A bipartisan group of 42 governors of states and five governors of U.S. territories sent a letter on February 22 urging House and Senate leaders to extend for at least six months the enhanced federal match for Medicaid included in the American Recovery and Reinvestment Act of 2009. The following governors did not sign the letter: Janice Brewer (R-AZ), C. L. Otter (R-ID), Bobby Jindal (R-LA), Tim Pawlenty (R-MN), John Hoeven (R-ND), Mark Sanford (R-SC), Rick Perry (R-TX), and Gary Herbert (R-UT).
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Tuesday, February 23, 2010
Friday, February 12, 2010
New HCBS Participant-Directed Services Clearinghouse Online Website
The HCBS Clearinghouse has added a new theme page maintained by the National Resource Center for Participant-Directed Services at Boston College regarding information and resources on participant-directed services (self-directed services). The new site includes an online manual for developing and implementing participant-directed services; CMS guidance on the DRA Section 6087, the “Optional Choice of Self-Directed Personal Assistance Services (PAS) Medicaid state option; and state experiences with managing rebalancing efforts.
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Go Direct - Social Security
Millions of Americans still receive their Social Security and other federal benefit payments by paper check, which can be vulnerable to delays, loss or theft. By supporting the U.S. Department of the Treasury's campaign to encourage the use of electronic payments for federal benefits, you can help senior citizens, people with disabilities and others in your community choose a safer, easier way to get their money. Treasury suggests the use of two electronic payment options:
The U.S. Department of the Treasury encourages the use of two safer, easier alternatives to paper checks for federal benefits: Go Direct and the Direct Express card.
The U.S. Department of the Treasury encourages the use of two safer, easier alternatives to paper checks for federal benefits: Go Direct and the Direct Express card.
- Treasury's Go Direct® campaign offers Americans with bank accounts a fast, easy way to sign up for direct deposit. For more information about Go Direct and how to sign up please visit http://www.godirect.org/ or call the toll-free Go Direct campaign helpline at (800) 333-1795
- The Direct Express® Debit MasterCard® card is designed as a safer, more convenient alternative to paper checks for Social Security and Supplemental Security Income (SSI) benefit recipients who don't have a bank account. For more information about the Direct Express card or how to sign up please visit http://www.usdirectexpress.com/ or call toll-free (877) 212-9991
Kaiser Examines Medicaid and Managed Care
The Kaiser Commission on Medicaid and the Unisured issued a policy brief Monday, February 8th which provides an overview of the Medicaid program’s increasing reliance on managed care to deliver services. Medicaid provides health and long-term care coverage to nearly 60 million low-income individuals, or roughly 1 in 5 Americans. About 70 percent of Medicaid enrollees receive some or all of their services through managed care. Adopting managed care also gives states more cost predictability and control over their Medicaid programs, and contracts with managed care plans offer states a mechanism, through quality measurement and improvement requirements, for holding plans accountable for the quality of care they provide to Medicaid enrollees.
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Friday, February 5, 2010
Senate To Move on First Jobs Bill Week of February 8th
Provisions of a Senate $80 billion jobs bill expected in Thursday's Democratic press conference with Majority Leader Reid (D-NV), Durbin (D-IL) and Baucus (D-MT) were not forthcoming as Senators said details for a bill would be unveiled Friday or Monday. Reid expects to vote on the first jobs creation bill by end of next week before the Congressional week-long Presidents' Day recess that begins February 12th.
Senate leaders continued to negotiate a bipartisan package of tax incentives and safety-net spending for laid-off workers Thursday, but the must-pass nature of the bill meant it was beginning to attract unrelated legislative freight. The House-passed jobs bill costs $154 billion heavily focused on infrastructure and FMAP extension. However, the Senate jobs bill is to focus on tax credits and tax payroll relief for small businesses, highway funding, and possibly extension of unemployment insurance and COBRA. At this point, it is not expected to include FMAP extension. See related brief on Reid and Rockefeller bill and push to get FMAP in this jobs bill. Read more!
