Georgia Chapter, American Academy of Pediatrics

Former Governors Recommend Reforms to Medicaid Waivers

2012-03-06T09:31:00.000-05:00

Former Governors Recommend Reforms to Medicaid Waivers

BY: Dylan Scott| Nation | March 1, 2012 governing magazine

Can the federal government make it easier for states to adapttheir Medicaid programs to ever-changing circumstances? That is the corequestion addressed by the Bipartisan Policy Center’sGovernors’ Council in a new paper recommending reforms to Medicaid waivers.

Their answer: Yes. By streamlining and standardizing the waiverprocess, the Centers for Medicare and Medicaid Services (CMS) would allowstates to pursue more innovative strategies that improve care and lower costs,argued six former governors (three Democrats, three Republicans) who make upthe Governors' Council. Council members include former Govs. Phil Bredesen(Tennessee), Jim Douglas (Vermont), Brad Henry (Oklahoma), Linda Lingle(Hawaii), Mike Rounds (South Dakota) and Ted Strickland (Ohio).

For now, the application and review process is “an 800-poundgorilla,” said Douglas at a briefing withreporters.

States can apply for three kinds of waivers that exempt themfrom certain provisions of the Social Security Act, which allow them to: enrollMedicaid patients in managed-care programs (Section 1915b); move long-term carepatients into community settings (Section 1915c); and pursue broad reforminitiatives (Section 1115). They can also file for state plan amendments (SPA)that make minor changes to their Medicaid programs.

The Governors’ Council made six recommendations that they saywould bring more transparency to the waiver process and reduce theadministrative burden for states. Generally, they called for setting clearparameters and developing templates that would ensure states know what toinclude in their applications in order to gain approval. They urged a moretimely process; reviews are supposed to take 90 days, but CMS often extends theperiod with further questions. One Tennesseewaiver took a year to be approved, Bredesen said.

The governors also recommended establishing a mechanism thatwould allow waivers that have proven successful to become permanent or semi-permanent.For example, Bredesen said his state’s TennCare is built on various waivers.But every five years, Tennesseemust reapply, despite the fact that the program couldn’t function without thewaivers. Vermont saved more than $260 millionover five years with its Global Committment to Health initiative, Douglas said, but still faced uncertainty when reapplyingfor a waiver.

With the Medicaid expansion under the Affordable Care Act (ACA)looming, the council stressed the necessity of adapting such changes. “Theseare going to be triply important,” Bredesen said. “This antiquated, serialprocess… needs to be streamlined.” The governors also contend that a morenormalized process would simplify efforts to transfer successful waiverprograms across state lines.

Jason Grumet, president of the Bipartisan Policy Center, acknowledged thatthe recommendations were primarily designed to “start a dialogue” aboutimproving the process. But the feeling on the council was that the issue wasripe for discussion.

“We should all value efficiency,” Strickland said. “I thinkthere is a feeling that the process is not as efficient as it could or shouldbe.”

Male newborn circumcision rate falls to lowest level :: March 2, 2012 ... American Medical News

2012-03-06T09:21:00.000-05:00

amednews: Male newborn circumcision rate falls to lowest level :: March 2, 2012 ... American Medical News

Diverted special fees under fire | ajc.com

2012-03-06T09:13:00.000-05:00

Diverted special fees under fire | ajc.com

Georgia lawmakers race to beat crossover day deadline | The Augusta Chronicle

2012-03-06T09:12:00.001-05:00

Georgia lawmakers race to beat crossover day deadline | The Augusta Chronicle

Healthy young brains a key to Georgia’s future | Georgia Health News

2012-03-06T09:12:00.000-05:00

Healthy young brains a key to Georgia’s future | Georgia Health News

Georgia Senate approves bill that would allow electronic prescriptions | jacksonville.com

2012-03-06T09:11:00.000-05:00

Georgia Senate approves bill that would allow electronic prescriptions | jacksonville.com

$19B Budget Moving Forward

2012-03-06T09:09:00.000-05:00

$19B Budget Moving Forward

Supreme Court keeps California Medicaid pay cut lawsuit alive :: March 5, 2012 ... American Medical News

2012-03-06T09:08:00.000-05:00

amednews: Supreme Court keeps California Medicaid pay cut lawsuit alive :: March 5, 2012 ... American Medical News

Children with Abnormal Breathing In Sleep - Show Tendency For Behavioral Problems

2012-03-06T09:07:00.000-05:00

Children with Abnormal Breathing In Sleep - Show Tendency For Behavioral Problems

