WeeklyFinancingNewsPulseNationalEditionfinal20091002.pdf (PDF | 285.15 kb)
SAMHSA222s Weekly Financing News Pulse: National Edition October 2, 2009 10/2/09 1 SAMHSA222s Weekly Financing New Pulse: National Edition National News Senate Finance Committee Completes Health Reform Legislation, House Leaders Continue Moving Towards a Single Bill FEHBP Employee Premiums to Increase in 2010 Pharmacy Groups Sue CA, NY, and WA Over Medicaid Drug Prices Polls Find Mix ed Messages on Health Care Reform H1N1 Vaccine Ships Ahead of Schedule, Government Plans Monitoring System SAMHSA Awards $16.8 Million to States and Communities to Support Healthy Transitions for Mentally Ill Youth SAMHSA Awards Project LAUNCH Grants to Promote Children222s Wellbeing SAMHSA Awards $33 Million for Substance Abuse Treatment and HIV Services 3M Tool Translates ICD - 9 to ICD - 10 Xerox Retirees Sue Over Plans to Cut Retiree Health Benefits Studies Released GAO Report Finds Medicaid Fraud and Abuse Related to Controlled Substances GAO Report Finds CMS Must Broad en Nursing Home Oversight Census Bureau Releases Preliminary Regional Insurance Data, Finds Disparities RWJF Report Finds States Facing Rapid Cost Increase Without Health Reform KFF Medicaid Directors Survey Finds Enrollment and Cost Increasing KFF Releases Health Reform Briefs Analyzing Women222s Issues, Comparative Effectiveness Research, Medicare, and Medicaid/CHIP Report Examines Strategies for Controlling Medicare Spending Hewitt Associates Predicts 10 Percent Cost Increase for Employer- Sponsored Health Insurance Trust for America222s Health Report Says H1N1 Epidemic Could Overwhelm Hospitals Around the Hill: Hearings on Health Financing For quest ions or comments, please contact Kevin Hennessey ( kevin.hennessy@samhsa.hhs.gov ). SAMHSA222s Weekly Financing News Pulse: National Edition October 2, 2009 10/2/09 2 National News Senate Finance Committee Completes Health Reform Legislation, House Leaders Continue Moving Towards a Single Bill : At 2:08 a.m. on October 2, Senate Finance Co mmittee Chair Max Baucus (D - MT) announced that the Senate Finance Committee completed all sections of its health care reform bill, the America222s Health Future Act of 2009 . The announcement ends a committee markup period that began September 22 and covered 564 amendments; a final Finance Committee vote is expected October 6 or 7. The delayed vote gives the Congressional Budget Office (CBO) time to score the new bill so th at committee members can vote based on the cost of the final bill ( AP, 10/2 ; The Hill, 10/1 ; Washington Post, 10/2 ). Among the numerous changes to the Chairman222s Mark, the Finance Committee appr oved An amendment sponsored by Sens. Olympia Snowe (R - ME) and Charles Schumer (D - NY) that exempts individuals from the health insurance mandate if they cannot purchase a plan for less than 8 percent of their income and also reduces and delays the penalti es for those who do not purchase coverage ( The Hill, 10/1 ; Washington Post, 10/1 ) An amendment allowing health insurance plans to give financial incentives for beneficiaries engaging in healthy behavior, including quitting smoking and exercising ( Kaiser Health News, 10/1 ) An amendment allowing seniors to deduct personal medical expenses exceeding 7.5 percent of their income ( Kaiser Health News, 10/1 ) An amendment proposed by Senate Finance Committee Ranking Member Charles Grassley (R- IA) requiring Congress and congressional staff to purchase health insurance through the newly - created state- based exchanges rather than accepting coverage through the Federal Employee Health Benefits Program (FEHBP) ( Washington Post, 9/30 ) In addition, the Committee rejected numerous amendments including, An amendment, sponsored by Sen. John D. Rockefeller (D - WV) to create a public plan under which reimbursement rates are tied to Medicare rates ( Kaiser Health News, 9/30 ) A public plan amendment, sponsored by Sen. Schumer, that would allow the government to negotiate rates like private sector ( Kaiser Health News, 9/29 ) Senator Orrin G. Hatch222s (R- UT) amendments to expand limits on abortion funding beyond the Chairman222s Mark restrictions requiring private plans that cover abortion to do