WeeklyFinancingNewsPulseNationalEditionfinal2010402.pdf (PDF | 177.84 kb)
SAMHSA222s Weekly Financing News Pulse: National Edition April 2, 2010 4/2/10 1 SAMHSA222s Weekly Financing News Pulse: National Edition National News President Obama Signs Final Health Care Reform Bill, Work Begins on Implementation Senate Fails to Pass House222s 223Extenders224 Bill Before Recess President Obama to Nominate Berwick as CMS Administrator Reps. Waxman and Stupak Ask Maj or Corporations to Substantiate Claims that Health Care Reform will Limit Job Creation and Increase Costs TRICARE Extends Web -Based Mental Health Demonstration Project Polls Find Public Remains Split on Health Care Reform After Bill Signing Studies Released Study Finds Availability of Nursing Home Mental Health Services Failed to Improve Post -OBRA IOM Report Assesses Military Readjustment Needs, Emphasizes Importanc e of Mental Health Services Study Finds Mental Health Patients More Likely to Fall Into Medicare 223Doughnut Hole224 HHS OIG Report Finds MA Insurers Violate Marketing Rules Study Finds Financial Burden of Health Care Continues to Rise RWJF Brief Finds Federal ACO Legislation Does Not Violate Antitrust Policies KFF Finds Increasing Uninsurance as Youth Age Out of Medicaid, CHIP 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 2, 2010 4/2/10 2 National News President Obama Signs Final Health Care Reform Bill, Work Begins on Implementat ion : On March 30, President Barack Obama signed the Health Care and Education Affordability Reconciliation Act ( HR 4872) making changes to the Patient Protection and Affordable Care Act ( HR 3590) he signed into law on March 23 ( Kaiser Health News, 3/31 ). With the legislation signed, the bulk of the implementation work rests with federal agencies, particularly the U.S. Departments of Health and Human Services (HHS ), the Treasury , and the Internal Revenue Service (IRS). T hough the health care bills allocate $1 billion for implementation over 10 years, the Congressional Budget Office (CBO) estimates implementation will cost $10 to $20 billion over a decade, funded largely through future appropriations ( USA Today, 3/31 ). HHS has begun work to create a federally- funded national network of high -risk insurance pools to cover individuals who have been denied coverage by private insurers because of pre-existing conditions. According to the bill, the program must begin operation in 90 days and continue until 2014 when health insurance exchanges are in p l ace. HHS has not released any details on the effort; however, the bill provides $5 billion to subsidize premiums and allows HHS Secretary Kathleen Sebelius to administer the pool directly through HHS or contract it out to states or non -profit entities ( Kaiser Health News, 3/26 ). In other implementation news, America222s Health Insurance Plans (AHIP) President Karen Ignagni wrote a letter to Secretary Sebelius promising that health insurers will accept HHS222 interpretation of a health care reform provision ensuring insurance coverage for children by September. Ignagni said insurers will not block HHS regulations clarifying that the new law requires insurers to off er coverage to all children regardless of pre -existing conditions ( Kaiser Health News, 3/30 ; Kaiser Health News, 3/31 ). Meanwhile, on April 1, the federal government offered states the option to expand Medicaid coverage to 133 percent of the federal poverty level (FPL) with states paying their regular share of the cost until mandated coverage and full federal funding begin in 2014. Though most states are unlikely to exercise the option, states with more generous coverage like Connecticut, the District of Columbia, Maine, Massachusetts, Minnesota, Pennsylvania, Tennessee, and Washington, may obtain additional federal funding for existing services currently funded by the state ( Kaiser Hea lth News, 4/1 ). Finally, state governors, legislators, and attorneys general are clashing over whether to join the suit filed by 13 attorneys general contesting the constitutionality of HR 3590222s individual mandate. As of April 1, only Indiana had announ ced its intention to join the suit ( Kaiser Health News, 3/30 ). Senate Fails to Pass House222s 223Extenders224 Bill Before Recess: The Senate failed to Pass the House222s 223extenders224 bill, the Continuing Extension Act of 2010 ( HR 4851 ) , before the April Congressional recess. The bill would have extended the American Recovery and Reinvestment Act (ARRA) unemployment benefits and COBRA subsidies an d delay ed a scheduled 21 percent Medicare physician reimbursement reduction , all of which are set to expire during Congr ess222 two -week recess. Physicians222 Medicare reimbursement reductions were slated to take effect April 1; however, the Centers for Medica re & Medicaid Services (CMS) has