Tag: State News

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[MM Curator Summary]: Florida says not to the Dem’s latest Medicaid expansion strategy. And asks for more data on how much taxpayers are paying for non-citizens…

Clipped from: https://floridapolitics.com/archives/611373-florida-will-reject-medicaid-coverage-for-immigrants/

The Biden administration is making Medicaid available for nearly 580,000 people who came to the United States as children but can’t otherwise qualify for Medicaid because of their immigration status.

But Florida won’t be taking advantage of the option that was announced in April. In fact, Gov. Ron DeSantis’ administration is doubling down on its opposition.

DeSantis made clear at a Jacksonville news conference Wednesday he has no intention of tapping into the program. He made the comments after signing SB 1718, a sweeping immigration bill that requires private employers with 25 or more employees to use the E-Verify system for new employees and essentially bans Florida counties from issuing identification cards or other documents to individuals who do not provide proof of lawful presence in the United States.

The new law also aims to understand undocumented immigrants’ health care costs better because, as the Governor noted: “You show up to an emergency room, they treat you; it doesn’t matter if you are illegal or legal.”

According to DeSantis, Florida emergency rooms provided about $340 million in care to undocumented immigrants in the state fiscal year ending July 1, 2022.

“And taxpayers were on the hook for two-thirds of those costs,” DeSantis said. “The Biden administration is trying to increase those costs. They want to actually use Medicaid to cover illegal aliens, which we don’t support and won’t do in Florida. But that’s their vision in terms of what they want to do,” DeSantis said.

The Governor said he thinks the $340 million figure captures just “some” of the health care costs, saying, “We think that there’s more.”

To that end, SB 1718 requires hospitals that receive Medicaid funding to ask patients whether they are United States citizens, lawfully present in the United States, or unlawfully present in the United States.

The new law requires hospitals to submit quarterly reports to the state detailing the number of emergency department visits or admissions and how the patients responded to the question.

“The public deserves an honest accounting of how much this is costing us in terms of services, and health care is probably No. 1,” he said.

The health care provision was one of the more controversial elements of the immigration bill as opponents contended that it would dissuade undocumented immigrants from seeking health care.

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MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: CO hopes to use a new provider tax scheme to fund fixes to its abysmal BH services for vulnerable kids. The new plan would cap the “admin” vig of the magic money funds at 15% of “assessments” and then slough off the rest to help address BH needs. So, the leftovers.

Clipped from: https://thenevadaindependent.com/article/expanded-hospital-tax-could-boost-medicaid-rates-fund-behavioral-health-services

The entrance to Mountains Edge Hospital in Las Vegas on April, 19, 2019. (David Calvert/The Nevada Independent)

Nevada’s lack of state-supported services for child mental health issues has been described as a “crisis” — underscored by a federal investigation last year revealing that the state’s lack of adequate treatment and services to children and youth with behavioral health disabilities likely violated federal law.

But under a little-noticed bill that would allow private hospitals to implement an existing “provider tax,” state health officials are hoping to leverage up to $30 million in new state funds to address a lack of youth behavioral health resources. The initial funds could potentially grow to an estimated more than $100 million after the money is matched by the federal government in support of new Medicaid services and rate increases for behavioral health.

The proposed measure, SB435, would build upon an existing framework that grants private hospitals the ability to vote for a state-assessed “provider tax” of no more than 6 percent, earmarked as supplemental Medicaid payments as part of a federal dollar-matching program. The bill passed unanimously out of its first committee and has received an exemption from legislative deadlines.

The bill would also align state law with federal requirements by ensuring that tax proceeds are not solely used to offset tax payments made by the providers. Money generated could be used to fund supplemental Medicaid payments, enhance reimbursement rates and pay for state administrative costs to implement the new tax. The specifics of who receives the new payments outside of those paying the tax must be outlined in the poll issued by the state to determine whether there are enough votes to support the implementation of the tax.

One of the proponents of the measure, the Nevada Rural Hospital Partners, said the bill aims to fill the gaps in payments to providers and grants Medicaid the ability to address any unintended financial consequences that may stem from the new “tax” and Medicaid payments.

