The Pulse
April PULSE
FEATURED NEWS
As we publish this month’s PULSE there are two major pieces of Featured News we want to bring to your attention. One, of course, is the process around the state budget and Medicaid Expansion. Another is from the Federal level and involves the use of COPAYS, for all Medicare services, including both home care and hospice. This has been an ongoing issue that home care has been fighting but our sense is that hospice has felt somewhat immune from this discussion. However, this is a real scenario for the industries and could be crippling.
FEDERAL NEWS
MCA Opposes Copays for Home Care and Hospice
Last month, Midwest Care Alliance joined the National Association for Home Care & Hospice in Washington, D.C. to oppose the copay proposal. The imposition of a copay or deductible would:
- a) Be a “sick tax” on some of the oldest, poorest, sickest Medicare beneficiaries;
- b) Shift seniors to more costly hospital or nursing home settings; and
- c) Increase Medicare and Medicaid costs.
A home health copay was repealed in 1972 because of the burden it placed on seniors, collection costs, and the services it shifted to more costly settings. Click here to access a summary of the copay repeal. Patients and their families and friends already pay a huge copayment by providing an estimated $450 billion a year in unpaid care at home, costs that would be incurred by Medicare if these patients were in a hospital or nursing home. In the political circles and reviewing an article form the NY Times this last week leads me to have great concerns that co-pays across the healthcare industry is gaining steam. In light of the research that providing care in the home and community saves money, adding a co-pay here becomes a roadblock for patients to receive this care.
Join MCA in contacting your state Senators and Representative to voice your concerns regarding this added burden. Congress should be taking actions to encourage individuals to receive care in their home and communities not forcing them toward higher costs alternatives!
Look for an alert later this week from Midwest Care Alliance on the latest information regarding the co-pay proposal.
Ohio Budget Watch
Kasich and GOP leaders weigh Medicaid expansion
As House Republicans consider alternatives to Governor Kasich’s budget proposal to expand Ohio’s Medicaid program, Kasich maintained that he will not use state tax dollars to provide access to health insurance for the poor, as conservatives are urging. “Some in the legislature think we can spend state-of-Ohio money and reject the federal money ... I won’t tolerate it,” Kasich said at a Republican function in Jackson County on Wednesday night. “We’re not going to make you pay twice. ... That’s not acceptable.”
Kasich has been critical of members in his own party who oppose extending Medicaid coverage to 275,000 Ohioans living in poverty, often referred to as the “working poor.” Meanwhile, Kasich staffers say negotiations with President Barack Obama’s White House over flexibility to use federal dollars to pay for private insurance for some of the poor are going “very well.” So well, in fact, that members of Kasich’s team have begun to present it as a viable alternative for legislators to consider. The Kasich administration has been negotiating with the White House since November to use federal funds to pay for some people to buy private insurance. As it stands now under federal law, states could use federal dollars to expand Medicaid eligibility to include people with incomes up to 138 percent of the federal poverty level.
With the Ohio General Assembly on a two-week “spring break”, Republicans who control the House and Senate are in Columbus studying the issue and their options. One option is using money in the state budget to buy private insurance for Ohio residents who qualify. State Rep. Barbara Sears is gathering information on four options related to Medicaid expansion for the House to study.
Expanding Medicaid would result in $13 billion in taxpayer money coming back from the federal government over seven years. Kasich has been quick to point this out to opponents of expansion and said that “on these kinds of issues, we cannot be partisan or philosophically isolated from other people.”
“Where (the legislature) is going to land on this, it’s still up in the air,” said Greg Moody, director of Ohio’s Office of Health Transformation. At the moment, the House Republican caucus has not achieved a consensus on what to do about Medicaid, even if Kasich achieves flexibility from the Obama administration. With the House budget sub bill expected to be introduced on April 8th, Midwest Care Alliance encourages its members to contact their state legislators and ask them to support Medicaid expansion. MCA/MCE Boards unanimously voted to support Medicaid Expansion at its most recent meeting in March. Click here for a fact sheet on the benefits of expansion.
(Portions of the Story Originally Published in the Columbus Dispatch on March 29, 2013)
MCA Continues to Oppose Changes to the Board of Nursing Home Administrators (BENHA)
In last month’s PULSE, Midwest Care Alliance expressed its concern over changes being made to BENHA in the Budget Bill. The proposed Executive Budget expands the Board’s scope and authority so that it can provide education, training, credentialing and, if directed to do so by the Ohio General Assembly, licensure opportunities for administrators and others in leadership positions who practice in all long-term services and support settings. Midwest Care Alliance opposes expanding required credentialing to “others in leadership positions” and has asked the Ohio General Assembly to make any additional credentialing opportunities “optional.”
Initially, it appeared as though the House leaders would tweak the BENHA provisions in its version of the budget. However, in a recent meeting with Rep. Barbara Sears, Midwest Care Alliance learned that the House was going to leave the proposed BENHA language alone and ask the Senate to weigh the issue. Thus, Midwest Care Alliance will work with Senate leaders to ensure that any additional credentialing is optional.
