Posts Tagged Medicaid

Bipartisan Budget Act Boosts Health Programs

Bipartisan Budget Act Boosts Health Programs

In a rare show of bipartisanship for the mostly polarized 115th Congress, the Bipartisan Budget Act of 2018 is officially one for the record books. The week leading up to the final vote was far from smooth with Sen. Nancy Pelosi impressively filibustering on the floor of the U.S. Senate for eight hours to Rep. Rand Paul blocking the final vote late Thursday night/early Friday morning and forcing a six-hour government shutdown before allowing the final vote to be taken.

Now that President Trump has signed the Bipartisan Budget Act of 2018 here’s what you need to know:

Technical Amendments to MACRA. Makes several changes to the Medicare Access and CHIP Reauthorization Act (MACRA) that the medical community has been strongly advocating for, including:

  • Excludes Medicare Part B drug costs from MIPS payment adjustments and from the low-volume threshold determination;
  • Eliminates improvement scoring for the cost performance category for the third, fourth and fifth years of MIPS;
  • Allows CMS to reweight the cost performance category to not less than 10 percent for the third, fourth, and fifth years of MIPS;
  • Requires CMS to update on CMS’ website by Dec. 31 of each year, information on resource use measures including measures under development, the time-frame for such development, potential future resource use measure topics, a description of stakeholder engagement and the percent of expenditures under Medicare Part A and B that are covered by resource use measures.
  • Allows CMS flexibility in setting the performance threshold for years three through five to ensure a gradual and incremental transition to the performance threshold set at the mean or median for the sixth year;
  • Allows the Physician Focused Payment Model Technical Advisory Committee (PTAC) to provide initial feedback regarding the extent to which models meet criteria and an explanation of the basis for the feedback.

Physician fee schedule update (in lieu of Misvalued Codes). Reduces the Physician Fee Schedule conversion factor for 2019 from 0.5 percent to 0.25 percent. This is more favorable language than, and is in lieu of, the language in the House bill that would extend the “misvalued codes” provision for one additional year. The AMA estimated, based on the recommendations of the AMA / Specialty Society Relative Value Scale Update Committee (RUC), that the misvalued code provision in the House bill would have reduced the statutory 0.5 percent payment update in 2019 by 0.45 percent. Rejection of the misvalued code policy is an important outcome for future budget saving exercises. On a bipartisan basis, policymakers have recognized that the misvalued code “budget dial” is tapped out and should be shelved.

IPAB. Permanently repeals the Independent Payment Advisory Board. IPAB was a 15-member government agency created in 2010 by the Affordable Care Act for achieving specified savings in Medicare without affecting coverage or quality.

Children’s Health Insurance Program (CHIP). CHIP is extended for an additional four years beyond the previous Continuing Resolution’s six-year extension, with appropriations made through 2027.

Community Health Centers. Funding for community health centers is reauthorized for two years at a level of $3.8 billion for FY 2018 and $4 billion for FY 2019.

Medicare payment cap for therapy services. Permanently repeals the outpatient therapy caps beginning on Jan. 1, 2018.

National Health Service Corps. Funding for the National Health Service Corps is extended at the FY 2015 – 2017 annual level of $310 million for two additional years.

Teaching Health Center Graduate Medical Education. Funding for Teaching Health Center Graduate Medical Education is extended for two years at an annual level of $126.5 million, more than doubling annual funding for this program.

Geographic Practice Cost Indices (GPCI) floor. Extends the work GPCI floor for two additional years through Jan. 1, 2020.

Reducing EHR Significant Hardship. Removes the current mandate that meaningful use standards become more stringent over time. This eases the burden on physicians as they would no longer have to submit and receive a hardship exception from HHS.

Closing the Donut Hole for Seniors. Closes the Medicare Part D prescription drug “donut hole” sooner than under current law by increasing the discounted price manufacturers provide from 50 percent to 70 percent.

Emergency Medicaid Funds for Puerto Rico and the U.S. Virgin Islands. Puerto Rico’s Medicaid caps for 2018 – 2019 are increased by an additional $4.8 billion. The Virgin Islands’ caps are increased over the same time period by $142.5 million. Also, 100 percent federal cost sharing for Medicaid is provided for both territories through Sept. 30, 2019.

