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Posted on August 12, 2011 11:36
Categories: Feature Stories
Topics:
From SAMHSA's Weekly Financing News Pulse: National Edition: August 5, 2011: On August 9, Centers for Medicare & Medicaid
Services (CMS) officials announced a $75 million three-year Medicaid demonstration
project that will examine the impact of covering mental
health treatment in psychiatric hospitals with more than 17 beds. Often referred to as “institutions of mental
disease” (IMDs), Medicaid does not currently fund treatment at such facilities
for individuals aged 21 to 64. Created
and funded under national health care reform, the demonstration project is
designed to examine the quality of care that patients receive at such
facilities, their effect on emergency room utilization, and the overall
cost-effectiveness of such care. All
states may apply for the program; however, CMS only plans to accept a “limited
number."
View the August 12 Financing News Pulse: National Edition here (PDF | 242.31 kb)
SAMHSA222s Weekly Financing News Pulse: National Edition
August
12,
2011 8/12
/11
1
SAMHSA222s Weekly Financing News Pulse: National Edition
National News
House Republicans Question HHS on Health Plan
Waivers; HHS Awards Community Health Center
Grants, Denies Guam222s MLR Waiver Request
CMS to Launch Medicaid Demonstration Project Expanding Mental Health Coverage
HHS, DOI, and DOJ Create a New Federal Framework
to Coordinate Tribal Substance Abuse Programs
SAMHSA Awards Universities and Colleges $6.2 Million for Suicide Prevention
Two Universities to Launch Recovery Programs
Update: Democ
ratic Leaders File Brief Supporting Citizens222 Right to Contest State Medicaid Changes
Studies Released
Health Affairs Article Examines Health Reform222s Impact on Substance Abuse Treatment
NACH Finds States Medicaid
Changes Negatively Impact Children222s Care
KFF Maps Geographic Premium Variation in the Individual Market
Thomson Reuters Finds Geographic Spending Disparity in the Group Market, Uncorrelated with High
Medicare Spen
ding
Update: Moody222s says Non
-
Profit Hospitals Face Downgrades
Around the Hill: Hearings on Health Financing
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ose 223Health Care
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For questions or comments, please contact
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SAMHSA222s Financing News Pulse is a news consolidation service, designed to provide readers with streamlined
access to information published by local, regional, and national media.
While the News Pulse attempts to verify
our content, the editors of each publication cited in the summaries are ultimately responsible for
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in future editions; however, we also suggest that they contact the media source directly.
SAMHSA222s Weekly Financing News
Pulse: National Edition
August
12, 2011 8/12
/11
2
National News
House Republicans Question HHS on Health Plan Waivers; HHS Awards Community Health
Center Grants,
Denies Guam222s MLR Waiver Request
:
On August 3,
House Oversight and
Government Reform Committee Chair Darrell Issa
(R
-
CA)
sent a letter
to
U.S. Department of Health
and Human Services (HHS) officials, seeking information on
HHS222
decision to stop awarding the
waivers
exempting health plans from the law222s annual benefit l
imit requirement and requesting
detail on
the
waiver approval
process
.
September 22 is the last day that HHS will accept
waiver
applications. ( The Hill, 8/10 ; Kaiser Health Ne
ws, 8/11 ). In other health reform news, o
n August
9,
HHS
officials announced
$28 million in grants to establish new community health centers. Funded under health care reform, the
grants will go to 67 recipients
in 23 states and Puerto Rico
, increasing access to care for an estimated
286,000 individuals ( The Hill, 8/9 ; Modern Healthcare, 8/9 ; Kaiser Health News, 8/10 ). Finally,
on
August 5, HHS officials denied Guam222s request for an exemption from health
reform222s medical loss ratio
(MLR) requirements
, noting that Guam222s market is so small that the territory would not face penalty if it
failed to meet the rule222s standards. HHS officials also received letters from Michigan and Texas officials
requesting ML
R exemptions
( Kaiser Health News, 8/8 ).
CMS to Launch Medicaid Demonstration Project Expanding Mental Health Coverage
: On
August 9, Centers for Medicare &
Medicaid Services (CMS) officials announced a $75 million three
-
year
Medicaid demonstration project
that will examine the impact of cover
ing
mental health treatment in
psychiatric hospitals with more than
17 beds. Often referred to as 223institutions of mental disease224
(IMDs), Medicaid does not currently fund treatment at such facilities for individuals aged 21 to 64.