Senate leaders continued to negotiate a bipartisan package of tax incentives and safety-net spending for laid-off workers Thursday, but the must-pass nature of the bill meant it was beginning to attract unrelated legislative freight. The House-passed jobs bill costs $154 billion heavily focused on infrastructure and FMAP extension. However, the Senate jobs bill is to focus on tax credits and tax payroll relief for small businesses, highway funding, and possibly extension of unemployment insurance and COBRA. At this point, it is not expected to include FMAP extension. See related brief on Reid and Rockefeller bill and push to get FMAP in this jobs bill. Read more!
Senate and House Democratic Leaders Continue to Move Health Reform Process Forward
The leadership of both chambers are negotiating a pathway to resume passage of comprehensive health reform that includes significant provisions related to long-term services' issues. House Democrats remain reluctant to pass the Senate bill without assurances of changes.
In order to avoid an expected 60 vote cloture to end a filibuster Democratic leaders are still pursuing a path in which the House would agree to the Senate bill, but make changes through "the reconciliation process" that would require only 51 votes. Given the level of mistrust between the two chambers, the House wants the Senate to vote first on a reconciliation package that would modify the Senate bill's provisions including the so-called "Cadillac tax" on insurance plans costing more than $8,500 for individuals and deeper subsidies for low-income beneficiaries.
Meanwhile the Senate is pivoting to job creation bills while substance and process are worked out. Read more!
In order to avoid an expected 60 vote cloture to end a filibuster Democratic leaders are still pursuing a path in which the House would agree to the Senate bill, but make changes through "the reconciliation process" that would require only 51 votes. Given the level of mistrust between the two chambers, the House wants the Senate to vote first on a reconciliation package that would modify the Senate bill's provisions including the so-called "Cadillac tax" on insurance plans costing more than $8,500 for individuals and deeper subsidies for low-income beneficiaries.
Meanwhile the Senate is pivoting to job creation bills while substance and process are worked out. Read more!
Reid and Rockefeller Introduce Senate Bill to Extend FMAP--Push Next Week to Avert More Job Losses Without FMAP Extension
Senate Majority Leader Reid (D-NV) and Senator Rockefeller (D-WV) introduced legislation Thursday to extend by six-months the temporary federal funding for FMAP in last year's Recovery Act (ARRA). With states expected aggregate budget shortfall at $180 billion and only $40 billion covered by ARRA's FMAP through 2010, the $140 billion expected shortfall would cost a job loss of 900,000 jobs nationally.
ANCOR sent a letter to all Senators Tuesday urging immediate extension of ARRA FMAP funding. In a meeting with Rockefeller's staff last night, ANCOR was told that the bill (yet to have a bill number) has 33 Democratic sponsors. ANCOR asked if the legislation mirrors the House provision included in its job bill passed in December. Senate Finance staff confirmed that it was the same except for adding a provision regarding county pass-throughs. Rockefeller staffer has confirmed that she will be a part of ANCOR's free audio conference on FMAP on Thursday, February 11th.
Senate staff from multiple offices expressed the urgency of immediately including an FMAP extension to avert deeper budget cuts that states are now planning in their 2011 budgets. The temporary extension would be through June 2011. The intention is to include the legislation immediately in the first jobs bill that the Senate is expected to take up next week. Both the National Governors Association and National Conference (NGA) on State Legislatures (NCSL) sent bipartisan letters this week to Congress urging immediate extension of ARRA FMAP funding. ANCOR will have an alert out early next week pending fact sheet being developed by Senate staffers today. Read more!
ANCOR sent a letter to all Senators Tuesday urging immediate extension of ARRA FMAP funding. In a meeting with Rockefeller's staff last night, ANCOR was told that the bill (yet to have a bill number) has 33 Democratic sponsors. ANCOR asked if the legislation mirrors the House provision included in its job bill passed in December. Senate Finance staff confirmed that it was the same except for adding a provision regarding county pass-throughs. Rockefeller staffer has confirmed that she will be a part of ANCOR's free audio conference on FMAP on Thursday, February 11th.
Senate staff from multiple offices expressed the urgency of immediately including an FMAP extension to avert deeper budget cuts that states are now planning in their 2011 budgets. The temporary extension would be through June 2011. The intention is to include the legislation immediately in the first jobs bill that the Senate is expected to take up next week. Both the National Governors Association and National Conference (NGA) on State Legislatures (NCSL) sent bipartisan letters this week to Congress urging immediate extension of ARRA FMAP funding. ANCOR will have an alert out early next week pending fact sheet being developed by Senate staffers today. Read more!
