As this session of Congress winds down, the usual frenzy of last minute activity stoked the possibility that Congress may actually accomplish something before it adjourns.  This Congress, which only worked 103 days this year, failed to pass 9 of the 12 appropriations bills and decided to punt its appropriations responsibility to the 110^th Congress.  The big issue driving the health care legislation this week was the planned cut in Medicare payments to physicians that is scheduled to go into effect unless Congress acts.  Once it became clear that Congress was going to address this issue, many members of Congress, trade associations, and lobbyists saw this as their opportunity to catch the last train out of town and attempted to attach their proposals to the “doc fix.”  These issues include several Medicaid/SCHIP issues – addressing the state SCHIP funding shortfalls, extending the Transitional Medical Assistance program, preventing the Administration from implementing a crackdown on provider taxes, and possible DRA technical corrections.  Soon, the cost of the $12B “doc fix” bill swelled – with a limited number of offsets with which to pay for this package.  Although outgoing Speaker Dennis Hastert has said that the doc fix will be the only thing moving, that did not prevent Senate Finance Chairman Grassley and Ranking Member Baucus to continue moving forward on a package of other Medicare and Medicaid/SCHIP fixes.  Late Wednesday afternoon, the bipartisan health staff of the Finance Committee briefed health care advocates in Washington about a Medicaid/SCHIP package that included a codification of the provider tax; DRA technical corrections with respect to documentation, EPSDT, benefit flexibility, and cost sharing; a six month extension of TMA and Abstinence promotion; and filling states’ SCHIP funding shortfalls.  After the Senate came to agreement, they entered into negotiations with the House on the package.  The House negotiated with the Senate on most issues but rejected the Senate’s approach on funding SCHIP shortfalls, initially dropping that provision from the omnibus bill.  However, in a classic Washington strategic move, the Senate held up several bills that were priorities for the House of Representatives unless the SCHIP package was agreed upon.  In the end, the SCHIP shortfall package was attached to legislation reauthorizing the National Institutes of Health.  Both the larger omnibus package and the NIH reauthorization bill passed the full House and Senate in the waning hours of the 109^th Congress.  ACAP is reviewing these packages and will post summaries of the legislation on ACAP’s website when they become available.

ACAP’s December Policy Roundtable was privileged to hear from the Chief Health Counsel for the incoming Chairman of the House Energy and Commerce Committee, John Dingell (MI) firsthand.  ACAP invited Bridgett Taylor to discuss the health agenda for the 110^th Congress and the outlook for issues that the Committee will be considering.  (The Energy and Commerce Committee has sole jurisdiction over Medicaid in the House of Representatives.)  Ms. Taylor reiterated the general sense that Democrats will focus on two major health issues in their first “100 Hours” – allowing DHHS to negotiate drug prices under the Medicare Prescription Drug Benefit and overturning President Bush’s ban of federal funding for stem cell research.  After that, she suggested that there were a number of issues that the committee will address, including SCHIP reauthorization, health information technology, amendments to the Deficit Reduction Act, and other issues.  She also suggested that there were going to be a series of oversight investigations that will deal with a wide variety of health care issues.  ACAP also got some very good news on issues important to our plans – specifically that Mr. Dingell supports the extension of the Medicaid drug rebate to Medicaid health plans.  In addition, Ms. Taylor also said that she believed that actuarial soundness is vital principle in Medicaid managed care and something they supported.  When asked whether actuarial soundness would be a part of their oversight agenda, Ms. Taylor seemed to indicate that it would, provided that they had sufficient time and resources.  Overall, we were delighted that Ms. Taylor could join us and offer her insight into the outlook for health policy on the Hill next year.

Medicaid Commission Votes on Final Recommendations: ACAP Supports Care Coordination, Cautions Against Lack of Protections

The Department of Health and Human Services’ Medicaid Commission held its final meeting November 16 and 17 for the purpose of voting on a set of final recommendations that will lead to the long-term sustainability of the Medicaid program. These recommendations will be included in a report to be delivered to the Secretary by December 31, 2006, which follows a September 2005 Commission report that recommended ways to achieve $10 billion in savings to the Medicaid program over five years.

The Commission issued five broad recommendations, subdivided into specific areas. Broad categories include long-term care, benefit design – focusing largely on increased flexibility for states, eligibility – emphasizing the ability of states to streamline complex eligibility categories, health information technology, and quality and care coordination for all enrollees.

Although additional detail on all of the recommendations is needed for a full assessment of their merits, ACAP interpreted “care coordination” as managed care, and as such supports the recommendation provided these proposals include safeguards for beneficiaries and ensure that plans have the necessary experience and capabilities to care for this vulnerable population. ACAP also stated that all health plans providing managed care should receive actuarially sound payment rates for Medicaid services to allow plans to give good care to enrollees. ACAP stressed that increased benefit and eligibility flexibility not be implemented without adequate federal protections for enrollees, and asked that any increased emphasis on enrollee responsibility not ignore the critical role of health care providers and health plans in the health care relationship.

ACAP’s response is posted on the ACAP website, and the Medicaid Commission’s recommendations are available from ACAP staff.

 

On December 6, Bridgett Taylor, Congressman Dingell’s Chief Health Counsel to the House Energy and Commerce Committee presented her view of the new Congress’ health policy agenda, which includes SCHIP reauthorization, health information technology, and Medicaid fixes.  Chris Koppen provided an update on the election results and reported on ACAP’s plans to welcome new members of Congress with ACAP briefing folders.  Brenda Whittle and Beth Marootian of Neighborhood Health Plan of Rhode Island provided a valuable presentation on cultivating relationships with Congress, and earmarks. 

2007 Roundtable Schedule

ACAP is currently working on the 2007 Roundtable Schedule and we will post it at: http://www.communityplans.net/members/default.asp#Staff%20Roundtables by Friday, December 15, 2007.