Created and funded under national health care reform, the demonstration project is designed to
examine the quality of care that patients receive at such facilities, the
ir
effect on emergency room
utilization, and the o
verall cost
-
effectiveness of such care. All states may apply for the program;
however, CMS only plans to accept a 223limited number224 ( The
Hill, 8/9 ).
HHS, DOI, and DOJ Create a New Federal Framework to Coordinate Tribal Substance Abuse
Programs
:
On August 5, U.S. Department of Health and Human Services (HHS)
Secretary Kathleen
Sebelius
,
U.S. Department of Interior
(DOI)
Secretary Ken Sala
zar
, and U.S. Attorney General Eric
Holder
announced a new federal framework to coordinate substance abuse prevention and treatment
among American Indian and Alaskan Native
c
ommunities. Called for under the
Tribal Law and Order Act
of 2010,
which President Obama signed in July 2010, the
Memorandum of Agreement
(MOA) describes
how
an inter-
departmental coordinating council will guide the new federal effort while the
U.
S.
Substance Abuse and Mental Health Administration222s (SAMHSA)
Office of Indian Alcohol and
Substance Abuse
will coordinate tribal
substance abuse programs
at the federal level
( DOI via the Cherokee One Feather, 8/5 ).
S
AMHSA Awards Universities and Colleges $6.2 Million for Suicide Prevention
:
On
August 1,
the
Substance Abuse and Mental Health Services Administration (SAMHSA) announced plans to award
over $6.2 million in grants to help
21 colleges and universities enhance suicide prevention and crisis
services. Designed to serve students with behavioral health problems, grant funds will help
develop
training programs for students and campus personnel,
create on
-
campus networks, conduct educational
seminars, prepare and distribute educational materials
,
and promote the National Suicide Prevention
lifeline,
which
provides 24
-
hour help for individuals with suicide
-
related problems. Sixteen schools will
receive Campus Suicide Prevention grants under the Garrett Lee Smith Memorial Act, receiving
up to
SAMHSA222s Weekly Financing News
Pulse: National Edition
August
12, 2011 8/12
/11
3
$102,000 per year for up to three years. In addition, five schools
will receive grants under health care
reform, receiving up to $306,000 over three yea
rs
( SAMHSA, 8/1 ; St. Cloud Times, 8/9 ).
T
wo Universities to Launch Recovery Programs: The University of Michigan
(UM) and the
Pennsylvania State University
(Penn State) announced plans to launch drug and alcohol recovery
programs this sum
mer. UM222s Collegiate Recovery Program is slated to launch using $10,000 in
university health services funds, providing sel
f-
help recovery courses and alcohol
-
and drug-
free
activities
.
Penn State
has dedicated space and staff for its recovery program. I
n related news, t
his
summer, 20 colleges formed the Association for Recovery in Higher Education
to promote the spread of
similar programs ( The Wall Street
Journal, 8/10 ).
U
pdate:
Democratic Leaders File Brief Supporting Citizens222 Right to Contest State Medicaid
Changes:
Numerous Democratic leaders including Senate Majority Leader Harry Reid
(D
-
NV) and
House Minority Leader Nancy Pelosi (D
-
CA) filed an amicus brief with the U.S. Supreme Court
in a
lawsuit challenging Medicaid rate reimbursement cuts in California. In the brief, Democratic
legislators
argue
that private individuals have standing to sue states to enforce the federal standard
of care
. The
bri
ef
comes after the
Obama Administration
filed an amicus brief
on May 26, arguing that private
individuals lack standing to sue states. Federal law requires that Medicaid rates ensure beneficiaries
access to the same level of care
as the privately insured
,
stipulating that rates must be set at a level
223sufficient to enlist enough providers
.224
Both
filing
s
came in a set of cases consolidated under the name
Douglas v. Independent Living of Southern California, under which private individuals and providers sue
d
California over Medicaid reimbursement reductions made in 2008 and 2009. The case is the first on the
Supreme Court222s
docket for January 2012 ( All Headline News, 8/10 ).