STATE & REGULATORY NEWS
Reimbursement for the Medicare Hospice Benefit under the federal-state ICDS Demonstration
In March, Jeff Lycan, President/CEO and Ryan Dureska, Director of Government Affairs with Midwest Care Alliance, met with representatives from the Office of Medical Assistance to discuss the reimbursement model for the Medicare Hospice Benefit under the ICDS plan. In particular, Midwest Care Alliance sought clarification from the Agency regarding the Medicaid payment to nursing facilities (NF) for dual eligible beneficiaries receiving the Medicare Hospice Benefit.
At the meeting, Midwest Care Alliance asked the Office of Medical Assistance to specifically address whether the payment process for “room and board” in the Social Security Act § 1902(a)(13)(B) would change under the ICDS demonstration. Hospice providers are confused over how room and board payments will be handled as states implement Managed Care programs.
MCA also asked for clarification related to rate setting for the Medicaid Hospice Benefit for beneficiaries who are Medicaid only. The Social Security Act § 1902(a)(13)(B) requires that Medicaid programs pay for hospice care "in amounts no lower than the amounts, using the same methodology, used under Part A [of Medicare]". One question MCA has is whether ICDS Plans will be held to those payment rates for Medicaid hospice beneficiaries under the demonstration.
Midwest Care Alliance is working with the Office of Medical Assistance to come to the following agreement: the State of Ohio’s contracted ICDS Plans will make a separate payment to hospices to cover the “room and board” costs of individuals who have elected hospice and whose residence in a NF or ICF/MR which would otherwise be covered by Medicaid. The payments for “room and board” will be authorized by the plan and must be “equal to 95 percent of the rate that would have been paid by the State under the plan for facility services in that facility for that individual
In regard to the second question, Midwest Care Alliance is working with the Office of Medical Assistance to come to the following agreement: hospices will continue to be reimbursed the “level of care” rates and payment specified in the Social Security Act § 1902(a)(13)(B) which requires that Medicaid programs pay for hospice care "in amounts no lower than the amounts, using the same methodology, used under Part A [of Medicare]" and that the Health Plans participating in the ICDS will be held to those payment rates for Medicaid hospice beneficiaries under the demonstration. This is the current process and our position is that this should not change under the ICDS demonstration project. MCA will notify members when these points are clarified.
Criminal Background Check Rules Calling for Fee Increase Remain Delayed
Last month, MCA reported that the Criminal Background Check Rules proposed by the Attorney General’s Office to increase the fee for Criminal Background Checks were temporarily removed from the rulemaking process. Up to this point, we have not heard what the Attorney General plans to do with this rule. On February 15, the Attorney General’s Office placed the rules in “To Be Refiled” status. Ohio Revised Code 109:5-1-01 authorizes BCI to charge a specified fee to conduct a state background check. The most recent version of the “To Be Refiled” rule package contained a modification that called for significant increases in the authorized state fee over the next two fiscal years.
The amendment would have maintained the current fee of twenty-two dollars ($22.00) until June 30, 2013. On July 1, 2013, the fee would have increased to twenty-five dollars ($25.00) and on July 1, 2014, the fee would have increased to and remained at twenty-eight dollars ($28.00). This represents an overall increase in the background check fee of $6.00, (27% increase) implemented in equal steps over two fiscal years.
Midwest Care Alliance continues to oppose the increase and maintains that any increase in the fee for Criminal Record Checks is unacceptable in the current economic climate.
March 31, 2013 Last Day to Retain “Direct Care” Worker With Disqualifying Criminal Record
The last day to retain a “direct care” worker with a disqualifying criminal record via limited grandfathering was March 31, 2013. See rule 173-9-07 of the Administrative Code and the ODA's FAQ page for more information on the criminal records checks requirements.
MOLST
Midwest Care Alliance continues to work with parties interested in the MOLST proposal and will provide a more detailed update of our progress in next month’s PULSE. Because the legislature is devoting its attention to budget matters until the summer, our goal is for MOLST to be ready to be introduced early in the fall.
Pediatric Respite Rules
MCA works with Department of Health as Rules for Pediatric Respite Care programs are drafted
Ohio House Bill 303 of the 129th Ohio General Assembly, which governs pediatric respite care programs, went into effect on March 21, 2013. The law requires the Department of Health to promulgate rules regulating pediatric respite care programs, which are programs that provide services to patients under age 27 who have been diagnosed before age 18 with life-threatening diseases or conditions that shorten life expectancy. The Department of Health continues to draft these rules with input from MCA and other interested parties.
During the course of our discussions with the Department, MCA was informed that hospice agencies that provide pediatric respite care will not face any additional burdens under these rules.
