Statehealthfacts.org Posts Updated, New Information On Medicare, Medicaid

New and updated data, Statehealthfacts.org: Statehealthfacts.org has added new and updated data on Medicare and Medicaid. New data from the CMS Office of the Actuary on Medicare on Medicare spending estimates by state of residence for 1995 through 2004 are available for all states. These estimates are based on where individuals reside and include total Medicare spending; spending on hospital care, physician services, dental services, home health care, drugs and nursing home care; total per enrollee spending; per enrollee spending by service type; and the average annual percent growth in Medicare spending from 1995 to 2004. New data on total Medicaid spending estimates by state of residence for 1995 through 2004 also are available for all states (Kaiser Family Foundation release, 5/1).

Senate speeds to vote on Medicaid moratorium bill

Senators could vote as early as this week on a bill to delay seven Medicaid regulations. Senate Majority Leader Harry Reid (D-NV) late last week granted fast-track status to the legislation (H.R. 5613).

As a result of Reid's move, the legislation bypassed the Senate Finance Committee and heads straight to the Senate. The House last week passed the bill by a strong majority – enough to override a potential presidential veto. The Bush administration would be willing work with lawmakers on some of the rules, according to Kerry Weems, acting administrator of the Centers for Medicare & Medicaid Services.

Congressmen and governors have sharply criticized the rules because of their expected negative impact on Medicaid funding to states. The rules would place limits on Medicaid funding to government-owned nursing homes and hospitals, among other restrictions. The bill would delay the regulations, many of which are scheduled to take effect in coming weeks, until April 1, 2009.

House overwhelmingly approves Medicaid moratorium bill

The House Wednesday approved by a veto-proof margin a bill that would delay the implementation of seven onerous Medicaid regulations until April 1, 2009.

Lawmakers approved by a vote of 349-62 Protecting the Medicaid Safety Net Act of 2008 (H.R. 5613). The legislation would place a moratorium on pending regulations that, among other consequences, restrict the use of the allowable provider tax and curtail Medicaid funding to government-funded skilled nursing facilities and other healthcare facilities. One rule that limits provider taxes was scheduled to go into effect on Tuesday. The Bush administration on Tuesday has threatened to veto the legislation, which now moves to the Senate.

Thousands More Medicaid Enrollees Could Get Home And Community-Based Care Under New Rule

housands of Medicaid beneficiaries who were previously limited to receiving care in an institutional setting may now be given the option to receive that care in their homes and communities, under a proposed rule published by the Centers for Medicare & Medicaid Services (CMS).

The Deficit Reduction Act of 2005 (DRA) gave states a new option to provide home-and-community based services (HCBS) to Medicaid beneficiaries without applying for a demonstration waiver. The proposed rule provides guidance to states on how to implement this provision of the DRA.

Under this option, states will now be able to set their own eligibility or needs-based criteria for providing HCBS. Previously, to qualify for assistance with personal care, home health care or other services in the home or community setting, beneficiaries were required to be at imminent risk of institutionalization. The DRA provision eliminates this requirement and allows states to cover Medicaid recipients who have incomes no greater than 150 percent of the federal poverty level, or $15,600 per individual in 2008, and who satisfy the needs-based criteria.

"Thousands more Medicaid beneficiaries may now be able to opt for needed long-term support services in their homes rather than institutions," said CMS Acting Administrator Kerry Weems. "Breaking the historic link between long-term care and institutions will level the playing field and give beneficiaries new choices for how they receive care."

The proposed rule emphasizes "person centered" care, giving individuals an active role in developing their care plans, and the "self-direction" option in which states can allow individuals to take charge of their own services. The services states may make available under this benefit include case management, homemaker, home health aide, personal care, adult day health, habilitation, and respite care. The DRA also allows states to provide special services to individuals with chronic mental illness, including day treatment or other partial hospitalization, psychosocial rehabilitation, and clinic services.