Studies Released
Health Affairs Article Examines Health Reform222s Impact on Substance Abuse Treatment: An article
published in Health Affairs
explores the looming expansion and transformation of public
substance abuse treatment under national health care reform. Authored by Jeffery Buck of the
Centers
for Medicare & Medicaid Services (CMS), the article notes that public substance abuse treatment
currently operates largely o
utside the mainstream health care system
, utilizing unique funding streams,
administrative mechanisms, and service delivery vehicles
. However, Buck notes that substance abuse
treatment is slated t
o
become better integrated with
in
the general health care system, expanding the
variety of treatment providers while shifting away from residential and stand
-
alone programs towards
outpatient programs and integrated care ( Kaiser Health News, 8/5 ).
NACH Finds States
Medicaid Changes Negatively Impact Children222s Care
:
On August 10, the
National Association of Children222s Hospitals (NACH) released its 2011 Mid
-
Year State Legislative Factsheets ,
examining trends in state legislation passed between January 1 and June 30, 2011. The
NACH found that more states have reduced Medicaid and Children222s Health Insurance Program (CHIP)
payments for children222s services than have raised them, noting that 10 states lowered reimbursement
rates while
only
four increased
them
. In addition, nine states have passed legislation that the NACH says
will reduce children222s access to health care or create new barriers to obtaining coverage ( The Hill, 8/10 ; Kaiser Health News, 8/11 ).
KFF Maps Geographic Premium Variation in the Individual Market
:
On August 9, the Kaiser
F
amily Foundation (KFF) released a brief
examining
National Association of Insurance Commissioners
SAMHSA222s Weekly Financing News
Pulse: National Edition
August
12, 2011 8/12
/11
4
(NAIC) data on
health insurance premium variation in the individual market
, finding
that premiums vary
substantially between states. For 2010, KFF found that average monthly premiums ranged from $136 in
Alabama to $400 in Vermont and Massachusetts, averaging $215 across all states. KFF suggests that the
brief provides a useful baseline for consumers and policymakers examining
the state of insurance policy
before the full implementation of health care reform. KFF has also released a map
depicting premium
variation between states ( KFF, 8/9 ; Kaiser Health News, 8/10 ).
Thomson Reuters Finds Geographic
Spending Disparity in the Group Market, Uncorrelated
with High Medicare Spending
:
On July 26, Thomson Reuters
(TR)
published a whitepaper
examining
spending
in the employer
-
sponsored
health insurance market. TR found t
hat
, while considerable
geographic variation exists
,
that
variation
does not correlate with areas of
high Medicare spending. The
authors not
e
that McAllen, TX is frequently cited as metropolitan area with the highest Medicare
spending,
yet
the city was among those with the lowest spending in
commercially
-
sponsored
plans. The
authors
highlight the need for additional research into employer-spon
sored coverage, noting that
Medicare data is not reflective of the private insurance market. TR222s
analysis does not control for
geographic price variation or health status and does not cover all employers ( Thomson Reuters via PRNewswire, 8/10 ; Kaiser Health News, 8/10 ; Kaiser Health News, 8/10 ; Wall Street Journal, 8/10 ).
Update: Moody222s says
Non
-Profit Hospitals Face Downgrades: On Augus
t 10,
Moody222s Investors
Services
issued a report warning
that non-
profit hospitals are increasingly facing credit downgrades in
light of
declining revenue. Noting that the 4 percent median revenue growth rate was the lowest
Moody222s has observed in 20 years, the report highlights c
uts to Medicare and Medicaid c
oupled with
declining patient loads
as contributing to the decline
. The
report
comes after Moody222s downgraded
several
no
n-
profit hospitals in July
and warned of the effects of state Medicaid cuts
( Moody222s, 8/9 ; Wall Street Journal, 8/10 ; Feirce Healthcare, 8/11 ). Around the Hill: Hearings on Health Financing
The House and Senate are in recess for the remainder of August but will hold regular pro forma sessions. The
Senate will resume
legislative business on September 6 and the House will do so on September 7.
Senate Health, Education, Labor and Pensions Committee
:
Aid to Children222s Hospitals; Autism
September 7
, 1
0
:00 a.m. 430 Dirksen
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