Administration Issues Paul Wellstone Mental Health Parity Interim Final Rule
The administration Wednesday issued interim final rules implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which requires parity between mental health or substance use disorder benefits and medical/surgical benefits with respect to health care insurance coverage. These interim final regulations are effective on April 5, 2010.
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CMS Issues Clarifying Letter on Ticket to Work Outcome and Milestone Payments to Employment Networks
On Thursday, January 28th, CMS issued a letter to State Medicaid Directors clarifying that Ticket Outcome and Milestone payments to Employment Networks (ENs) under the Ticket to Work program do not conflict with regulatory requirements and do not constitute an overpayment of Federal dollars for services provided because EN payments are payment for an outcome, rather than for a Medicaid service rendered. The letter indicates that State agencies and/or providers interested in participating in the Ticket to Work program as ENs are encouraged to do so.
We know that many organizations have been waiting for this policy clarification in order to make the final decision to become an EN or, if already an EN, to accept Ticket assignments and receive payments. To obtain the EN RFP, visit: http://www.ssa.gov/work/enrfp.html. For assistance with completing the application to become an EN, please contact a CESSI Account Manager at 1-877-743-8237 (v/tty) or visit www.cessi.net/ttw. Existing ENs should contact MAXIMUS at 1-866-949-ENVR (3687) or 1-866-833-2967 (tty) with any questions.
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We know that many organizations have been waiting for this policy clarification in order to make the final decision to become an EN or, if already an EN, to accept Ticket assignments and receive payments. To obtain the EN RFP, visit: http://www.ssa.gov/work/enrfp.html. For assistance with completing the application to become an EN, please contact a CESSI Account Manager at 1-877-743-8237 (v/tty) or visit www.cessi.net/ttw. Existing ENs should contact MAXIMUS at 1-866-949-ENVR (3687) or 1-866-833-2967 (tty) with any questions.
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Tuesday, February 2, 2010
President Obama Includes FMAP Extension in Budget
President Barack Obama's FY 2011 Budget endorses and includes a $28 billion six month extension of Enhanced Medicaid (FMAP). Without this provision, states would have been expected to make dramatic budget cuts this session to make up for the sudden loss of federal revenue that had previously sustained earlier recession budgets.
The FMAP extension had earlier been passed twice (most recently in December 2009) by the U.S. House of Representatives, but was stalled in the Senate with the aftermath of the demise of the current Health Care Reform bill.
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The FMAP extension had earlier been passed twice (most recently in December 2009) by the U.S. House of Representatives, but was stalled in the Senate with the aftermath of the demise of the current Health Care Reform bill.
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Monday, February 1, 2010
President Submits FY 2011 Budget Proposal with FMAP Extension, No Medicaid Cuts, and Freeze on Domestic Programs
President Obama submitted a $3.8 trillion budget request to Congress on Monday, while taking in $2.6 trillion in revenues in FY 2011.The budget submission kicks off the annual appropriations' processes in the House and Senate. The budget request includes for the first time federal spending on the wars in Iraq and Afghanistan as well as federal spending to cover the adjusted minimum tax. The administration's proposal includes $25.5 billion for a six month extension to the Recovery Act's federal FMAP funding to help cash-strapped states with their Medicaid budgets. No cuts to Medicaid are included in his budget.
The president will request $561 million in the 2011 budget, an 80 percent increase in discretionary funds to support identification of prevention, and enforcement of Medicaid and Medicare programs. The budget includes cuts in some discretionary spending as well as elimination or consolidation of some federal programs (e.g. VR programs, HUD programs) beginning in FY 2011. The proposal includes about $100 billion worth of policies intended to help create more jobs this year. ANCOR will provide a detailed analysis on its website and in WICs Live early next week.
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The president will request $561 million in the 2011 budget, an 80 percent increase in discretionary funds to support identification of prevention, and enforcement of Medicaid and Medicare programs. The budget includes cuts in some discretionary spending as well as elimination or consolidation of some federal programs (e.g. VR programs, HUD programs) beginning in FY 2011. The proposal includes about $100 billion worth of policies intended to help create more jobs this year. ANCOR will provide a detailed analysis on its website and in WICs Live early next week.