so only with private premium funds ( CQ Politics, 9/30 ) Sen. Grassley222s amendment requiring individuals applying for Medicaid or Children222s Health Insurance Program (CHIP) benefits to provide a government ID ( Kaiser Health News, 9/29 ) The bill will not alter the Medicare physician payment system and will task the National Association of Insurance Commissioners with setting many of the new rules regarding the issuing and marketing of insurance products ( CQ Today, 10/1 ; Los Angeles Times, 9/28 ). After the Finance Committee approves the bill, Senate Majority Leader Harry Reid (D - NV) will begin combining it with the one passed by the Senate Health, Education, Labor and Pensions (HELP) Committee July 15 (Financing News Pulse7/20 edition). Sen. Reid must decide how to combine the more liberal HELP Committee bill with the Finance Committee bill, including determining whether to include a public plan in the version he wants to bring to the Senate f loor the week of Columbus Day ( Kaiser Health News, 10/1 ). Meanwhile, House Speaker Nancy Pelosi (D - CA) and leading House Democrats met throughout th e week to continue their efforts to merge the three House committees222 bills into a single bill to bring to the House floor ( Kaiser Health News, 9/30 ). Fi nally, Roll Call reports that the Obama Administration has secretly drafted its own health care bill, which administration officials plan to release only if it will help secure passage of a bill; SAMHSA222s Weekly Financing News Pulse: National Edition October 2, 2009 10/2/09 3 however, Roll Call222s sources were inconsistent regarding the progress on the bill ( Kaiser Health News, 9/30 ). F EHBP Employee Premiums to Increase in 2010: On September 29, the Office of Personnel Management (OPM) a nnounced that employees enrolled in the Federal Employees Health Benefits Program (FEHBP) will pay an average of 8.8 percent more for health care in 2010. FEHBP employee premiums increased 7.9 percent in 2009 and 2.9 percent in 2008. OPM reports that the federal government will continue to cover roughly 70 percent of employees222 health care premiums; however, market forces have necessitated the premium increases ( Kaiser Health News, 9/30 ; Washington Post, 9/30 ). Pharmacy Groups Sue CA, NY, and WA Over Medicaid Drug Prices: The National Association of Chain Drug Stores , the National Community Pharmacists Association and other smaller pharmacy groups sued California, New York, and Washington on September 30 over a failure to adjust Medicaid prescription reimbursements to account for new average wholesale price s set September 26. The associations claim that the states violated the Social Security Act by failing to get the new rates approved; the associations222 lawyers report that failure to implement the change could cost drug stores $200 million annually ( Reuters, 9/30 ; Kaiser Health News, 10/1 ). The lawsuits come after pharmacy associations and Walgreen Co. had conflicts over Medicaid reimbursement rates in Washington and Delaware earlier this year (Financing News Pulse 8/31, 8/13, 4/6 editions). P olls Find Mixed Messages on Health Care Reform : A CBS/New York Times poll released September 24 found that, when asked whether they approve of President Barack Obama222s health care reform plan, 46 percent of respondents say they do not know enough about the plan to make a determination, while 30 percent support the plan and 20 percent oppose it ( Kaiser Health News, 9/25 ; New York Times, 9/24 ) . Asking a related question, a Rasmussen Reports poll conducted September 24 - 25 found that 41 percent of respondents support the 223proposals making their way through Congress224 while 56 percent oppose them. The Rasmussen poll also found that only 33 percent of seniors favor the plan while 59 percent oppose it ( CQ Politics, 9/28 ; Kaiser Health News, 9/29 ). Meanwhile, a Kaiser Family Foundation (KFF) poll released September 29 found that, while 57 percent of respondents believe that health reform is 223more important than ever,224 only 42 percent of respondents believe their families would be better off and 53 percent believe the country would be better off after reform. The poll also found strong support for many individual