Prevention and Public Health Fund (PPHF). The Senate bill reduces funding for the PPHF by $1.35 billion between FY 2018 – 2027.

Other Select Budget Agreement Provisions:

Note: there is an agreement to include these funds in the Omnibus before the March 23 deadline.

  • $6 billion in funding for the opioid crisis and for mental health
  • $4 billion to rebuild and improve VA Hospitals and clinics
  • $2 billion for NIH research (above CURES Act increases)

Click here if you would like to see how Alabama’s Congressional Delegation voted.

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Medical Association’s 2018 State and Federal Agendas

Medical Association’s 2018 State and Federal Agendas

The Medical Association Board of Censors has met and approved the Association’s 2018 State and Federal Agendas. These agendas were developed with guidance from the House of Delegates and input from individual physicians. As the Alabama Legislature and U.S. Congress begin their work for 2018, additional items affecting physicians, medical practices and patients may be added to this list.

Download the Medical Association’s 2018 State and Federal Agendas (PDF)

 

2018 STATE AGENDA

 

The Medical Association supports:

  • Ensuring legislation “first do[es] no harm”
  • Extending the Medicaid payment bump for primary care to all specialties of medicine
  • Eliminating the health insurance-coverage gap for the working poor
  • Ensuring fair payment for patient care and reducing administrative burdens on physicians and medical practices
  • Strengthening existing tort reforms and ensuring liability system stability
  • Empowering patients and their doctors in making medical decisions
  • Continued physician compounding, dispensing of drugs
  • The same standards and reimbursements for telehealth and face-to-face visits
  • Training, education and licensing transparency of all individuals involved in patient care
  • Continued self-regulation of medicine over all areas of patient care
  • Increased state funding to upgrade the Prescription Drug Monitoring Program to a useful tool for physician monitoring patients at risk for drug interactions and overdose potential
  • Using data analytics to combat the drug abuse epidemic by strengthening research capabilities of pre-approved, de-identified prescription information
  • Maintaining the Alabama Department of Public Health as the repository for PDMP information to ensure continuity for prescribers and dispensers and security for patients
  • Standard opioid education in medical school so the physicians of tomorrow are prepared to face the realities and responsibilities of opioid prescribing

 

The Medical Association opposes:

  • The radical Patient Compensation System legislation
  • Legislation/initiatives increasing lawsuits against physicians
  • Non-physicians setting standards for medical care delivery
  • Tax increases disproportionately affecting physicians
  • Expanding access to the Prescription Drug Monitoring Program (PDMP) for law enforcement
  • Statutory requirements for mandatory PDMP checks
  • Further expansion of Maintenance of Certification (MOC) requirements
  • Changes to workers’ compensation laws negatively affecting treatment of injured workers and medical practices
  • Any scope of practice expansions that endanger patients or reduces quality of care
  • Biologic substitution legislation that allows lower standards in Alabama than those set by the FDA that doesn’t provide immediate notifications to patients and their physicians when a biologic is substituted, and that increases administrative burdens on physicians and medical practices

 

2018 FEDERAL AGENDA

 

The Medical Association supports:

  • Meaningful tort reforms that maintain existing state protections
  • Reducing administrative and regulatory burdens on physicians and medical practices
  • Repeal of the Affordable Care Act and replacement with a system that:
    • Includes meaningful tort reforms that maintain existing state protections
    • Preserves employer-based health insurance
    • Protects coverage for patients with pre-existing conditions
    • Protects coverage for dependents under age 26
    • With proper oversight, allows the sale of health insurance across state lines
    • Allows for deducting individual health insurance expenses on tax returns
    • Increases allowed contributions to health savings accounts
    • Ensures access for vulnerable populations
    • Ensures universal, catastrophic coverage
    • Does not increase uncompensated care
    • Does not require adherence with insurance requirements until insurance reimbursement begins
    • Reduces administrative and regulatory burdens
  • Overhauling federal fraud and abuse programs
  • Reforming the RAC program
  • Prescription drug abuse education, prevention and treatment initiatives
  • Allowing patient private contracting in Medicare
  • Expanding veterans’ access to non-VA physicians
  • Reducing escalating prescription drug costs
  • A patient-centered MACRA framework, including non-punitive and flexible implementation of new MIPS, PQRS and MU requirements
  • Congressional reauthorization of CHIP (Children’s Health Insurance Program) at the current enhanced funding level
  • Better interstate PDMP connectivity
  • Eliminating “pain” as the fifth vital sign
  • Repealing the “language interpreters” rule
  • Requiring all VA facilities, methadone clinics and suboxone clinics to input prescription data into state PDMPs where they are located