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Friday, January 29, 2010
President Obama Taps Vice President to Lead Middle Class Task Force
President Obama announced Mondaythe formation of a White House Task Force on Middle Class Working Families that would target raising the living standards of middle-class, working families. In addition to regular meetings, the task force will conduct outreach sessions with labor, business, and advocacy communities. The President set out five goals for the task force. The announcement includes the creation of a new website at www.AStrongMiddleClass.gov that also solicits public comment. ANCOR will explore ways that its policy issues can be brought forward to the task force.
Vice President Bidgen will lead this initiative that will be comprised of top-level administration policy makers including the Secretaries of Labor, Health and Human Services, Education, and Commerce, and the Directors of the National Economic Council, the Office of Managemen and Budget, the Domestic Policy Council, and the Chair of the Council of Economic Advisors. President Obama has set the following goals for the task force: expanding education and lifelong training opportunities; improving work and family balance; restoring labor standards, including workplace safety; helping to protect middle-class and working-family incomes; and protecting retirement security. The first official meeting will be on February 27, 2009 in Philadelphia, Pennsylvania. The topic of the first meeting will be: "Green Jobs: A Pathway to a Strong Middle Class."
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Vice President Bidgen will lead this initiative that will be comprised of top-level administration policy makers including the Secretaries of Labor, Health and Human Services, Education, and Commerce, and the Directors of the National Economic Council, the Office of Managemen and Budget, the Domestic Policy Council, and the Chair of the Council of Economic Advisors. President Obama has set the following goals for the task force: expanding education and lifelong training opportunities; improving work and family balance; restoring labor standards, including workplace safety; helping to protect middle-class and working-family incomes; and protecting retirement security. The first official meeting will be on February 27, 2009 in Philadelphia, Pennsylvania. The topic of the first meeting will be: "Green Jobs: A Pathway to a Strong Middle Class."
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Bipartisan Policy Center Launches Debt Reduction Task Force
Co-chairs of the Bipartisan Policy Center, former Senate Budget Chairman Pete Domenici (R-NM) and Former Office of Management and Budget and Congressional Budget Office Director Alice Rivlin announced Monday that they will lead a task force to develop a comprehensive, balanced and politically-viable budget plan for expedited consideration by the Administration and Congress.
The task force believes that the U.S. cannot simply rely upon economic growth to solve the federal fiscal imbalance and it plans to examine a broad range of spending and revenue options—with all options on the table. This effort is separate from failed Senate efforts this week to establish through statute a commission to make recommendations to Congress or President Obama’s plan to establish a commission via executive order. A listing is available of the Center’s Deb Reduction Task Force , as well as video and other activities on the Center’s website.
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The task force believes that the U.S. cannot simply rely upon economic growth to solve the federal fiscal imbalance and it plans to examine a broad range of spending and revenue options—with all options on the table. This effort is separate from failed Senate efforts this week to establish through statute a commission to make recommendations to Congress or President Obama’s plan to establish a commission via executive order. A listing is available of the Center’s Deb Reduction Task Force , as well as video and other activities on the Center’s website.
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President’s FY 2011 Budget to Include Freeze on Non-Security Discretionary Funds for Three Years
In conversations with Administration officials on Tuesday, ANCOR learned that the proposed freeze to be included in the President’s proposed FY 2011 budget submitted to Congress on February 1st will not affect mandatory programs (entitlements) such as Social Security, Medicaid, and Medicare. The proposal would not place a freeze on defense, homeland security, Veteran’s Affairs, or international/global funding. The proposed budget will seek to save $250 billion over 10 years to help address the $8 trillion deficit that this Administration said it inherited.
The freeze or cuts will not be equally borne across federal discretionary programs—some programs may get an increase, while others will be frozen or cut, and some eliminated. Officials stated that questions regarding specific programs would have to await the submission of the budget on Monday. As ANCOR members will recall, discretionary programs equal only 15 percent of the federal budget, with 85 percent spent on entitlement programs, interest on the national debt, and defense-related spending. Read more!