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“SB435 ensures that our small Critical Access Hospitals in Nevada won’t be unintentionally harmed by the implementation of the provider fee,” said Blayne Osborn, president of Nevada Rural Hospital Partners. “Beyond that, the bill puts forward critical funding to support behavioral health providers in Nevada, which our rural communities desperately need and our hospitals fully support.” 

Though administrators and proponents of the measure describe it as a “provider tax,” it acts more as an assessment, allowing the state to pay the private hospitals more money for Medicaid services with the caveat that a provider is not being guaranteed by the state that they will receive sufficient payments to offset taxes paid as necessary to avoid federal scrutiny.

One of the proponents is Gov. Joe Lombardo. While on the campaign trail, he promised not to raise taxes, and a spokesperson said SB435 does not undermine that vow.

“Senate Bill 435 advances an existing framework that private hospitals were authorized to seek in 2017, and critically, it does not raise taxes or require a two-thirds vote at the Legislature,” Lombardo spokesperson Elizabeth Ray wrote in an emailed statement.

Under an amendment proposed by Lombardo’s office and brought by the state Department of Health and Human Services, the measure would direct the agency to pull no more than 15 percent of what is collected from the “provider tax” for administrative costs. Any remaining money collected for administrative purposes would need to be set aside for future Medicaid expenditures aimed at supporting “behavioral health care for recipients with serious behavioral health conditions and psychiatric disorders.”

That amendment is a direct response to come into compliance with federal disabilities law after the publication of the October report from the Department of Justice finding that Nevada does not provide its children with behavioral health disabilities adequate community-based services and unnecessarily institutionalizes children, sometimes out of state. 

The report indicated that more than 1,700 Nevada children were admitted to a hospital for psychiatric care in 2020, and that same year, more than 480 children received services in residential treatment facilities — places the state reported where children remain an average of nine to 12 months, sometimes longer.

Data gathered as part of the reporting process revealed that most children in residential care did not receive state behavioral supportive services, and less than a fifth of the children who were hospitalized for psychiatric care in 2020 received wraparound care coordination from the state. Findings also showed the state relies on residential treatment facilities in and outside of Nevada to treat children with behavioral health disabilities.

“Nevada has a history of leaving mental and behavioral health behind or on a bus to another state,” Children’s Advocacy Alliance lobbyist Lea Case said during public testimony. “We support this first step while recognizing that there will still be a need for increased and sustainable funding to address the shortcomings noted in the DOJ report.”

Lombardo’s proposed budget shows the “provider tax” is estimated to bring in more than $388 million annually in new state revenue, with 15 percent allocated for administrative costs and any remaining funding within that percentage going toward behavioral and psychiatric services. The state estimates that this new state revenue could result in about $850 million to $1 billion in total for new supplemental Medicaid payments to private hospitals in Nevada. 

Director of Health and Human Services Richard Whitley said he estimates that 15 percent of the proposed “provider tax” would generate about $30 million for behavioral health, specifically, which can be matched with dollars from the federal government. The match could more than double or triple the money for behavioral health services, he said, potentially generating more than $100 million for behavioral health care in Medicaid.

“This will benefit both adults and children and reduce impact on the hospitals and the crisis services that are currently being provided in our emergency rooms,” Whitley said during a mid-April hearing on the measure.

Nevada Department of Health and Human Services Director Richard Whitley speaking with Assemblywoman Sarah Peters (D-Reno) in the Legislature in Carson City on February 8, 2023. (David Calvert/The Nevada Independent)

Nevada Medicaid Administrator Stacie Weeks said the state hopes to implement the tax by January 2024 and estimated it would support about 55 private hospitals within Nevada.

“It will create new supplemental payments, inpatient and outpatient, in addition to state-directed payments in our managed care program,” Weeks said during the hearing.

Though the budget includes estimations and projections related to the “provider tax,” a more detailed model of the finances and program, as well as the total funding generated, is expected to be available in June if the bill passes. Representatives of the Nevada Psychiatric Association, legal services providers, Clark County and the Nevada Republican Club testified in support of the proposed bill at its hearing last month.