ordered that claims processed on or after April 1 be delayed an additional 10 days beyond the agency222s standard 14 -day hold. The additional delay will allow the Senate to pass legislation avoiding the reimbursement reduction after Congress reconvenes April 12. In addition, Senate Democrats plan to provide unemployment and COBRA benefits retroactively for individuals who lose benefits during the recess ( Kaiser Health News, 3/30 ; Bloomberg via BusinessWeek, 3/29 ; CQ Politics, 3/26 ). President Obama to Nominate Berwick as CMS Administrator: News outlets report that President Obama plans to nominate Dr. Donald Berwick as CMS Administrator. CMS has been without a permanent administrator since Dr. Mark B. McClellan stepped down in October 2006. Dr. Berwick SAMHSA222s Weekly Financing News Pulse: National Edition April 2, 2010 4/2/10 3 currently serves as President and CEO of the Institute for Healthcare Improvement , a non- profit organization seeking to improve health care quality worldwide. Dr. Berwick is also a professor at the Harvard School of Public Health and Harvard Medical School . CMS has roughly 4,500 employees, 102 million beneficiaries, and an annual budget of $780 billion ( Kaiser Health News, 3/29 ; Kaiser Health News, 3/31 ; Harvard Crimson, 3/30 ; AP via Washington Post, 3/28 ). Reps . Waxman and Stupak Ask Major Corporations to Substantiate Claims that Health Care Reform will Limit Job Creation and Increase Costs: House Energy and Commerce Committee Chair Henry Waxman (D - CA) and House Energy and Commerce Oversight and Investigations Subcommittee Chair Bart Stupak (D -MI) sent letters March 26 to the heads of AT&T Inc. , Verizon Communications Inc. , Caterpillar Inc. , and Deere & Co. asking the companies to substantiate their claims that health care reform legislation will increase costs and undercut job creation. The letters ask th e companies to provide documents by April 9 and request in-person testimonies before the Oversight and Investigations Subcommittee on April 21 ( Congress Daily, 3/29 ; Kaiser Health News, 3/30 ). TR ICARE Extends Web - Based Mental Health Demonstration Project: TRICARE will extend the TRICARE Assistance Program (TRIAP), allowing enrollees to obtain face-to -face web -based mental health counseling seven days a week and 24 hours a day. The demonstration project will provide assessments, short-term counseling, and referrals to more comprehensive care to eligible participants through March 20, 2011 ( Federal Computer Week, 3/26 ). Po lls Find Public Remains Split on Health Care Reform After Bill Signing: A USA Today/Gallup poll released March 30 found that 50 percent of respondents believe that the passing of health care reform legislation is a 223bad thing224 while 47 percent believe it is a 223good thing.224 The USA Today poll also fo und that nearly 75 percent of respondents believe that Congress should 223take another crack at the law224 and half of those respondents think Congress should repeal it. T hough most USA Today respondents believe that the bill will increase health care costs and raise the federal deficit, they also believe the bill will improve overall health care coverage. Meanwhile, a CNN/Opinion Research Corp. poll showed President Obama222s approval rating up to 51 percent , fro m 46 percent before passing health care legislation. However, another CNN poll found that 56 percent of Americans disapproved of health care reform legislation while only 42 percent approved ( Kaiser Health News, 3/29 ; Kaiser Health News, 4/1 ; Kaiser Health News, 3/30 ; CNN, 3/30 ; Politico, 3/30 ; USA Today, 3/29 ). Studies Released Study Finds Availability of Nursing Home Mental Health Services Failed to Improve Post - OBRA: A study published in Psychiatric Services found that overall availability of nursing home-based mental health services failed to improve after the implementation of the Omnibus Budget Reconciliation Act of 1987 (OBRA). Though OBRA requires nursing homes to detect and treat mental illness among r esidents, data from 1995 through 2004 show that roughly 80 percent of facilities provided on- site mental health services in each survey year. The study also found that facilities were more likely to provide mental health services if they were larger, in metropolitan areas, or in the Northeast region. I OM Report Assess es Military Readjustment Needs, Emphasizes Importance of Mental Health Services: At the request of Congress, the Institute of Medicine (IOM) published a preliminary assessment of the needs of U.S. military personnel returning from the wars in Iraq and Afghanistan. The SAMHSA222s Weekly Financing News Pulse: National Edition April 2, 2010 4/2/10 4 report notes that long -term costs are difficult to predict b ecause the wars are fundamentally different from previous American wars. However, the