New Co-Sponsor for H.R. 868

Congresswoman DeGette (D-CO) recently signed onto H.R. 868 as a co-sponsor. We thank Sharon Walters from Mosaic who spent a great deal of time communicating with Congresswoman DeGette's office. Read more!

ANCOR Releases H1N1 Issue Brief

ANCOR has recently released an H1N1 Issue Brief.The issue brief will be updated as new information comes in. To ensure you have the most updated copy check our Pandemic Flu Website. For questions contact Mary Pauline Jones. Read more!

Washington state court case

U.S. District Court Judge in Washington Rules State Violated Rights of Individuals with Disabilities in Cutting Adult Day Health Programs. Cuts to a Washington program that provides rehabilitative therapy and skilled nursing services to disabled individuals living in community-based residential settings must be restored, a federal trial court ruled Sept. 4 (Ryan v. Dreyfus, W.D. Wash., No. 2:09-cv-908, 9/4/09). The U.S. District Court for the Western District of Washington said a class of Medicaid-eligible individuals who had been receiving benefits under Adult Day Health programs were entitled to an injunction against the Washington Department of Social and Health Services (DSHS) and its secretary, Susan N. Dreyfus, because the benefits were terminated without notice. Termination without notice and an opportunity for a hearing violates the due process rights of the individuals who, until July 1, were receiving services through the ADH programs, the court said. The class representatives are entitled to an injunction because they showed they would prevail on their claims that the state violated the 14th Amendment of the U.S. Constitution, as well as the Medicaid Act, and demonstrated an injury that could be redressed by such relief, the court said. The class-wide case management activities that DSHS has undertaken since the commencement of this litigation have provided for post-termination hearings for those individuals who request them. The court ruled: “The class members were entitled to a pre-termination hearing, not a post-termination hearing. Pending a hearing, the class member's ADH services are reinstated. Thus, in order to remedy the due process violation, the class members' ADH services must be immediately reinstated and then DSHS can provide the notice and opportunity to be heard that it should have provided before July 1.
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HIPAA: HHS Issues Rule Requiring Individuals Be Notified of Breaches of Their Health

The breach notification notice of proposed rule making requires HIPAA covered agencies to give notification to affected individuals of breaches of unsecured protected health information (PHI). Business associates of HIPAA covered agencies are required to notify the agency following discovery of a breach of unsecured protected health information maintained by the business associate. The requirement for breach notification applies only to breaches of “unsecured protected health information,” which means PHI that has not been secured by use of a technology or methodology specified in guidance of the Secretary of HHS. That guidance essentially requires encryption or destruction of the PHI. The rule is effective September 23, 2009. However, HHS specifically states, "...we will use our enforcement discretion to not impose sanctions for failure to provide the required notification for breaches that are discovered before 180 calendar days from the publication of this rule, or February 22, 2010. During this initial time period - after this rule has taken effect but before we are imposing sanctions - we expect covered entities to comply with this subpart and will work with covered entities, through technical assistance and voluntary corrective actions, to achieve compliance." ANCOR is working to develop products and other information to assist members with this new development.
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Senate Health Care Update

Senate Finance Chairman Baucus released a draft framework Tuesday and expects to have his Chairman’s report out by September 15th and proceed to a mark-up of a Finance bill the week of September 21st. Read more!

State Discriminated Against Mentally Ill, Judge Rules

New York Federal District Judge Ruled in ADA Case Against New York City. The judge ruled that the state was violating the Americans With Disabilities Act by housing more than 4,300 mentally ill people in New York City in more than two dozen adult homes. He said the residents had little hope of mingling with anyone in the wider community. The ruling, which applies to individuals with mental illness who are not considered dangerous to themselves or others, suggested that the state would have to begin finding individual apartments or small homes for virtually all adult-home residents who wanted one. Look for the article in the September 9th edition of the New York Times.
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Senator Harkin Takes Over as Chair of HELP Committee

It was announced this week that Senator Tom Harkin (D-IA) will be the new Chair of the Senate Health, Education, Labor, and Pensions Committee following the death of former HELP Chairman Ted Kennedy. This ended the speculation as to whether the committee’s most senior Democrat, Senator Chris Dodd (-CT)—who lead the committee through health care reform when Senator Kennedy became ill—would choose to become the new chairman. Dodd chose to remain Chair of the Senate Banking Committee and Senator Harkin gave up his chairmanship of the Senate Agriculture, Nutrition, and Forestry Committee.
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New HCBS Promising Practice