CURRENT STATE LEGISLATION & STATEHOUSE NEWS
Midwest Care Alliance Tracked Bills
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HB3 |
HEALTH BENEFIT EXCHANGE (SEARS B, KUNZE S) To specify licensing and continuing education requirements for insurance agents involved in selling, soliciting, or negotiating sickness and accident insurance through a health benefit exchange. |
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Current Status: |
3/19/2013 - Referred to Committee Senate Insurance and Financial Institutions |
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None |
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HB21 |
VOTING PROCESS-HEALTH CARE ISOLATION ELECTOR (STEBELTON G) To establish a process to permit an elector who is confined to a health care facility under isolation to vote with the assistance of bipartisan board of elections employees. |
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Current Status: |
2/26/2013 - House Policy and Legislative Oversight, (First Hearing) |
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None |
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HB59 |
BIENNIAL BUDGET (AMSTUTZ R) To make operating appropriations for the biennium beginning July 1, 2013, and ending June 30, 2015; to provide authorization and conditions for the operation of state programs. |
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Current Status: |
3/21/2013 - House Finance and Appropriations, (Seventh Hearing) |
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Comments: |
None |
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HB79 |
LIFE-SUSTAINING TREATMENT WITHDRAW-WITHHOLD (BOOSE T) To provide that an individual's statutory priority to decide whether or not to withhold or withdraw life-sustaining treatment for the individual's relative is forfeited if the individual is charged with felonious assault or aggravated assault resulting in the relative being in a terminal condition from the physical harm suffered. |
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Current Status: |
2/27/2013 - Referred to Committee House Judiciary |
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Comments: |
None |
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More Information: |
No link available |
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HB87 |
SEX OFFENDER NOTIFICATION-LONG-TERM CARE FACILITY (LETSON T, RETHERFORD W) To provide notice to a long-term care facility when a Tier III or similar category sex offender/child-victim offender indicates an intent to reside in the facility or registers an address within the specified geographical notification area including the facility. |
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Current Status: |
3/6/2013 - Referred to Committee House Judiciary |
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Comments: |
None |
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HB91 |
HEALTH CARE FREEDOM ACT (YOUNG R, THOMPSON A) To enact the Health Care Freedom Act. |
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Current Status: |
3/20/2013 - House Health and Aging, (First Hearing) |
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Comments: |
None |
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SB70 |
OHIO CIVIL RIGHTS LAW (TAVARES C) To specify that discrimination by an employer against any person because of the person's credit history is an unlawful discriminatory practice under the Ohio Civil Rights Law. |
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Current Status: |
3/13/2013 - Referred to Committee Senate Commerce and Labor |
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Comments: |
None |
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No Bills Introduced Since 3/22/2013 |
Month in Review
FY14-15 BUDGET
House Speaker William Batchelder (R-Medina) and Senate President Keith Faber (R-Celina) recently released a joint statement saying they want to cut income taxes and are looking to enact some tax reforms "in the short term," but are asking for more input from businesses, forecasting a process that could stretch beyond the budget. This followed largely negative reaction to Gov. John Kasich's tax reforms in House subcommittee testimony. They thanked Kasich "for starting the discussion" and said all three of them "share common goals and principles."
Former Ohio Supreme Court Justice Evelyn Lundberg Stratton urged support for Gov. John Kasich's proposed expansion of Medicaid under the federal Affordable Care Act in a Cleveland Plain Dealer op-ed column in March. The plan is proposed in HB59 (Amstutz).
Conferees worked out a deal on the transportation budget and turnpike bonding plan in HB51 (McGregor-Patmon), followed by Senate agreement and House passage. The bill sets the speed limit for rural interstates at 70 mph, requires most turnpike bond funding to go to Northern Ohio, and freezes tolls for shorter E-Z Pass trips, among other provisions.
Ohio University economist Richard Vedder recently testified to the House Finance and Appropriations Committee on Gov. John Kasich's tax reforms, saying while the plan isn't perfect, it could help improve the economy by reducing income taxes, which he said are the most harmful to growth.
Rep. Ron Amstutz (R-Wooster), the House finance chairman, said the House version of HB59 will include income tax cuts, but said any sales tax expansion would look different than the administration's proposal, and the severance tax increase likely won't be included.
Lt. Gov. Mary Taylor told attendees of the Ohio Gas Association 2013 Technical Summit she believes a compromise with lawmakers on the administration' severance tax proposals is possible.
GENERAL ASSEMBLY/STATEHOUSE
The Senate unanimously passed three health related measures in late March: SB4 (Manning-Oelslager), which requires pulse oximetry screenings for newborns; SB9 (Bacon), which creates standards for health exchange navigators; HCR4 (Romanchuk-Ruhl), and SB24 (Obhor), which designates Oct. 15 as Pregnancy and Infant Loss Remembrance Day.
HEALTH & HUMAN SERVICES
Ahead of the third anniversary of the federal Affordable Care Act's enactment, the U.S. Department of Health and Human Services (HHS) released data Monday touting how tens of millions more Americans received new health services in the past two years. Michael Hash, director of the department's Office of Health Reform, said 71 million more people received at least one preventive health care service, such as a flu shot or mammogram, in 2011 and 2012. In addition, about 34 million Medicare and Medicare Advantage enrollees received at least one service without out-of-pocket costs.
Elaine Ryan, vice president for state advocacy and strategy integration for AARP, said Tuesday her group is concerned about the effect the federal health care law will have on people whose income fluctuates around 100 percent, the threshold for certain coverage assistance programs if the state does not expand Medicaid. She also said states that don't expand Medicaid risk exposing employers to higher penalties.
