Wednesday, April 28, 2010
Friday, April 9, 2010
Mental Health America Hails Enactment of Historic Health Care Reform Bill
ALEXANDRIA, Va. (March 23, 2010)-Mental Health America today hailed the "Patient Protection and Affordable Care Act" signed by the President today. The legislation will greatly expand access to mental health care and addiction treatment-particularly for the 32 million previously uninsured Americans who will gain access as a result.
Treatment for these conditions is recognized as critical to overall health by being included on the list of essential benefits that must be covered in new plans offered to the uninsured.
"This health care reform legislation marks a tremendous step forward in our efforts to improve access to care for individuals with mental health or substance use conditions and in our advocacy for prevention of these conditions," said David Shern, Ph.D., president and CEO of Mental Health America.
The groundbreaking achievement last year with the enactment of the "Mental Health Parity and Addiction Treatment Act" (MHPAEA) firmly established that discriminatory limits on mental health and substance use conditions will no longer be permitted. Mental Health America is pleased to see the health care reform legislation carries this principle forward and extends the MHPAEA requirements beyond current law to health insurance plans offered to small businesses and individuals. These principles are also reflected in the expansion of Medicaid which would require those newly eligible to receive mental health and substance use services at parity with other benefits.
Access to care will also be improved due to insurance market reforms in this new law that will prohibit pre-existing condition exclusions, rescissions of coverage when people most need it, pricing premiums based on health status, and annual and lifetime limits on benefits.
The health care reform law will also establish a new requirement that coverage for dependent children must be available up to age 26 and will provide additional funding for school-based health clinics. Both provisions are critical in light of the fact that mental health conditions often strike during the adolescent and young adult years but most will not receive treatment until many years later, if at all.
Mental Health America places a high priority on prevention, particularly among children and youth, and thus we are please with the new requirements to cover preventive services as well as programs to support community-based prevention activities.
"We also strongly support the provision in this law that will eliminate the donut hole in the Medicare prescription medication coverage as Medicare is a crucial source of support for millions of people with behavioral health conditions," Dr. Shern said.
Among the many other important new programs and reforms are initiatives to support education and training of additional mental health and addiction treatment providers and to improve coordination of care through a new state option for medical/health homes in Medicaid that includes individuals with serious mental health conditions among the priority populations.
Contact: Steve Vetzner, (703) 797-2588 or svetzner@mentalhealthamerica.net
Mental Health America is the country's leading nonprofit dedicated to helping all people live mentally healthier lives. With our century of service to America and our more than 300 affiliates nationwide, we represent a national movement that promotes mental wellness for the health and well-being of the nation- everyday and in times of crisis.
Treatment for these conditions is recognized as critical to overall health by being included on the list of essential benefits that must be covered in new plans offered to the uninsured.
"This health care reform legislation marks a tremendous step forward in our efforts to improve access to care for individuals with mental health or substance use conditions and in our advocacy for prevention of these conditions," said David Shern, Ph.D., president and CEO of Mental Health America.
The groundbreaking achievement last year with the enactment of the "Mental Health Parity and Addiction Treatment Act" (MHPAEA) firmly established that discriminatory limits on mental health and substance use conditions will no longer be permitted. Mental Health America is pleased to see the health care reform legislation carries this principle forward and extends the MHPAEA requirements beyond current law to health insurance plans offered to small businesses and individuals. These principles are also reflected in the expansion of Medicaid which would require those newly eligible to receive mental health and substance use services at parity with other benefits.
Access to care will also be improved due to insurance market reforms in this new law that will prohibit pre-existing condition exclusions, rescissions of coverage when people most need it, pricing premiums based on health status, and annual and lifetime limits on benefits.
The health care reform law will also establish a new requirement that coverage for dependent children must be available up to age 26 and will provide additional funding for school-based health clinics. Both provisions are critical in light of the fact that mental health conditions often strike during the adolescent and young adult years but most will not receive treatment until many years later, if at all.
Mental Health America places a high priority on prevention, particularly among children and youth, and thus we are please with the new requirements to cover preventive services as well as programs to support community-based prevention activities.
"We also strongly support the provision in this law that will eliminate the donut hole in the Medicare prescription medication coverage as Medicare is a crucial source of support for millions of people with behavioral health conditions," Dr. Shern said.
Among the many other important new programs and reforms are initiatives to support education and training of additional mental health and addiction treatment providers and to improve coordination of care through a new state option for medical/health homes in Medicaid that includes individuals with serious mental health conditions among the priority populations.
Contact: Steve Vetzner, (703) 797-2588 or svetzner@mentalhealthamerica.net
Mental Health America is the country's leading nonprofit dedicated to helping all people live mentally healthier lives. With our century of service to America and our more than 300 affiliates nationwide, we represent a national movement that promotes mental wellness for the health and well-being of the nation- everyday and in times of crisis.