CMS has posted a new HCBS Promsing Practice to the CMS website entitled, "Lessons Learned from Using a Health Information Technology Program that Combines Claims-Level Data with Service-Level Data". It can be found at http://www.cms.hhs.gov/promisingpractices/downloads/medicaiddata.pdf. A list of all the HCBS Promising Practices can be found at http://www.cms.hhs.gov/PromisingPractices/HCBSPPR/list.asp#TopOfPage. This new report describes how Medicaid claims data can be combined with service-level data to improve the quality and cost-effectiveness of services provided in community mental health centers (CMHCs). It describes how CMHCs in three States have used a particular system, Service Process Quality Management (SPQM), to improve quality and achieve cost savings. Read more!

HHS Conference Call on H1N1

HHS will be hosting an information sharing conference call on H1N1 on September 14, 2009.

Call: 1-800-837-1935; Conference ID: 2H1N1
Date: September 14, 2009
Time: 1:30 -3:00 pm, Eastern DS Time

Opening Remarks --- Chair- Dr. Nicole Lurie, Assistant Secretary for Preparedness and Response
Co-Chairs – CAPT Clare Helminiak, Dr. Sally Phillips, and RADM Ann Knebel
Moderator – Susie Butler, CMS Office of External Affairs

Agenda
The purpose of this information session is to update and inform the provider community about issues around H1N1 preparedness and response, vaccine availability, infection control, and other questions that have come in. We will cover the following topic areas:

1. General Update

2. Vaccines and Antivirals

3. Special Populations

4. Healthcare System Surge Capacity

5. Infection Control and Personal Protective Equipment

Submit questions in advance: We invite you to submit questions now at: H1N1.listening@hhs.gov

Please note – we know that we cannot respond to each individual email question. Submitting questions prior to the call will allow us to address as many questions as possible.

Helpful websites, should you have questions:

· www.flu.gov

· www.cdc.gov/H1N1flu

· http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm100228.htm -- information on antivirals

· http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6539.pdf -- CMS billing information

· http://www.cms.hhs.gov/Emergency/Downloads/Medicare_FFS_Emergency_Qs_As_082609.pdf --Information for Medicare Fee-for-Service Providers

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All callers, please dial: 1-800-837-1935 and use Conference ID 2H1N1.


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Virginia Announces Plan to Address FY2010 Budget Shortfall

Governor Tim Kain today announced his plan to address the FY 2010 budget shortfall of over $1.35 billion.

While there are no projected rate cuts for Medicaid services in the plan offered by the Governor today, the plan does:

• eliminate 100 of the 200 MR/ID Waiver slots which were approved by the General Assembly for January 1, 2010
• reduce funding for community services boards by 5%
• eliminate 20 DBHDS Central Office positions and require a one day furlough for all executive branch staff (for most the Friday before Memorial Day)
• eliminate direct management of the Community Resources Pharmacy

It also projects a General Fund savings of $97M because the federal Medicaid share has increased from a projected 60.19% to 61.58% for the last quarter of FY 09 and for FY10 as a result of the Federal stimulus package.

Click here to read the entire report.

Special thanks to Jennifer Fidura for providing us with this information.

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Ohio Joins Other States in Removing Condition of “Mental Retardation” from State Agency’s Name

Thanks to Than Johnson of Champaign Residential Services, Inc. for reporting to ANCOR that the “Ohio Department of Mental Retardation and Development Disabilities” will be changing its name, following passage of bills unanimously by both state legislative chambers, to drop the term “mental retardation.” Governor Ted Strickland signed the legislation on June 7th—which becomes effective in 90 days of enactment—renames the agencgy the Department of Developmental Disabilities. More than 40 other states have made similar changes by removing the term “mental retardation.” Individual Ohio county “MR/DD boards” have already begun changing their names. Read more!

WICS Live: Around the States

Wisconsin: HHS Extends SeniorCare Program: Governor Jim Doyle (D) and the state's congressional delegation announced August 18th that the state's prescription drug plan, SeniorCare, will be extended to 2012. SeniorCare, which was first initiated in 2002, offers a comprehensive prescription drug benefit to Wisconsin residents aged 65 and older with income at or below 200 % of the Federal poverty level (FPL) and are not otherwise receiving full Medicaid benefits. SeniorCare serves nearly 90,000 Wisconsin seniors.