Rep. Dingell Introduces Legislation That Would Delay Seven New Medicaid Regulations For One Year

House Energy and Commerce Committee Chair John Dingell (D-Mich.) on Thursday introduced a bill (HR 5613) that would postpone seven new Medicaid regulations for one year -- "potentially killing them, depending on who is president by then," CQ Today reports (Wayne, CQ Today, 3/14). The regulations, proposed by the Bush administration, would prohibit states from using federal Medicaid funds to help pay for physician training, place new limits on Medicaid payments to hospitals and nursing homes operated by state and local government, and limit coverage of rehabilitation services for people with disabilities, including those with mental illnesses (Kaiser Daily Health Policy Report, 3/4).

Dingell in a statement said, "The restrictions the administration is imposing on Medicaid are harmful and will undoubtedly put the health of thousands of our most vulnerable children at unnecessary, indefensible risk." Dennis Smith, director of the Center for Medicaid and State Operations at CMS, said the Bush administration does not plan to delay the regulations because of congressional concerns.

CMS Proposes New Rules For Redesigning Medicaid, States Have Greater Flexibility In Benefits, Cost Sharing

Two new proposed rules that would give states unprecedented flexibility in designing their own Medicaid programs, including adjusting their benefit package to more closely align with beneficiary needs and requiring increased cost sharing by enrollees, were announced by the Centers for Medicare and Medicaid Services (CMS).

The proposed rules would implement provisions of the Deficit Reduction Act of 2005 and the Tax Relief and Health Care Act of 2006. The rules are the latest in a series of regulations to implement the Administration's goals of aligning Medicaid more closely with private market insurance and giving states more control over their Medicaid benefits packages.

Absence Of Cancer Diagnosis And Treatment In Elderly Medicaid-Insured Nursing Home Residents

UroToday.com- A study in the January 2008 issue of the Journal of the National Cancer Institute suggests that Medicaid patients in nursing home care receive limited cancer services. While the prevalence of cancer in nursing home patients is 1 in 10, according to Dr. Bradley and coauthors this population has received little attention in outcomes research.

In the U.S, Medicaid is the predominant payer for long-term residential nursing home care. These patients often have low income, frail, and more than 30% of them require assistance to perform 3 or more activities of daily living. It is reported that nursing home staff may not effectively recognize and treat cancer. The researchers used statewide Medicaid and Medicare data merged with the Michigan Tumor Registry to identify a study sample of patients with a first primary cancer diagnosis. Tumor registry patients were matched to the state Medicare Denominator file for the years 1996-2000 and all claims for inpatient, outpatient, physician, and hospice services were identified. Those with at least one year of claims history before the month of diagnosis were selected, as this permitted an estimate of patients' comorbidity burden. The researchers calculated odds ratios for late or invasive but unknown stage of cancer, death within 3 months of diagnosis, receipt of hospice services, and receipt of cancer-directed surgery.

Effects of Cash and Counseling on Personal Care and Well-Being

Medicaid beneficiaries who have disabilities and receive traditional support services from Medicaid agencies often have little control over their care. Cash and Counseling is a flexible, consumer-driven program that gives Medicaid beneficiaries a monthly allowance. With this allowance they can purchase goods and services that facilitate independence, and they can hire whomever they like as caregivers, including family members and friends. This paper examines the effects of Cash and Counseling on the types and amount of personal assistance services Medicaid beneficiaries received, on the beneficiaries’ satisfaction with their care, and on their overall well-being.

Federal Government Encourages States to Make Self-Directed Personal Care an Option for Disabled Medicaid Consumer Who Need Help at Home

Centers for Medicare & Medicaid Services allows state Medicaid programs to offer a "Cash & Counseling" state plan option without first obtaining a federal waiver. This change comes after evaluation found that Cash & Counseling improves quality of life, reduces unmet needs for care, and helps disabled consumers maintain health without costing Medicaid substantially more than traditional services.

CMS Issues Proposed Rule To Empower Medicaid Beneficiaries To Direct Personal Assistance Services, USA

A proposed rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services delivered by an agency, was announced by the Centers for Medicare & Medicaid Services (CMS).

Through the rule on display today at the Federal Register, CMS requests public comment on how states could allow Medicaid beneficiaries who need help with the activities of daily living to hire, direct, train or fire their own personal care workers rather than working with personnel employed by an agency. Beneficiaries could even hire qualified family members who may already be familiar with the individual's needs to perform personal assistance (not medical) services.