Friday, March 19, 2010
2010 Mental Health Month: Live Your Life Well
Mental Health America continues its tradition to celebrate "May is Mental Health Month" which began in 1949. This year, our theme "Live Your Life Well" challenges us to promote whole health and wellness in homes, communities, schools, and inform those who don't believe it's attainable.Keeping the vision of our founder Clifford Beers who began his work in 1909 to raise awareness of the importance good mental health hygiene and quality healthcare we encourage others to advocate and improve mental health conditions for children and adults living with these health challenges.
Please view the following mental health brochures and fact sheets created especialy for mental health month!
*Are You Feeling Stressed Out?
*Parenting During Tough Economic Times
*Depression: Know the Signs
*Stress: Know the Signs
*Staying Well When You Have a Mental Health Condition
*Helping Children Grow Up Healthy
*Taking Care of An Aging Parent
see the National MHA site for more information about Mental Health Month:
http://www.nmha.org/go/may
Please view the following mental health brochures and fact sheets created especialy for mental health month!
*Are You Feeling Stressed Out?
*Parenting During Tough Economic Times
*Depression: Know the Signs
*Stress: Know the Signs
*Staying Well When You Have a Mental Health Condition
*Helping Children Grow Up Healthy
*Taking Care of An Aging Parent
see the National MHA site for more information about Mental Health Month:
http://www.nmha.org/go/may
Thursday, March 11, 2010
Do Kids Come Second in Budget Battle?
JOHN MCINERNEY TIMES-DISPATCH COLUMNIST
Published: March 10, 2010
It's tough being a kid in Virginia today, especially if mom or dad can't get health insurance on their own. Gov. Bob McDonnell and the House of Delegates have issued budget proposals that would make sure fewer children and pregnant women have access to health coverage than do now. They would deny 30,000 kids and expectant mothers access to the state's health insurance program and make that program among the most restrictive in the nation.
Virginia's children's health insurance program is called Family Access to Medical Insurance Security (FAMIS). It provides health insurance with affordable cost-sharing for 155,000 kids and thousands of pregnant women throughout the commonwealth. FAMIS is available to families who don't have coverage through an employer and can't afford it on their own. Income limits apply; a family of three has to make less than $36,600 a year to qualify.
FAMIS and programs like it have a proven record. Children with health insurance receive regular primary care for basic medical needs and as a result perform better in school, are healthier, on average, than those without insurance, and have a chance to be more productive workers and citizens. Including pregnant women in the program has obvious benefits too, allowing them the prenatal care that can help reduce infant mortality and improve the health and development of the child. In short, FAMIS is more than health coverage; it provides peace of mind to thousands of Virginia's families and is a great investment in the state's future.
And, it's needed now more than ever. The prolonged national recession means more and more Virginians have lost their jobs and the health insurance that went with them. Yet, at a time when the case could be made for opening FAMIS to more kids, the state is on the verge of kicking out thousands.
McDonnell says he would close FAMIS to anyone not currently enrolled. The House of Delegates says reduce income eligibility to a point where a family of three making more than about $31,500 would no longer qualify.
Defending their proposals, lawmakers have left the impression that Virginia is overly generous with health care spending and that the cost of providing care to kids is not merited. In reality, Virginia ranks near bottom in how much we spend on these programs and who is eligible for them. Though the state is one of the 10 wealthiest in per capita income -- which would seem to suggest room to be generous -- only two states spend less per-capita on Medicaid. And 42 states cover children whose families have incomes at higher levels than Virginia's FAMIS. That includes all of our neighboring states. In 2009 alone, 23 states expanded eligibility or simplified enrollment policies. Virginia was not among them.
This is not to deny Virginia has money problems. Like other states it has seen record drop-offs in revenues because of the recession. Certainly, Virginia's $4 billion budget shortfall over the next two years will require tough choices. But 18 states, including several in the South, have dealt with or currently face even larger projected shortfalls in the coming year. Yet only Arizona (which faces a deficit twice as high as ours) and Virginia have chosen to make forcing kids out of their health care programs part of the plan for balancing the state budget.
There are other ways to close the gap between people's growing needs and the state's shrinking resources. But the House of Delegates and McDonnell have rejected a balanced approach that would include new revenue instead of relying only on cuts in spending. And they refuse to curtail generous corporate welfare programs they claim provide incentives to business, without evidence of their effectiveness or attempts to measure results. All they have is wishful thinking in contrast to the rock-solid evidence that investing in kids' health pays off big-time.
Lawmakers say the cuts to FAMIS would save the state more than $37 million over the next two years. Actually it would cost the state much more than that. They ignore that every dollar Virginia spends on FAMIS brings the state almost two dollars in federal funds. So the proposed cuts would mean Virginia forgoes about $70 million in federal funding. That adds up to a reduction of over $100 million in health care services for Virginia's kids and pregnant moms.