A Healthy Teenager Is A Happy Teenager

2012-03-06T09:06:00.000-05:00

A Healthy Teenager Is A Happy Teenager

Immaturity May Lead To Misdiagnosis Of ADHD

2012-03-06T09:05:00.000-05:00

Immaturity May Lead To Misdiagnosis Of ADHD

Emergency docs blast Medicaid denials based on final diagnosis - FierceHealthcare

2012-03-02T10:10:00.000-05:00

Emergency docs blast Medicaid denials based on final diagnosis - FierceHealthcare

New bill would restore child-only policies | Georgia Health News

2012-03-02T10:08:00.000-05:00

New bill would restore child-only policies | Georgia Health News

Judge: Graphic Cigarette Labels Violate First Amendment - Health Blog - WSJ

2012-03-02T10:06:00.000-05:00

Judge: Graphic Cigarette Labels Violate First Amendment - Health Blog - WSJ

Mayo Clinic gains presence in Georgia | Georgia Health News

2012-03-02T10:05:00.000-05:00

Mayo Clinic gains presence in Georgia | Georgia Health News

Co-Sleeping Puts Children At Risk

2012-03-01T13:23:00.000-05:00

Co-Sleeping Puts Children At Risk

WABE: Providers Welcome Governor's Proposed Payment Bump of Medicaid Reimbursement Rates (2012-02-22)

2012-03-01T13:21:00.000-05:00

WABE: Providers Welcome Governor's Proposed Payment Bump of Medicaid Reimbursement Rates (2012-02-22)

amednews: Flu season gets a late start :: Feb. 27, 2012 ... American Medical News

2012-03-01T09:44:00.000-05:00

amednews: Flu season gets a late start :: Feb. 27, 2012 ... American Medical News

Strike a balance as a boss :: Feb. 13, 2012 ... American Medical News

2012-03-01T09:43:00.000-05:00

amednews: Strike a balance as a boss :: Feb. 13, 2012 ... American Medical News

Physical Activity Levels In Children Not Altered By Active Video Games

2012-03-01T09:35:00.000-05:00

Physical Activity Levels In Children Not Altered By Active Video Games

Sport Concussions: Teenagers More Vulnerable

2012-03-01T09:34:00.000-05:00

Sport Concussions: Teenagers More Vulnerable

Language Development Predicted In Children

2012-03-01T09:33:00.000-05:00

Language Development Predicted In Children

Parents urged to deal with overweight, obese children | The Augusta Chronicle

2012-02-28T15:37:00.000-05:00

Parents urged to deal with overweight, obese children | The Augusta Chronicle

Drug test bill passes committee | ajc.com

2012-02-28T15:33:00.000-05:00

Drug test bill passes committee | ajc.com

Following Adoption, 92 Percent Of Families Are Satisfied With Their Decision

2012-02-28T15:32:00.001-05:00

Following Adoption, 92 Percent Of Families Are Satisfied With Their Decision

Obesity-Asthma Link In Children Varies By Race/Ethnicity, Study Finds

2012-02-28T15:32:00.000-05:00

Obesity-Asthma Link In Children Varies By Race/Ethnicity, Study Finds

Human Papilloma Virus Vaccine Should Be Given To Boys, According To AAP

2012-02-28T15:31:00.000-05:00

Human Papilloma Virus Vaccine Should Be Given To Boys, According To AAP

AMA pushes IPAB repeal ahead of House panel’s vote - The Hill's Healthwatch

2012-02-28T10:24:00.000-05:00

AMA pushes IPAB repeal ahead of House panel’s vote - The Hill's Healthwatch

Senate panel OKs welfare drug testing | Georgia Health News

2012-02-28T10:20:00.000-05:00

Senate panel OKs welfare drug testing | Georgia Health News

Autism not diagnosed as early in minority children - USATODAY.com

2012-02-28T10:18:00.000-05:00

Autism not diagnosed as early in minority children - USATODAY.com

Medicaid task force to focus on kids, families | Georgia Health News

2012-02-27T16:44:00.000-05:00

Medicaid task force to focus on kids, families | Georgia Health News

More Gaming Leads To More Impulsivity, Attention Difficulties In Children

2012-02-27T16:05:00.000-05:00

More Gaming Leads To More Impulsivity, Attention Difficulties In Children

Pediatrician's Personality, Empathy Trump Knowledge Of Spanish, Quick Service For Latina Moms

2012-02-27T16:04:00.000-05:00

Pediatrician's Personality, Empathy Trump Knowledge Of Spanish, Quick Service For Latina Moms

