Medicaid

A Government Accountability Office report released Wednesday finds the agency that oversees Medicaid approved managed care contracts that might not have met federal requirements.

The report found regional gaps in oversight and in the data the states collect to ensure the rates insurance companies charge for the care of Medicaid beneficiaries are accurate.

The top Democrat and Republican on the Senate panel that has jurisdiction over Medicaid immediately called on the Centers for Medicare and Medicaid Services to increase its oversight.

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After months of trying, chamber ends debate on legislation to provide states with billions of dollars for Medicaid and education.

Senate Majority Leader Harry Reid (D-Nev.) said Tuesday night in a statement that the Congressional Budget Office would save money over the next 10 years and Republicans shouldn't have any reason to oppose it. 

"Our plan to keep teachers in the classroom, police officers on the beat and firefighters on call is not only fully paid-for, but it also saves taxpayers money," Reid said in a statement. 

Democrats will need one Republican to get them the 60 votes needed to end a filibuster. 

The bill would provide $16 billion in Medicaid funding to states and $10 billion for teachers and first responders. 

The measure is paid for by closing corporate tax loopholes that allow U.S.-based multinational companies to use foreign tax credits to reduce their U.S. taxes. The measure also rescinds previously appropriated money and cuts future food stamp benefits.

"This amendment meets every test Republicans claim to be concerned about. They have no more excuses, and tomorrow, they will have a choice: lay off teachers weeks before the new school year starts and fire the first responders who keep us safe, or help these workers keep their jobs and help our economy recover."

A vote scheduled for Monday was postponed until Wednesday after a CBO  analysis showed the measure would add $5 billion to the deficit over the next 10 years. 

Senate Minority Leader Mitch McConnell (R-Ky.) has called the bill a payoff to public employee unions. 

"Our friends on the other side are now in the business of paying for states to hire more workers even if they can't afford it on their own," McConnell said Monday. "It creates a permanent need for future state bailouts, at a time when we can least afford it."

The trade association that represents nonprofit safety net health plans released a new report Tuesday on strategies to improve primary care in Medicaid.

The paper, released by the Association for Community Affiliated Plans, outlines efforts to increase access to primary care, encourage coordination and team-based care, and reward effective primary care. One of the stated goals of healthcare reform has been to transform the U.S. healthcare system to reward quality over quantity of care, and primary care is seen as vital to that effort.

"The strategies outlined in this report show that Medicaid-focused health plans are leading the way in transforming the delivery of primary care," said Deborah Kilstein, ACAP’s director of quality management and operational support. "While there is much discussion about new models for delivering health care, this paper helps take a concept and show how health plans are already working hard to undertake innovative new approaches." 

Among the examples provided:

• Neighborhood Health Plan of Rhode Island is working with local community health centers to encourage more multi-disciplinary care, provide same-day, 24-hour access, use more sophisticated information technology, and foster patient self-management;

• Contra Costa Health Plan of California uses five case-management programs, tailored for different populations and health needs, to enhance the coordination of patient care and address related social needs;

• CareSource in Ohio has developed a system for sharing electronic health records to improve the quality of care by reducing duplicate services and medical errors while improving the tracking of the use of prescription drugs. CareSource also uses financial incentives to encourage better patient engagement.

The Republican Policy Committee on Tuesday morning sent out a memo to staffers highlighting the major changes in the Senate bill that extends enhanced federal Medicaid funding to states for six months.

Senate Majority Leader Harry Reid (D-Nev.) tabled the initial bill Monday afternoon after it received a bad score from the Congressional Budget Office. Reid then filed for cloture on the new bill, which contains the same $16.1 billion, phased-down Medicaid enhancement as the original bill; a vote is expected Wednesday.

The major changes include:

- Paring back the enhanced food stamp benefits provided under the recovery act one year earlier than previously expected, starting March 31, 2014, instead of 2015;

- Eliminating the Advanced Earned Income Tax Credit (EITC), which allows individuals to receive a portion of the Earned Income Tax Credit in their paychecks. This means workers would no longer be able to receive an advance payment of their expected EITC through their employer;

- Establishing new rules for electing a foreign tax credit in certain situations involving the acquisition of covered assets;

- Eliminating $238 million in offsets coming from the Navy;

- Eliminating $300 million in offsets from the Rural Utilities Service Distance Learning, Telemedicine and Broadband Program;

- Eliminating $361.8 million from the Special Supplemental Nutrition Program for women, infants and children.

The Senate on Monday effectively postponed legislation providing more than $16.1 billion next year to state Medicaid programs.

The vote to table the bill was 95 to 0. 

The Medicaid provision, part of a $26 billion proposal designed to help states weather a tough economy, ran into trouble Monday when the Congressional Budget Office estimated the package would add $5 billion to the budget deficit.

Democratic leaders say they'll tweak their proposal to pay the entire tab. A vote on the revised bill is expected as early as Wednesday. 

Children's hospitals and other medical centers on Monday became eligible to enroll in a Medicaid program that offers discounted drugs, as called for in the healthcare reform law.

As many as 1,500 additional hospitals — including children’s hospitals, free-standing cancer centers, critical access hospitals, rural referral centers and sole community hospitals — are now eligible for the 340B program, which provides discounts on brand-name drugs to facilities that serve poor people. Factoring in clinics and health centers, the number of sites participating in the 340B program will rise from more than 14,000 to nearly 20,000, according to the Department of Health and Human Services.

HHS estimates the facilities will be able to save an average of 20 percent to 50 percent of the cost for covered drugs thanks to the program.

The drug industry agreed to the expansion during the healthcare reform debate but beat back proposals to expand the discount to inpatient drugs, which are delivered at the hospital. The discount only applies to outpatient drugs.

Entities that have completed the registration process will be added as their eligibility is confirmed, according to HHS. The registration process will require at least three days of processing time. 

All required documents need to be submitted by September 27. The rolling, online admission process ends Sept. 30.

Cash-strapped states won't be able to sigh in relief just yet.

Senate Majority Leader Harry Reid (D-Nev.) is expected shortly to ask the Senate to table a bill that would have extended enhanced federal Medicaid payments to states for six months. The $16.1 billion Medicaid provision is paid for but is part of a larger education and public safety jobs bill.

Reid filed for cloture on the bill Thursday but the Congressional Budget Office helped doom it on Monday when it said it would increase the deficit by almost $5 billion.

"Earlier today CBO informed us that the score did not turn out as we intended," reads a message from the Senate leadership. "Certain spending cuts did not produce the savings needed.

"Therefore, we expect Senator Reid to soon ask consent to modify the pending amendment so that it is indeed budget neutral. 

"We expect Republicans to object to that request. If they do, Sen. Reid will move to table the pending motion to concur and offer a new amendment. 

"That amendment will fund hundreds of thousands of jobs and will be fully paid for according to CBO."

If, as expected, Reid refiles for cloture, a vote on the Medicaid FMAP (federal medical assistance percentages) extension will be delayed until Wednesday at the earliest.

The Senate bill that would extend enhanced federal Medicaid payments to states would raise the deficit by almost $5 billion, according to a Congressional Budget Office estimate obtained by The Hill. 

The $16.1 billion cost of the Medicaid FMAP (Federal Medical Assistance Percentages) increase is fully offset, but other provisions of the bill would add $4.891 billion to the deficit over 10 years. Lobbyists and health policy analysts say the score might doom a proposal that was already failing to attract support from moderate Republicans. 

A cloture vote is expected around 5:30 p.m.