components of health care reform, with 68 percent favoring an individual insurance mandate, 67 percent favoring an employer mandate, and 82 percent favoring expansions of Medicaid and CHIP ( Kaiser Health News, 9/29 ; CQ Politics, 9/29 ). Finally, an NPR/KFF/Harvard School of Public Health poll found that 71 percent of respondents believe that the health reform proposals were paying too little attention to 223people like them.224 However, the same poll found that 34 percent of respondents were not following health reform closely ( Kaiser Health News, 9/30 ). H 1N1 Vaccine Ships Ahead of S chedule, Government Plans Monitoring System : A spokesman for Sanofi - Aventis announced September 29 that the first round of 75 million injectable H1N1 (swine flu) vaccines shipped ahead of schedule, preparing the government to have over 6 million doses of t he vaccine by early October. In addition, the Centers for Disease Control and Prevention (CDC) is preparing an extensive tracking system to detect any adverse reactions to the vaccine, including documenting baseline conditions for future comparison purpos es. The government is also sponsoring SAMHSA222s Weekly Financing News Pulse: National Edition October 2, 2009 10/2/09 4 outcome tracking programs through Harvard University Medical School and Johns Hopkins University ( Kaiser Health News, 9/30 ; Kaiser Health News, 9/25 ; Washington Post, 9/28 ; Kaiser Health News, 9/28 ). SAMHSA Awards $16.8 Million to States and Communities to Support Healthy Transitions for Mentally Ill Youth : O n September 24, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced $16.8 million in state and community grants for integrated home - and community - based services and supports for youth and young adults with serious mental illness. The program, called t he Health y Transitions Initiative , will issue five - year grants to develop or build upon existing systems to provide youth and their families with educational and employment opportunities and mental health assistance in GA, ME, MD, MO, OK, UT, and WI ( Media Newswire, 9/25 ; SAMHSA 9/24 ). S AMHSA Awards Project LAUNCH Grants to Promote Children222s Wellbeing : SAMHSA announced that it will award $51 million in Project LAUNCH (Linking Actions for Unmet Needs in Children222s Health) grants to state and tribal youth programs over the next five years. Project LAUNCH promotes wellness in children ages 8 and below by addressing the physical, emotional, social, cognitive and behavioral aspects of their development. Under the program, CA, DC, IA, IL, KS, MA, MI, NY, NC, OH, OR, and WI will receive up to $850,000 annually for five years ( Media Newswire, 9/25 ; SAMHSA, 9/24 ). S AMHSA Awards $33 Million for Substance Abuse Treatment and HIV Services : On September 30, SAMHSA announced more than $33 million in funding to provide coordinated substance abuse treatment and HIV/AIDS services to traditionally underserved communities. The grants awarded under the Targeted Capacity Expansion Program (TCE/HIV) for Substance Abuse Treatment and HIV/AIDS Services are project ed to be funded up to $450,000 per year for treatment services, and up to $350,000 per year for outreach and pretreatment services. The five - year grants will go to organizations in AZ, CA, FL, IL, MA, NJ, NY, OK, and TN ( Media Newswire, 10/1 ; SAMHSA, 9/30 ). 3 M Tool Translates ICD - 9 to ICD -10: 3M Health Information Systems has developed software that translates ICD - 9 codes from existing data systems into the new ICD - 10 code sets that must be implemented by October 2013. The tool can convert existing information systems and software to ICD - 10 or create customized mappings for more complex systems ( Health Data Management, 9/24 ). Xe rox Retirees Sue Over Plans to Cut Retiree Health Benefits : The Association of Retired Xerox Employees is suing Xerox Crop. over company plans to eliminate supplemental benefits for retirees over 65. The supplemental benefits, which the retirees allege Xerox promised them under the terms of their employment, provide benefits designed to supplement Medicare coverage, which begins at 65. If implemented, the benefit reduct ion would immediately affect 8,000 current retirees and an additional 8,000 