Study Suggests Underage Drinking Laws Reduce Future Criminal Behavior

2012-02-27T16:02:00.000-05:00

Study Suggests Underage Drinking Laws Reduce Future Criminal Behavior

Proposed Stage 2 requirements raise the bar for providers - Modern Healthcare

2012-02-27T15:57:00.002-05:00

ProposedStage 2 requirements raise the bar for providers

By Christine LaFave Grace MODERNHELATHCARE

Posted:February 23, 2012 - 5:15 pm ET

Theproposed Stage 2 meaningful-use requirements raise the barfor hospitals and eligible professionals on the use of computerized physicianorder entry, electronic prescribing and electronic recording of severalpatient-health measures, according to CMS officials.

Related Articles

Four health information technology and policy officials with theCMS previewed the Stage 2 measures in a presentation at the HealthcareInformation and Management Systems Society's 2012 Conference and Exhibition in Las Vegas on Thursdaymorning. On Thursday afternoon, the proposed requirements were published on the Office of theFederal Register's website (PDF). They are slated to bepublished in the Federal Register on March 7.

Under the proposed Stage 2 standards, hospitals as well as eligibleprofessionals—the latter category includes physicians not employed byhospitals—would have to use CPOE for more than 60% of medication, laboratoryand radiology orders, double the share required under the Stage 1 standards.

The CPOE requirement is one of more than a dozen core objectives that hospitalsand EPs would have to meet as part of demonstrating their meaningful use ofelectronic health-record systems, which would make them eligible to receivefederal health IT incentive payments.

Other core objectives for both hospitals and EPs include the use of electronicprescribing for more than 50% of prescriptions issued, the recording ofdemographic data for more than 50% of patients, recording of vital signs inmore than 80% of patient encounters and recording smoking status for more than80% of patients.

In an effort to promote electronic engagement with patients, Stage 2 wouldrequire that more than 50% of patients be provided online access to theirhealth information and demonstrate that more than 10% had actually accessedthat information.

Among the proposed menu objectives for EPs are electronic recording of familyhealth history for more than 20% of patients, successful ongoing transmissionof syndromic surveillance data, successful ongoing transmission of cancer caseinformation and successful ongoing transmission of data to a specialized cancerregistry. For hospitals, menu objectives include electronic recording ofadvance directives for more than 50% of patients and the use of electronicprescribing for more than 50% of discharge prescriptions.

Supreme Court punts on right to challenge Medicaid cuts - The Hill

2012-02-27T15:56:00.000-05:00

Supreme Court punts on right to challenge Medicaid cuts

By Julian Pecquet - 02/22/12 03:17 PM ET

The Supreme Court on Wednesday declined to decide whether California doctors and patients have the right to challenge state Medicaid cuts.

Plaintiffs had argued that the state violated the federal Medicaid statute by approving deep cuts that would hurt patients' access to care, and the 9th Circuit Court of Appeals recognized their right to seek redress. The question before the high court was whether the cuts could be struck down under the Supremacy Clause of the Constitution, which declares that federal statutes trump state law when the two are at odds.

The justices however ruled 5-4 that because the federal Medicaid agency has signed off on the cuts since the suits were first filed, the lower court should reexamine the case "in light of the changed circumstances."

The four conservatives on the High Court dissented, arguing those changed circumstances were irrelevant.

The Medicaid law doesn't allow providers or beneficiaries to sue to prevent cuts, Chief Justice John Roberts wrote in dissent, and the plaintiffs can't count on the Supremacy Clause to circumvent that obstacle.

"To decide this case, it is enough to conclude that the Supremacy Clause does not provide a cause of action to enforce the requirements [of the Medicaid statute] when Congress, in establishing those requirements, elected not to provide such a cause of action in the statute itself," he wrote.

In its majority opinion, the high court does not take a stance on the Supremacy Clause but strongly urges the plaintiffs and the lower court to abandon that line of argument. Instead, the justices write, the cuts are ripe for a challenge under the Administrative Procedure Act now that federal regulators have signed off on them.

"Respondents' basic challenge now presents the kind of legal question that ordinarily calls for APA review," Justice Stephen Breyer wrote for the majority. "The Medicaid Act commits to the federal agency the power to administer a federal program. And here the agency has acted under this grant of authority."

Gov. Jerry Brown (D-Calif.) had sought permission to cut provider payment rates by 10 percent in order to cut the state's deficit by hundreds of millions of dollars. The Centers for Medicare and Medicaid Services approved some of those cuts late last year.