HHS Using Tougher Standards to Calculate Improper Medicare Payment Rates for 2009

As part of the Obama Administration’s goal of reducing waste, fraud and abuse in Medicare, the HHS and CMS significantly revised and improved its calculations of Medicare fee-for-service (FFS) error rates in 2009. “As we move forward in our review of the Medicare and Medicaid error rate data, we expect to be able to determine if there are specific trends that can better help us identify weaknesses in our programs or systems,” said Acting CMS Administrator Charlene Frizzera. “We hope to be able to use data available through the use of new electronic health record reporting that can help in the design of new and innovative approaches to finding emerging trends and vulnerabilities in high risk areas such as durable medical equipment and home health.” HHS Secretary Kathleen Sebelius and Frizzera also pointed out the HHS and the CMS would invest more time and resources into working with providers to eliminate errors through increased and improved training and education outreach. “It’s important that we continue to work closely with doctors, hospitals and other health care providers to make sure they understand and follow the more comprehensive fee-for-service requirements,” said Frizzera. “We are committed to working closely with them to reduce the rate of improper payments.”
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Senate Health Reform Bill Contains Long Term Services and Workforce Provisions

The newly introduced Senate health reform bill contains the ANCOR-supported CLASS Act, the Community First Choice Option, and other provisions to improve Home and Community Based Services. While the House-passed version contains both of those provisions and a temporary extension of the Recovery Act’s FMAP increase to states experiencing high unemployment, the Senate bill did not include the FMAP bump.

Also of note is Section 6201, which expands an existing nationwide program for national and state background checks on direct patient access employees of long-term care facilities and providers. The provision would require the establishment of a nationwide program for national and state background checks on direct patient access employees of certain long-term supports and services facilities or providers.

Another workforce provision (Section 5507) would establish a demonstration grant program through competitive grants to provide aid and supportive services to low-income individuals with the opportunity to obtain education and training for occupations in the health care field that pay well and are expected to experience labor shortages or be in high demand. The provision would also establish a demonstration program to competitively award grants for up to six states for three years to develop core training competencies and certification programs for personal and home care aides.

ANCOR will be providing further details as staff continue analysis of the bill.

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Reid Presents $848 Billion Health Care Reform Package to Senate

All 2074 pages were introduced on Wednesday and contain provisions (long summary and short summary) that would extend coverage to 31 million Americans. Unlike the House-passed bill, the Senate’s version does NOT contain employer mandates, but employers with 50 or more employees which did not provide health insurance would pay a penalty if workers received government subsidies to purchase coverage through the exchange. The bill also includes and expansion of the Medicaid program eligibility to include people who make up to 133 percent of the federal poverty level.
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Vote to Begin Debate on Health Reform Bill “Patient Protection and Affordable Care Act,” (H.R. 3590) Set for Saturday

Senate Majority Leader Harry Reid (D-NV) has scheduled a vote to begin debate on the chamber’s health care overhaul bill for Saturday night, although it is not definite that Reid has the 60 votes he needs to overcome a Republican filibuster and bring the measure to the floor. Under a unanimous consent agreement reached Thursday, Republicans agreed to waive their prerogative to insist on 30 hours of post-cloture debate if Reid prevails on the procedural question and to forgo a roll call vote on adopting the motion to proceed, which would require just a simple majority to prevail. That could allow senators to begin their Thanksgiving recess on Saturday, rather than Sunday or later. Senate Democrats are attempting to get their version of their bill approved by the Christmas break, but it is unclear whether sufficient time remains on the legislative calendar for that to happen.
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Mid-Year Shortfalls Open a $31 Billion Gap in 35 States

According to an update by the Center on Budget and Policy Priorities, at least 42 states plus the District of Columbia are enacting cuts in major areas of state services—including health care (28 states) and services to individuals with disabilities and the elderly (24 states and DC). The worst recession since the 1930s has caused the steepest declines in tax receipts have led many states to face large budget gaps even after making deep cuts. You can view a table of state-by-state mid-FY 2010 budget gaps at http://www.cbpp.org/cms/index.cfm?fa=view&id=711
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CMS Withdraws Medicaid Rehab Proposed Rule

CMS is withdrawing the proposed rule, “Medicaid Program: Coverage for Rehabilitative Services” originally published in the Federal Register on August 13, 2007 (72 FR 45201). The withdrawal notice will be published in the November 23, 2009 Federal Register. As you will recall, the rule proposed to “clarify the definition of Medicaid ‘rehabilitative services’ [including elimination of rehabilitation services except under certain circumstances], established new documentation [including 15-minute unit billing], and other requirements.”