The freeze or cuts will not be equally borne across federal discretionary programs—some programs may get an increase, while others will be frozen or cut, and some eliminated. Officials stated that questions regarding specific programs would have to await the submission of the budget on Monday. As ANCOR members will recall, discretionary programs equal only 15 percent of the federal budget, with 85 percent spent on entitlement programs, interest on the national debt, and defense-related spending. Read more!
Reid Postpones Unveiling of Jobs Plan
Senate Majority Leader Harry Reid (D-NV) has postponed unveiling his plan for a series of jobs bills until next week in order to include proposals outlined by President Barack Obama during Wednesday’s State of the Union address. Obama’s State of the Union caused a “delay by a few days to incorporate a few of the president’s suggestions,” Senate Democratic Policy Committee Chairman Byron Dorgan (D-ND)said, including the president’s call for new small-business capital gains provision.
Earlier Thursday, Reid acknowledged that he is planning to move a series of smaller, targeted jobs bills this year rather than one large package. Democrats are hoping that by moving several bills throughout the year they can keep the issue on the front burner and lure some GOP support along the way.
The first bill, which could be introduced as early as next week with the intention of passing it before the Febrary 13 recess, could include provisions dealing with small businesses, infrastructure and taxes.
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Earlier Thursday, Reid acknowledged that he is planning to move a series of smaller, targeted jobs bills this year rather than one large package. Democrats are hoping that by moving several bills throughout the year they can keep the issue on the front burner and lure some GOP support along the way.
The first bill, which could be introduced as early as next week with the intention of passing it before the Febrary 13 recess, could include provisions dealing with small businesses, infrastructure and taxes.
Read more!
ANCOR Offers Comments at Invitation-Only HHS/DOJ Summit on Fraud and Abuse
ANCOR participated Thursday in an all-day Summit on Fraud sponsored by HHS Secretary Sebelius and Attorney General Holder that brought together federal agencies, state officials, and some private providers and health care insurers. Both Sebelus and Holder emphasized that this administration has a top priority placed on the detection, prevention and enforcement of Medicare, Medicaid, and health care fraud, waste and abuse. Secretary Sebelius announced that President Obama's proposed budget to be released on February 1st makes an historic federal investment--$1.7 billion or 80% increase--in efforts to address fraud, waste and abuse.
Top federal officials stressed that this first ever fraud summit would not be the last. The summit included comments from the HHS Inspector General (IG) and included CMS Medicaid and Medicare, Administration on Aging, HHS IG, and other federal officials along with federal and state law enforcement officials. One theme of the summit was to bring public and private stakeholders together to discuss solutions to address detection and prevention of fraud and abuse.
ANCOR was one of a few private providers along with private health insurers in attendance. ANCOR had the opportunity to comment in an afternoon breakout session on the duplication of multiple audits and reviews, and urged coordination of federal and state efforts. ANCOR also reminded officials--as they spoke about limited federal, state, and local resources--that providers are also facing an environment of severe cuts, the costs of multiple audits and reviews, and resources diverted from providing supports and services. In addition to better coordinating efforts and refocusing on suspicious trends in provider claims, ANCOR urged federal and state officials to better share information and engage providers in solutions.
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Top federal officials stressed that this first ever fraud summit would not be the last. The summit included comments from the HHS Inspector General (IG) and included CMS Medicaid and Medicare, Administration on Aging, HHS IG, and other federal officials along with federal and state law enforcement officials. One theme of the summit was to bring public and private stakeholders together to discuss solutions to address detection and prevention of fraud and abuse.
ANCOR was one of a few private providers along with private health insurers in attendance. ANCOR had the opportunity to comment in an afternoon breakout session on the duplication of multiple audits and reviews, and urged coordination of federal and state efforts. ANCOR also reminded officials--as they spoke about limited federal, state, and local resources--that providers are also facing an environment of severe cuts, the costs of multiple audits and reviews, and resources diverted from providing supports and services. In addition to better coordinating efforts and refocusing on suspicious trends in provider claims, ANCOR urged federal and state officials to better share information and engage providers in solutions.
