House Vote on Health Reform May Be as Soon as Tomorrow

The House of Representatives' first floor vote on health reform may come as early as Saturday. This comprehensive bill, the Affordable Health Care for America Act (H.R. 3962), has important provisions that ANCOR supports.

--Inclusion of the Community Living Services and Supports Act (the CLASS Act), a new actuarially sound, premium-based, national long term services insurance program to help adults with functional impairments remain independent in their communities. This cash benefit would reduce the burden on federal and state Medicaid programs.

--Inclusion of the current American Recovery and Reinvestment Act increase in federal Medicaid payments (FMAP) to states with high unemployment rates for an additional six months.

--Inclusion of a statement of support for the Community First Choice Option to encourage states to cover Medicaid community-based attendant services and supports. (included in manager's amendment)

Your Message: Include the CLASS Act, FMAP increase, and the Community First Choice Option provisions in H.R. 3962-the Affordable Health Care for America Act.

Respond to ANCOR’s Action Alert by entering your zip code in the "Call Now" window to get your Representative's telephone number. All you have to do is make the call, use the talking points, and leave your feedback.

You can also send your Representative an email using the message above. Simply find your Representative's email address using ANCOR's Congressional Directory.

Read more!

Medicaid Audits Got Down? ANCOR is Offering a Two Part Series on How Providers Can Survive Audits and Reviews with Barb Edwards. Save the Date!

Did you miss ANCOR's most popular Governmental Activities Seminar preconference EVER?

If you couldn't make it to the September conference, or even if you want to hear it all again and want another chance to ask The Expert, ANCOR is excited to bring you a series of two webinars featuring Barb Edwards and her Medicaid expertise. Ms. Edwards is a principal in Health Management Associates, former interim director of the National Association of State Medicaid Directors, and former Ohio State Medicaid Director.

Dates: November 16th and November 23rd

Time: 2:00 PM to 4:00 PM (EST) both days

Registration Begins Next Week-Watch for Details
(Can't make the date - Order a recording)

Driven in part by Congressional pressure to combat fraud, waste and abuse, there is a growing attention being paid to program integrity within the Medicaid program. Many state and federal players have authority to conduct provider audits or other reviews under Medicaid, and audits have increased. Find out what providers need to know to about the purpose and use of audits and how to prepare for them.

Webinar #1: Medicaid Program Integrity and YOU

Ms. Edwards will take you through the history of Medicaid's focus on program integrity and the federal structure of Medicaid. She will also cover the KEY Medicaid integrity programs, including PERM (Payment Error Rate Measurement) and HHS Office of Inspector General audits, including their purpose, audit protocols, how CMS uses these audits, and MUCH more! You will also hear directly from other ANCOR providers about their experiences. Of course, time will be allowed for "Q and A" with Barb and the provider-presenter.

Webinar #2: Providers and Medicaid Oversight: Getting Ready

Ms. Edwards will give a more detailed look at three federal oversight programs: waiver reviews, the Medicaid Integrity Program, and the False Claims Act. She will also focus on provider readiness for these audits. Again, hear from an ANCOR provider with first-hand experience and take advantage of the "Q and A" session following the presentation.

Read more!

FDA Fights False Claims About H1N1 Treatments

There are over 140 drugs, devices and pieces of equipment marketed over the Internet that have landed on a list of fraudulent swine-flu-fighting products compiled by the Food and Drug Administration. It is violation of federal law to market products that claim to prevent or treat H1N1 and that have not been approved by the F.D.A. While most claims about products are so outlandish that they are dismissed, it posses the problem that individuals may have a false sense of protection. Read more!

New H.R. 868 Co-Sponsors

Rep. Rush Holt (D-NJ), Rep. Lucille Roybal-Allard (D-CA), Rep. Brian Higgins (D-NY), and Rep. Michael Arcuri (D-NY) signed on this week as co-sponsors to the Direct Support Professionals Fairness and Security Act (H.R. 868). Thank you to Barbara Merrill and the MENTOR Network for contacting Rep. Roybal-Allard's office. Thank you as well to everyone who also contacted their members urging them to sign on. Read more!

NASDDDS Survey on State Plans to Close or Downsize

In late October 2009, NASDDDS conducted a brief email survey of member state agency officials regarding the existence of plans to close or downsize large state-operated institutional programs in their respective states. Respondents were additionally requested to indicate whether or not their current plans were being implemented in response to financial considerations.

Total NASDDDS member state agencies: 51

Total number of states responding to the survey: 49 (96%)

Of the 49 responding states, 11 (22%) states reported that they had closed all state operated institutions for persons with intellectual and developmental disabilities (IDD).

Of the 38 states operating institutional programs that responded to the survey (unduplicated count):

4 (11%) states are planning to close one or more facilities and not downsize other programs or facilities.

14 (37%) states are planning to downsize existing facilities but not close any institutions.