 

The Medical Association opposes:

  • Non-physicians setting standards for medical care delivery
  • Publication of Medicare physician payment data
  • National medical licensure that supersedes state licensure
  • Legislation/initiatives increasing lawsuits against physicians

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CMS Announces New Medicaid Policy to Combat Opioid Crisis

CMS Announces New Medicaid Policy to Combat Opioid Crisis

Just a week after President Trump declared the opioid epidemic a public health emergency, the Centers for Medicare & Medicaid Services (CMS) announced a new policy to allow states to design demonstration projects that increase access to treatment for opioid use disorder (OUD) and other substance use disorders (SUD). CMS’s new demonstration policy responds to the President’s directive and provides states with greater flexibility to design programs that improve access to high quality, clinically appropriate treatment.

Through this updated policy, states will be able to pay for a fuller continuum of care to treat SUD, including critical treatment in residential treatment facilities that Medicaid is unable to pay for without a waiver, according to a letter CMS sent to state Medicaid directors. Previously, states had been required to build out their entire delivery system for SUD treatment while also meeting rigid CMS standards before Medicaid demonstration approvals could be granted. The new policy will allow states to provide greater treatment options while improving their continuum of care over time.

According to a new study, nearly a quarter of patients on Medicaid filled a prescription for an opioid painkiller in 2015. Express Scripts, one of the largest pharmacy benefits manager of Medicaid drug benefits in the country, analyzed data on 1.8 million opioid prescriptions given to 3.1 million Medicaid enrollees in 14 states. It found that 6 percent of all Medicaid prescriptions were for opioids. Of those that acquired opioids, nearly one-third took the medications for more than 30 days.

Opioids also contributed notably to costs, accounting for 4.1 percent of plan costs overall. Medicaid enrollees are 10 times more likely to be drug addicts or substance abusers than the general population, according to the report.

In the letter, CMS said that state projects under its new program should aim to make notable improvements over the course of five years with goals to increase access, reduce overdose deaths, reduce use of the emergency department or inpatient care for drug addiction treatment and improve care coordination.

CMS also said that it will “ensure states take significant steps” to reduce opioid prescribing.

Posted in: Opioid

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CBO Analysis of Proposed CHIP Funding Bill Causes Doubt

CBO Analysis of Proposed CHIP Funding Bill Causes Doubt

More than three weeks after the deadline to renew the Children’s Health Insurance Program, the Congressional Budget Office has released an analysis of the five-year extension bill, which would extend the bill to 2022 so they can make a few changes, including revamping federal matching rates. The CBO analysis, which also indicated the proposed legislation would increase the federal deficit by $8.2 billion by 2027, is causing Alabama and other states to fear and doubt the CHIP funding.

Nationally, CHIP provides insurance for children up to age 19 whose households make up to 312 percent of the poverty line – up to $50,688 a year for a household of two, and up to $63,710 for a household of three. Qualifying families pay premiums – ranging from $52 to $104 per child per year, depending on income – as well as co-pays. ALL Kids, administered by the Alabama Department of Public Health, covers about 83,000 children, while about 70,000 CHIP recipients fall under Alabama Medicaid.

The Medical Association was a vital in creating CHIP in Alabama more than 20 years ago as a way to provide more health insurance coverage to children of families with low and moderate incomes. Although this is a nationwide crisis, Alabama’s program has funds to continue through March, while some states may lose all their funding by December.

Studies credit CHIP with a steep decline in the number of uninsured children in the country and particularly successful in Alabama. A 2014 study credited CHIP with reducing the number of uninsured children in Alabama 18 percent between 2011 and 2014.