In other news, the state plans to require competitive bids from managed care organizations (MCOs) to oversee the BadgerCare Plus program in populous southeastern Wisconsin for the first time. It is s part of a plan to save $600 million from the program, provides health insurance primarily for low-income families with children under 19. The state also plans to use the contracts to impose stricter performance requirements for MCOs that contract with the state for the program. Read more!

WICS Live: Around the States

Utah: State’s Health Exchange “Open for Business”: Under the new program, participating small businesses will pay employees a stipend, which they can use to purchase health insurance. The new state-run web site then allows workers to compare the available 72 insurance plans on the site and select the health insurance plans that best fits their needs. Proponents believe it is a small step to help the state’s uninsured purchase health coverage, while critics say that the program will make things worse by encouraging companies to drop employer-based coverage and that the available policies are designed for younger—and healthier—workers. Read more!

WICS Live: Around the States

Oregon: Despite Budget, Health Care Reform Moves Forward: State lawmakers passed several initiatives during the legislative session to continue remaking the state’s health care system. One bill, HB 2009, established a Health Care Workforce Strategic Fund to “coordinate efforts to recruit and educate health care professionals and retain a quality workforce to meet the demand that will be created by the expansion in health care coverage, system transformations and an increasingly diverse population.” The bill also creates the Oregon Health Authority, the Oregon Health Authority Fund, and the Oregon Health Policy Board, the latter of which is charged with “ensur[ing] that Oregon’s health care workforce is sufficient in numbers and training to meet the demand that will be created by the expansion in health coverage, health care system transformations, an increasingly diverse population and an aging workforce.” Another bill, HB 2116, funds the Health Care for All Oregon Children program to provide health insurance coverage for uninsured children and also channels funding to community health centers to ensure services for low-income adults. Read more!

WICS Live: Around the States

New York: New Law Allows Unmarried Children to Remain on Parents’ Health Insurance: The new law, signed by Governor David Patterson (D) on August 5th is available to families with children up to age 29. More than 30% of the state’s uninsured population is between the ages of 19-29. Until now, many of those people became ineligible for coverage under their parents' policy after 19 or when they graduated from college. An increasing number are also unemployed or have low-paying jobs that do not offer health coverage. The new law took effect September 1st. The law also extends eligibility for COBRA-- which allows former employees to buy insurance from their company's group health plan at its full cost -- from 18 months to 36 months. Read more!

WICS Live: Around the States

New Jersey: State to Require Insurers to Provide Screening, Therapy for Children with Autism: Governor Jon S. Corzine (D) signed legislation August 13th, requiring individual and group health plans and health maintenance organizations in New Jersey to cover expenses associated with screening for autism and other developmental disabilities and provide medically necessary physical, occupational, and speech therapy. The legislation, which is effective 180 days after enactment, also requires insurers to cover up to $36,000 a year in expenses for medically necessary behavioral intervention for individuals younger than 21 who are diagnosed with autism. The mandatory benefit amount will be adjusted yearly for inflation beginning in 2012. Insurers are barred from denying coverage on the basis that the treatment is not restorative. Read more!

WICS Live: Around the States

Nebraska: State Expands SCHIP Program: Effective September 1st, children in families with incomes up to 200% of the Federal Poverty Level (FPL) are eligible for Kids Connection, the state’s CHIP. The law raises the state’s income ceiling from 185% FPL to about $44,100 annually for a family of four. Nebraska joins 15 other states who have raised their income eligibility to 200% FPL. The Kids Connection expansion was part of the Legislature's response to the Safe Haven crisis last summer, in which parents dropped off 36 children at hospitals. Read more!

WICS Live: Around the States

Massachusetts: Governor Announces State to Provide Health Coverage for Legal Immigrants: Governor Duval Patrick (D) announced August 31st that the state will continue to provide health care coverage for the state’s estimated 31,000 legal immigrants through a new state-funded program that will provide slightly scaled-back coverage. . Earlier in the year, state lawmakers voted to end coverage as part of an effort to address the state’s budget shortfall. Legal immigrants have had access to health insurance since 2006 under Commonwealth Care, the state’s mandatory health insurance law. The program's implementation will be staggered over a three-month period. Patrick's office said it is expected that a significant number of members will be enrolled in October and all members of the new plan will be enrolled by December 1st. Read more!

