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VOR Weekly E-Mail Update
June 29, 2006
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Table of Contents
1. House Panel Approves Labor-HHS-Education Spending Bill
2. Medicaid: HHS allows Idaho to implement Deficit Reduction Act-Based
Reforms
3. Washington, D.C.: Group Home Failures Persist
4. Happy Fourth of July Holiday!! Celebrate Choice by Joining VOR - see
form at end of this update or visit http://www.vor.net
Coming up: FOCUS ON MISSOURI: St. Louis Post-Dispatch Series: Broken
promises, broken lives
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1. House Panel Approves Labor-HHS-Education Spending Bill
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By Kate Schuler, CQ Staff
CQ Today
A House Appropriations subcommittee on Wednesday approved the fiscal 2007
spending bill for the departments of Labor, Health and Human Services, and
Education after lawmakers on both sides
decried the budget cap a situation Democrats largely blamed on the Bush
administration's tax cuts.
Subcommittee members approved the draft legislation on a party- line vote
of 9-7.
The bill would provide $141.9 billion in discretionary funds, a 0.6 percent
increase over fiscal 2006 levels. The fiscal 2006 version of the
legislation (PL 109-149) included $141.1 billion in discretionary funds.
"We obviously didn't have all the money we'd like to have had," said panel
Chairman Ralph Regula, R-Ohio.
Still, the draft bill's spending cap is $4.1 billion more than President
Bush requested.
Even within that budget constraint, the subcommittee for the first time in
several years would increase the maximum amount of a Pell grant the main
federal student aid program by $100, to $4,150. Subcommittee ranking
Democrat David R. Obey of Wisconsin, however, said that even if the
additional $100 per student is made available, it wouldn't make up for the
years the grant total did not increase. He said that when adjusted for
inflation, the boost would need to be $350 to equal last year's "purchasing
power" of the grant. Democrats also pointed out that previous efforts to
raise that figure for student aid have been stripped out of final spending
bills.
Republicans bucked the president's proposal to eliminate some college prep
programs for low-income students funding TRIO Talent Search and TRIO
Upward Bound programs to the fiscal 2006 level of $828 million and the GEAR
UP program to this year's budget of $303 million. The bill would fund Head
Start at the 2006 level of $6.8 billion and would authorize $1.3 billion
for vocational education that Bush had proposed eliminating.
The subcommittee could be setting itself up for a fight with the Senate
over the Low-Income Home Energy Assistance Program (LIHEAP). The
subcommittee bill would decrease funding by one-third, from $3.2 billion to
$2.1 billion.
In March, the House cleared legislation (PL 109-204) to increase spending
for LIHEAP, ending a fight between northern Republicans concerned about the
high cost of heating fuel and fiscal conservatives opposed to increased
funding for the program.
Obey has said he believes that faced with such a tight level of funding,
the House will not be able to pass the Labor-HHS-Education bill as a
stand-alone measure. If it doesn't, the legislation would have to be rolled
into an omnibus appropriations bill, something GOP leaders say they intend
to avoid.
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2. Medicaid: HHS allows Idaho to implement Deficit Reduction Act-Based Reforms
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Summary: The Idaho State Plan Amendment, approved by HHS and described
below, can be found a:
http://www.healthandwelfare.idaho.gov/site/3629/default.aspx
Medicaid: HHS Allows Idaho to Implement Deficit Reduction Act-Based Reforms
BNA Health Care Daily Report
June 2006
Idaho Gov. Dirk Kempthorne (R) joined the health and human services
secretary May 25 to announce federal approval of a state plan amendment
implementing Medicaid reforms made possible
by the increased flexibility allowed under the Deficit Reduction Act of
2005.
"Idaho is on the cutting edge in crafting Medicaid benefit packages to the
needs of its residents and I commend Governor Kempthorne for this
innovative work," HHS Secretary Michael Leavitt said. "These changes make
sense for beneficiaries and the very future of the Medicaid program."
In a conference call with reporters, Kempthorne described the Medicaid
changes as an attempt to "modernize" the state's Medicaid program.
An Idaho Medicaid official said the state does not expect the Medicaid
reforms initially to produce significant savings.
Benchmark Benefits
Under the approved Medicaid changes, Idaho will offer three benefit
packages aimed at specific groups of Medicaid beneficiaries, according to
HHS. The benefit packages are intended to meet the specific needs of the
disabled, dual eligibles (low-income seniors eligible for both Medicaid and
Medicare coverage), and children.
Idaho's Benchmark Basic plan will serve healthy children and adults and
will offer most of the traditional Medicaid benefits, except long-term
care, organ transplants, and intensive mental health treatment. Children
under 19 years old will continue to receive benefits through the Early,
Periodic Screening, Diagnostic and Treatment requirements of Medicaid.
Elderly and disabled beneficiaries will receive care in the Enhanced
Benchmark plan. This plan will cover all traditional Medicaid benefits
including long-term or institutional care. Beneficiaries enrolled in the
Benchmark Basic plan needing additional benefits will be transferred to the
Enhanced Plan.