“The benefits package for children is very comprehensive,” said Dr. Wes Stubblefield, a Florence pediatrician and president of the Alabama Chapter of the American Academy of Pediatrics. “It’s everything recommended by the American Academy of Pediatrics that’s recommended as a standard of care for children for preventative care.”

The Medical Association will continue to monitor the progress of this proposed legislation and is eager to work with lawmakers toward a positive solution.

Posted in: CHIP

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UPDATE: Lawmakers Back to the Drawing Board for CHIP Funding Renewal

UPDATE: Lawmakers Back to the Drawing Board for CHIP Funding Renewal

UPDATED OCT. 12, 2017 — Legislation to renew funding for the Children’s Health Insurance Program has stalled in the U.S. House as lawmakers continue debating how to pay for the program. This is the third delay requested by the Democrats as the lawmakers now work to mark up the legislation to extend funding for critical programs other than CHIP, such as Community Health Centers and to provide an additional $1 billion to Puerto Rico’s Medicaid program.

Both parties agree on the urgency of passing a CHIP bill. Federal funding for the program expired Sept. 30, and the longer Congress delays taking action, the tougher it will be on states.

Eleven states anticipate they will burn through their federal funding by the end of 2017, according to the Kaiser Family Foundation, and 32 states project they will exhaust federal funds by the end of March 2018.

Click here to read House Energy and Commerce Committee Chairman Greg Walden’s Statement on CHIP and Extending Critical Public Health Programs


OCTOBER 6, 2017 — After being unable to come together to meet a Sept. 30 deadline that would have renewed funding for the Children’s Health Insurance Program for five years, lawmakers in Washington were back at the drawing board this week looking for solutions to ensure federal funding for CHIP even though the Senate Finance Committee reached a bipartisan deal in mid-September to extend funding for five years.

Earlier in September, the U.S. Senate Finance Committee reached an estimated $8 billion bipartisan agreement to renew CHIP funding for five years and phase out the 23 percent Obamacare funding bump. States would have maintained eligibility through 2019, and after that there would be no so-called maintenance of effort for children of parents with incomes more than 300 percent of the federal poverty level.

The Medicaid and CHIP Payment and Access Commission has estimated that all states will exhaust their federal CHIP reserves in 2018 without an extension but warns that an extension alone will not be enough.

“If Congress extends funding but does not include the 23 percentage-point increase in the federal matching rate that was provided in the ACA, most states will still face shortfalls, since many assumed continued funding with the enhanced match rate,” it noted.

In Alabama, CHIP funding is split between Alabama Medicaid and the Alabama Department of Public Health. ADPH administers the ALL Kids program, which covers about 83,000 of Alabama’s children, while Medicaid provides covers for an additional 70,000 children.

The Medical Association, the Alabama Chapter of the American Academy of Pediatrics, state lawmakers and a number of organizations advocating for children’s health care petitioned the Alabama Congressional Delegation to support reauthorization of a bipartisan CHIP funding bill before the Sept. 30 deadline. In a letter to the Alabama Congressional Delegation outlining support for CHIP reauthorization, the coalition cited the great strides made possible through CHIP in ensuring children have access to the care they need. As well, any reductions in federal CHIP funding could cause problems for not only Alabama’s ALL Kids program but also children enrolled in Alabama Medicaid.

Posted in: CHIP

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Coalition Pushes for CHIP Reauthorization

Coalition Pushes for CHIP Reauthorization

 

 

DOWNLOAD A COPY OF THE JOINT LETTER

The Medical Association, the Alabama Chapter of the American Academy of Pediatrics, state lawmakers and a number of organizations advocating for children’s health care are petitioning the Alabama Congressional Delegation to support reauthorization of a bipartisan CHIP funding bill before the Sept. 30 deadline. In a letter to the Alabama Congressional Delegation outlining support for CHIP reauthorization, the coalition cited the great strides made possible through CHIP in ensuring children have access to the care they need. As well, any reductions in federal CHIP funding could cause problems for not only Alabama’s ALL Kids program but also children enrolled in Alabama Medicaid.

Below is the letter, and more signees are expected before the Sept. 30 deadline. Download a copy of the letter here.