Background and a future vote

The proposed bill takes advantage of a law passed under Republican Gov. Brian Sandoval during the 2017 legislative session that allows for a provider fee or tax program, as long as it is developed in collaboration with a majority of providers from medical facilities such as doctors’ offices, hospitals or other licensed medical offices, or an agency providing personal care assistance services. 

As part of the 2017 law, the provider tax program would be developed at the request of a group of providers and could proceed only with the approval of a supermajority vote of the providers (67 percent) within the group. Once that happens, the state division of Health Care Financing and Policy is given regulatory authority to assess and run a provider fee or tax program.

Whitley said the state’s low Medicaid rates have contributed to an overall provider shortage, and the “provider tax” will help address the shortage by ultimately bringing in more Medicaid dollars. He and other presenters said that the state will treat the proposed provider tax as a contract with the hospitals and, when voting, all hospitals will receive every detail related to the tax, including how the funding will be used and the tax percentage.

“The hospitals have to agree to participate in this,” Whitley said, adding that the provider tax under the new bill could also help public rural hospitals by opening the door for supplemental Medicaid payments to those hospitals in the event that something changes within the Medicaid structure as a result of the new private hospital tax.

The Nevada Hospital Association brought forward the request for the provider tax, the outlines of which were detailed in a public workshop held earlier this year by the Division of Health Care Financing and Policy.

A spokesperson for the association said all Nevada health care providers, including hospitals, are underfunded by Medicaid. In the past 20 years, she said hospital Medicaid rates have only increased 5 percent overall though hospital costs have increased approximately 50 percent, and additional funding is needed to preserve and sustain Medicaid services.

“We support the administration’s efforts to bring more funding through Medicaid provider fee programs,” said spokesperson Jeanne Corbit. “And we are working with the administration and lawmakers to craft legislation that sustains and improves access to hospital services.”

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: CO’s resuming of PA rules for medically complex kids support is quite disruptive.

Clipped from: https://coloradosun.com/2023/05/10/medicaid-in-home-nursing-care-children/

Parents of children with disabilities so severe they say they need round-the-clock care to live at home are growing increasingly frustrated with the state Medicaid division as confusion over policy changes has dragged on for months. 

Families of children who need breathing and feeding tubes to survive say they’re again receiving denials for in-home nursing services after the latest freeze on the prior-authorization process was lifted. 

“The law hasn’t changed. The criteria hasn’t changed,” said Jack Robinson, an attorney representing 20-25 families who have appealed the denials they received from the Medicaid division. “The only basis to reduce a child’s hours is if they got better. In none of the situations that I’m dealing with have they gotten better.” 

Department officials say only a fraction of the 948 people who’ve asked for private-duty nursing services have been denied the benefit or had their hours cut. And families are still receiving services while they appeal.

The confusion goes back to three years ago, when the Colorado Department of Health Care Policy and Financing — which includes Medicaid — put a freeze on the prior-authorization process for in-home nursing care for children and kept the freeze throughout the coronavirus pandemic. That meant families were receiving services based on physicians’ orders but without having the state contractor that processes claims making a determination about whether they were medically necessary. 

In the meantime, Colorado switched to a new contractor. Kepro, a national company, handles prior-authorization requests submitted by agencies that supply private-duty nurses.

After the pandemic shutdown ended and the prior-authorization process resumed in November 2021, so many families were denied services or had their children’s hours reduced that the state department again put the prior authorization process on a freeze. Some families told The Colorado Sun they were in panic mode for months until the department initiated the emergency freeze last October. 

But the prior-authorization process is back on again, and denial and reduction letters began hitting mailboxes in March and April, setting off a new wave of frustration.

Families upset over recent denials

Pam Rogers said services were cut by 14 hours per week for her 9-year-old daughter who uses a wheelchair, cannot communicate and survives with a gastronomy tube for nutrition. Rogers adopted the girl so she didn’t have to spend her life in a hospital. 

“She has comorbidities in literally every system of her body,” Rogers said. “If someone is not assessing her comfort, pain, red marks on her side. … all of these little things can turn into very big expensive things and potentially fatal things.” 

In addition to the girl, Rogers has a biological daughter who choked and suffered a brain injury at age 2. She also adopted four other medically fragile children from foster care, including a baby who was living in a hospital.