retirees upon reaching age 65 ( Buffalo News, 10/1 ). Studies Released GAO Report Finds Medicaid Fraud and Abuse Related to Controlled Substances : A Government Accountability Office (GAO) report presented to the Senate Homeland Security and Governmental Affairs Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security on September 30, documented 65,000 instances of improper distribution of controlled substances under Medicaid programs in California, Illinois, New York, North Carolina, and Texas during FY2006 and FY2007. The GAO estimates that the fraud and abuse cost $65 million over SAMHSA222s Weekly Financing News Pulse: National Edition October 2, 2009 10/2/09 5 two years and Senate panel members suggested better Medicaid oversight as a potential source of health reform savings ( Kaiser Health News, 9/30 ; GAO, 9/30 ; U SA Today, 9/29 ). GAO Report Finds CMS Must Broaden Nursing Home Oversight : A GAO report prepared for a Senate Aging Committee hearing and released September 28, concluded that the C enters for Medicare & Medicaid Services (CMS) must increase its nursing home oversight and recommended that the agency expand the number of 223special focus faculties224 (SFFs) that it monitors. CMS currently identifies up to 136 poorly performing nursing homes as SFFs and subjects them to increased inspections; however, the GAO audit concluded that 508 nursing homes meet the SFF criteria and ought to be included in the special monitoring. The GAO also recommended that CMS give stronger consideration to a home222s perfor mance on a nationwide scale in determining its classification as an SFF, rather than emphasizing intra- state comparison. Two years ago, CMS officials publicly agreed with a GAO report outlining the need to expand the SFF program but reported lacking suffi cient resources to implement the change ( AP, 9/27 ; Kaiser Health News, 9/28 ). C ensus Bureau Releases Preliminary Regional Insurance Data, Finds Disparities : On September 22, the U.S. Census Bureau released a preliminary eva luation of regional health insurance coverage from the 2008 American Community Survey (ACS). The report, which is still a working paper, found a significant regional disparity in health insurance coverage, with the highest insurance rate in Rep. Jim McGov ern222s (D - MA) district near Worcester (96.6 percent) and the lowest rate in Rep. Gene Green222s (D - TX) district in Houston (59.9 percent). The authors note that health insurance rates vary because of differences in state insurance law as well as regional differences in employment and demographic characteristics ( AP, 9/25 ; Kaiser Health News, 9/25 ). RW JF Report Finds States Facing Rapid Cost Increase Without Health Reform: A Robert Wood Johnson Foundation (RWJF)/ Urban Institute report released September 30 projects the 10 - year outcomes of current health care cost trends at the national and state levels. Under the worst- case scenario, the report finds that insurance rates will drop dramatically, employer- sponsored health insurance prem iums will rise while the rate of employer- sponsored insurance falls, Medicaid and CHIP costs will increase, and uncompensated care costs will skyrocket. The report estimates the number of people without health insurance would increase by 30 percent in 29 states and 10 percent in every other state , while employer - sponsored health insurance premiums would double in 27 states and increase by over 60 percent in the other 23 . Furthermore, Medicaid and CHIP costs would increase by at least 75 percent in all st ates , with half of the states experiencing a doubling of costs. Finally, uncompensated care costs would increase by over 100 percent in 45 states ( Kais er Health News, 9/30 ; RWJF, 9/30 ). KFF Medicaid Directors Survey Finds Enrollment and Cost Increasing : The KFF Commission on Medicaid and the Uninsured released a report and factsheet detailing the results of the Medicaid budget survey for state222s FYs2009 and 2010. The survey found that Medicaid enro llment grew an average of 5.4 percent in FY2009 while average Medicaid spending increased 7.9 percent over the same time. The survey also determined that, based on initial legislative appropriations, states face an average 