We, the undersigned Alabama elected officials and organizations advocating for children and pregnant women in our state, write to urge your support of the Hatch-Wyden bill, Keeping Kids’ Insurance Dependable and Secure (KIDS) Act (S. 1827). This bipartisan legislation ensures stability for vulnerable children by extending funding for the Children’s Health Insurance Program (CHIP) for five years. The bill also provides additional protections for low-income children and increases flexibility for states.

As you know, federal funding for CHIP expires on September 30, 2017. Without certainty from Congress on CHIP funding, states will be forced to make drastic cuts to the program. This could mean slashing enrollment, reducing benefits, and imposing higher costs for families.

CHIP is a bipartisan success story. The program was created in 1997 and has been championed by lawmakers on both sides of the aisle since its very beginning. Together with Medicaid, CHIP has helped to reduce the numbers of uninsured children by a remarkable 68 percent. Now is the time for Congress to stabilize the CHIP funding stream and protect the gains in children’s health coverage that have resulted in more than 95 percent of all children in America being enrolled in some form of insurance coverage.

The program is designed around what children need. It offers benefits that are age-appropriate, including dental coverage and mental health and substance abuse services, which may not be covered by a family’s employer-sponsored insurance.

CHIP plans include networks of pediatricians, pediatric medical and surgical subspecialists, and children’s hospitals, which are especially critical for children with special health care needs.

Families deserve peace of mind knowing that they will be able to access the care and support services their children rely on to be healthy.

Currently in Alabama, 157,000 children are covered by CHIP, known as ALL Kids in our state. With state budgets already set for the coming year, states are counting on CHIP to continue in its current form. Changes to CHIP’s structure – including changes to the Maintenance of Effort or the enhanced CHIP matching rate – would cause significant disruption in children’s coverage and leave states with critical shortfalls in their budgets. Given CHIP’s track record of success, changes to CHIP that would cause harm to children must not be made. In Alabama, we would be forced to use funds originally appropriated for Alabama Medicaid to keep children covered on CHIP. So lack of continued funding at its current level would mean a double hit for Alabama!

Today, we stand united in urging you and your colleagues to work together to enact a five-year extension of CHIP funding.  Securing this critical source of coverage for children and pregnant women into the future is an important opportunity for meaningful, bipartisan action to honor CHIP’s 20 years of success.

Thank you for all you do for our state and the children of Alabama.

 

Sincerely,

Representative Steve Clouse, Chair, House Ways and Means General Fund Committee

Representative Anthony Daniels, House Minority Leader

Representative Nathaniel Ledbetter, House Majority Leader

Representative Mac McCutcheon, Speaker of the House

Representative April Weaver, Chair, House Health Committee

Senator Del Marsh, Senate President Pro Tempore

Senator Jim McClendon, Chair, Senate Health & Human Services Committee

Senator Greg Reed, Senate Majority Leader

Alabama Academy of Family Physicians

Alabama Arise

Alabama Chapter-American Academy of Pediatrics

Alabama Children First

Alabama Hospital Association

Children’s of Alabama

Medical Association of the State of Alabama

UAB Health System

University of South Alabama Health System

VOICES for Alabama’s Children

 

Posted in: CHIP

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CMS Reveals New Medicare Card Design; Strengthens Fraud Protections

CMS Reveals New Medicare Card Design; Strengthens Fraud Protections

The Centers for Medicare & Medicaid Services has redesigned its Medicare card to remove Social Security numbers and use a unique, randomly-assigned number in an effort to better protect users from identity theft and fraud.

CMS will begin mailing the new cards to people with Medicare benefits in April 2018 to meet the statutory deadline for replacing all existing Medicare cards by April 2019. People with Medicare will also be able to see the design of the new Medicare card in the 2018 Medicare & You Handbook. The handbooks are being mailed and will arrive throughout September.

“The goal of the initiative to remove Social Security numbers from Medicare cards is to help prevent fraud, combat identify theft, and safeguard taxpayer dollars,” said CMS Administrator Seema Verma. “We’re very excited to share the new design.”

