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VOR is the only national organization advocating for a full
range of
residential and support options for people with mental
retardation,
including Medicaid-certified Intermediate Care Facilities for
the Mentally
Retarded (ICFs/MR) and home and community-based care. VOR
supports choice.
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VOR Weekly E-Mail Update
September 22, 2006
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1. Federal Legislation Update
2. Senate Bill Would Eliminate Part D Cost-Sharing for Medicaid
HCBS
Recipients
3. Planned Medicaid Cuts Cause Rift With States
4. JOIN OR CONTRIBUTE TO VOR TODAY PLEASE!! See
Membership/Contribution/Referral Form at end of Update.
Coming Up: Election News === VOTE!!!!
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1. Federal Legislation Update
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With only 7 days left before the scheduled September 29 recess,
not much in
the way of disability- related legislation is expected to be
considered.
The bills we are watching may come up during the "lame duck"
session after
the elections, including -
(A) Line item veto legislation - there is no word yet on whether
or not
this will be considered.
(B) Sunset Commission legislation -- there is no word yet on
whether or not
this will be considered.
(C) Appropriations, including Labor, Health and Human Services,
and
Education - this WILL be taken up after the elections.
Appropriations set,
of course, the federal budget for the coming year, so we will be
watching
for any attempts to further erode Medicaid. See e.g., the
article below,
"Planned Medicaid Cuts Cause Rift With States," and
http://www.aamc.org/advocacy/063006.pdf for a letter from a
bipartisan
group of 44 Senators urging HHS Secretary Mike Leavitt to not
act on
Administrative proposal that would reduce Medicaid payments for
providers.
(D) Social Security Reform -- the President is eager to revisit
this issue
and may reopen the debate soon after the elections.
According to the Washington Post, the President "remains eager
to cut
entitlement spending."
"The Bush administration has begun sounding out lawmakers and
other key
figures about mounting a new bipartisan effort to rein in the
costs of
Medicare, Medicaid and Social Security after the midterm
elections,
according to officials in the administration and on Capitol
Hill.
"No specific plan has been advanced, and administration
officials are
proceeding gingerly given the political debacle that beset the
White House
last year when President Bush promoted a plan to create private
accounts in
the Social Security program. But they have been sending strong
signals in
recent weeks that they want to try something again after the
elections in
November." (Washington Post, August 11, 2006)
VOR members will receive regular updates and Action Alerts, as
appropriate.
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2. Senate Bill Would Eliminate Part D Cost-Sharing for
Medicaid HCBS
Recipients
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Summary: In its comments on the proposed regulations to Part D,
VOR argued
that Home and Community Based Services Recipients should be
entitled to the
same cost sharing exemptions as ICF/MR residents, based on the
premise that
eligibility for HCBS waivers is the same as eligibility for ICFs/MR.
Perspectives
NASDDDS
August 2006
[Perspectives is published monthly by the National Association
of State
Directors of Developmental Disabilities Services (NASDDDS). A
subscription
to Perspectives is $95/year and can be ordered by visiting
http://www.nasddds.org, or calling 703-683-4202].
Senator Gordon Smith (R-OR) has introduced a bill designed to
extend to
extend the Part D cost- sharing projections enjoyed by dual
eligibles
living in nursing facilities to dual eligible beneficiaries who
receive
Home and Community Based Services (HCBS) in a home setting
through an 1115
or 1915(c) waiver, as well as those residing in a home setting
or in
assisted living, residential care facilities, or other licensed
facilities
such as group homes for people with mental retardation and
developmental
disabilities, psychiatric health facilities, and mental health
rehabilitation centers. The bill, The Home and Community
Services
Co-Payment Equity Act of 2006 (S. 2409), would exempt waiver
participants
from paying copayments for their Part D drugs.
In the Medicare Modernization Act (MMA), Congress exempted dual
eligibles
living in nursing facilities and ICFs/MR from any cost sharing
for Part D
prescription drugs, but did not extend this protection to dual
eligibles
living in the community and receiving services through Medicaid
waivers.
The National Center for Assisted Living (NCAL) and the American
Health Care
Association (AHCA) have organized a coalition of more than 30
groups,
including NASDDDS, in support of the legislation, arguing that
the affected
population typically has demonstrated a need for an
institutional level of
care and has similar needs, incomes, and vulnerabilities as
those living in
nursing homes and ICFs/MR. The groups signed a letter delivered
to Senator
Smith's office encouraging passage of his legislation.
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3. Planned Medicaid Cuts Cause Rift With States
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The New York Times
August 13, 2006
By Robert Pear
The White House is clashing with governors of both parties over
a plan to
cut Medicaid payments to hospitals and nursing homes that care
for millions
of low-income people.
The White House says the changes are needed to ensure the fiscal
integrity
of Medicaid and to curb excessive payments to health care
providers.
But the plan faces growing opposition. The National Governors
Association
said it would impose a huge financial burden on states, already
struggling
with explosive growth in health costs.
More than 330 members of Congress, including 103 Republicans,
have objected
to the plan. A letter signed by 82 House Republicans says it
would
seriously disrupt financing of Medicaid programs around the
country. A
bipartisan group of 50 senators recently urged President Bush to
scrap the
proposed rules, which were set forth in his 2007 budget and
could be issued
before the end of this year.