5 (13%) states are panning to close one or more institutions and downsize additional facilities.

15 (39%) states have no plans to close or downsize state operated institutional programs.

Summarizing the results of the data from the 38 states reveals that:

9 states (24%) have plans to close one or more institutions.

19 states (50%) have plans to downsize programs, reducing the census of existing facilities.

Financial Impact

10 states (26%) made the decision to close and/or downsize IDD facilities due to financial reasons.

Of the 4 states with plans to close some facilities but not downsize others, three states are closing the facilities for financial reasons.

Of the 14 states with plans to downsize but not close facilities, three states are downsizing for financial reasons.

Of the 5 states with plans to both close and downsize existing facilities, three states made the decision for financial reasons.
Read more!

Updated House health care bill section-by-section summary

The House has posted the attached updated (November 1) section by section summary of the health care bill.
Read more!

WICS Live: Around the States

Tennessee: State Freezes CHIP Enrollment. As of November 30th, the state will not accept new applications for the state’s expanded CHIP, which provides coverage to children and pregnant women in families with incomes up to 250% of the Federal poverty level and do not qualify for Medicaid. There will be no service cuts to program beneficiaries already enrolled in the program. Read more!

WICS Live: Around the States

Wisconsin: BadgerCare Plus Core Plan Reaches Maximum Enrollment. Governor Jim Doyle (D) announced October 5th that the program, which provides health insurance coverage for adults without children and not enrolled in any other health insurance program, has reached capacity and suspended enrollment as of October 9th. Those applying for coverage now are being placed on a waiting list. Doyle has directed the state Department of Health Services to design a proposal to provide some basic level of health coverage for those on the waiting list. Doyle said the state received 60,000 applications for the new program since the program began June 15th and most applicants had no income. The program must remain budget-neutral, which means the state can only afford to cover approximately 54,000 individuals. Read more!

WICS Live: Around the States

Texas: Harris County Unveils TexHealth Harris County 3-Share Plan. Officials in Harris County, which includes Houston and Sugar Land, unveiled a new small business insurance option October 20th. Harris County alone has over 1 million uninsured residents; Texas has the nation’s largest uninsured rate. The 3-Share Plan, which hopes to make a small dent in the uninsured rate, will divide monthly premiums among the employer, employee, and a subsidy fund. In the program’s first two years, a $5.5 million subsidy pool will make insurance coverage available to 5,000 uninsured workers. Workers making less than $16 an hour would pay 17% of their monthly premiums. Workers making more would split the premium 50-50 with employers. Read more!

WICS Live: Around the States

Minnesota: Governor Proposes Interstate Insurance Compact. In a letter to other governors October 21st, Governor Tim Pawlenty (R) asked his counterparts to join him in establishing an interstate health insurance compact that would call for standards in the health care market, enabling insurers to compete with one another across state boards. According to Pawlenty's letter, the proposed compact would allow states to share common regulatory standards, thereby facilitating the purchase of health insurance across state lines. It would also allow more insurers to do business in states would both increase competition and choice. The proposal would need Congressional consent and would also likely need legislative approval in Minnesota, since state law now requires health care insurers doing business in the state to be non-profit. Read more!

WICS Live: Around the States

Pennsylvania: Budget Stalemate Is Finally Over. After 101 days without a state budget, Governor Ed Rendell (D) and lawmakers reached a budget agreement, with Rendell signing the state’s $27.8 billion budget Friday, October 9th. The measure cuts overall spending by more than 1 percent and relies on nearly $500 million in new taxes on sales of cigarettes, little cigars and business taxes. The bill does not raise sales or income taxes, the state’s two biggest sources of revenue. Read more!

New York: 500 Show Up At Hearing to Protest More Proposed Budget Cuts. The hearing, which was held by the State Senate in Brookhaven, Long Island, was the second in a series to gauge public reaction to mid-year budget cuts proposed by Governor David Paterson (D) to close a current $3 billion budget gap and a projected $2 billion deficit next year. The majority of the attendees at the 5 ½ hour meeting were people with disabilities and disability advocates, who decried Paterson’s proposal to eliminate $65 million in community services and education programs so that individuals with disabilities can live independently. Read more!

New Mexico: Special Legislative Session Ends with Lawmakers Approving 7.6% Cut for All Agencies Under Governor’s Control. The special session was called to address a $650 million revenue shortfall in the state budget. The state Health Department could lose about $38 million in state funding—and an additional $155 million in Federal funding—if Governor Bill Richardson (D) signs the measure. Richardson must decide whether to sign the measure by November 12th. If enacted, cuts will be required for Medicaid, including mental health and substance abuse services for low-income New Mexicans and medical services for uninsured children and individuals with developmental disabilities. Read more!

