Friday, December 30, 2011
Thursday, December 29, 2011
Wednesday, December 28, 2011
Friday, December 23, 2011
Thursday, December 22, 2011
Wednesday, December 21, 2011
Tuesday, December 20, 2011
Sunday, December 18, 2011
Macon Pediatric Resident Dies in Car Crash
It is with extreme sadness that we inform you of the
death
of Empress Hughes, DO, a first year pediatric resident at
the Medical Center
and Mercer in Macon
Wednesday, December 14, 2011
Tuesday, December 13, 2011
Bill would require Medicaid to pay promptly - Modern Healthcare
Bill would require Medicaid to pay promptly
Posted: December 12, 2011 - 2:30 pm ET
Reps. Brian Bilbray (R-Calif.) and Anna Eshoo (D-Calif.) have introduced legislation that would require the Medicaid program to reimburse all providers—including nursing facilities, hospitals and community health centers—in a more timely manner.
The bill, known as the Fair Pay to Medicaid Providers Act (PDF), would extend to these healthcare providers a provision that requires Medicaid to reimburse 90% of claims to physicians in 30 days and the remainder within 90 days, according to Eshoo's office.
The bill, known as the Fair Pay to Medicaid Providers Act (PDF), would extend to these healthcare providers a provision that requires Medicaid to reimburse 90% of claims to physicians in 30 days and the remainder within 90 days, according to Eshoo's office.
“This is a common-sense bill directed to patients,” Eshoo said in a news release. “Our healthcare professionals and facilities deserve to be reimbursed in a predictable and consistent timeframe in order to provide optimal care to those in need. We must ensure that our communities' most vulnerable citizens do not face a disruption in healthcare services, and our bipartisan bill helps to make sure their care is not held up by red tape and bureaucracy.”
The bill has been referred to the House Energy and Commerce Committee.
The bill has been referred to the House Energy and Commerce Committee.
Monday, December 12, 2011
HHS' CHIP Program Launches Medicaid.gov
HHS' CHIP Program Launches
Medicaid.gov
The Center for Medicaid and Children Health Insurance Program (CHIP) Services launched a new website last week.
The website
features guidance on federal policies, statistical breakdowns of Medicaid and
CHIP programs, a State
Resource Center
In a letter
introducing the website, Cindy Mann, director of the Center for Medicaid and
CHIP Services, asked for feedback on how to improve its functionality and
content. "We are a work in progress," Mann said. "We wanted
to make the key elements available as quickly as possible and we have plans for
ongoing improvements."
The new website is located at http://www.medicaid.gov/.
Thursday, December 8, 2011
Wednesday, December 7, 2011
Monday, December 5, 2011
NAMD Testifies on Pharmaceutical Treatment Issues for Children in Foster Care
December 1, 2011- NAMD Director Testifies Before Senate
Committee on Pharmaceutical Treatment Issues for Children in Foster Care
NAMD’s Director discussed the particular concerns
for foster care children in the Medicaid program, including some of the
findings in the report released by the Government Accountability Office,
entitled “Foster Children: HHS Guidance Could Help States Improve
Oversight of Psychotropic Prescriptions.” He noted while
psychotropic medications show enormous promise in treating a wide variety of
serious conditions, there are concerns about how current prescribing patterns
can negatively impact the foster care population. He went on to urge
policymakers to ensure valid comparisons are made before drawing conclusions.
In discussing the challenges and complexities of
this issue, Mr. Salo told the Subcommittee. “There are unfortunately a number
of reasons why state oversight policy, or medical practice may have failed to
keep up with the ever changing literature or other developments. These are not
meant to be excuses for failure to act, but indicative of the breadth of the
challenges that face systemic reform. Furthermore, it cannot be stressed enough
how unique are the challenges faced by the children in the foster care system.”
Several states were part of the GAO study and all
have been undertaking efforts to address the identified shortcomings. Mr. Salo
noted that there is a need for broader systemic reform.
“There are a number of solutions that can and should
be implemented to help improve this situation. 1) The GAO report recommends
promulgating additional federal guidance from HHS to the states; 2) More
clinical research is needed on the effects and implications of treating
children of any age and in any situation with psychotropics that have only been
tested on adults; 3) More work needs to be done to break down the barriers to
coordinating and integrating care for vulnerable populations in Medicaid, with
an added focus on the varied, complex and challenging behavioral health
conditions experienced by children in foster care; 4) While Medicaid coverage
and payment policy can and should change, many of the challenges in this issue
are medical policy issues, and as such, require the broader medical community
to also adapt; and 5) NAMD, working collaboratively with key partners such as
the Medicaid Medical Directors and the State Mental Health Program Directors
can develop and disseminate best practices in this area and work with states to
implement them.”