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ANCOR Co-sponsors National Call-In Days and Roll Call Ad Urging Congress to Complete Health Care Reform That Includes Long-Term Supports
Working together with a group of aging and disability national organizations, ANCOR joined in sponsoring a Roll Call Ad that calls on Congress to pass legislation now that includes The CLASS Act and other important improvements to expand and increase funding options for home and community supports and services. Other efforts included national call-in days to Congressional offices this week. ANCOR thanks all members who responded to the National Call-In alert this week.
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No Firm Strategy Emerges Yet for Congress to Complete Health Care Reform
House and Senate Democratic leaders January 28th said President Obama's State of the Union speech might help re-energize Congress in its push to pass health care reform legislation. Getting the House to pass the Senate bill, along with approval of a smaller measure making changes to the Senate legislation favored by House lawmakers via the budget reconciliation process, remains under serious consideration.
Under reconciliation, legislation in the Senate can be approved with just 51 votes. That package was expected to include new language on the makeup of health insurance exchanges, changes to the so-called Cadillac tax on high cost health insurance plans in the Senate bill, and more generous federal subsidies for low- and middle-income individuals seeking to purchase insurance than contained in the Senate bill. House Speaker Pelosi (D-IA) said House Democratic leaders would soon lay out the content of the smaller bills, but “right now, we want to see where the Senate will go on its legislation.“
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Under reconciliation, legislation in the Senate can be approved with just 51 votes. That package was expected to include new language on the makeup of health insurance exchanges, changes to the so-called Cadillac tax on high cost health insurance plans in the Senate bill, and more generous federal subsidies for low- and middle-income individuals seeking to purchase insurance than contained in the Senate bill. House Speaker Pelosi (D-IA) said House Democratic leaders would soon lay out the content of the smaller bills, but “right now, we want to see where the Senate will go on its legislation.“
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Grassley Introduces Bill to Fight Fraud, Waste, and Abuse in Medicaid, Medicare, and SCHIP
On the same day that the departments of Health and Human Services and Justice held a Summit on Health Care Fraud (see related article) Ranking Senate Finance Member Chuck Grassley (R-IA)Thursday introduced the “Strengthening Program Integrity and Accountability in Health Care Act." Grassley's legislation brings together "bipartisan initiatives to fight fraud, waste and abuse in taxpayer-sponsored health care programs, which all face serious budgetary challenges.” It includes many of the themes for fighting fraud addressed in the HHS/DOJ summit.
The bill would strengthen the Federal False Claims Act, strengthen provider screening requirements, establish provider compliance program requirements and increase disclosure requirements of entity and provider ownership, increase federal funding, strengthen reporting requirements for Medicaid and Medicare Integrity Programs, and improve collection and sharing of data. “As spending on these programs continues to grow, Congress should act quickly to pass these reforms out of respect for taxpayers and on behalf of program beneficiaries.”
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The bill would strengthen the Federal False Claims Act, strengthen provider screening requirements, establish provider compliance program requirements and increase disclosure requirements of entity and provider ownership, increase federal funding, strengthen reporting requirements for Medicaid and Medicare Integrity Programs, and improve collection and sharing of data. “As spending on these programs continues to grow, Congress should act quickly to pass these reforms out of respect for taxpayers and on behalf of program beneficiaries.”
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Senate Rejects Proposed Congressional Commission on Defict Reduction, President Obama Will Create Commission Through Executive Order
In a 53-46 vote Tuesday on Senate Budget Chairman Conrad's (D-ND) and Ranking Member Judd Gregg's (R-NH) bipartisan amendment to a bill to increase the debt ceiling to $14.3 trillion (H J Res 45), the Senate rejected creation of a congressional debt commission that would establish a fast-track process for placing the panel's future recommendations on the floor for an up-or-down vote. Some opposed the amendment because they thought it removed authority from Congress to do its job and make individual policy decisions regarding deficit-reduction. Democratic opponents feared it as a pathway to cuting Medicare and Medicaid, while Republican opponents feared it could be a way to enact tax increases. President Obama will issue an executive order to create a commission as the administration pivots its agenda to emphasize deficits and the economy. However, the creation of such a panel through executive ordert will lack the authority for fast-track consideration by Congress and only produce recommendations.
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