The Aurora mom fears the ongoing denials for families like hers will lead to fewer options for medically fragile children. 

“They are making it incredibly hard on a daily basis to care for them,” Rogers said. “They are adding 100% more stress than is ever needed. Every single time we feel like we resolve one thing, they try to break another thing. They just keep placing more barriers and more barriers to the point I don’t know what the future holds.” 

Robinson said he is representing several families who have been denied or partially denied nursing services and are appealing to an administrative law judge. “Medicaid benefit is a property right,” the attorney said. “They are in essence taking away that property right without a change in circumstances.” 

Robinson said a few of the children, who are only 2 or 3 years old, did not previously have to go through a prior authorization because of the freeze on that process. But several of his clients were approved in the past and have now been denied the same level of in-home services. 

The parents, some of whom have set up licensed medical foster homes and adopted children from the foster care system who were abandoned in hospitals, believed they would receive services for the rest of their lives, Robinson said. 

“The whole idea is that we are trying to set up a home setting that would provide these incredibly medically fragile, complicated kids with nursing services,” he said. “Now all of a sudden the whole landscape changes. We can’t send the child back to the hospital.” 

Katerina Evers and her husband, both nurses, have adopted eight medically fragile children. Two were dropped from 24-hour nursing services to zero hours, the couple learned at the end of April. 

“It’s like they are playing with people’s lives.”

— Katerina Evers, mother of eight medically fragile children

One of those is a 16-year-old girl who has a g-tube, oxygen, a wheelchair and behavioral issues because of previous abuse. She had been approved for round-the-clock services for the past 11 years, since she was adopted by the Evers from an abusive home, Evers said. 

The other is a 9-year-old girl whom the Evers adopted as an infant. The child’s face and neck were not formed correctly and she needs an artificial airway to breath and a tube to eat because of a cleft palate. Evers said she received a letter from the state contractor saying the girl’s services were not medically necessary because she is “in a state of transition.”

“What transition would that be?” Evers asked. “She has been like this since infancy. The letters make no sense.” 

She wonders why the Medicaid division can’t grandfather in the families who already had 24-hour services and enact its policy changes in the future.

“It’s like they are playing with people’s lives,” she said. 

About 200 denials issued since November 2021

From November 2021 to last month, 948 people applied for private-duty nursing services. In 86.5% of cases, families were fully approved for services, according to Medicaid officials.

But there were 71 full denials and 134 partial denials issued during that time. 

Denials happen because the services aren’t deemed medically necessary or for technical reasons, meaning that more information about their needs is required. 

Since last fall, Medicaid officials have provided additional training about the prior-authorization process to the 30 or so agencies in Colorado that place private-duty nurses in homes. The state also worked with its contractor to write clearer denial letters that provide an explanation and describe a family’s right to appeal. 

In addition, the Medicaid division met with disability advocacy groups to hear their concerns, and reached out individually to families who had complained publicly about denials. 

“While you may have a few voices that are really loud, we really wanted to understand the scope of the over 900 people that receive this benefit,” said Bonnie Silva, the director of the Office of Community Living at the state health care department. “Let’s make sure we understand all of the problems.”

At the same time, the Department of Health Care Policy and Financing is reviewing the rules around private-duty nursing, which have not been updated for several years. There is no rule, for example, dictating how many medically fragile children one nurse can care for at a time. The department is holding a series of public meetings and plans to present proposed rules to its rule-making medical services board in early 2024. 

We’ve worked hard to err on the side of the member, err on the side of how do we be really cautious and make sure that our policies don’t result in harm.

— Bonnie Silva, Office of Community Living

The private-duty nursing program cost $113 million in 2022.

Silva said that any child who in previous years had been approved for services through the prior-authorization process but had their services deemed “not medically necessary” in the latest process was automatically approved by the department “while we take more time to look at those.” 

Some families, however, told The Sun that they are panicked because they believe they have been denied or might be denied after such a review. 

It’s not the goal of Medicaid for anyone to lose services, Silva said. 

“We’ve worked hard to err on the side of the member, err on the side of how do we be really cautious and make sure that our policies don’t result in harm, while also having some fidelity to the responsibility that we have that is extraordinary around the funding that we receive,” she said.