August 29, 2008
NOT SEVENTH HEAVEN
If seventh reg not delayed, quality of care would decrease
In June Congress enacted moratoria on six out of seven Centers for Medicare & Medicaid Services (CMS) regulations, but upheld the regulation on Medicaid Reimbursement for Outpatient Services. The regulation shifts reimbursement for outpatient services from Medicaid to the lower-paying and more restrictive Medicare rate. This political stunt would devastate poor and disabled people in 18 states who rely on outpatient Medicaid. Not only would Medicare's lower reimbursement rates jeopardize the quality of existing outpatient services, Medicare simply won't pay for outpatient services such as vision, psychiatric and dental services.
Because of the new regulation New York State could lose more than $450 million in funding for family planning, dialysis, rehabilitation, services for the developmentally disabled, AIDS care and other services. This funding catastrophe would derail the state's plans for meaningful Medicaid reform to shift patients into front line community-based care settings. "There are some family-planning facilities and Planned Parenthoods that might not be able to stay open with this new reimbursement," said Lara Kassel, advocacy coordinator for Medicaid Matters New York. Housing Works President and CEO told Gay City News that if this regulation stays in effect Housing Works won't be able to operate all of its four AIDS Adult Day Healthcare Centers. For an (in progress) spreadsheet from Paterson's office of organizations that will be affected, click here.
New York's not the only state that will suffer. In comments to Congress, California's Medicaid Director wrote, "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." In Nevada, while the cost was not specified in the analysis, the state Medicaid director wrote, "The more restricted definition of 'outpatient services' may not only reduce hospital revenues by limiting/eliminating reimbursable services, but create major access problems as well." Illinois stands to lose $130 million in 2008. The Illinois Medicaid program is underfunded by billions of dollars. "The state is keeping Medicaid afloat by delaying payments to providers, often by six months or more. On top of that, payment rates are terribly low. This has reduced access to specialists and is making it harder for patients to find providers, and that applies to ID docs as well as specialists for HIV-related conditions," said AIDS Foundation of Chicago's John Peller. "The bottom line is that any cut in federal funds will negatively impact access for people living with HIV/AIDS."
The reason the CMS regulation on Medicaid reimbursement passed while the others were held is arbitrary political football. Bush wouldn't have signed the Iraq Appropriation bill with all the regulations in place. In order to allow him to save face, Congress eliminated kept one regulation in place. Because the rule is so complicated, many states and hospitals are still figuring out the financial impact of this new regulation.
State fights back
State Medicaid Director Deborah Bachrach said New York State is currently engaged in a "multi-pronged strategy" to fend off this harmful shift. The state's Washington, D.C. office is working with CMS staff in order to adopt more favorable interpretation of the law. The state is also working with New York's Congressional delegation to vote to delay the regulation until April 2009. The other six regulations were also delayed until then. New York Senators Charles Schumer and Hillary Clinton are currently drafting a letter to CMS, urging them to impose a moratorium on the regulation. (See below on how to do your part). Worst case scenario, the state will consider litigation.
Although Bachrach said she was "optimistic" that the CMS reg can be curtailed, a Capitol Hill insider said "things are not looking so good" and that the Bush administration has already taken steps to make the rule final. Congresspeople are currently all in Denver or en route to the Twin Cities, and nothing's going to happen until they come back from recess on September 8. Watch your inbox for action alerts to bombard your legislators then.
Contact members of Congress and tell them to delay implementation of the CMS proposed rule on hospital outpatient and community clinci services. the Congressional switchboard number is 800-828-0498. To find out who your representative is, go to house.gov.