SAMHSA222s Weekly Financing News Pulse: National Edition April 16, 2010 4/16/10 1 SAMHSA222s Weekly Financing News Pulse: National Edition National News Employer Reimbursement Program Scheduled to Begin, Federal Health Reform Lawsuit Takes Shape, Obstacles to Implementation CMS Sanctions Aetna over Medicare Part D Plan Transition Update: President Signs 223Extenders224 Bill, Restores Medicare Reimbursement Rate Pfizer Discloses Payments Update: ONDCP Director Testifies about National Drug Control Budget, Increase in Substance Abuse Prevention and Treatment Polls Find Most Americans Still Oppose Health Care Re form, Industry Experts Support DOJ222s OJJDP Announces Juvenile Drug Court Grants Studies Released KFF Brief Compares Medicaid and CHIP under Reform with Previous Law Health Affairs Releases Study on Implementation of Electronic Records Ortho - McNeil Study Examines Continuity of Care for Schizophrenia AHRQ Releases Reports on Quality of Health Care and Disparities UnitedHealth Group Report Suggests State Changes to Medicaid NASHP Releases Report on LTSS under Health Care Reform and States222 Options Around the Hill: Hearings on Health Financing To Subscribe to SAMHSA222s Weekly Financing News Pulse, please go to the following link and choose 223Health Care Financing224: https://service.govdelivery.com/service/multi_subscribe.html?code=USSAMHSA&origin=http://www.samhsa.go v/enetwork/success.aspx For questions or comments, please contact Kevin Hennessy ( kevin.hennessy@samhsa.hhs.gov ). SAMHSA222s Weekly Financing News Pulse: National Edition April 16, 2010 4/16/10 2 National News Employer Reimbursement Program Scheduled to Begin, Federal Health Reform Lawsui t Takes Shape, Obstacles to Implementation : The U.S. Department of Health and Human Services (HHS) has announced that it will make forms available in June for federal reimbursement of employers222 costs to cover the health care of early retirees. The program, which was authorized under the Patient Protection and Affordable Care Act , has $5 billion available and will begin making payments on June 23. Employers will be reimbursed for 80 percent of claims between $15,000 and $90,000 for retirees age s 55 to 64. Employers that receive the federal funds must use the money to lower health care costs for the early retirees. Funding permitting, the program is proje cted to o perate until 2013 ( Kaiser Health News, 4/14 ; Business Insurance, 4 /13 ). The U.S. judge presiding over the federal lawsuit over health care reform s aid that t here will likely be no evidence discovery phase because he and the attorneys involved believe the suit can be resolved using previous case law. The plaintiffs have until May 14 to file an amended complaint containing all the states that have decided to join onto the suit, and the judge has scheduled the first arguments of the case for September 14 ( Pensacola News Journal, 4/15 ). In other implementation news, because national health care refo rm was passed using the legislative process known as 223reconciliation224 , legislators were unable to change the dates in the draft legislation that they passed. Consequently, states and the federal government have already missed deadlines that they must now address retroactively. Guidance on the supplemental drug rebate that was scheduled to be released in January is projected to be released in the next week ( The Washington Post, 4/12 ; Kaiser Health News, 4/13 ). On April 7, U.S. Department of Health and Human Services Secretary Kathleen Sebelius sent a letter to s tate officials warning them of potential health care reform fraud. She warned officials of scams involving fraudulent health insurance policies and door -to -door salesmen offering coverage during a supposed limited open -enrollment period. The secretary urged vigilance and vigorous prosecution of those committing fraud ( USA Today, 4/10 ; Kaiser Health News, 4/13 ). Twenty -eight s tates are considering expanding the role of nurse practitioners to address concerns about access to care following health reform222s expansion of insurance coverage. These expansions are intended to improve the availability of primary care physicians (PCPs). States are examining whether to allow the nurse practitioners to operate without strict oversight from doctors and prescribe narcotics. Medicare currently reimburses nurse practitioners 85 percent of what it pays to physicians ( The Dallas Morning News, 4/14 ). CMS Sanctions Aetna over Medicare Part D Plan Transition : On April 5, the Centers for Medicare and Medicaid Services (CMS) sent a letter to Aetna Inc. informing the Connecticut based insurer that it has until April 21 to resolve issues stemming from changes to its Medicare prescription drug coverage, or it will be suspended from signing up additional seniors for the drug plans. CMS decided to sanction Aetna over its management of the transition from an open formulary drug p lan in 2009 to a closed formulary drug plan in 2010. Under the open formulary plan all drugs were covered, but under the closed formulary plan only certain drugs are covered, with preference given to generics. Aetna provides prescription drug coverage throu gh Medicare Part D to 586,000 seniors, either through Medicare Advantage plans with a Medicare Part D component, or through stand alone Medicare Part D plans. According to Aetna, 20,000 of those covered by its Medicare prescription drug plans were affecte d by the transition issues. CMS alleges that Aetna did not provide seniors taking drugs no longer covered under the new formulary with the requisite one- time 30 -day transition supply of the drugs, and that Aetna did not handle appeals to the new formulary quickly