Medicaid finances health care for more than 50 million
low-income people,
with money provided by the federal government and the states.
Under the White House plan, the federal government would reduce
Medicaid
payments to many public hospitals and nursing homes by
redefining allowable
costs. It would also limit the states ability to finance their
share of
Medicaid by imposing taxes on health care providers. About
two-thirds of
the states have such taxes.
The federal government pays at least 50 percent of Medicaid
costs in each
state and more than 70 percent in the poorest states.
Bush administration officials say states have used creative
bookkeeping and
accounting gimmicks to obtain large amounts of federal Medicaid
money
without paying their share. Moreover, they contend, some states
have
improperly recycled federal money to claim additional federal
Medicaid
money.
States have managed to draw down more federal Medicaid dollars
with fewer
state dollars, said Dennis G. Smith, director of the federal
Center for
Medicaid and State Operations.
State and local officials, members of Congress, hospitals,
nursing homes
and advocates for poor people make several arguments. First,
they say, Mr.
Bush is doing by regulation what he unsuccessfully asked
Congress to do by
legislation in the last two years. Second, they say, prior
administrations
and the Bush administration itself approved many of the state
taxes that
would be deemed improper under the new rules.
Gov. Arnold Schwarzenegger of California, a Republican, said,
The
administration is attempting to reverse decades of federal
Medicaid policy
through the regulatory process, less than a year after Congress
rejected
these misguided cuts.
In Missouri, Gov. Matt Blunt, a Republican, said the change
could mean a
loss of more than $84.9 million for his state. That, he said,
would
jeopardize the continuity of care for Medicaid recipients and
set back
efforts to improve care in nursing homes.
Gov. M. Jodi Rell of Connecticut, a Republican, protested the
White House
plan in a letter to Mr. Bush. She said the effects would be
disastrous in
states like Connecticut, which relies on fees collected from
nursing homes
to help pay its share of Medicaid costs.
Democratic governors, including Janet Napolitano of Arizona,
Edward G.
Rendell of Pennsylvania and Kathleen Sebelius of Kansas, also
denounced the
White House plan. Ms. Sebelius said the cuts would make it much
more
difficult for health care providers like the University of
Kansas Hospital
to serve Medicaid recipients and people without insurance.
The cuts contemplated by the White House would not reduce the
cost of care.
But state officials said the changes would put pressure on
states to reduce
Medicaid benefits, restrict eligibility or lower payments to
health care
providers.
Medicaid is one of the largest, fastest-growing items in state
budgets. To
pay their share of the costs, states often rely on general
revenue from
sales and income taxes. But many also levy special taxes on
hospitals,
nursing homes and other health care providers. In many cases,
providers
willingly pay such taxes because the revenue shores up Medicaid
and can be
used by states to obtain federal matching payments.
Under current rules, a state can impose a tax equal to 6 percent
of the
revenue of a hospital or nursing home. The administration wants
to lower
the allowable tax rate to 3 percent. The federal government
would reduce
its Medicaid payment to any state that levied taxes above that.
Michael O. Leavitt, the secretary of health and human services,
said this
change would remove incentives for states to shift the
responsibility to
fund their share of the Medicaid program to health care
providers.
Hospitals and nursing homes, he said, should welcome the change
because it
would reduce their taxes.
But Thomas P. Nickels, senior vice president of the American
Hospital
Association, and Bruce A. Yarwood, president of the American
Health Care
Association, a trade group for nursing homes, said the plan was
simply a
way to cut Medicaid.
If provider taxes are cut, the Medicaid program will be reduced,
and that
will harm beneficiaries, Mr. Nickels said. We do not see a
political will,
at the federal or state level, to supplant provider taxes with
other types
of revenue.
In February, Mr. Bush signed a bill that gave states power to
revamp
Medicaid by altering eligibility and benefits. That measure is
expected to
cut the growth of federal Medicaid spending by $4.9 billion over
five
years. The White House estimates that the new rules will save
the federal
government even more: $12.2 billion over five years.
The administration said it needed to impose stricter limits on
Medicaid
payments to public hospitals and nursing homes because such
payments far
exceeded the actual cost of services in many states.
The changes may seem technical. But Marvin R. OQuinn, president
of Jackson
Health System in Miami, said they would directly and adversely
affect
patients.
Dr. Bruce A. Chernof, director of the Los Angeles County
Department of
Health Services, said the cuts would reduce access to services
in a county
where 33 percent of residents are uninsured. The countys five
public
hospitals operate trauma centers and burn treatment units for
all patients,
not just Medicaid recipients, he said.
The effects are magnified by the way Medicaid is financed. For
each dollar
that a state loses in provider tax revenue, the federal
government will
reduce its contributions by $1 in California and Connecticut,
and by $3 in
a poor state like Mississippi.
The White House said Mr. Bush would also adopt stricter policies
on
Medicaid payments for rehabilitation and school-based health
services.
Copyright 2006 The New York Times Company
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Tamie Hopp
Executive Director
Director, Government Relations and Advocacy
REFERRAL/MEMBERSHIP/CONTRIBUTION FORM
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additional
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payment to:
Voice of the Retarded
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