CMS has assigned all people with Medicare benefits a new, unique Medicare number, which contains a combination of numbers and uppercase letters. People with Medicare will receive a new Medicare card in the mail, and will be instructed to safely and securely destroy their current Medicare card and keep their new Medicare number confidential. Issuance of the new number will not change benefits that people with Medicare receive.

Health care providers and people with Medicare will be able to use secure look-up tools that will allow quick access to the new Medicare numbers when needed. There will also be a 21-month transition period where doctors, health care providers, and suppliers will be able to use either their current SSN-based Medicare Number or their new, unique Medicare number, to ease the transition.

This initiative takes important steps towards protecting the identities of people with Medicare. CMS is also working with healthcare providers to answer their questions and ensure that they have the information they need to make a successful transition to the new Medicare number. For more information, please visit: www.cms.gov/newcard.

How can providers get ready for the changes?

  • Ask your billing and office staff if your system can accept the new 11-digit alphanumeric Medicare Beneficiary Identifier or
  • If your system cannot accept the new number, system changes should be made by April 2018
  • If providers use vendors to bill Medicare, ask them about their MBI practice management system changes and make sure they are ready for the change
  • Verify your patients’ addresses: If the address you have on file is different than the address you get in electronic eligibility transaction responses, ask your patients to contact Social Security and update their Medicare records. This may require coordination between your billing and office staff.

For more information go to https://www.cms.gov/Medicare/New-Medicare-Card/Providers/Providers.html

Posted in: Medicare

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U.S. Senate Announces 5-Year CHIP Funding Program

U.S. Senate Announces 5-Year CHIP Funding Program

The U.S. Senate Finance Committee reached an estimated $8 billion bipartisan agreement that renews funding for the Children’s Health Insurance Program for five years and phases out the 23 percent Obamacare funding bump. States would have to maintain eligibility through 2019, and after that there would be no so-called maintenance of effort for children of parents with incomes more than 300 percent of the federal poverty level.

While the deal does not include details of how the Congress would pay for the funding extension, the proposed legislation would maintain Obamacare’s 23 percent increase in the federal matching rate to states for 2018 and 2019 and begin to ratchet it down in 2020, according to GOP and Democratic aides. The bump is set at 11.5 percent in 2020 and would be totally eliminated starting in 2021. Amendments to the proposed legislation are expected.

“The Medical Association began working with Alabama’s Congressional Delegation in January when we traveled to Washington, D.C., for the Government Relations Conference,” said Executive Director Mark Jackson. “We wanted to express to them the importance that CHIP funding be renewed and the impact the program has on our residents. We are pleased to see that there is a bi-partisan proposal in the Senate that will keep CHIP funding in place.”

CHIP is authorized through 2019, but funding runs out at the end of September. CHIP covers families with income levels between 138 percent and 405 percent of the federal poverty level. States determine the eligibility levels within those parameters, and the ACA requires that states maintain eligibility levels that were in place as of March 23, 2010. States that reduce eligibility lose federal Medicaid funding. Eligibility levels are capped between 200 percent and 300 percent of poverty in 30 states, and in 19 states eligibility levels are higher than 300 percent of poverty, although those states don’t receive the higher match rate for enrollees above the 300 percent threshold, according to American Action Forum. The Finance deal would let states drop eligibility levels to 300 percent of poverty after 2019.

More than 97 percent of CHIP enrollees have family income of 250 percent of poverty, according to the American Action Forum analysis.

The American Academy of Family Physicians and more than 130 other organizations issued a statement on Sept. 6 calling on legislators to save the CHIP from chaos and families from confusion by extending the program’s funding for five years before it expires on Sept. 30.

“CHIP has a proven track record of providing high-quality, cost-effective coverage for low-income children and pregnant women in working families,” the statement said. “CHIP was a smart, bipartisan solution to a real problem facing American children and families when it was adopted in 1997, and its importance and impact in securing a healthy future for children in low-income families has only increased. As Congress continues to work on larger health system reforms, a primary goal should be to improve health coverage for children, but at a minimum, no child should be left worse off. We urge our nation’s leaders to work together to enact a five-year extension of CHIP funding as an important opportunity for meaningful, bipartisan action.”