Dual eligibles will be enrolled in the Coordinated Benchmark plan, which
will include all the benefits of the state's traditional Medicaid program.
Dual eligibles participating in this program will be required to enroll in
the Medicare outpatient coverage plan (Part B) and the new Medicare
prescription drug benefit (Part D).
Beneficiaries will be allowed to opt out of the new benchmark benefits at
any time and return to regular Medicaid, according to HHS.
Initially, Idaho had pursued implementing the Medicaid changes under a
waiver, a state Medicaid official said. Passage of the Deficit Reduction
Act of 2005 allowed Idaho and other states new flexibility to offer
alternate benefit packages to different Medicaid populations. Based on the
new flexibilities provided by the DRA, Idaho was able to implement the
Medicaid reforms by submitting a state plan amendment to the Department of
Health and Human Services, Leavitt said during the conference call with
reporters.
Idaho's Medicaid changes also allow the state to implement a long-term care
partnership program, which encourages the purchase of private long-term
care insurance. Extension of the long-term care partnership program was
included in the Deficit Reduction Act.
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3. Washington, D.C.: Group Home Failures Persist
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Group Home Failures Persist
Care Still Lacking, D.C. Report Says
By Karlyn Barker
© 2006 The Washington Post Company
Saturday, June 24, 2006
The District government continues to provide dangerous, substandard care to
disabled residents at some of its group homes and has recently hampered
oversight efforts by failing to provide full and timely information on
critical operations, a federal court monitor has found.
In her latest quarterly report, court monitor Elizabeth Jones describes
numerous and chronic problems with the city's Mental Retardation and
Developmental Disabilities Administration. She also questions whether she
is getting complete reports on death investigations, saying that at least
one document she received from the District was edited to remove
information critical of the city.
A review of five deaths between late 2004 and late 2005 showed that
recommendations issued after death investigations weren't always shared
with direct care providers, putting group home residents at risk, she said.
"Staff cited for neglect continue to be employed in the system," she wrote.
Jones's report could not have come at a worse time for the D.C. government,
which is fending off an attempt to have the troubled mental retardation
agency placed in court receivership. A hearing on the request is set for
Thursday.
The District opposes court takeover, arguing that it would derail reform
efforts. City officials filed a detailed response to the court monitor's
report but would not comment further. They disputed many of Jones's
criticisms and said the city is moving on several fronts to address her
concerns about health care and access to information.
"Promising efforts are being made to empower provider medical staff to
better lead the delivery of care," the officials said.
Jones's report did not provide details of the five deaths, four of which
she has mentioned in previous reports. She said separate reports on each
death will be filed with the court after a physician hired by her office
completes a review.
An attorney for the family of one of the deceased, a 58-year-old man in
fragile health who lived in a group home in Northeast Washington, said he
died in September after choking on peaches.
"He was blind and deaf and had become increasingly debilitated in the six
months" before his death, the attorney, Joseph Cammarata, said, adding that
the family did not want to release his name.
"It's hard to explain how a person who was being assisted eating choked,
unless there was some type of carelessness," he said. "It's beyond time for
someone to act to prevent these tragedies from recurring."
A spokeswoman for the group home operator, Metro Homes, which runs nine
residential facilities in the city, said the man received "quality care up
until the time he was taken to the ER." She would
not comment further.
Jones gave a blistering assessment of the city's reform efforts.
"The continuing failure to remedy critical systemic issues of substandard
care, treatment and oversight means that other clients will experience
needless pain, delayed or non-existent attention to high risk situations
involving health and safety, and unnecessary threats to their very
existence," she wrote. "The urgency to remedy these systemic failures could
not be greater."
After discovering that one death report had been partially deleted, Jones
said she asked that copies of certain original death reports be sent to her
directly by the contractor that does the investigations. She said the
contractor was told not to comply -- and that she had to get another court
official to intervene before the unedited reports were released to her.
D.C. officials said the death reports are edited to ensure quality and to
correct typographical errors, not to alter any of the findings.
Jones cites problems with case managers, saying that many are not doing
sufficient monitoring; with home care staff; and with the care that some
group home residents receive if they are sent to an emergency room or
hospitalized.
District officials questioned some of Jones's criticisms about case
management and said the mental retardation agency has no jurisdiction or
authority over hospitals or physicians. They provided thumbnail accounts of
several of the agency's clients, using only their initials, to illustrate
improvements in services.
The District is a defendant in a 30-year-old class-action lawsuit over its
care of people with mental retardation. The surviving 665 class-action
members all had lived at Forest Haven, the city's former institution for
the mentally retarded. The mental retardation agency serves about 2,000
mentally and physically disabled people, most of whom live in about 360
group homes.
Sandy Bernstein of University Legal Services, which represents the
plaintiffs in the suit and is seeking the court takeover, said the home
where the man choked to death was supposed to be closed by the city but
remains open. She said she is alarmed by ongoing case management concerns,
particularly because the District has one of the lowest case management
ratios in the country.
The court monitor's report "indicates the District continues to provide
poor care to individuals with developmental disabilities," Bernstein said.
"The problems are very much still out there, and people are at risk of
harm."
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Tamie Hopp
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