And if the health impacts of that are not compelling enough, consider the economic implications. That money doesn't just go into the atmosphere somewhere. It pays doctors, hospitals, and other providers of health care to children. So a $100 million cut means that much less economic activity in the state, further threatening our fragile recovery.
A state's budget reflects its priorities as a society. Closing off FAMIS to thousands who need it would be an unmistakable statement that Virginia's priorities are seriously misplaced.
John McInerney is health policy director for The Commonwealth Institute for Fiscal Analysis.
Contact him at john@thecommonwealthinstitute.org
Published: March 10, 2010
It's tough being a kid in Virginia today, especially if mom or dad can't get health insurance on their own. Gov. Bob McDonnell and the House of Delegates have issued budget proposals that would make sure fewer children and pregnant women have access to health coverage than do now. They would deny 30,000 kids and expectant mothers access to the state's health insurance program and make that program among the most restrictive in the nation.
Virginia's children's health insurance program is called Family Access to Medical Insurance Security (FAMIS). It provides health insurance with affordable cost-sharing for 155,000 kids and thousands of pregnant women throughout the commonwealth. FAMIS is available to families who don't have coverage through an employer and can't afford it on their own. Income limits apply; a family of three has to make less than $36,600 a year to qualify.
FAMIS and programs like it have a proven record. Children with health insurance receive regular primary care for basic medical needs and as a result perform better in school, are healthier, on average, than those without insurance, and have a chance to be more productive workers and citizens. Including pregnant women in the program has obvious benefits too, allowing them the prenatal care that can help reduce infant mortality and improve the health and development of the child. In short, FAMIS is more than health coverage; it provides peace of mind to thousands of Virginia's families and is a great investment in the state's future.
And, it's needed now more than ever. The prolonged national recession means more and more Virginians have lost their jobs and the health insurance that went with them. Yet, at a time when the case could be made for opening FAMIS to more kids, the state is on the verge of kicking out thousands.
McDonnell says he would close FAMIS to anyone not currently enrolled. The House of Delegates says reduce income eligibility to a point where a family of three making more than about $31,500 would no longer qualify.
Defending their proposals, lawmakers have left the impression that Virginia is overly generous with health care spending and that the cost of providing care to kids is not merited. In reality, Virginia ranks near bottom in how much we spend on these programs and who is eligible for them. Though the state is one of the 10 wealthiest in per capita income -- which would seem to suggest room to be generous -- only two states spend less per-capita on Medicaid. And 42 states cover children whose families have incomes at higher levels than Virginia's FAMIS. That includes all of our neighboring states. In 2009 alone, 23 states expanded eligibility or simplified enrollment policies. Virginia was not among them.
This is not to deny Virginia has money problems. Like other states it has seen record drop-offs in revenues because of the recession. Certainly, Virginia's $4 billion budget shortfall over the next two years will require tough choices. But 18 states, including several in the South, have dealt with or currently face even larger projected shortfalls in the coming year. Yet only Arizona (which faces a deficit twice as high as ours) and Virginia have chosen to make forcing kids out of their health care programs part of the plan for balancing the state budget.
There are other ways to close the gap between people's growing needs and the state's shrinking resources. But the House of Delegates and McDonnell have rejected a balanced approach that would include new revenue instead of relying only on cuts in spending. And they refuse to curtail generous corporate welfare programs they claim provide incentives to business, without evidence of their effectiveness or attempts to measure results. All they have is wishful thinking in contrast to the rock-solid evidence that investing in kids' health pays off big-time.
Lawmakers say the cuts to FAMIS would save the state more than $37 million over the next two years. Actually it would cost the state much more than that. They ignore that every dollar Virginia spends on FAMIS brings the state almost two dollars in federal funds. So the proposed cuts would mean Virginia forgoes about $70 million in federal funding. That adds up to a reduction of over $100 million in health care services for Virginia's kids and pregnant moms.
And if the health impacts of that are not compelling enough, consider the economic implications. That money doesn't just go into the atmosphere somewhere. It pays doctors, hospitals, and other providers of health care to children. So a $100 million cut means that much less economic activity in the state, further threatening our fragile recovery.
A state's budget reflects its priorities as a society. Closing off FAMIS to thousands who need it would be an unmistakable statement that Virginia's priorities are seriously misplaced.
John McInerney is health policy director for The Commonwealth Institute for Fiscal Analysis.
Contact him at john@thecommonwealthinstitute.org
Friday, March 5, 2010
COURT RULING ON CALIFORNIA MEDICAID CUTS MAY IMPACT VIRGINIA
This court ruling has significant implications for Virgina as the House of Delegates and Senate consider cuts to Virginia's Medicaid program. Following the attached article concerning the California ruling is an analysis of Virginia's proposed cuts to Medicaid written by VOCAL.