Nearly 9 million children whose families could not otherwise afford health insurance have access to health care because of CHIP. The program also enables pregnant women in 19 states to obtain the health care they need to have healthy pregnancies and give birth to healthy infants. Many families covered by the program have incomes too high to qualify for Medicaid.

Posted in: CHIP

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Alabama Medicaid Seeks Public Comments

Alabama Medicaid Seeks Public Comments

Alabama Medicaid is seeking public comment on an amendment to the Alabama Home and Community-Based Intellectual Disabilities Waiver.

Medicaid Intellectual Disabilities Waiver Amendment | Comments Submitted by October 8, 2017

The Alabama Medicaid Agency is seeking public comment on its proposal to amend the Alabama Home and Community-Based Intellectual Disabilities Waiver (ID Waiver).

The waiver supports Alabama citizens who have a diagnosis of Intellectual Disabilities and who would otherwise require the level of care offered in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) institution to remain in the community. The waiver provides services such as day services and in-home supports. The amendment proposes changes to the sections pertaining to Individual Directed Goods and Services and self-directed services.

A copy of the proposed application can be found on the Alabama Medicaid Agency website. Click here to view waiver documents.

The comment period is open until October 8, 2017. Written comment regarding the proposed waiver amendment are welcome and should be mailed to Samantha McLeod, Associate Director via mail to: Alabama Medicaid Agency, Long Term Care Division, P.O. Box 5624, Montgomery, AL 36103-5624 or via email to samantha.mcleod@medicaid.alabama.gov.

Posted in: Medicaid

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What If No One Was On Call…2017 Legislative Review

What If No One Was On Call…2017 Legislative Review

In times of illness, injury and emergency, patients depend on their physicians. But what if no one was on call? Public health would be in jeopardy. However, the same holds true during a legislative session. What would happen if the Medical Association was not on call, advocating for you and your patients at the Alabama Legislature? Keep reading to find out.

Moving Medicine Forward

Patients and their physicians want assurances about not only the quality of care provided, but also its continued availability, accessibility, and affordability. Patients want to make health decisions with their doctors, free from third-party interference. Continued progress toward these objectives requires constant vigilance in the legislative arena, where special interest groups seek to undermine physician autonomy, commoditize medicine and place barriers between physicians, their patients and the care their patients need.

If no one was on call… Alabama wouldn’t be the 20th state to enact Direct Primary Care legislation. DPC puts patients and their doctors back in control of patients’ health and helps the uninsured, the under-insured and those with high-deductible health plans. SB 94 was sponsored by Sen. Arthur Orr (R-Decatur) and Rep. Nathaniel Ledbetter (R-Rainsville).

If no one was on call… the Board of Medical Scholarship Awards could have seen its funding slashed but instead, the program retained its funding level of $1.4 million for 2018. The BMSA grants medical school loans to medical students and accepts as payment for the loan that student’s locating to a rural area to practice medicine. The BMSA is a critical tool to recruiting medical students to commit to practice in rural areas. As well, the economic footprint of every physician is at least $1 million, which improves both community health and local economies.

If no one was on call… Medicaid cuts could have been severe, possibly reducing access for patients within an already fragile system in which less than 20 percent of Alabama physicians participate. Due to work done during the 2016 second special session and the 2017 session, sufficient funds were made available for Medicaid without any scheduled cuts to physicians for 2018. Increasing Medicaid reimbursements to Medicare levels – a continued Medical Association priority – could further increase access to care for Medicaid patients.

Beating Back the Lawsuit Industry

Personal injury lawyers are constantly seeking new opportunities to sue doctors. While Alabama’s medical liability laws have fostered fairness in the courtroom and improved the legal climate, each year personal injury attorneys seek to undo parts of the very law that helps keep “jackpot justice” and frivolous suits in check.

If no one was on call… an $80 million tax increase on physicians to fund a new government-administered malpractice claims payout system called the Patients Compensation System could have passed. The PCS would administer damage claims for physical injury and death of patients allegedly sustained at the hands of physicians. Complaints against individual physicians would begin with a call to a state-run 1-800 line and would go before panels composed of trial lawyers, citizens and physicians to determine an outcome. In addition, any determinations of fault would be reported to the National Practitioner Databank. The Patient Compensation System would undo decades of medical tort reforms, which the Medical Association championed and is forced to defend from plaintiff lawyer attacks each session. The PCS deprives both patients and doctors of their legal rights.

