State Medicaid Cutbacks?

Medicaid is a rapidly growing sector of the health care arena.  Today, 50 million low income people receive health benefits from their State Medicaid program.  The 50 million individuals are comprised of adults, large numbers of seniors and disabled patients in nursing homes, and 1 in 4 children in America.

Image Courtesy Of savemedicaid.org

Medicaid costs are the top expense of most state’s budget. With this in mind, states have asked HHS, Kathleen Sebelius for help. The states have requested to reduce enrollment within their respective states and raise eligibility criteria to foster this reduction. Another aspect of this request is their revenue shortfall of $175 billion. With the current administrations stimulus bill drying up at the end of this year all states are scrambling to find ways to survive.  The easy state budget cuts have been made and now hard realities must be reviewed. To make up this difference the states have asked to cut Medicaid enrollment and reduce eligibility. Currently each state much maintain a Medicaid enrollment level.

Secretary Sebelius urged states to find savings through other approaches, including charging higher co-payments for some services, limiting certain benefits, managing high-cost patients more efficiently, squeezing drugs costs, and cracking down on improper payments.

"We are committed to responsiveness and flexibility, and will expedite review of state proposals," Sebelius wrote. "My team stands ready to come to your state to discuss your priorities and how we can help achieve them."

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. Pam can be contacted at Pamela.Argeris@merrillcorp.com.

HHS Strengthens Health Information Privacy and Security through New Rules

“To improve the health of individuals and communities, health information must be available to those making critical decisions, including individuals and their caregivers. While health information technology will help America move its health care system forward, the privacy and security of personal health data is at the core of all our work.”

--U.S. Health and Human Services Secretary Kathleen Sebelius

On July 8, Secretary Sebelius announced important new rules to strengthen the Health Insurance Portability and Accountability Act of 1996 (HIPAA), improve the privacy of health information and help all Americans understand their rights and the resources available to safeguard their personal health data.

In short, the proposed rule would strengthen and expand enforcement by:

• Expanding individuals’ rights to access their information and to restrict certain types of disclosures of protected health information to health plans;
• Requiring business associates of HIPAA-covered entities to be under most of the same rules as the covered entities;
• Setting new limitations on the use and disclosure of protected health information for marketing and fundraising; and
• Prohibiting the sale of protected health information without patient authorization.
  

“The benefits of health IT can only be fully realized if patients and providers are confident that electronic health information is kept private and secure at all times,” said Georgina Verdugo, Office for Civil Rights director at HHS. “This proposed rule strengthens the privacy and security of health information, and is an integral piece of the administration’s efforts to broaden the use of health information technology in health care today.”

In addition, HHS also launched a privacy website to help visitors easily access information about existing HHS privacy efforts and the policies supporting them. The site emphasizes the deep commitment to privacy in the collection, use and exchange of personally identifiable information. This new resource provides Americans with confidence that their personal information is secure and underscores HHS’ goal of greater openness and transparency in government.

For more information about the new rule, click HERE.

For other HHS Recovery Act programs, click HERE.

News from the World Healthcare Congress

Among the many announcements made at the 7th Annual World Healthcare Congress, acting director of the Center for Drug and Health Plan Choice Jonathan Blum was introduced as the new Policy Director for the Centers for Medicare and Medicaid, reporting directly to HHS Secretary Kathleen Sebillius.

In his presentation, Jonathan made several key statements:

• On the Medicare side, CMS will take the lead in payment reform and quality improvement measures, stressing a desire to partner with State Medicaid and Private Payers to reduce cost, improve quality outcomes, and maximize available dollars.
  
• His first priorities are dealing with Part D, where the "donut hole" will be closed in a ten year period.
• CMS is also looking to contract for discounts. Changes to payments for Medicare Advantage (MA) plans will occur and have basis of payment on quality and outcomes in 2012. When plans have an increase in their quality rating and elevate outcomes, they will receive a reward of higher payments.
• The CMS Center for Innovations has been established to open in January 2011 with funding of $10 million. They are planning on creating an Accountable Care Organization (ACO) policy for Medicare Programs, Pay for Performance Systems (PPS) for hospitals. However, bundled payment will take more time. With the Center for Innovations, CMS now has the authority to take successful demonstration projects from inception to reality without having to return to Congress for approval. For unsuccessful projects, there will still be valuable information learned.
• Next steps for MA include streamlining the process for beneficiaries, developing best-care models (with an emphasis on coordination of care for members), and creating better quality and more competitive plans.
• There has not been a substantial change in the number of PFFS plans leaving the market place, however, there is an all-time high of beneficiary satisfaction in their MA plans and are increasing their request of geographical areas.
• Fraud and abuse continue to be a huge area for CMS and will continue to be addressed.
  

Jonathan clearly has both the credentials and contacts to be successful in his new role, and his remarks indicate that he has a firm grasp on the process to develop and implement many of the new regulations that will be addressed in the upcoming months and years.