Paula Price
MHAV
Executive Director
Federal Appeals Court Rules Against California's Reduction in Medicaid Rates
By Tom Gilroy BNA March 5, 2010
LOS ANGELES—The U.S. Court of Appeals for the Ninth Circuit reiterated March 3 its oft-stated opinion that California may not cut its Medi-Cal reimbursement rates purely for budgetary reasons, but instead must rely on responsible cost studies, prior to any cuts, to show that the planned reductions do not reduce access to care for Medicaid recipients (California Pharmacists Assn. v. Maxwell-Jolly, 9th Cir., No. 09-55532, 3/3/10).
The ruling, affirming a preliminary injunction granted by a federal district court judge in February 2009 against a planned 5 percent rate cut voted by the Legislature in September 2008 (A.B. 1183), again relied heavily on the Ninth Circuit's 1997 decision in Orthopaedic Hospital v. Belshe, , 103 F.3d 1491. In Orthopaedic, the court held that Section 30(A) of the Medicaid Act requires that payments for Medi-Cal services “must be sufficient to enlist enough providers to provide access to Medicaid recipients.”
That, in turn, required that the Department of Health Services, the predecessor agency to the current Department of Health Care Services (DHCS), “must rely on responsible cost studies, its own or others,’ that provide reliable data as a basis for its rate setting.”
Judge Christina A. Snyder of the U.S. District Court for the Central District of California had granted a preliminary injunction against the A.B. 1183 reimbursement cuts. Snyder cited the Ninth Circuit's decision in Orthopaedic, and said a DHCS analysis supporting the rate reductions was completed well after enactment of the law, and thus did not meet the requirements set out in Orthopaedic.
The challenge to the rate cuts was brought by a group of adult day health care centers (ADHCs), hospitals, pharmacies, and other beneficiaries of the state's Medicaid program, known as Medi-Cal. It was similar to a lawsuit filed in 2008 by other providers protesting a 10 percent Medi-Cal rate cut, which Snyder also blocked, and the Ninth Circuit upheld (Independent Living Center of Southern California v. Shewry, C.D. Cal., No. CV 08-3315 CAS (MANx), preliminary injunction grated 8/18/08) (162 HCDR, 8/21/08).
More recently, Snyder on Feb. 24 granted, on virtually identical grounds as the other cases, a preliminary injunction sought by the California Hospital Association, against state legislation (A.B. 5) that effectively freezes certain designated hospital services at 2008-2009 levels (California Hospital Association v. Maxwell-Jolly, C.D. Cal., No. CV 09-8642 CAS (MANx), preliminary injunction granted 2/24/10).
Rejecting State's Argument
In its appeal of the adult day care centers' preliminary injunction, the state argued that Orthopaedic did not hold that rate-setting had to be based upon pre-enactment legislative studies undertaken and completed by the Legislature itself prior to the action authorizing implementation of the cuts. That case focused solely on the department's actions, and thus only the department was required to consider Section 30(A) requirements, the state maintained.
But the Ninth Circuit three-judge panel disagreed. The court in Orthopaedic did, in fact, focus on the department, since it was setting the rates in that instance. Nevertheless, the state is “misguided” in thinking that focus “absolves the legislature of the same requirements when it sets rates,” Judge Milan D. Smith Jr., who wrote the opinion, stated. In Orthopaedic, the Legislature was “one step removed from the regulations promulgated by the Department,” and thus the Ninth Circuit had no reason to focus on what that body considered before rates were set, Smith noted. “Yet if the legislature elects to bypass the Department, and set rates itself, it must engage in the same principled analysis we required of the Director in Orthopaedic II,” he added
“In sum, we find nothing remarkable in holding that the final body responsible for setting Medicaid reimbursement rates must study the impact of the contemplated rate reduction on the statutory factors of efficiency, economy, quality of care, and access to care prior to setting or adjusting payment rates,” the court wrote. The appellate court also agreed with Snyder that the DHCS's post hoc analysis of the rate cuts did not satisfy the requirements of Orthopaedic. “To satisfy Section 30(A), any analysis of reimbursement rates on the statutory factors of efficiency, economy, quality, and access to care must have the potential to influence the rate-setting process,” the court ruled.
Yet the DHCS analysis of A.B. 1183 with regard to adult day care centers was issued more than five months after enactment of the law, it noted. While that was still before the cuts were actually implemented, the Ninth Circuit was not persuaded by the DHCS's argument that the director could have vetoed the cuts if he determined they did not comply with Section 30(A).
Finally, the appellate court rejected the state's claim that the lower court erred when it found that plaintiffs demonstrated a likelihood of irreparable harm if the preliminary injunction was not granted. In fact, showing a procedural violation of the statute, namely the state's failure to consider the impact of the rate cuts on the statutory factors set forth in Section 30(A), may demonstrate a likelihood of success on the merits that the setting of provider reimbursement rates conflict with Section 30(A), the court stated.
