Sunday, June 8, 2008

CMS Medicaid Hearing, November 1, 2007

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:

  1. 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 …"
  2. 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."
  3. 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."
  4. 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."
  5. 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."
  6. 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."
  7. 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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