enough. The sanctions do not impact seniors already covered by Medicare prescription drug coverage through Aetna. The open -enrollment period for privately run Medicare plans recently ended, and will not begin again until the fall. The only seni ors SAMHSA222s Weekly Financing News Pulse: National Edition April 16, 2010 4/16/10 3 that could potentially be signed up for the programs until then, and who Aetna would be prevented from enrolling under the CMS sanctions, are those just turning 65. Aetna representatives say the company is working with beneficiaries and the federal go vernment to resolve the problem as quickly as possible ( The Wall Street Journal, 4/10 ; The Philadelphia Inquirer, 4/10 ; Kaiser Health News, 4/12 ). Update : President Signs 223Extenders224 Bill , Restore s Medicare Reimbursement Rate: On April 15, President Barack Obama signed into law the Continuing Extension Act of 2010 ( HR 4851) after the U.S. Senate and U.S. House approved the measure earlier the same day. The bill extends the American Recovery and Reinvestment Act (ARRA) unemployment benefits and COBRA subsidies to June 2 and delays a scheduled 21 percent Medicare physician reimbursement reduction. The physician222s Medicare reimbursement reductions were slated to take effect April 1; however the Centers for Medicare and Medicaid Services (CMS) ordered that claims processed on or after April 1 be delayed until April 15. Those claims will now be reimbu rsed at the newly extended rate ( The Washington Post, 4/16 ; The Associated Press, 4/15 ) . Pfizer Discloses Payments: On March 31, Pfizer Inc. disclosed through an online database that in the last six months of 2009 it made $20 million in payments to doctors and medical professionals and $15.3 million in payments to academic medical centers for research. The disclosure comes as part of a settlement over a federal criminal investigation into illegal marketing of drugs by Pfizer. GlaxoSmithKline, Eli Lilly , and Merck operate similar databases. Critics contend that the pharmaceutical companies222 sites are not transparent and simple enough to use. Under the Patient Protection and Affordab le Care Act222s component known as the Physician Payment Sunshine Act , starting in 2013 pharmaceutical companies and medical device makers will be subject to stricter disclosure requirements regarding such payments and will be required by law to operate online payment disclosure databases ( Kaiser Health News, 4/13 ; New York Times, 4/12 ; Kaiser Health News, 4/9 ; Pittsburgh Business Times, 4/9 ). Update: ONDCP Director Testifies about National Drug Control Budget, Increase in Substance Abuse Prevention and Treatment: On April 14, the Office of National Drug Control Policy Director Gil Kerlikowske testified before the House Committee on Oversight and Government Reform222s Subcommittee on Domestic Policy about President Barack Obama222s proposed FY2011 National Drug Control Budget. President Obama222s FY2011 budget requests $15.5 billion to reduce drug use and its consequences, a $521.1 million increase over FY2010 funding levels. The drug control budget would increase prevention and treatment funding by 6.5 percent over FY2010 funding levels. Kerlikowske testified that the National Drug Cont rol Strategy will address demand through an expansion of the public health response to the issue, integration of drug treatment into mainstream medicine, and focusing on community level engagement ( The Washington Independent, 4/14 ). Polls Find Most Americans Still Oppose Health Care Reform, Industry Experts Support : A new poll by the Associated Press and GfK found that 50 percent of Americans oppose health care reform while 39 percent support it . Seniors were more likely than those 64 and under to oppose reform. In addition, 57 percent reported that they expect to pay more for their personal health care, and 47 percent believe that the quality of their care is going to decline . Only 28 percent surveyed reported that they understood health care reform extremely or very well. O n April 5, The Commonwealth Fund released a survey it commissioned wit h Modern Healthcare on the stance of health care industry experts toward health care reform in the month prior to the passage of the Patient Protection and SAMHSA222s Weekly Financing News Pulse: National Edition April 16, 2010 4/16/10 4 Affordable Care Act . The survey found that 88 percent believed that health care reform would expand access to affordable insurance for the uninsured, and that 65 percent or more supported nearly all of the components of the legislation. Those surveyed identified the number of available primary care physicians, the states222 capacity for implementation, and enforcement of the individual insurance mandate as areas of concern. They listed improved affordability, prevention and control of chronic disease, and improving cost cont rols as areas that need to be readdressed in the next two to three years ( Associated Press, 4/15 ; Kaiser Health News, 4/15 ; The Commonwealth Fund, 4/5 ; Kaiser Health News, 4/9 ). DOJ222s OJJDP Announces Juvenile Drug Court Grants: The U.S. Department of Justice222s (DOJ) Office of Juvenile Justice and Delinquency Prevention (OJJDP) has announced that it is offering grants of up to $300,000 to develop and establish a comprehensive support service initiative in juvenile drug court programs that have been operational for three years or more . The initiatives would provide health services, mentoring, and other support services to youth in the drug court programs. The grants are available for states, state courts, local courts, units of local government, and t ribal governments, and applications are due on