Concerns Over Antipsychotic Drug Prescriptions for Foster Kids Spur Potential Legislation
By Rebecca Adams, CQ HealthBeat Associate
Editor December 1, 2011
At a hearing before the Committee on Homeland Security and Governmental Affairs, Bryan Samuels, commissioner of the Department of Health and Human Services’ Administration on Children, Youth and Families, said that HHS would give the panel recommendations on what to include in a bill and would try to steer states to do more to prevent overmedicating foster children.
The moves come after a new Government Accountability Office (GAO) report raised concerns about the use of psychiatric drugs in foster care children. Babies were given medication for mental illness, according to the report, even though the drugs could be harmful to young children. A medical expert testified at the hearing that he could not think of any situation in which a baby would need a psychiatric drug.
Thousands of children who live in the five states that the GAO studied were given high doses that could be unsafe. And hundreds of children were taking five or more drugs at one time, even though the GAO said that there is no medical evidence that a regimen of so many medications was safe or effective.
The drugs are often paid for by Medicaid, the federal-state program for low-income earners.
Samuels said that Health and Human Services officials would comply with the GAO recommendation to issue a guidance to state Medicaid and child welfare agencies explaining the best practices for monitoring the use of psychiatric drugs in foster children. But Samuels said that Congress would have to intervene with legislation before HHS could issue a national standard that all state Medicaid agencies would have to follow. Carper, D-Del., and Brown, R-Mass., encouraged him to send them ideas for a bill soon.
Foster Child Testifies
“Meds aren’t gonna help a child with their problems,” he said. “It’s just going to sedate them.”
Ke’onte’s adopted mother, Carol Cook, said she had been concerned about the number of drugs he was taking. “He was just lights out,” she said, acting like a zombie within 15 minutes of taking some of the medication.
After Cook and her husband adopted Ke’onte, they decided with a pediatrician to wean him off all of the drugs. The process was not easy.
“He was very interesting the first few months,” she said with a wan smile. He would scream and cry for no apparent reason, she said.
But after a few months, his behavior improved significantly.
“He went from break dancing on the principal’s desk in her office to not going to the principal’s office for a whole month,” she said. From the time the boy entered school at his new home in January until the summer break in May, “he was almost a different child.”
Sen. Tom Coburn, R-Okla., a doctor, said he had studied the boy’s prescription protocol and found that two of the five drugs that the boy had been taking had the opposite effect as the other three. Coburn also said that three of the drugs were not approved for children.
After Ke’onte testified, the audience clapped. He gave Carper a hug and fist bump as he left the room.
Brown said he was “heartbroken” by Ke’onte’s testimony and said he “really was shocked” by the findings in the GAO study.
Report Findings
The rate of foster children who were prescribed five or more psychiatric drugs simultaneously was 0.11 percent to 1.33 percent in the five states, compared to rates of .01 percent to .07 percent among non-foster children in the states studied. GAO investigator Gregory Kutz said the use of five or more drugs is a “high-risk practice.” The report said that “only limited evidence supports the use of even two drugs concomitantly in children.”
Foster children also were given higher doses of the drugs than is considered safe. About 1.12 percent to 3.27 percent of children in foster care were given levels that were higher than the maximum recommended dosage, compared to 0.16 percent to 0.56 percent of children in other types of homes.
And 0.3 percent to 2.1 percent of babies in foster care were prescribed a psychotropic drug, compared to 0.1 percent to 1.2 percent of other children. Some of the anti-anxiety drugs could have been prescribed for physical rather than mental problems, the GAO said. But the report said that “these cases raise significant concerns because infants are at a stage in their development where they are potentially more vulnerable to the effect of psychotropic drugs.”
Samuels said in his testimony that a 2010 study of children in 13 states showed that foster care children in Medicaid were prescribed antipsychotic medications at nearly nine times the rate of children in Medicaid who were not in foster care.
One change that Medicaid directors in some states could make would be to require prior authorization of the drugs before Medicaid will reimburse for them, if state law allows that. In some states, said Matt Salo, executive director of the National Association of State Medicaid Directors, legislatures have banned prior authorization under pressure from drug companies that make the drugs, patient advocates or a general public that is wary of government interference in the physician-patient relationship. Even in those states, however, electronic systems could be established that would issue a warning when certain types of prescriptions are filled.
Samuels said that in his previous experience as child welfare director in
All of the witnesses said that some type of additional oversight should be undertaken.
“Clearly, we need to do better,” Salo said.
Sunday, December 4, 2011
Thursday, December 1, 2011
Thinking Through Health Exchanges- Governing Magazine
TennCare Director Darin Gordon has distinguished himself by
asking hard questions about the impact of the Affordable Care Act.
