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To protect and enhance school-based health services for all children

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The Rescission Regulation is Final!
_______________________________
Official CMS News Release
June 29, 2009

MEDICAID NEWS

FOR IMMEDIATE RELEASE
Contact CMS Media Affairs Office
Monday, June 29, 2009
(202) 690-6145

HHS RESCINDS MEDICAID REGULATIONS


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 This rule was rescinded because CMS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.

 

LEAnet Comments on Rescission Regulation (2287-P2)

June 1, 2009

Download a copy of the LEAnet comments in .pdf format by clicking here.  To see all comments posted, click here.

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.

A brief biography is included below:

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.

Secretary Duncan outlines school reform agenda

May 22, 2009

Click here for the full report

Farewell, 2287

May 1, 2009

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.

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!

May 12 at 3:00 p.m. EST/12:00 p.m. PST
RSVP today and submit a question for
Mrs. Edelman to answer during the webcast.

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.

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April 27, 2099

The official FMAP increases are available in the Federal Register.  See second and third pages.

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.

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 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 Useful Links as We Enter the Obama Years

December 2, 2008

                                   SCHIP

More on The Baucus Proposal

November 13, 2008

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  This regulation affects school based health clinics..

Coming Soon - What did CMS Really Say at the NAME Conference?

 State Budget Woes Hit Schools Hard

October 7, 2008

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

We Need Your Help

LEAnet relies on voluntary funding from organizations and individuals.  If you are one of the many educators or

clinicians, school nurses, etc., whose jobs or programs were saved because of our work in preserving federal

Medicaid reimbursement programs for administration and transportation services,

please help us out by contributing using the link below. 

The fight is not over, as the moratorium protection for these programs expires on April 1, 2009. 

LEAnet is working hard to secure ongoing reimbursement through permanent changes in the law.

  We suggest individual subscriptions/donations of $25.00, though larger amounts are certainly welcome. 

We accept credit cards and PayPal.

Large institutional subscriptions can be negotiated be calling 989-400-2271. 

All  subscribers will receive an invitation to participate in regular LEAnet telephone conferences

and email updates that provide more information than the standard LEAnet alerts.

Click Here to Download a Membership Brochure and Application

News of the Day

The Fat Lady Finally Sang !

We are 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 with 6 Medicaid regulations.  Congratulations to all of you who worked on the campaign to move Congress.   It just shows you what a lot of will, determination and team effort can accomplish. You should never forget what you accomplished.  We are proud to be a part of your team!

The Medicaid Safety Net Remains Intact !!

June 26, 2008

Late last evening, in a 92 to 6 vote, the U. S. Senate approved the War Supplemental Appropriations bill that included moratoria until April 2009 on six Medicaid regulations. The Senate approved the language that the House passed last Friday.  The President is expected to sign the bill into law, probably in the coming week.  The six regulations that will be on moratoria are: Targeted Case Management, Rehabilitation Option, School Based Services, Public Provider Cost Limit, Graduate Medical Education, and Provider Tax.  Left out of the package was the seventh regulation dealing with reimbursement for Outpatient Services.  That regulation is not expected to be finalized by CMS until November; moreover it is not clear if it can be finalized if the GME and Public Provider regulations are covered by the moratoria, given their financial linkages.

Thank You!

 Manual for Grassroots Activists

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