Health Information Exchange – An entity comprised of multiple stakeholders (i.e., providers, clinics, health departments, state actors, etc.) exchanging health information in a digital format.
Further reading
https://www.medicaid.gov/medicaid/data-and-systems/hie/index.html
Government Accounting Standards Board – Agency dedicated to greater accountability and well-informed decision making through excellence in public-sector financial reporting.
Further reading
Helping you consider differing viewpoints. Before it’s illegal.
Article 1: Nevada May Become First State To Offer Medicaid To All, Regardless Of Income, Alison Kodjak, NPR June 13, 2017
Clay’s summary: I think SprinkleCare is political posturing that appeals mainly to those who know very little about CAID – but its getting dreamers excited, so maybe I’m the one who doesn’t know so much.
Key Passage from the Article
Under the proposal, Medicaid coverage would be offered alongside commercial insurance on Nevada’s state-run health exchange starting in 2019. Sprinkle says he’s not sure what the coverage would cost. The state would conduct an analysis of the Medicaid program to determine the size of premiums.
They would likely be lower than traditional insurance premiums, because Medicaid reimburses doctors less than most insurance plans and also pays lower prices for prescription drugs.
“If the expansion goes away, I really think this is going to be a viable option for those who lose coverage,” Sprinkle says. He estimates about 300,000 Nevadans may enroll.
He says that if the Republican health care bill becomes law, people could use the tax credits in the bill to buy into Medicaid. And if it doesn’t, they could still use their tax credits and subsidies from the Affordable Care Act, or Obamacare, to buy in.
To be able to sell policies on the exchange, Nevada would have to get approval from the Centers for Medicare and Medicaid Services in the form of a waiver. Sprinkle says he has had discussions with CMS officials who were open to the idea.
Article 2: Medicaid expansion to cost states nearly $9 billion, Kimberly Leonard, Washington Examiner, June 15, 2017
Clay’s summary: When budgeting for Medicaid expansion, go ahead and double whatever proponents say it will cost. Triple it for any estimates beyond 5 years. Some of this is because states paid nothing up until this year, some of it is because the per member costs of expansion members was were woefully underestimated.
Key Passage from the Article
State spending for Medicaid expansion under Obamacare is expected to reach $8.5 billion in 2018, a $4 billion increase from 2016, according to a national report released Thursday.
The report, assembled annually by the National Association of State Budget Offices, or NASBO, shows that median general fund spending on Medicaid grew 2.7 percent in fiscal 2016 and is estimated to grow at 5.2 percent in fiscal 2017. That outpaces growth in median general fund revenue, which reached 2.4 percent in fiscal 2016 and 2.5 percent in fiscal 2017.
Article 3: Willowbrook, the institution that shocked a nation into changing its laws, Matt Reimann, Timeline, June 14, 2017
Clay’s summary: Our colleagues in the Caid and general health space who fought to end places like Willowbrook did the Lord’s work. I think they are on par with Abolitionists.
Key Passage from the Article
The Willowbrook State School opened on October, 1947, admitting 20 mentally disabled patients from upstate institutions. In only a short time, Willowbrook was overfilled and understaffed. By 1955, it had reached its full capacity of 4,000 occupants. Around that time, hepatitis infections ran rampant among patients and staff. Only a short time later, in 1960, an outbreak of measles killed 60 patients.
Yet these snapshots fail to convey the wretched and abhorrent conditions Willowbrook patients lived under. Despite its name as a “school,” there was barely any educational structure at Willowbrook. When teaching did happen, it was only for a handful of cooperative students, and only for around two hours per day.
Most of the Willowbrook experience was defined by constant neglect, a condition that the overstressed and underfunded staff were not necessarily responsible for. In some buildings, the mentally disabled were let to huddle in rooms, moaning, fidgeting, meandering, all with little care or resources. Many went naked for lack of clothing and supervision. Others sat drenched in their urine and feces, and some smeared them on the walls and on their clothes, with no available garments to replace them. Sexual and physical abuse at the hands of fellow patients and employees was common, as was disease.
Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2szI2LI (Pray for our nation. Even if you don’t believe in prayer. Or our nation. We gotta make as much noise as we can in the desperate hopes that He will hear us.)