If no one was on call… physicians could have been exposed to triple-damage lawsuits for honest Medicaid billing mistakes. The legislation would create new causes of civil action in state court for Medicaid “false claims.” The legislation would incentivize personal injury lawyers to seek out “whistleblowers” in medical clinics, hospitals and the like to pursue civil actions against physicians and others for alleged Medicaid fraud, with damages being tripled the actual loss to Medicaid. The standard in the bill would have allowed even honest billing mistakes to qualify as “Medicaid fraud,” creating new opportunities for lawsuits where honest mistakes could be penalized.

If no one was on call… physicians would have been held liable for the actions or inactions of midwives attending home births. While a lay midwife bill did pass this session establishing a State Board of Midwifery, the bill contains liability protections for physicians and also prohibitions on non-nurse midwives’ scope of practice, the types of pregnancies they may attend, and a requirement for midwives to report outcomes.

If no one was on call… the right to trial by jury, including jury selection and jury size, could have been manipulated in personal injury lawyers’ favor.

If no one was on call… physicians could have been held legally responsible for others’ mistakes, including home caregivers, medical device manufacturers and for individuals following or failing to follow DNR orders.

Protecting Public Health and Access to Quality Care

Every session, various pieces of legislation aimed at improving the health of Alabamians are proposed. At the same time however, many bills are also introduced that endanger public health and safety, like those where the legislature attempts to set standards for medical care, which force physicians and their staffs to adhere to non-medically established criteria, wasting health care dollars, wasting patients’ and physicians’ time and exposing physicians to new liability concerns.

If no one was on call… legislation could have passed to lower biologic pharmaceutical standards in state law below those set by the FDA, withhold critical health information from patients and their doctors, and significantly increase administrative burdens on physicians.

If no one was on call… allergists and other physicians who compound medications within their offices could have been shut down, limiting access to critical care for patients.

If no one was on call… numerous scope of practice expansions that endanger public health could have become law, including removing all physician oversight of clinical nurse specialists; lay midwives seeking allowance of their attending home births without restriction or regulation; podiatrists seeking to amputate, do surgery and administer anesthesia up the distal third of the tibia; and marriage and family therapists seeking to be allowed to diagnose and treat mental disorders as well as removing the prohibition on their prescribing drugs.

If no one was on call… state boards and agencies with no authority over medicine could have been allowed to increase medical practice costs through additional licensing and reporting requirements.

If no one was on call… legislation dictating medical standards and guidelines for treatment of pregnant women, the elderly and terminal patients could have been placed into bills covering various topics.

Other Bills of Interest

Rural physician tax credits… legislation to increase rural physician tax credits and thereby increase access to care for rural Alabamians did not pass but will be reintroduced next session.

Infectious Disease Elimination… legislation to establish infectious disease elimination pilot programs to mitigate the spread of certain diseases failed to garner support on the last legislative day.

Constitutional amendment proclaiming the State of Alabama’s stance on the rights of unborn children… legislation passed to allow Alabamians to vote at the November 2018 General Election whether to add an amendment to the state constitution to:

“Declare and affirm that it is the public policy of this state to recognize and support the sanctity of unborn life and the rights of unborn children, most importantly the right to life in all manners and measures appropriate and lawful…”

If ratified by the people in November 2018, this Amendment could have implications for women’s health physicians.

Coverage of autism spectrum disorder therapies… legislation passed to require health plans to cover ASD therapies, with some restrictions.

Portable DNR for minors… legislation establishing a portable DNR for minors to allow minors with terminal diseases to attend school activities failed to garner enough votes to pass on the last legislative day.

If the Medical Association was not on call at the legislature, countless bills expanding doctors’ liability, increasing physician taxes and setting standards of care into law could have passed. At the same time, positive strides in public health — like passage of the direct primary care legislation — would not have occurred. The Medical Association is Alabama physicians’ greatest resource in advocating for the practice of medicine and the patients they serve.

Posted in: Advocacy

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