BY: John Buntin
| November 29, 2011 Governing Magizine
Open enrollment in the new health exchanges mandated by the Affordable Care Act (ACA) is two years away (Supreme Court permitting, of course). But according to Darin Gordon, director of
Over the course of the past year, Gordon has made a reputation
for himself by asking tough questions about the impact of the ACA on the state
insurance market and on economic competitiveness, questions born of his
experience as the longest-serving TennCare director in the agency's history. I
caught up with Gordon after the recent NAMD annual conference to talk about how
the Volunteer State
You've said that people need to think more carefully about the
ways the new health exchanges will interact with existing Medicaid programs.
What do you see as the trickiest points of intersection?
There are basically three areas around exchange planning.
There's governance, there's the insurance market and there's exchange
operations. It seems to me as though there's been a great deal of focus on how
to get the governance structure right, which isn't a bad thing. It's a
necessary step. But unfortunately, I think in some instances folks are spending
more time trying to ascertain who is going to have a seat at the table than
working on some of the areas that have more far-reaching implications: the
impact of exchanges on the insurance market and then exchange operations
themselves.
Let's talk about the potential impact of exchanges on the state
insurance market. What are some of your concerns?
Well, it's obviously different from state to state, but let's
look at the individual insurance market here in Tennessee
We're moving from medical underwriting to guaranteed issue in
2014. We're moving from exclusions and riders which say that certain
pre-existing conditions are not covered, to [new rules that require that] all
conditions covered on the first day. Where today we have premiums adjusted for age,
tobacco, geography, health, gender, etc., we're going to be moving to premiums
being adjusted for age, tobacco and geography only. We may be moving from
having a group of state-level benefit mandates, which will differ with varying
requirements, to a new essential health benefit (now a national standard),
which has yet to be fully defined.
So having all that occur at the same time you are trying to
manage a mass expansion in Medicaid enrollment, and having the new player [the
exchange] come on the scene, where you have folks in the exchange and folks
outside of the exchange -- what's that interplay? Our goal, as we're looking at
what's the best solution for Tennessee
Because we didn't approach it intelligently. Yes, absolutely.
The ACA allows states to either set up their own health exchange
or have the federal government come in and set up an exchange for them. More
recently, the Centers for Medicare & Medicaid Services (CMS) has also
floated the possibility of a hybrid partnership model. Tennessee hasn't
made a decision on whether it's going to create a state exchange or not, but
you've created the Tennessee
We spent the last year meeting with a wide variety of
stakeholders, traveling thousands of miles, having literally hundreds of
meetings just to solicit feedback from various stakeholders, whether they be
businesses, agents, brokers, insurers, providers, advocates, you name it. We've
had a discussion with them about what an alternative to a federal exchange
might look like. We spent over a year doing that and we've released a draft white
paper that lays out some alternatives based on those discussions.
Then we will be meeting with [Gov. Bill Haslam] in December to give him a
report based on what all we've heard, and then hope to have a recommendation on
whether the state should operate the exchange or whether we should defer that
authority to the federal government.
Let's talk a little bit about exchange operations and the
problem of churn. When Medicaid directors and others talk about churning and
the need to address it, what are they talking about?
Churn is what happens when people have to move back and forth
between or among programs because some factor in their eligibility changes. For
example: An adult could be Medicaid eligible when reform starts in 2014. But
because he gets a small raise, he has to move out of Medicaid and into the
exchange. His children may still be in Medicaid, or maybe one of them is in
Medicaid and one in [the state Children's Health Insurance Program].
This is an area that concerns me a lot because government
typically designs new programs and then we all talk about how we make people's
transition between the new and old programs more smooth, as opposed to just
redesigning multiple legacy programs into a single, more functional program. If
you look at all the different programs we have, they all offer subsidized
health-care coverage based on different criteria. We set up multiple programs
that basically do, in essence, the same thing in the end and then struggle with
how to help folks transition between them. We are trying to identify ways to
minimize the disruption that will occur as people move from program to program
when their circumstances change.
The bridge plan would basically allow states to offer an
alternative to those individuals who have had Medicaid in the recent past. This
plan would only be available to those individuals and, in essence, the health
plans that would be in that bridge option would be those Medicaid plans that
currently provide services to our members. That means that when an individual's
circumstances change, then they would have the ability to stay with the same
health plan, and the family could stay together. We think that this approach
would assist in minimizing some of the issues around churn while also
addressing some of the confusion that some family members would have when
different members of the family are eligible for different public programs.
What's has reaction from CMS been to this idea?
I think there's been a lot of interest at the CMS level to try
to address the issue but it's been somewhat of a challenge to get everyone to
get to an actual approval.
What are some of the more pressing questions that CMS hasn't
answered yet about exchanges and about exchange design?