If at least some providers stop treating Medi-Cal beneficiaries as a result of the rate cuts, and evidence indicates that at least some adult day care center providers would stop treating beneficiaries due to A.B. 1183, that might be sufficient for a finding of irreparable harm, Smith wrote.
“We have now handed down multiple decisions instructing the State on Section 30(A)’s procedural requirements,” Smith noted in the court's conclusion. “We trust that the State now understands that in order for it to comply with Section 30(A)’s ‘requirement that payments for services must be consistent with efficiency, economy, and quality of care, and sufficient to ensure access,’ …it must: 1) ‘rely on responsible cost studies, its own or others,’ that provide reliable data as a basis for its rate setting,’ … and 2) study the impact of contemplated rate change(s) on the statutory factors prior to setting rates, or in a manner that allows those studies to have a meaningful impact on rates before they are finalized,” he added. Because the state did neither with regard to A.B. 1183, the district court's order granting plaintiffs a preliminary injunction was affirmed, Smith added.
Reaction to Decision
The DHCS did not return a call seeking comment on the decision.
Lloyd Bookman, of Hooper, Lundy & Bookman in Los Angeles, who along with colleagues Byron J. Gross and Jordan B. Keville, represented the plaintiffs, told BNA March 3 his clients “obviously are very delighted with the Ninth Circuit's decision.”
Bookman also said he hoped the state Legislature, and the DHCS, would heed what the court has said when seeking to adjust Medi-Cal rates.
Text of the Ninth Circuit opinion is at http://www.ca9.uscourts.gov/datastore/opinions/2010/03/03/09-55532.pdf. A not-for-publication memorandum in the case is at http://www.ca9.uscourts.gov/datastore/general/2010/03/03/0955365mem.pdf
The following is from VOCAL
*********************************************
The House and Senate Budget Bills currently do not match each other. The Legislature must reconcile them and are actively working on that task now. If the information below about Medicaid eligibility is of concern to you, you can use the information at the end of this message for the contact information for the Budget Conferees.
If you choose to contact the Conferees do so by close of business today, Friday, March 5th.
Senate Bill 30 contains a provision that would reduce the Medicaid eligibility from the current 80% of Federal Poverty Level to 75% of Federal Poverty Level.
-This change will affect approximately 9,950 individuals receiving public mental health services.
-The critical services that the need to remain in the community will be severely impacted: psychiatry, medications, case management, day treatment, and psychosocial rehabilitation
-The reduction will not provide real savings for Virginia because the needs of the individuals must be met with General Fund dollars, especially if the individuals fall back on higher-cost crisis-driven care such as inpatient acute care at state hospitals.
-The eligibility was raised from 75% to 80% in 2001 after a 4 year Hall-Gartlan study of the system, and the drive to maximize Medicaid reimbursement and limit General Fund obligations.
Budget Conferees:
Senator Colgan -(804) 698-7529 email: district29@senate.virginia.gov
Senator Houck - (804) 698-7517 email: district17@senate.virginia.gov
Senator Howell - (804) 698-7532 email: district32@senate.virginia.gov
Senator Saslaw - (804) 698-7535 email: district35@senate.virginia.gov
Senator Stosch - (804) 698-7512 email: district12@senate.virginia.gov
Senator Wampler - (804) 698-7540 email: district40@senate.virginia.gov
Delegate M. Kirkland Cox -- (804) 698-1066 email: delkcox@house.virginia.gov
Delegate Johnny S. Joannou -- (804) 698-1079 **no email**
Delegate S. Chris Jones-- (804) 698-1076 email: delcjones@house.virginia.gov
Delegate R. Steven Landes --(804) 698-1025 email: delslandes@house.virginia.gov
Delegate Lacey E. Putney-- (804) 698-1019 email: dellputney@house.virginia.gov
Delegate Beverly J. Sherwood -- (804) 698-1029 email: delbsherwood@house.virginia.gov
Paula Price
MHAV
Executive Director
Federal Appeals Court Rules Against California's Reduction in Medicaid Rates
By Tom Gilroy BNA March 5, 2010
LOS ANGELES—The U.S. Court of Appeals for the Ninth Circuit reiterated March 3 its oft-stated opinion that California may not cut its Medi-Cal reimbursement rates purely for budgetary reasons, but instead must rely on responsible cost studies, prior to any cuts, to show that the planned reductions do not reduce access to care for Medicaid recipients (California Pharmacists Assn. v. Maxwell-Jolly, 9th Cir., No. 09-55532, 3/3/10).
The ruling, affirming a preliminary injunction granted by a federal district court judge in February 2009 against a planned 5 percent rate cut voted by the Legislature in September 2008 (A.B. 1183), again relied heavily on the Ninth Circuit's 1997 decision in Orthopaedic Hospital v. Belshe, , 103 F.3d 1491. In Orthopaedic, the court held that Section 30(A) of the Medicaid Act requires that payments for Medi-Cal services “must be sufficient to enlist enough providers to provide access to Medicaid recipients.”
