG) and
the Government Accountability Office (GAO) have identified these categories of
expenses as being susceptible to fraud, waste, and abuse.
Under the Medicaid program, Federal payment is available for the costs of
administrative activities “as found necessary by the Secretary for the proper
and efficient administration of the State plan.” The final rule would eliminate
reimbursement under the Medicaid program for the costs of certain activities
based on a Secretarial finding that these activities are not necessary for the
proper and efficient administration of the State plan, nor do they meet the
definition of an optional transportation benefit. Based on these determinations,
under the final rule, Federal Medicaid payments would no longer be available for
administrative activities performed by school employees or contractors,