For optimist readers- http://bit.ly/2szB7Sr
SHOUTOUT TO MY SOA PEEPS- Great time with my actuary friends at the SOA Health Meeting in FL this week. Thanks again to everyone for making it another great experience!
I’LL TAKE MINE WITH SPRINKLES- In case you haven’t heard, a rep from NV has thought of something none of us have in the 50+ years of the program: Medicaid for All! This is such a great idea, but why stop there? Why not Medicare for All (paging Dr. Sanders)? Or TriCare for All? Or BlueCross Blue Shield for All? If I would have known I can just append the magic words “For All” to something and get stuff without worrying about pesky things like costs, actual eligibility requirements and, oh, I don’t know, general freakin’ stability- I would have been namin’ and claimin’ it years ago (paging Dr. Osteen). Ferraris for All…Checklist of questions before you get starry-eyed on this one: What will be the FMAP (will there be FMAP)? Will provider rates stay at Medicaid rates? Will this be done with a State Plan Amendment, or an 1115 Waiver? Do you think CMS will approve either? Or, are you thinking NV is so serious about this, it will do it all with state-only dollars? What percent of individuals (now that the individual mandate is likely gone) do you think will choose to “buy” Medicaid on the exchange (would you buy Medicaid if you had a choice)? How will the subsidies for this one work? Will anyone buy it without a subsidy? If the state is selling coverage (Mike Sprinkle’s plan) and calling it Medicaid, is that actually Medicaid? Is the state now an MCO and subject to MLR rules, MCO taxes, etc? Hashtag: ImportantQuestions.
GOING, GOING, GONE! Any hopes that expansion costs would ever flatten out, that is. New data shows state expansion costs in 2018 will be $8.5B- more than a 100% increase over 2016. Some of this is that the tab is finally come due (states started paying a % of costs this year), but a lot of it is states’s eyes were bigger than their stomachs and expansion costs a LOT more than dreamers ever dreamed.
MEDICAID IN THE GOLDEN STATE FOR EVERYBODY? NOT SO FAST- CA reps dropped plans to give Medicaid to all undocumented persons in the state. There were plans to use tobacco taxes to cover the initiative, but seems those $s will instead go to increase Medicaid provider rates.
SOONER STATE WILL PAY DOCS LATER RATHER THAN SOONER- OK Caid officials have proposed to float payments to providers by a month in order to not decrease rates. Not sure I understand the overall logic, so write in if you know more. Scarily similar to what we wrote about last time re: IL being $2B behind in Caid payments.
BEAVER STATE GETS NEW TAXES TO FUND CAID HOLE- OR reps passed a new $550M tax on hospitals and health plans to avoid Medicaid cuts. The state faces a $1.4B budget hole (not just Caid).
HEALTH HOME PROVIDERS BEG FOR MORE BREAD IN THE BEEHIVE STATE- Home health aides now have better employment options with the upturning economy, and Utah home health agencies are asking for more Medicaid funding to be able to pay employees more than their other options.
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Alan Nisselson of the Bronx plead guilty this week for his role in a $27M false claims Medicaid fraud conducted by his company Narco Freedom. Elizabeth Powell of Helena, MT plead guilty for her role in a $450k Medicaid fraud involving physical therapy claims. She got her family to say they were getting PT and then diverted the payments out of the physical therapist’s bank account. Kester Atumonyogo of New York was indicted for stealing $1M with a nutritional formula fraud. Mr. A used a stolen SSN to enroll his DME company (Monack Medical Supply) and then started billing MCOs like mad. Robert and Kristina Corrado (father and daughter) of Nesconset, NY stole $2M from Caid using a kickback scheme that provided housing to homeless people only if they agreed to get treatment at their substance abuse treatment center. Wilbert Veasey, Jr. of Dallas, TX was sentenced to 17 years for his role in a $400M home health fraud ($500k was Caid, $22M was MediCare). Kathleen Tuorila of Del Rio, TX was sentenced this week for her role in a $3.5M DME Medicaid fraud. She helped submit false claims for power wheelchairs. Total taxpayer tab this week: roughly $57M. Congratulations, Alan- You win!
That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (Weeds everywhere!) and keep running the race (you know who you are).
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FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: Bapa mengutus Anak untuk menyelamatkan dunia
Fiscal Year – Measuring a year beginning October 1 and ending September 31.
