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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Friday, November 20, 2009
Thursday, November 19, 2009
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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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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Wednesday, November 18, 2009
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.
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Tuesday, November 17, 2009
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&.
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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.
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Monday, November 16, 2009
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!
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!
Friday, November 13, 2009
Clarification on H1N1 Priority Vaccination Groups
Henry Claypool from HHS said that we expect clarification on the issue of DSPs being considered health care personnel as related to distribution of the H1N1 vaccine in the next couple of days. This should also clarify which individuals with disabilities fall into the priority groups.
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Reid Hopes to Debate Health Reform Next Week
Senate Majority Leader Harry Reid (D-NV) Tuesday night started the process of making a place on the Senate calendar to begin debate next week on the Senate health reform proposal. Republicans are expected to mount a filibuster of the motion to proceed, which if successful would prevent the bill from being debated on the Senate floor. Reid needs 60 votes to overcome the filibuster, and he has been working to secure the votes of all 60 members of the Democratic Conference, given unanimous Republican opposition. Despite the formal calendar process, the timing of the Senate’s health care debate is still in doubt. Reid has given his Members assurances that he would not bring a measure to the floor without a formal cost estimate from the Congressional Budget Office (CBO). The CBO score is expected by the end of this week, but once Reid sees the estimate, he may seek tweaks to the bill that could delay the final score.
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NGA and State Budget Officals Project States Will Continue to Face Fiscal Difficuties in Comming Years.
In a preliminary review of the biannual report The Fiscal Survey of States, officials from the National Governors Association (NGA) and the National Association of State Budget Officers (NASBO) today forecasted continued fiscal difficulties for states. In fiscal 2009, states were forced to reduce General Fund expenditures by 4.8 percent and are expected to reduce fiscal 2010 General Fund expenditures by at least 4.0 percent, marking the first time that state spending has declined in back to back years. The weakening of state fiscal conditions is reflected in the $250 billion in budget gaps faced by states between fiscal 2009 and fiscal 2011. Of the $250 billion, states closed $72.7 billion in budget gaps during fiscal 2009 and $113.1 billion before the enactment of their fiscal 2010 budgets to bring them into balance with drastically declining revenues.
"These are the worst numbers we’ve ever seen in the decades of putting together this report," said NASBO Executive Director Scott D. Pattison. "States have been forced to lay off and furlough employees, raise taxes, drain rainy day funds and sharply cut state spending in ways that impact every part of state government."
Even after closing these gaps, an additional $14.5 billion in budget gaps remains in fiscal 2010, and states face at least $21.9 billion in budget gaps for fiscal 2011. To help close these gaps, 42 states cut their enacted fiscal 2009 budgets by $31.2 billion, and 33 states cut their fiscal 2010 expenditures by $53.5 billion. Additionally, states enacted tax and fee increases of $23.8 billion along with additional increases in other revenue measures of $7.7 billion for fiscal 2010.
"States will continue to struggle over the next decade because of the combination of the length and depth of this economic downturn, the projected slow recovery and the overhang of unmet needs," said NGA Executive Director Raymond C. Scheppach. "The unmet needs are those postponed or deferred during the crisis including, replenishing retiree pension and health care trust funds and financing maintenance, technology and infrastructure investments. States will also need to rebuild contingency or rainy day funds. The bottom line is that states will not fully recover from this recession until late in the next decade."
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"These are the worst numbers we’ve ever seen in the decades of putting together this report," said NASBO Executive Director Scott D. Pattison. "States have been forced to lay off and furlough employees, raise taxes, drain rainy day funds and sharply cut state spending in ways that impact every part of state government."
Even after closing these gaps, an additional $14.5 billion in budget gaps remains in fiscal 2010, and states face at least $21.9 billion in budget gaps for fiscal 2011. To help close these gaps, 42 states cut their enacted fiscal 2009 budgets by $31.2 billion, and 33 states cut their fiscal 2010 expenditures by $53.5 billion. Additionally, states enacted tax and fee increases of $23.8 billion along with additional increases in other revenue measures of $7.7 billion for fiscal 2010.
"States will continue to struggle over the next decade because of the combination of the length and depth of this economic downturn, the projected slow recovery and the overhang of unmet needs," said NGA Executive Director Raymond C. Scheppach. "The unmet needs are those postponed or deferred during the crisis including, replenishing retiree pension and health care trust funds and financing maintenance, technology and infrastructure investments. States will also need to rebuild contingency or rainy day funds. The bottom line is that states will not fully recover from this recession until late in the next decade."
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Monday, November 9, 2009
If ARRA Federal Increase in Medicaid FMAP Is Not Extended, States Will Be Faced with Tough Choices in 2011.
Federal Medicaid fiscal relief in the ARRA have been critical in helping states to address budget shortfalls, perserve eligibility, avoid or reduce provider cuts, and avoid or soften program cuts. See Kaiser’s October 2009 fact sheet: Medicaid and State Budgets: From Crunch to Cliff.
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Connecticut Budget Update
Governor Rell of Connecticut announced rescissions of up to 5% in various state agency line items at the end of the day November 5. The Governor can make line item cuts up to 5% without need for Legislative approval. The total of the rescissions is $34M. The deficit is now projected at $400M by the Office of Policy and Management (the Governor’s budget office) and at $628 by the Comptroller. The Secretary of OPM stated yesterday that the intention is to balance the budget through cuts, not higher taxes.
Most of the cuts in the human services state agency accounts are in the “Personal Services” line – the account for state personnel salary/wage expense. The DCF residential Board and Care – Foster and Residential and Emergency Services had the largest reductions that have the potential to affect community providers. In DDS, the autism pilot was reduced, but other service delivery accounts were not touched. DMHAS wasn’t cut. DSS cuts include a reduction in “Aid to the Disabled,” a large account. Medicaid wasn’t cut.
The Governor’s press announcement
The proposed rescissions (14 pages)
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Most of the cuts in the human services state agency accounts are in the “Personal Services” line – the account for state personnel salary/wage expense. The DCF residential Board and Care – Foster and Residential and Emergency Services had the largest reductions that have the potential to affect community providers. In DDS, the autism pilot was reduced, but other service delivery accounts were not touched. DMHAS wasn’t cut. DSS cuts include a reduction in “Aid to the Disabled,” a large account. Medicaid wasn’t cut.
The Governor’s press announcement
The proposed rescissions (14 pages)
Thank you to Stan Soby of Oak Hill for providing ANCOR with this update.
Read more!
House Passes Health Care Reform
Saturday night the House passed their America's Affordable Health Choices Act of 2009(H.R. 3200) with lawmakers voting 220-215. The Senate has yet to take their legislation to the floor and is still waiting on scoring from the Congressional Budget Office. Remember to look at the Senate legislation very closely as it differs greatly from the Legislation passed in the House.
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Friday, November 6, 2009
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!
--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!
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!
Thursday, November 5, 2009
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.
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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!
Tuesday, November 3, 2009
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!
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!
Monday, November 2, 2009
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!
Read more!
Sunday, November 1, 2009
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.
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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.
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