WICS Live: Around the States

Missouri: Governor Cuts Additional $204M from State Budget. The cuts, made by Governor Jay Nixon (D) on Wednesday, include cuts to some Medicaid providers. The governor’s budget director said the state will cut $32.5 million from Medicaid, some of which will come from reduced payments to providers, and other cost-saving measures, such as more reliance on generic prescription drugs. Provider payments will only be reduced for services where the state’s reimbursement rate is higher than that of Federal rate. Read more!

WICS Live: Around the States

Colorado: Governor Outlines Second Rounds of Budget Cuts. Governor Bill Ritter (D) October 28th laid out his plan to cut another $286 million from the state budget, including reductions in Medicaid provider rates and more cuts to higher education. The governor cut $3.1 million from Medicaid providers, reducing rates by 1%, bringing this year's total cuts to the program to 4.5%. The cuts come on top of the $1.8 billion budget shortfall the state has already covered over the past year. The governor’s office warned that more cuts may be ahead, before the state’s budget year ends in June. State workers have also been ordered to take 4 additional furlough days in an effort to save money. Ritter this week will present his budget for the next fiscal year, and even deeper cuts are expected. The governor’s budget director said additional cuts are needed because of higher-than-expected Medicaid enrollment growth and previous cuts that Ritter backed away from—including $4.5 million he tried to cut for aid to low-income residents and people with disabilities. Read more!

WICS Live: Around the States

Washington: State Agrees to Restore In-Home Supports to Children with Disabilities Enrolled in Medicaid. According to a settlement agreement, the state has agreed to restore services to 4,000 children with disabilities. The settlement comes after a lawsuit was filed to prevent the state from cutting services as of July 1st; the cuts were directed by the Legislature to manage a budget deficit for the 2009-2011 biennium budget. The state is still in discussions with representatives of adults with disabilities. As of October 19th, plaintiffs and representatives from the Department of Social and Health Services in hopes of submitting a consent decree for Federal court approval. Another case involving Medicaid cuts has been appealed to the U.S. Court of Appeals for the Ninth Circuit after a Federal District Court refused to grant a preliminary injunction for beneficiaries and family members providing in-home supports as employees of other agencies. Read more!

WICS Live: Around the States Blog

North Carolina: Budget Cuts Mean Medicaid Program Will Lose $1.5 Billion. The state continues to squeeze savings out of Medicaid program, cutting provider rates, but state officials are warning that service cuts and job losses in health care could be looming. About 11,000 more people than estimated were enrolled in Medicaid during the months of August and September, increasing the pressure on the state budget. Read more!

WICS Live: Around the States

New York: State Will Reimburse Pharmacies that Provide H1N1, Seasonal Flu Vaccine to Medicaid Fee-for-Service Beneficiaries. It is the first time Medicaid-enrolled pharmacies will provide flu shots since a 2008 law took effect, permitting pharmacist to administer the shots. Medicaid recipients enrolled in managed care plans have access to immunizations through their providers. Read more!

WICS Live: Around the States

Louisiana: State to Audit Medicaid Providers to Root out Fraud and Abuse. The state Department of Health and Hospitals announced October 29th that it will roll out a new effort to combat fraud in the state’s Medicaid program by auditing more than 700 private firms that provide in-home services for the elderly and people with disabilities. The audits come in the wake of years of growth in the state’s home and community-based services; in the last 7 years, costs grew by 174% and now cost the state $673 million annually. Read more!

WICS Live: Around the States

Florida: State Previews First Phase of Electronic Health Records. The state Agency for Health Care Administration (ACHA)October 28th unveiled the MyFlorida Health eBook and eBaby Book, making the state the first in the nation to allow Medicaid recipients to access personal health records over the Internet. Within the next month, 2.6 million Medicaid beneficiaries will be able to access their health records and enter and track their health information by using their Medicaid ID number. Medicaid recipients also will be able to track family histories, print them, and share the information with health care providers, AHCA said. Read more!

WICS Live: Around the States

California: Statewide Study Finds Federal Citizenship Requirement Imposes Significant Burden on Counties.The study, conducted by the California Endowment and California Healthcare Foundation, found that the citizenship requirement made it difficult for most individuals, including children over age 16 and people born outside the state, to access Medicaid because they had difficulty finding birth certificates, driver’s licenses, and other acceptable documentation. Officials reported that no cases of existing Medicaid recipients had previously claimed false citizenship. At the same time, all 58 counties in the state reported increased workloads, backlogs, and costs to implement the citizenship verification requirement. Read more!

WICS Live: Around the States

California: State Prevented From Implementing November 1st Cuts to In-Home Support Services. A Federal judge October 19th issued a preliminary injunction to prevent the state from implementing planned cuts to an estimated 130,000 children and adults with disabilities and the elderly because of the substantial harm that would result. U.S. District Court Judge Claudia Wilken ruled that the plaintiffs in the class action suit were likely to show at trial that the service cuts, resulting for the recent state budget, violate Federal law. Read more!