That, in turn, required that the Department of Health Services, the predecessor agency to the current Department of Health Care Services (DHCS), “must rely on responsible cost studies, its own or others,’ that provide reliable data as a basis for its rate setting.”
Judge Christina A. Snyder of the U.S. District Court for the Central District of California had granted a preliminary injunction against the A.B. 1183 reimbursement cuts. Snyder cited the Ninth Circuit's decision in Orthopaedic, and said a DHCS analysis supporting the rate reductions was completed well after enactment of the law, and thus did not meet the requirements set out in Orthopaedic.
The challenge to the rate cuts was brought by a group of adult day health care centers (ADHCs), hospitals, pharmacies, and other beneficiaries of the state's Medicaid program, known as Medi-Cal. It was similar to a lawsuit filed in 2008 by other providers protesting a 10 percent Medi-Cal rate cut, which Snyder also blocked, and the Ninth Circuit upheld (Independent Living Center of Southern California v. Shewry, C.D. Cal., No. CV 08-3315 CAS (MANx), preliminary injunction grated 8/18/08) (162 HCDR, 8/21/08).
More recently, Snyder on Feb. 24 granted, on virtually identical grounds as the other cases, a preliminary injunction sought by the California Hospital Association, against state legislation (A.B. 5) that effectively freezes certain designated hospital services at 2008-2009 levels (California Hospital Association v. Maxwell-Jolly, C.D. Cal., No. CV 09-8642 CAS (MANx), preliminary injunction granted 2/24/10).
Rejecting State's Argument
In its appeal of the adult day care centers' preliminary injunction, the state argued that Orthopaedic did not hold that rate-setting had to be based upon pre-enactment legislative studies undertaken and completed by the Legislature itself prior to the action authorizing implementation of the cuts. That case focused solely on the department's actions, and thus only the department was required to consider Section 30(A) requirements, the state maintained.
But the Ninth Circuit three-judge panel disagreed. The court in Orthopaedic did, in fact, focus on the department, since it was setting the rates in that instance. Nevertheless, the state is “misguided” in thinking that focus “absolves the legislature of the same requirements when it sets rates,” Judge Milan D. Smith Jr., who wrote the opinion, stated. In Orthopaedic, the Legislature was “one step removed from the regulations promulgated by the Department,” and thus the Ninth Circuit had no reason to focus on what that body considered before rates were set, Smith noted. “Yet if the legislature elects to bypass the Department, and set rates itself, it must engage in the same principled analysis we required of the Director in Orthopaedic II,” he added
“In sum, we find nothing remarkable in holding that the final body responsible for setting Medicaid reimbursement rates must study the impact of the contemplated rate reduction on the statutory factors of efficiency, economy, quality of care, and access to care prior to setting or adjusting payment rates,” the court wrote. The appellate court also agreed with Snyder that the DHCS's post hoc analysis of the rate cuts did not satisfy the requirements of Orthopaedic. “To satisfy Section 30(A), any analysis of reimbursement rates on the statutory factors of efficiency, economy, quality, and access to care must have the potential to influence the rate-setting process,” the court ruled.
Yet the DHCS analysis of A.B. 1183 with regard to adult day care centers was issued more than five months after enactment of the law, it noted. While that was still before the cuts were actually implemented, the Ninth Circuit was not persuaded by the DHCS's argument that the director could have vetoed the cuts if he determined they did not comply with Section 30(A).
Finally, the appellate court rejected the state's claim that the lower court erred when it found that plaintiffs demonstrated a likelihood of irreparable harm if the preliminary injunction was not granted. In fact, showing a procedural violation of the statute, namely the state's failure to consider the impact of the rate cuts on the statutory factors set forth in Section 30(A), may demonstrate a likelihood of success on the merits that the setting of provider reimbursement rates conflict with Section 30(A), the court stated.
If at least some providers stop treating Medi-Cal beneficiaries as a result of the rate cuts, and evidence indicates that at least some adult day care center providers would stop treating beneficiaries due to A.B. 1183, that might be sufficient for a finding of irreparable harm, Smith wrote.
“We have now handed down multiple decisions instructing the State on Section 30(A)’s procedural requirements,” Smith noted in the court's conclusion. “We trust that the State now understands that in order for it to comply with Section 30(A)’s ‘requirement that payments for services must be consistent with efficiency, economy, and quality of care, and sufficient to ensure access,’ …it must: 1) ‘rely on responsible cost studies, its own or others,’ that provide reliable data as a basis for its rate setting,’ … and 2) study the impact of contemplated rate change(s) on the statutory factors prior to setting rates, or in a manner that allows those studies to have a meaningful impact on rates before they are finalized,” he added. Because the state did neither with regard to A.B. 1183, the district court's order granting plaintiffs a preliminary injunction was affirmed, Smith added.
Reaction to Decision
The DHCS did not return a call seeking comment on the decision.