Further reading
http://www.ncsl.org/research/fiscal-policy/fy-2017-state-budget-status.aspx
Federal Register Notice – A compilation of all presidential proclamations, executive orders, and federal agency regulations and proposed rules.
Further reading
https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services
Federally Qualified Health Center – Entities as defined under Sections 1861 and 1905 of the Social Security Act as being eligible to be reimbursed under Medicaid and Medicare as federally qualified health centers.
Further reading
https://www.cms.gov/Center/Provider-Type/Federally-Qualified-Health-Centers-FQHC-Center.html
Federal Poverty Level – In 2011 for a family of 4, was $22,350.
Further reading
Helping you consider differing viewpoints. Before it’s illegal.
Article 1: Federal judge weighing whether Illinois must prioritize paying Medicaid bills, Chicago Tribune, Kim Geiger, 6/6/2017
Clay’s summary: IL Medicaid providers have been hung out to dry and are owed $2B. But hey expansion saves money, puppies and the environment, right? Also- Illinois budgeting and politics is a special kind of crazy.
Key Passage from the Article
A federal judge heard arguments Tuesday over whether Comptroller Susana Mendoza should be required to prioritize payments to some Medicaid providers among Illinois’ billions of dollars in unpaid bills that keep piling up during the state budget stalemate.
The court dispute reflects the mounting difficulty of balancing Illinois’ competing financial obligations in the midst of an ongoing political fight between Republican Gov. Bruce Rauner and Democrats who control the General Assembly.
Judge Joan Lefkow indicated in court on Tuesday that she was sympathetic to the complaints of the Medicaid patients, but that she was unlikely to go as far as telling the comptroller which bills should be set aside in order to make the payments.
Article 2: How Much Will The GOP’s Medicaid Per-Capita Cap Save, If Anything? CBO Refuses To Say, Forbes, Avik Roy, 6/8/2017
Clay’s summary: Block granting Medicaid may not save anything at all – but its an important Boogeyman for leftie fear-mongers to trot out when scaring-up the masses against AHCA.
Key Passage from the Article
CBO identifies three provisions in the AHCA that drive the $834 billion in reduced Medicaid spending. The first is the AHCA’s repeal of Obamacare’s Medicaid expansion. The second is its repeal of Obamacare’s individual mandate, which the CBO implausibly believes will lead more than 5 million people to drop out of Medicaid. The third is the per-capita cap reform of the pre-Obamacare Medicaid program.
Remarkably, and unusually, the CBO has decided not to break out the relative effects of these three provisions onto the Medicaid reform: a silence that has led to massive confusion among states who falsely believe that their traditional Medicaid programs will be subject to massive cuts.
CBO appears to believe that it’s too complicated to tease out the impact of the AHCA’s various provisions on Medicaid, because they interact with each other. But CBO does analyses of interacting provisions all the time.
This is all we know about the CBO’s view of the impact of per-capita caps: that they will “reduce outlays.” But the essential question is: by how much?
Article 3: Michigan: Medicaid expansion producing big savings, Detroit News, Jonathan Osling, 6/5/2017
Clay’s summary: It’s all fun and games until you have to be the one paying for it. Cue squishy savings theories to help skirt the previously agreed upon exit strategy.
Key Passage from the Article
Gov. Rick Snyder’s administration wants to broaden the equation used to calculate state savings from expanded Medicaid eligibility as it works to protect the Healthy Michigan plan from a potential demise. The 2013 Michigan law includes a trigger that would end expanded eligibility for the low-income health insurance coverage if state costs outweigh savings that result from federal funding . . . But the administration is disputing projections that the cost-savings trigger could put the program on the chopping block regardless of what happens at the federal level, arguing state savings go beyond traditional budget lines. . . “If you look at savings in uncompensated care and other savings that are out there, I don’t think that would sunset this particular plan,” Pscholka said. “I think you have to look at all the savings that are taking place with hospitals and everywhere else. That number is pretty large.”
Electronic Health Record / Electronic Medical Record – Medical records that are saved and shared electronically, through many different methods. A health or medical record in digital format.
Further reading
https://www.cms.gov/Medicare/E-Health/EHealthRecords/index.html?redirect=/EhealthRecords/
