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| Volume 13 Number
79 Thursday, April 24, 2008 |
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| ISSN 1091-4021 | |
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Lead
Report | |
House Passes Bill to Delay Medicaid Rules;
Resistance in Senate Expected, Says Leavitt
The House April 23 passed a bill that would place seven controversial Medicaid rules in moratorium until April 1, 2009, but efforts to delay the rules could have a tougher time in the Senate.
The House passed the Medicaid Safety Net of 2008 (H.R. 5613) by a veto-proof margin of 349-62, but there appears to be more division in the Senate about whether the rules should be delayed.
"I applaud today's overwhelming passage of the House companion to the Economic Recovery in Health Care Act," Sen. John D. Rockefeller (D-W. Va.) said in a statement. "Today's vote sends a clear bipartisan message to the President that his misguided attacks on health care for the poor will not be tolerated during his remaining time in office. The Senate needs to act quickly, not only on the House-passed bill, but also to address the August 17 CHIP directive."
Rockefeller, chairman of the Senate Finance Health Care
Subcommittee, is a lead sponsor of the Senate measure (S. 2819), which along
with placing the rules in moratorium would delay a directive concerning
eligibility levels for the State Children's Health Insurance Program (67 HCDR,
04/8/08 
).
However, Charles E. Grassley (R-Iowa), ranking member of the Senate Finance Committee, has said Congress and the Bush administration cannot ignore the problems of fraud and waste in Medicaid, which the rules are intended to address.
"We should be talking about fixing the regulations so they better address real problems in Medicaid, but instead the House is trying to kick the can to next year," Grassley said in a floor statement April 16.
Fraud and Abuse
The seven rules in question were designed by the Centers for Medicare & Medicaid Services to curb fraud and waste within the Medicaid program. The rules would reduce or prohibit Medicaid reimbursements for public and teaching hospitals; narrow Medicaid coverage for outpatient hospital services, rehabilitation services, school-based administrative and transportation services, and case management services; and restrict how states raise funds for Medicaid.
CMS is concerned about some state practices that the agency regards as manipulating Medicaid reimbursement rules to increase the amount of federal funding received by states. However, opponents argue that CMS's changes would result in cuts to vital services for beneficiaries.
"By imposing this moratorium, the bill protects states, beneficiaries, and providers from the harmful regulatory changes that would undermine the Medicaid safety net and imperil critical services for our most vulnerable citizens," House Majority Leader Steny Hoyer (D-Md.) said in a statement after the vote. "At a time when the economy is significantly slowing down, it makes no sense to implement changes that compromise a program serving those families who are most in need."
The Bush administration has threatened to veto the legislation, and Health and Human Services Department Secretary Michael O. Leavitt said April 23 that he expects less support for the moratoriums in the Senate.
"I feel quite confident there will be significant resistance in the Senate," Leavitt told reporters April 23, when asked about the likely outcome of a vote.
Four of the rules are already subject to moratoriums, which expire in May and June.
Support, Future Action
Following the House vote, the National Association of Public Hospitals and Health Systems urged Congress to continue pushing the legislation.
"While pleased with this first step, we call on Congress not to stop working until this legislation is signed into law," Larry S. Gage, president of NAPH, said in a statement April 23. "The cost is too high and time is running out."
The Consortium for Citizens with Disabilities and the Mental Health Liaison Group also urged action on the moratoriums in letters to Senate leaders, suggesting that the moratoriums be attached to either an upcoming supplemental appropriations bill or in legislation to address Medicare physician fees.
The CCD noted in an April 18 letter that the targeted case management rule is "already creating chaos" because of the uncertainty surrounding its implementation.
The American Hospital Association also applauded the House vote in a April 23 statement.
"The solution to Medicaid's problems is not harsh spending cuts," Rick Pollack, executive vice president of AHA, said. "Rather, the program deserves a thoughtful, deliberate reform process that ensures that the nation meets its obligations to care for the neediest of our society."
More information about H.R. 5613 is available at
http://energycommerce.house.gov/MedicaidProtection_110/index.shtml. The Bush administration's statement is available at
http://whitehouse.gov/omb/legislative/sap/110-2/saphr5613-h.pdf.
By Sarah Barr
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