May 19 ( Join Together, 4/9 ) . Studies Released KFF Brief Compares Medicaid and CHIP under Reform with Previous Law: On April 5, the Kaiser Family Foundation (KFF) released a brief comparing the provisions in the new health care reform law impacting Medicaid and the Children222s Health Insurance Program (CHIP) with prior law regarding those programs. The brief focuses on changes to Medicaid financing and coverage, the interfacing of Medicaid and CHIP with new state- based insurance exchanges, and other changes to Medicaid benefits and access ( KFF, 4/7 ). Health Affairs Releases Study on Implementation of Electronic Records: Health Affairs released a study outlining the practical difficulties of implementing electronic health records in a small physician practice. The study was published in light of the fact that billions of dollars will soon be available for that purpose from the American Recovery and Reinvestment Act . The researchers were physicians operating in their own small practice which adopted electronic health records. They found that technological limitations led the system their office implemented to cause medication errors, interruptions to workflow, and other problems commonly encountered with paper record systems. The res earchers suggest that providers and policymakers consider alternative software and informatics models before investi ng in currently available systems ( Kaiser Health News, 4/9 ; Health Affairs, April, 2010 ) Ortho - McNeil Study Examines Continuity of Care for Schizophrenia: A study presented by Ortho-McNeil at the 2010 Quality of Behavioral Health Care Conference found that the most effective practices to ensure continuity of care for patients with schizophrenia and schizoaffective disorder are modest in cost and can be implemented at most psychiatric units in the community treatment system. The researchers found that social work support during the transition from inpatient to ambulatory care, establishing facility level protocols for the transfer of patients to outpatient providers, and participating in reg ional joint planning efforts all improved the continuity of care for patients with schizophrenia and schizoaffective disorder ( PR Newswire, 4/14 ). SAMHSA222s Weekly Financing News Pulse: National Edition April 16, 2010 4/16/10 5 AHRQ Releases Reports on Quality of Health Care and Disparities: The Agency for Healthcare Research and Quality (AHRQ), a division of the U. S. Department of Health and Human Services (HHS), released its two annual studies on health care quality and disparities for 2009; the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR). Both reports examine effectiveness in health care, patient safety, timeliness, patient -orientation, and efficiency of care. The NHQR found that the median level of receipt of needed services nationally was 58 percent, and noted that the uninsured are less likely to obtain preventative care or chronic disease management than the insured . The NHDR found that minorities and the poor are significantly more likely to receive a lower quality of care, and that their access to care is also worse ( DOTmed, 4/15 ; AHRQ, 4/15 ). UnitedHealth Group Report Suggests State Changes to Medicaid: On April 15, UnitedHealth Group released a report projecting that $366 billion could be saved through the modernization of Medicaid, of which $149 billion would be saved by the states. The report suggests that this can be achieved primarily through broader use of coordinated care techniques, increased use of managed care for Medicaid beneficiaries with long - term care needs, and modernization of Medicaid222s administrative and transactional processes. The report also suggests that Medicaid reimburseme nt rates be permanently raised to equal those of Medicare, citing a survey UnitedHealth conducted of primary care physicians (PCPs) that found that 67 percent of PCPs believe new Medicaid beneficiaries will have difficulty finding a PCP if the program is n ot reformed ( Kaiser Health News, 4/15 ; UnitedHealth Group, 4/15 ; The Wall Street Journal, 4/15 ). NASHP Releases Report on LTSS under Health Care Reform and States222 Options : A recent report by the National Academy for State Health Policy (NASHP) examines the initiatives in the Patient Protection and Affordable Care Act that enhance long term services and supports (LTSS) and improve coordination of primary and chronic care for the elderly and adults with disabilities. The report finds that the Act222s provisions establish delivery systems demonstrations and Medicaid options that the states can adopt to implement state reform. The report analyzes the provisions regarding: national voluntary long-term care insurance; Medicaid options and incentives for financing LTSS expansions; other LTSS provisions; the coordination of primary and chronic care; and nursing home reform ( Kaiser Health News, 4/9 ). Around the Hill: Hearings on Health Financing Senate Finance Committee : Unemployment Insurance April 14, 10:00 a.m., 215 Dirksen House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies : Fiscal 2011 Appropriations: Labor, HHS, Education April 14, 10:00 a.m., 2853- C Rayburn House Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies : Fiscal 2011 Appropriations: Military Construction, VA April 14, 10:00 a.m., H -143 Capitol Building Senate Veteran222s Affairs Committee : VA Disability Compensation SAMHSA222s Weekly Financing News Pulse: National Edition April 16, 2010 4/16/10 6 May 5, 9:30 a.m., 418 Russell House Veterans Affairs Committee : Vietnam Veterans Longitudinal Study May 5, 10:00 a.m., 334 Cannon Senate Veteran222s Affairs Committee : Veterans Issues May 19, 9:30 a.m., 418 Russell