IOM issued preliminary recommendations for the Department of Veterans Affairs (VA) and the Department of Defense (DOD) to assess the scope and magnitude of the problems facing new veterans and their families. IOM recommends that the federal government estimate the number of mental health professionals needed to meet the new demand and determine where to locate them to best serve the returning service members and their families. In addition, IOM recommends that the DOD and VA conduct or fund research to develop guidelines for long-term care management and assess the effectiveness of existing and planned services ( IOM, 3/31 ; Kaiser Health News, 4/1 ; U.S. News & World Report, 3/31 ). Stu dy Finds Mental Health Patients More Likely to Fall Into Medicare 223Doughnut Hole224: Examining Medicare enrollees in eight states, a study published in the Journal of General Internal Medicine isolated certain factors associated with increased entrance into Medicare222s prescription drug payment gap, the 223doughnut hole224. The authors found that gap entry was significantly higher among women and those with diabetes and dementia. In addition, though not as strongly correlated as diabetes or dementia, the study found that individuals with mental health conditions were also more likely to fall into the coverage gap ( BusinessWeek, 3/29 ). H HS OIG Report Finds MA Insure r s Violate Marketing Rules : An HHS Offi ce of the Inspector General (OIG) report examined insurer222s Medicare Advantage (MA) marketing practices, finding that all six of the companies OIG investigated violated MA marketing rules . The study examined Aetna Inc. , Universal American Corp. , Munich American Holding Corp. , Freedom Health Plans , MD Care , and Blue Cross Blue Shield of South Carolina , whose combined enrollees constitute 7 percent of all MA beneficiaries. The OIG found that all five insurers that used independent sales agents utilized compensation practices that yielded inappropriate financial incentives and five of the six companies did not insure that sales agents were fully qualified under CMS regulations. The OIG recommends that CMS take action regarding specific instance of non -compliance, audit MA insurers with a special focus on marketing restrictions, and issue additional guidance and regulations to protect enrollees from improper marketing ( Health News Florida, 3/31 ; Kaiser Health News, 3/31 ). S tudy Finds Financial Burden of Health C are Continues to Rise: A study published March 25 in Health Affairs found that the ratio of out-of -pocket health care expenditures to family income, the financial burden of health care, increased nationally from 2001 to 2006. The study found significant variance between states but noted that such variance owes more to differing levels of average income than state -level differences in out -of -pocket costs. The authors noted that rising health care costs affected all socioeconomic strata, finding that the financial burden of health care was highest among middle and upper-in come people. Finally, the study also found that 30 percent of U.S. citizens have a high financial burden of health care or are uninsured ( Kaiser Health News, 3/26 ). R WJF Brief Finds Federal ACO Legislation Does Not Violate Antitrust Policies : The Robert Wood Johnson Foundation (RWJF) published a George Washington University222s School of Public Health and Human Services brief examining the antitrust implications of proposed legislation in the House and Senate to create Accountable Care Organizations (ACOs) to serve Medicare and Medicaid patients. The antitrust concerns stem from the legislation222s proposal that ACOs act as a single delivery organization in which physicians and hospitals merge operations. The brief found that the legislation is consistent with longstanding antitrust policies ( Robert Wood Johnson Foundation, 3/16 ; Kaiser Health News, 3/26 ). SAMHSA222s Weekly Financing News Pulse: National Edition April 2, 2010 4/2/10 5 KFF Finds Increasing Uninsurance as Youth Age Out of Medicaid, CHIP: Using data from 2003 to 2007, a Kaiser Family Foundation (KFF) brief released March 19 examines trends in insurance coverage among young adults who age out of Medicaid and the Children222s Health Insurance Program (CHIP ) after turning 19 years old. The KFF finds that 42 percent of those enrolled in Medicaid as children become uninsured and only 10 percent receive coverage through private health insurance. The KFF also notes that the recession is increasing the uninsurance rate for youth aging out of Medicaid and suggests that states increase Medicaid eligibility to counter this trend until national health care reforms take effect ( KFF 3/19 ; Kaiser Health News, 3/26 ). Around the Hill: Hearings on Health Financing Congress is out of session and reconvenes April 12.