Lloyd Bookman, of Hooper, Lundy & Bookman in Los Angeles, who along with colleagues Byron J. Gross and Jordan B. Keville, represented the plaintiffs, told BNA March 3 his clients “obviously are very delighted with the Ninth Circuit's decision.”
Bookman also said he hoped the state Legislature, and the DHCS, would heed what the court has said when seeking to adjust Medi-Cal rates.
Text of the Ninth Circuit opinion is at http://www.ca9.uscourts.gov/datastore/opinions/2010/03/03/09-55532.pdf. A not-for-publication memorandum in the case is at http://www.ca9.uscourts.gov/datastore/general/2010/03/03/0955365mem.pdf
The following is from VOCAL
*********************************************
The House and Senate Budget Bills currently do not match each other. The Legislature must reconcile them and are actively working on that task now. If the information below about Medicaid eligibility is of concern to you, you can use the information at the end of this message for the contact information for the Budget Conferees.
If you choose to contact the Conferees do so by close of business today, Friday, March 5th.
Senate Bill 30 contains a provision that would reduce the Medicaid eligibility from the current 80% of Federal Poverty Level to 75% of Federal Poverty Level.
-This change will affect approximately 9,950 individuals receiving public mental health services.
-The critical services that the need to remain in the community will be severely impacted: psychiatry, medications, case management, day treatment, and psychosocial rehabilitation
-The reduction will not provide real savings for Virginia because the needs of the individuals must be met with General Fund dollars, especially if the individuals fall back on higher-cost crisis-driven care such as inpatient acute care at state hospitals.
-The eligibility was raised from 75% to 80% in 2001 after a 4 year Hall-Gartlan study of the system, and the drive to maximize Medicaid reimbursement and limit General Fund obligations.
Budget Conferees:
Senator Colgan -(804) 698-7529 email: district29@senate.virginia.gov
Senator Houck - (804) 698-7517 email: district17@senate.virginia.gov
Senator Howell - (804) 698-7532 email: district32@senate.virginia.gov
Senator Saslaw - (804) 698-7535 email: district35@senate.virginia.gov
Senator Stosch - (804) 698-7512 email: district12@senate.virginia.gov
Senator Wampler - (804) 698-7540 email: district40@senate.virginia.gov
Delegate M. Kirkland Cox -- (804) 698-1066 email: delkcox@house.virginia.gov
Delegate Johnny S. Joannou -- (804) 698-1079 **no email**
Delegate S. Chris Jones-- (804) 698-1076 email: delcjones@house.virginia.gov
Delegate R. Steven Landes --(804) 698-1025 email: delslandes@house.virginia.gov
Delegate Lacey E. Putney-- (804) 698-1019 email: dellputney@house.virginia.gov
Delegate Beverly J. Sherwood -- (804) 698-1029 email: delbsherwood@house.virginia.gov
Thursday, February 25, 2010
Alerts on Health Reform, Medicaid Funding Increase
February, 2010
Time to Raise Your Voice—TAKE ACTION!
Alerts on Health Reform, Medicaid Funding Increase
This is a crucial time to raise your voice. In the next weeks, Congress will be deciding whether it moves forward on health reform. In addition, there’s an opportunity to extend vital increases in federal support for state Medicaid programs. But progress on these items won’t happen unless your legislators hear from you. Use the Action Alerts linked below to let Congress know you want them to move on health reform and Medicaid increases.
Health Care Reform: On Thursday, February 25, the White House will host a summit that will bring leaders from both parties together and seek to put health care reform back on track. The summit will be broadcast live on C-SPAN beginning at 10 am EST. Lawmakers will discuss a plan released this week by President Obama that would put families and small businesses in control of their health. The President’s plan adopts the Senate-passed bill while incorporating a number of provisions from the House-passed health care reform bill and other key changes, including a proposal to give the government the ability to block huge increases in insurance rates. You can read the plan here.
This reform plan would cover most uninsured Americans and access to mental health care and substance use treatment would be greatly expanded. In addition, significant steps would be taken to improve coordination between behavioral health and general health care. Additional Medicaid federal financing for all states is also proposed as the President’s plan would eliminate the special provision for Nebraska’s Medicaid program included in the Senate-passed bill. In addition, the Medicare “donut hole” for prescription drug coverage would be closed. The President would also add education and training grants for mental and behavioral health care. In addition, this proposal would support a loan repayment program for pediatric, mental and behavioral health specialists who provide services to children and adolescents in underserved areas or with underserved populations. In addition, new conditions of participation in Medicare would be imposed on community mental health centers to ensure they are providing necessary and high quality care.
Your voice is crucial to moving reform forward. Tell your legislators that they need to continue the fight for reform and complete action on an overhaul of the system. Use this form to contact them. TAKE ACTION!