The area that is of most concern to us from a timing
perspective, again, is the bridge product. That's an important thing for us
because it really helps determine where we may go from here. There are several
steps the various health plans will have to make with the state insurance
commissioner if the bridge option becomes a real option for us.
We also need some guidance on what the federal essential health
benefits will be. The law requires that the full actuarial value of any
state-mandated health benefits offered by qualified health plans that are not
included in the [federal] essential health benefits must be fully funded with
state funds. Our Legislature returns this January and if action will be needed
regarding the state-mandated benefits, it will have to occur during this
session.
There are still questions related to CMS's [September] proposed
hybrid partnership model of running exchanges with the states. They came out
with a proposal which didn't really feel like a partnership; it was actually
still a federal plan. States were expecting some things that they didn't
necessarily see with the proposal that was shared. If the feds want to be able
to assist states that choose to operate their own exchange, the federal
government should consider developing the process for determining the
exemptions from the individual mandate. They could develop the rating system
for plan quality and cost metrics. They could develop enrollee satisfaction
tools and measurements. Consistency here might be helpful and it should reduce
some level of the implementation complexity for the states. Also, the determination
of the affordability and the minimum value of employer-sponsored insurance,
that's going to be challenging. Some have even talked about having the federal
government determine the eligibility for the premium tax credits altogether.
The states have had additional discussions with the federal
government on this front. I know they are taking another look at this given the
feedback; however, we really do not have enough clarity to be able to determine
whether these are functions that the federal government is truly willing to
take on.
We're also looking at the process CMS is proposing for what
states will be required to do if changes are needed to their programs once
fully operational. What has been discussed thus far is a process similar to the
State Plan process used in Medicaid. That process is very cumbersome. It's also
perplexing given that the state-based exchanges are supposed to be
self-sustaining and not dependent on federal funding for ongoing operations,
yet states would be required to get federal approval for changes they feel are
appropriate. If no federal funding is involved at that point, why should states
have to keep going back and asking for federal permission? That makes no sense.
It would also be enormously helpful to the states to have the
final exchange rules. While the draft rules were released in the last several
months, the comments that were submitted during that time may potentially
reshape those rules. At times, CMS has said, "Look, we've answered that in
our regulations." But then other times we talk to them about concerns with
some of the regulations and their comments are: "Well, submit your
comments and we'll change it."
Well, which is it? Are they set in stone, or are they still
being shaped? If they are set in stone, we have concerns that have not been
addressed, and if they are still being shaped, we have problems, because we
need answers now. Not knowing what the final rules will be makes
conceptualizing these complex systems much more challenging.
This brings me to a big question. Former CMS
Administrator Don Berwick spoke at the NAMD conference and I was
struck by how he began his speech. He said, "This is a speech that might
fail." I think that why he said that was because his speech was very much
about changing the delivery system, improving the quality, and not about
helping the states pare costs.
Yeah, absolutely. The states are in the position where we need
solutions that could be implemented quickly and see savings in the next several
months. The things that he discussed were items that require some significant
lead time for implementation and would take a great deal of time before you
start seeing the financial benefits.
Right. So was it a speech that succeeded, or was it a speech
that failed?
The way that I interpreted it was that the solutions that he was
talking about were not necessarily the solutions that can solve the immediate
problems we have, from a financial perspective. I believe that his speech
sought to explain the types of things we should be looking at just beyond the
immediate -- which is fair. The way that I've described it is it's like saying
to someone, "We have this fire on our doorstep," and them responding
by talking about constructing a fire suppression system in the front room.
While it is important to be thinking of the things to minimize these fires in
the future (and to the extent bandwidth exists to do so, it is advisable) we
have to be focused on the incredible challenge of fighting the fire that is
right in front of us first. When the immediate crisis is contained, looking at
and implementing various mid to long term strategies to limit future problems
must occur, or else the crisis will become far too common.
Let's talk about the vendors with whom states and the feds will
have to work. When I talk to vendors, there's a lot of frustration about the
high cost of responding to vague RFPs.
If you really look at it, in all fairness to everybody, the
timelines are incredibly short and there are many IT projects currently
ongoing. In the area of e-health, for example, states are deploying electronic
health record systems and setting up infrastructure that allows those systems to
interface and exchange information in a seamless and coordinated fashion. Other
states have been retooling their Medicaid management information systems while
others are working on new eligibility systems. And then, with the insurance
exchanges, most every state and the federal government will be coming to market
at the same time trying to get quality contractors in to stand these up as
well. We've already started to see a strain in that market with respect to
having enough people with the right skills to help implement these types of
systems successfully. My concern is that when the federal government and the
larger states go out to bid on these projects, they will garner the best of the
remaining resources. The other states may then be further challenged in finding
experienced people with the right skills to stand these things up. The resource
challenge coupled with the aggressive timelines make this a very real concern.
Subscribe to:
Posts (Atom)