WICS Live: Around the States

Maine: Governor John Baldacci (D) held a ceremonial bill signing August 24th, marking the enactment of two health-related bills.A Health Care Bills of Rights is intended to provide more transparency in the state’s healthcare marketplace and provide more public information about quality and costs of health care. The second bill requires insurers to provide a clear explanation of benefits for services when claims are filed. Both laws take effect September 12th. Read more!

WICS Live: Around the States

Delaware: New Law Increases State CHIP’s Reach: Governor Jack Markell (D) August 27th signed legislation to extend the state's Children's Health Insurance Program (CHIP) to children in families with incomes over 200% of the federal poverty level (FPL). Delaware has about 20,000 uninsured children, but only about half of them are eligible for CHIP and Medicaid coverage. The new law will permit approximately 9,000 families to buy into the state’s SCHIP at the state’s cost. To be eligible, a child over age 2 in a family with income above 200% of poverty must have been uninsured for at least three consecutive months, unless his or her parent is eligible for unemployment benefits or lost health benefits coverage involuntarily. Read more!

California: Governor’s Line-Item Vetoes in Budget Unconstitutional State Legislative Counsel Bureau Concludes: In the state’s revised budget, Governor Arnold Schwarzenegger (R) made line-item vetoes totaling $489 million, including cutting an additional $50 million from the state’s CHIP program, that Schwarzenegger said were necessary to maintain sufficient reserve funds. In responding the Democratic lawmakers who requested the review by the Legislative Counsel Bureau (LCB), the LCB determined that Schwarzenegger overstepped his constitutional authority, largely because the governor already exercised his line-item veto authority on previous appropriations in the state’s initial FY 09-10 budget enacted in February. The LCB also opined that the governor's line-item veto authority only can be used to decrease an appropriation and cannot be used to increase a budget reduction proposed by the Legislature. Schwarzenegger's Legal Affairs Secretary Andrea Lynn Hoch disagreed, stating that a budget, whether orginal or amended, can only contain legislative appropriations and a governor’s authority to veto appropriations is unquestioned, setting the stage for potential litigation over the line-item vetoes. Read more!

WICS Live: Around the States

Connecticut, Arizona Strike Budget Deals; Pennsylvania Remains Without Budget: Nearly two months into the current fiscal year, Pennsylvania is the only state without a FY 2009 budget Type In Connecticut, Governor Jodi Rell (R) announced September 2nd that she will allow a biennial budget written by Democratic lawmakers to take law without her signature on September 8th, ending the longest budget battle in state history. The two-year, $37 billion budget includes an increase in the state income tax for certain individuals, reduces the estate tax and increases the cigarette tax by $1 to $3 per pack. Rell did exercise her line-item veto authority, cutting about $8.3 million in spending. Arizona’s budget battle ended Friday, September 4th. Governor Jan Brewer's (R) mix of vetoes and bill signings. However, work remains to close a $4 billion spending gap. Read more!

WICS Live: Around the States

Medicaid: States Can Get 90% FFP for Medicaid Administrative Activities Related to Adoption of EHRs: A new State Medicaid Directors letter offers preliminary guidance on State expenses related to activities in support of the administration of incentive payments to providers for the adoption of electronic health records. While 100% match for provider incentive payments to adopt ERHs will not be immediately available, the letter reminds states that they can begin to receive the 90 percent federal financial participation (FFP) match for some initial planning activities related to the administration of the incentive payments. The letter is available at http://www.cms.hhs.gov/smdl/downloads/SMD090109.pdf. Read more!

WICS Live: Around the States

Washington: Restraining Order Lifted, State May Implement Law Prohibiting Payment for In-home Support Services Provided by Agency Employees Related to the Client: The U.S. District Court for the Western District of Washington ruled August 12 that a group of Medicaid beneficiaries and individuals who provide supports and services in the home through agencies were not likely to prevail on their claim that the new law, SBH 2361, violated their rights under the Americans with Disabilities Act or the Medicaid Act. SBH 2361 prevents the state Department of Social and Health Services from paying a home care agency for services provided by a family member of the client. The law applies only to home care agency-associated providers (APs) and does not prevent Medicaid beneficiaries from obtaining services from their relatives as “individual providers” (IPs), the court said. In making its decision, the court noted that the question before it was whether the state statute violated the constitutional rights of the beneficiaries or the personal care services providers, not whether the Washington Legislature had made an appropriate legislative policy decision. Read more!

