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. Read more!

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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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)

Thank you to Stan Soby of Oak Hill for providing ANCOR with this update.

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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. Read more!

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.

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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.

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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!