Medicaid: The 2009 American Recovery and Reinvestment Act (ARRA) included a temporary increase in federal Medicaid matching funds to help alleviate state budget pressures and prevent cuts in coverage during the current economic downturn. This increase in Medicaid funding ends in December of this year (2010), but states continue to face extraordinary difficulty balancing their budgets for the next fiscal year. As a result many are considering cutting Medicaid benefits and eligibility, as well as provider rates as they develop their 2011 budgets. Senator Jay Rockefeller (D-WV) has introduced a bill, S. 3000, to extend the increased Medicaid funding provided in the ARRA.
The House passed an extension of the increase in federal Medicaid funding in December as part of a jobs creation bill called the “Jobs for Main Street Act” (H.R. 2847). The bill would provide a six-month extension of the increase in the federal Medicaid funds—amounting to $23.5 billion in additional federal funding for states. The Senate has also been working on a jobs creation bill, but the latest version proposed by the Democratic leadership did not include an extension of the federal Medicaid funding. However, the Senate plans to take up additional legislation in the weeks ahead to spur job and economic growth and this legislation should include an extension of the Medicaid funding increase.
State governments and governors are right now in the midst of developing their budgets for next year, and they need assurance that additional federal Medicaid funds will be forthcoming or else we will likely see dramatic cuts in Medicaid coverage. It will also be important to urge that these additional Medicaid funds come with strong maintenance of effort requirements to ensure these funds are only used to preserve Medicaid coverage. As Senate Democrats take steps to spur jobs and provide economic assistance, this is a key opportunity to urge them to include additional Medicaid funds for the states. Go to our Alert to contact your Senators. TAKE ACTION!
Mental Health Parity: Tell Us Your Story
The new federal mental health parity law became fully effective on January 1 of this year. It states that coverage in most insurance plans (generally those with 51 or more workers) for mental health and substance use must be on a par with your medical and surgical coverage. That means coverage for mental health and substance should require the same deductibles and co-payments. You can read more about the law and how it benefits you here.
Help us make sure the law is working for you by telling us your story. Is your health plan following the law? Did it drop mental health and substance use coverage? Whether you can report a success or problem—we want to hear from you. Go to our website and the form linked here to tell us your story. Your information will be kept confidential unless you want to share it with others.
Good News in Budget
The Obama Administration is proposing a Fiscal Year 2011 Budget that contains increases for most of the nation's public health agencies. The budget, which was released early in February, prioritizes public health programs, including increases in funding for the Substance Abuse and Mental Health Services Administration (SAMHSA), despite a difficult fiscal landscape.
Mental Health America looks forward to working with Congress and the Administration to build upon the proposed budget, which includes a $110 million increase (3.1 percent) for SAMHSA, a $1 billion increase (3 percent) for the National Institutes of Health and a $5.2 billion increase (8 percent increase) for mental health care services at the Department of Veterans Affairs.
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About the Advocacy Network
Mental Health America’s Advocacy Network is a powerful voice for change that is made up of thousands of individuals nationwide who take an active role in protecting America’s mental health through legislative advocacy. Together, we speak out and make our voice heard on equal access to care, federal funding, treatment and prevention.
Wednesday, February 17, 2010
Governor's Budget Recommendations: Bad News Gets Worse
From the Desk of Paula Price
MHAV Executive Director
Today Governor McDonnell announced his budget recommendations. For a full copy of his speech and specific recommendations go to http://www.governor.virginia.gov/News/viewRelease.cfm?id=47
As a result of the legislature’s rejection of former Governor Kaine’s tax increases the budget has an additional $2 billion dollar hole. Governor McDonnell’s proposal attempts to fill in that hole. His proposal restores some funds to public safety and K-12 and has no further cuts to higher education. However, there are significant cuts in health and human services as well as some other areas.
Now that the Governor has made his proposals they will go to the money committees in the House of Delegates and in the Senate. They will change the recommendations as they see fit and will probably make their report public by Sunday or Monday. Remember that the Governor’s proposals are just that. They will change. So hold on this could be a fast bumpy ride.
Some of the proposals are as follows:
•Consumer directed Medicaid services will be eliminated assumes 50% of people currently in program no longer need care and the other 50% will receive care from agencies.
•Lowers income requirement for long term care Medicaid eligibility.
•Freezes new enrollment into FAMIS
• Additional 10% cut in direct funding to CSBs totaling 15%
•Closure and sale of Commonwealth Center for Children and Adolescents with funds going to community based services, read CSBs.
•Elimination of funds for Healthy Families of Virginia
•Reduction of $1.8 million for Free Clinics
•Eliminate funds for local dental services (currently serves 24,066 people in 24 districts)
•Reduces funding for Virginia Health Care Foundation by 10, 15 and 40% over the next three years
•Eliminates funding for Child Advocacy Centers
There are many other areas of concern so I highly recommend you read the entire document. Health and Human Services starts on page 12 of the document. Block Grants could be at risk again but not to panic yet. I am told by the powers that be individual grants are not at risk.
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