WICS Live: Around the States

Utah: State Failing to Make Medicaid Fraud Recoveries: Results released in mid-August of a legislative audit shows that the state is losing $20 million in funding it could recover in Medicaid funding The Department of Health’s Bureau of Program Integrity, which is charged with checking for waste, fraud, and abuse in the state’s Medicaid program, failed to follow policies regarding prior authorization for services, and, due to an outdated cost-recovery tool, failed to review 78% of inpatient medical records, according to the audit. Read more!

WICS Live: Around the States

Louisiana: Impact of Medicaid Cuts Still Unknown: As of August 4th, payment rates for Medicaid providers in the state were reduced, in some cases more than 6%. The move is intended to close a $100 million budget gap in the current fiscal year. While providers and advocates are concerned of the long-term effects of the cuts, it is still too early to tell what the effects will be. Read more!

WICS Live: Around the States

Florida: Study Shows Medicaid Pilot Saves Money: A new study shows that the state’s Medicaid pilot program, which enrolled Medicaid beneficiaries in Duval and Broward Counties into manages care plans, is accomplishing one of its goals: saving money. The new report from the University of Florida found that the program, cut the size of beneficiaries’ medical bills over the programs first two years, compared with traditional Medicaid. The report also found that monthly spending on beneficiaries with disabilities dropped an average of $26 dollars while it rose $150 for beneficiaries in other counties. The new report—and the pilot program—are not without critics. Some critics belief that the report shows only short-terms savings, and long-term savings won’t be realized. The pilot was originally intended to be expanded statewide. The state faces a $300 million penalty from the federal government if it doesn't expand the program by 2011. Read more!

WICS Live: Around the States

Colorado: Governor Announces Medicaid Rate Cuts: Governor Bill Ritter (D) announced the cuts Tuesday, August 18th, reducing rates by 2.5% for providers of behavioral health and developmental disability services and by 1.5 % for medical providers to help close a $318 million budget shortfall. Such cuts should save the state $34.2 million in the fiscal year that ends June 30, 2010. The latest reductions follow a 2% rate cut for Medicaid providers on July 1st that was used to bridge a $1.4 billion budget gap that had existed previously. The Legislature also passed a bill creating a new fee on hospital beds beginning this fiscal year that is expected to allow more uninsured Coloradans to receive health coverage and to increase the provider reimbursement rates slightly. Read more!

WICS Live: Around the States

California: Court Again Upholds Injunction Against Medi-Cal Reimbursement Rate Cuts: In the ongoing legal battle over Medi-Cal rate reductions, the U.S. Court of Appeals for the Ninth Circuit August 7th issued another decision blocking Medi-Cal reimbursement rate cuts, this time for medical transportation and home health care services. The Appeals Court rules that a federal trial court properly issued an injunction preventing the state from reducing rates, solely because of the state's need to reduce expenditures, without complying with Medicaid Act requirements that the state to consider the effect of those cuts on efficient access to economical and high quality care. The appeals court also found that the petitioners, including Independent Living Center of Southern California Inc., demonstrated that they were likely to suffer irreparable harm if the injunction were denied. There was evidence before the trial court that state Medicaid transportation providers and home health care agencies already were reducing the scope or range of services because of the cuts, the Ninth Circuit said. Read more!

WICS Live: Around the States

Arizona: Medicaid Enrollment Increasing Rapidly, Adding to Budget Woes: Officials with the Arizona Health Care Cost Containment System, the state’s Medicaid agency said in normal year, new enrollments increase about 60,000. But with the downturn in the state’s service and construction industries, the state anticipates adding up to 300,000 new enrollees this year. The state is already having difficulty keeping up with the program’s current costs and is contributing to the state’s current budget standoff between Governor Jan Brewer (R) and the Republican-controlled legislature. They are at odds over the Governor’s 1% sales tax increase to close a $3 billion budget gap. Read more!

WICS Live: Around the States

Alaska: Lawsuit Filed Over Waiver Service Moratorium: As a result of HHS’ July moratorium on all new Medicaid waiver services, a class action lawsuit was filed in mid-August by four named individuals and others who all have medical and other disabilities and wish to receive services in their homes. The suit alleges that HHS Secretary Kathleen Sebelius of overstepping her authority in imposing the ban and also says the state’s Department of Health and Social Services’ Commission should have never agreed to the moratorium. The state was supposed to submit a detailed report to CMS by September 1st. Read more!