Maryland Appeals Court Ruling Could Broaden Medicaid Eligibility Standards For Elder Care

The Maryland Court of Special Appeals last month ruled that some Medicaid eligibility standards used by the Department of Health and Mental Hygiene were stricter than federal laws allow, and advocates hope the broad standards outlined in the case will be applied universally, the Baltimore Sun reports. The lawsuit was filed by Diane Byus on behalf of her mother, Ida Brown, after Brown was diagnosed with Alzheimer's disease and was unable to receive assistance through the Older Adults Waiver Program, a Medicaid program designed to provide services such as nursing and adult day care.

Maryland limits eligibility in the program to residents older than age 50 who have incomes less than $1,869 a month and require daily care from licensed health care professionals. Although Brown, who also has several chronic conditions, requires daily monitoring, she does not require constant care from a physician or nurse, the Sun reports. Attorneys from the Legal Aid Bureau and AARP argued in the case that state and federal laws limit eligibility to residents who regularly require "health-related care and services," such as those that could be provided in a nursing home, but not necessarily daily by a skilled nurse.

Long-Term Service and Supports: The Future Role and Challenges for Medicaid

This report examines the structure and impact of Medicaid’s role in long-term care. Based on a roundtable discussion of policy makers and experts and drawn from a body of health services research, the report highlights policy challenges facing the Medicaid program today and identifies issues in providing long-term care going forward. By gathering evidence to address key policy issues, such as integrating services, benefit design, quality monitoring and financing, the report can serve as a foundation for the current and ongoing policy debate regarding Medicaid’s future role as a provider of long-term care services and supports for low-income elderly and disabled Americans. Report (.pdf)

AMA Adopts New Policies On Disabled Patient Care

AMA supports reforms for disabled patients: The AMA passed new policy supporting Medicaid reforms that would provide disabled patients with equal access to home and community-based services so that they can live as independently as possible. The AMA supports passage of congressional legislation, the Community Choice Act of 2007, that would achieve these goals. This policy was recommended to the AMA by the American Academy of Physical Medicine and Rehabilitation and the American Association of Neuromuscular and Electrodiagnostic Medicine.

"People with disabilities who rely on Medicaid should not have to choose between the important care they need and the ability to live independently," said AMA Board Member Rebecca J. Patchin, MD. "We support Medicaid reforms so that disabled patients, together with their physicians, can decide where the best place is to receive medical care and support based on patients' individual needs."

Medicaid Spending Increased By 10.7% In First Half Of 2007

Medicaid spending increased by 10.7% in the first six months of 2007 -- the largest increase since 2001 -- and likely will reach $330 billion this year, according to a USA Today analysis of data from the Bureau of Economic Analysis. USA Today attributed the increased Medicaid spending in part to:

• Efforts by states to extend health insurance to more residents through Medicaid and SCHIP;
  
  
• Increased enrollment in Medicaid after a temporary decrease in 2006 that resulted from implementation of new proof-of-citizenship rules; and
  
  
• Increased Medicaid reimbursements for health care providers.

Medicaid drug rule may hurt recipients

WASHINGTON — An obscure provision slipped into a $120 billion Iraq spending bill in May threatens to leave some poor and disabled Medicaid recipients without prescription drugs in October.

In a case of unintended consequences, Congress inserted a rule cracking down on Medicaid fraud that requires that all non-electronic prescriptions for Medicaid patients be written on tamper-resistant paper.

The rule was devised as a way to raise nearly $150 million over five years for public hospitals, the amount that Medicaid fraud costs the federal government.

Asset Transfers That Would Allow Elderly To Qualify For Medicaid Rare, GAO Finds

Most nursing home residents are unlikely to have sold off assets below market value to qualify for long-term care coverage from Medicaid, according to a Government Accountability Office report released on Thursday, CongressDaily reports. Because of concerns that the practice might be widespread, Congress in 2006 passed a provision in the budget reconciliation law to expand from three years to five years the "look back" period in which seniors who transfer their assets at less than market value are ineligible for Medicaid.