CMS received a total of 1,845 public comments in response to the August 13, 2007 proposed rule. Congress included a moratorium on this regulation on December 29, 2007 and that moratorium was extended until April 1, 2009 in the Supplemental Appropriations Act of 2008. Before that moratorium was up Congress included a “Sense of Congress” in the American Recovery and Reinvestment Act of 2009 that the HHS Secretary should not promulgate as a final regulation the August 13th proposed rule. CMS has decided to withdraw the August 2007 proposed rule in light of Congressional concerns, public comments in 2007, and in order to assure agency flexibility in re-examining the issues, options, and alternatives with both the Congress and stakeholders.

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New Co-Sponsors for H.R. 868

Rep. Chris Van Hollen (D-MD)and Rep. Tim Bishop (D-NY) signed on as co-sponsors of the Direct Support Professionals Fairness and Security Act of 2009 (H.R. 868). Thank you to everyone who contacted their representative. Read more!

ANCOR Supports Introduction of Legislation to Eliminate the Term of Mental Retardation from Federal Law

U.S. Senators Barbara A. Mikulski (D-MD) and Michael B. Enzi (R-WY) introduced a bill on Tuesday, November 17th that would forever eliminate the words stigmatizing terms of “mental retardation” and “mentally retarded” from federal law books. Senator Mikulski said she was introducing the bill—known as Rosa’s Law—after attending a roundtable on special education last year where a mother told the Maryland lawmaker about how her daughter Rosa was labeled at school and the stigma, pain and anguish it caused her daughter and the entire family. The family reached out to their local Arc and the Maryland General Assembly were legislation was passed substituting the phrase “an individual with an intellectual disability. Senator Mikulski stated on the Senate floor today that she was introducing the “at the request of the family, a law on behalf of this little girl and on behalf of all of the children in the United States of America.... I’ve always thought the best ideas come from the people.” ANCOR joined with scores of other national groups in a letter supporting the legislation that would make the change to “intellectual disability. You can read Senator Mikulski’s entire statement on introducing Rosa’s Law at http://mikulski.senate.gov/record.cfm?id=319975&. Read more!

Additional Federal Fiscal Relief Needed to Help States Address Recession’s Impact or State Could Lose 900,000 Jobs in 2010

A November report by the Center on Budget and Policy Priorities finds that without additional federal assistance, states could be forced to institute additional deep budget cuts and tax increases in 2010. Although states received federal assistance for education, jobs and for their Medicaid programs last year with the passage of the ARRA stimulus, states will face a “cliff” on December 31, 2010 unless additional federal funding is forthcoming. With most governors sending their budget proposals to state legislatures between December and February, state lawmakers will have to pass budgets as early as March or April in some states and by the end of June in almost all states. If states do not know they will receive additional federal fiscal relief, they will begin implementing new budget cuts and tax increases by this summer, at the latest. The CBPP report states that budget projections suggest that states will face total deficits for state fiscal years 2011 and 2012 of as much as $260 billion beyond what can be covered by the limited ARRA funding that will remain available—reducing demand in the U.S. economy by as much as $260 billion. Read more!

Maine revenues continue to slip; shortfall as high as $400M

Gov. John Baldacci has ordered the preparation on an executive order to curtail state spending as state revenues continue to fall below estimates with Finance Commissioner Ryan Low expecting the revenue shortfall now will range between $300 million and $400 million for the two-year budget.

He said when preliminary figures were known late last week, the governor ordered the preparation of a curtailment order to stop state spending under his emergency budget authority. He said the curtailment process cannot make up for the entire revenue shortfall, but it is important to stop spending as soon as possible.

Last month the governor ordered agencies to identify how they would cut spending to meet a target of $200 million. Low said instead of another round of requests, his office will use those as a starting point and in one-on-one meetings with state agencies, push for further spending cuts.

Thank you to Bonnie-Jean Brooks for providing ANCOR with this information. Read more!