This is a YouTube video of the House Hearings on the Seven Medicaid Regulations and their impact on the States' Budgets and Service Delivery.
THE SEVEN MEDICAID REGULATIONS
A great deal of the Seven Medicaid Regulations has been made at the Third Annual Medicaid Congress in Washington DC. Below is a link to the United States House of Reproesentatives Committee on Oversight and Government Reform on the fiscal impact these seven regs will have on the 47 states repsonding to a request for informaiton.
Click here http://oversight.house.gov/documents/20080303111450.pdf for a link to the report. I've distilled the seven regs and their perceived impact to Medi-Cal and the California Healthcare System.
The Regulations:
The following is a synopsis of the impacts each of these new regs will have on Medi-Cal and its recipients:
- Cost limits for public providers (CMS 2258-FC)
Definition: Narrows definition of a public prover, limits payments to public providers to cost of treating Medicaid Patients
Loss of federal funds in 2008: $943.6 million Over 5 years: $4,718 million
Impact: "This proposal would have devastating impacts to California’s safety net hospitals … it could result in significant payment disruptions for Alameda County and the University of California …" - Payment for graduate medical education (CMS 2279-P)
Definition: Prohibits Federal matching funds for costs of GME programs as part of Medicaid reimbursement for inpatient or outpatient hospital services
Loss of federal funds in 2008: $266.4 million Over 5 years: $1,332 million
Impact: "California’s emergency rooms are in crisis status and this will lead to further instability if reimbursement for the cost of care in these areas is significantly reduced." - Redefine Outpatient Hospital Services
Definition: Narrows scope of Medicaid outpatient hospital services to Medicare outpatient hospital services paid on a prospective basis; excludes other Medicaid services (e.g., rehabilitative service) from coverage as outpatient hospital services
Loss of federal funds in 2008: $266.4 million Over 5 years: $1,332 million
Impact: "California’s emergency rooms are in crisis status and this will lead to further instability if reimbursement for the cost of care in these areas is significantly reduced." - Provider taxes (CMS 2275-P)
Definition: Implements Tax Relief and Health Care Act of 2006 reduction of threshold from 6% to 5.5% of revenues; substantially tightens "hold harmless" test
Loss of federal funds in 2008: $540 million Over 5 years: $2,700 million
Impact: "California has used health care provider ‘fees’ to improve the quality of, and access to, care in nursing homes and centers for the developmentally disabled." - Coverage of rehabilitative services (CMS 2261-P)
Definition: Prohibits federal matching funds for rehabilitative services furnished through a non-medical program (e.g. foster care, adoption services, education, juvenile justice)
Loss of federal funds in 2008: Not specified Over 5 years: Not specified
Impact: "The impact of this rule is dependent on how aggressively CMS chooses to interpret the rule’s elements … this rule puts at risk over $1 billion annually and $5 billion over a 5-year period for all of these services." - Payments for costs of school administrative and transportation services (CMS 2287-P)
Definition: Prohibits federal matching funds for administrative activities by school employees or contractors and for transportation of school-aged children from home to school and back
Loss of federal funds in 2008: $130 million Over 5 years: $650 million
Impact: "Currently Medicaid Administrative Activities (MAA) is claimed by almost 800 school units representing more than 56 percent of the school districts in California." - Targeted case management (CMS-2237-IFC)
Definition: Limits period of coverage for case management services for individuals transitioning from institutions to the community; specifies a 15 minutes unit of service for all case management services; bars coverage of case management activities as administrative costs
Loss of federal funds in 2008: $24 million Over 5 years: $119 million
Impact: "Potentially, California might conduct 100,000 fewer Medi-Cal beneficiary TCM encounters."
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