6.6 percent enrollment increase and 6.3 percent cost increase for FY2010. Finally, the survey found that, though the American Recovery and Reinvestment Act (ARRA) funding allowed 36 states to avoid eligibility reductions, 33 states reduced or froze provider reimbursement rates, and 39 m ore are SAMHSA222s Weekly Financing News Pulse: National Edition October 2, 2009 10/2/09 6 expected to do so in FY 2010 ( KFF, 9/30 ; Kaiser Health News, 10/1 ). In addition, KFF updated its Medicaid Benefits Online Database with the newest survey data. KFF Releases Health Reform Briefs Analyzing Women222s Issues, Comparative Effectiveness Research, Medicare, and Medicaid/CHIP : On October 1, KFF released a brief examining the implications of health care reform on women222s health care and a brief examining the current state of comparative effectiveness funding and the provisions of current health care legislation relating to comparative effectiveness research. ( KFF, 10/1 ; KFF, 10/1 ). In addition, KFF updated its brief s comparing Medicaid/CHIP provisions and Medicare provisions under the current health care reform bills ( KFF, 10/1 ; KFF, 9/24 ). R eport Examines Strategies for Controlling Medicare Spending: A report commissioned by KFF and prepared by Mathematica Policy Research Inc. examines methods for controlling Medicare costs that go beyond reducing provider payments. Among other cost - control measure s considered, the report examines medical homes, electronic health records ( EHRs ) , bundling of payments for episodes of care, accountable health organizations, and comparative effectiv eness research for potential short- and long- term cost savings. In addi tion, the report considers the ways in which potential cost - saving measures would alter future provider behavior ( KFF, 9/30 ). H ewitt Associates Predicts 10 Percent Cost Increase for Employer -Sponsored Health Insurance: A Hewitt Associates report estimates that the average combined out- of - pocket and premium costs for workers with employer- sponsored health insurance will increase 10 percent in 2010, to $4,023 annually. Hewitt also finds that employers222 annual share of health care costs will increase 6 percent, to $9,120 per employee over the same period ( Chicago Tribune, 9/28 ). T rust for America222s Health Report Says H1N1 Epidemic Could Overwhelm Hospitals : On October 1, the Trust for America222s Health released a report which found that, if 35 percen t of American222s are infected with H1N1, 15 states (AZ, CA, CT, DE, HI, MD, MA, NV, NJ, NY, OR, RI, VT, VA, and WA) could exceed hospital capacity. A Presidential Council previously warned that the virus could infect 30 to 50 percent of the population (Financing News Pulse 8/31 edition). The report also found that, under those conditions, an additional 12 states222 hospitals could exceed 75 percent of capacity. The trust recommends increased public health funding, a greater emphasis on cooperation between g overnments, and outreach to those most at risk for contracting the flu ( Stateline.org, 10/1 ; U.S. News & World Report, 10/1 ). Around the Hill: Hearings on Health Financing Senate Finance Committee: Health Care Revision September 29, 10:00 a.m., 216 Hart September 30, 9:30 a.m., 216 Hart October 1, TBA, 216 Hart Senate Small Business and Entrepreneurship Committee : Health Care Overhaul and Small Business September 29, 11:00 a.m., 562 Dirksen TBA, TBA SAMHSA222s Weekly Financing News Pulse: National Edition October 2, 2009 10/2/09 7 Senate Veterans Affairs Committee : VA Health Services Contracts September 30, 9:30 a.m., 418 Russell Senate Special Aging Committee : Health Systems Costs and Quality September 30, 11:00 a.m., 106 Dirksen Senate Homeland Security and Government al Affairs Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security : Medicaid Substance Abuse September 30, 3:00 p.m., 342 Dirksen Senate Finance Committee: HHS Nominations October 1, 10:00 a.m., 419 Dirksen House Veterans222 Affairs Subcommittee on Health: Veterans222 Health Bills October 1, 10:00 a.m., 334 Cannon House Veterans222 Affairs Subcommittee on Disability Assistance and Memorial Affairs: Implications of the VA222s PTSD Rule - Making October 7, 2:00 p.m., 334 Cannon
