The News Hound

[policy doctor]

Should affect SNP's.and Duals....U think?

Growing Number of Physicians Not Accepting New Medicaid Beneficiaries Amid Federal Payment Cuts, Rising Health Costs

[Jul 19, 2007]

The growing number of physicians who do not accept new Medicaid beneficiaries because of costs "is a large, little-discussed hurdle to some ambitious efforts to broaden health care coverage," the Wall Street Journal reports. According to the Journal, many state Medicaid programs, "straining under surging costs, are balancing their budgets by freezing or reducing payments to doctors," resulting in physicians -- particularly specialists -- dropping out of the program, according to the Journal. A 2006 report by the Center for Studying Health System Change http://www.hschange.com/ showed that almost half of all physicians polled said they had stopped accepting or were limiting the number of new Medicaid beneficiaries they will see.

However, expanding coverage through Medicaid or private Medicaid HMOs is a "linchpin" in universal health coverage plans in several states, including Massachusetts and California, as well as in campaign platforms of some 2008 presidential candidates. California Gov. Arnold Schwarzenegger (R) has proposed a universal coverage initiative that would place surcharges of 2% on physician fees and 4% on hospital revenue. The money would be used to increase Medicaid payments to encourage providers to treat more beneficiaries.

In addition, Michigan Gov. Jennifer Granholm (D) has proposed extending Medicaid coverage to 500,000 uninsured state residents. The Journal reports that policymakers hope the proposal will include increasing Medicaid payment rates to levels similar to Medicare, which are about two-thirds higher. However, many people are concerned that Granholm's plan to enroll more residents in the program "will give doctors even less reason to accept" Medicaid beneficiaries, according to the Journal (Fuhrmans, Wall Street Journal, 7/19).

 

[policy doctor]

Re: The News Hound7/27/07

Cost-Effective Health Care

Your Weekly Medicare Consumer Advocacy Update

July 26, 2007 Volume 7, Issue 29

The Democratic leadership that took over Congress in 2007 unveiled legislation this week that would make dramatic improvements in Medicare, especially the prescription drug benefit. While seniors' advocacy groups are cheering the proposed "Children's Health and Medicare Protection Act," an insurance industry trade group is spending a lot of money on TV ads to convince people it's a terrible idea. The commercials began running across the country this week, urging viewers to tell their congressional representatives to oppose it.

There are several provisions that the industry doesn't like that will protect consumers and save taxpayers money.

First, taxpayers would no longer be forced to overpay private Medicare Advantage (MA) plans, which get an average of 12 percent more per member than what it would cost under Original Medicare. These overpayments, which amount to $54 billion over the next four years, would be phased out by 2011.

In addition, MA plans that do not spend at least 85 percent of their payments from Medicare on medical benefits beginning in 2010 would be paid less and eventually would be excluded from participation in the MA program. These payments are a monthly allowance paid by Medicare for each member enrolled. Currently, there is no requirement for how much of that money must go toward providing health care and how much can be diverted to, for example, executive bonuses.

Under another section of the bill, MA plan members could not be charged copayments or other fees for benefits that are higher than what people in Original Medicare pay.

Does that sound so terrible? Only to insurance companies.

There are a number of provisions that would help people with Medicare.

Some of the proposed changes would help people whose incomes are too low to afford Medicare's out-of-pocket expenses. Eligibility criteria for the Medicare Savings Programs and the Part D drug benefit's Extra Help program would be expanded so that more low-income people with Medicare will receive discounted premiums. Allowable assets for participation in both programs would be increased to a maximum of $17,000 for an individual and $34,000 for a couple, with annual increases of $1,000 and $2,000, respectively.

People with Medicaid and Medicare would not be randomly assigned to private drug plans with no consideration of whether those plans cover their medications. To ensure that they have access to the drugs they need, they would be enrolled in only those plans that cover 95 percent of the 100 brand-name drugs and 95 percent of the 100 generic drugs most prescribed for people with Medicare.

People who are eligible for Extra Help--which provides drug plan premium discounts--would not have to pay a late penalty when they sign up for coverage.

In addition, the bill includes changes that would help prevent a lot of the rampant marketing fraud and abuse currently being perpetrated by the private plans. The National Association of Insurance Commissioners would be requested to develop standardized national marketing and advertising rules for private Medicare Advantage and stand-alone drug plans. The rules would be adopted by the U.S. Department of Health and Human Services and companies would have to follow them or face penalties for violations. States would be given the power to police the plans and impose fines on those that violate the rules.

The legislation would also protect people who joined a plan because of the drugs covered in its formulary. Members of drug plans that make midyear changes in formularies (the list of covered drugs) would be able to change plans, unless the formulary change was required for safety reasons.

Furthermore, the bill would give Medicare the ability to stay current with medical practice in its coverage of preventive health benefits. The secretary of health and human services would have the discretion to add coverage of new services to prevent or detect illness or disability. Fees for existing preventive services would be eliminated.

The legislation would make these necessary improvements while also expanding the State Children's Health Insurance Program due to expire in September.

Call your representatives to ask them to support these important improvements to Medicare and the provision of health care coverage to uninsured children. It's the "Children's Health and Medicare Protection Act," House Resolution 3162, and it should be enacted into law. Call the toll-free congressional switchboard at 800-828-0498 and ask to speak to your representatives.

Medical Record
"Clearly these [MA insurance] companies need more rigorous oversight and CMS is not prepared or seemingly unable to do the job. With all due respect, I find it highly unlikely, based on our experience during this situation, that CMS will be able to 'do better,' as Ms. [Acting Administrator Leslie] Norwalk suggests in a recent press release" (Testimony of Jim Poolman, Insurance Commissioner, State of North Dakota, before the U.S. House of Representatives Committee on Energy and Commerce Subcommittee on Oversight and Investigations on "Predatory Sales Practices in Medicare Advantage," June 26, 2007). http://energycommerce.house.gov/cmte_mtgs/110-oi-hrg.062607.Poolman-Testimony.pdf"So today I ask again, that Congress unencumber me for the unproductive, unnecessary, and dangerous preemptions that expose my citizens to the neglect and abuse I have described and let me do my job. ...If government cannot protect our most vulnerable--our children, our frail, our disadvantaged, our elderly--of what use are we?" (Testimony of Kim Holland, Oklahoma State Insurance Commissioner, before the U.S. House of Representatives Committee on Energy and Commerce Subcommittee on Oversight and Investigations on "Predatory Sales Practices in Medicare Advantage," June 26, 2007). http://energycommerce.house.gov/cmte_mtgs/110-oi-hrg.062607.Holland-Testimony.pdf

 

[midwestbroker]

There is always going to be bad news out there.

What kills me is that no one is talking about the PFFS thing. I have not seen or heard one story on it. Nor have I gotten any phone calls from clients concerning it.

 

[policy doctor]

At a meeting today I heard that Pffs plans are bit with high claim experience ratio to their zero-premium or low premium plans.

Supposedly, they are reconfiguring those plans for the 2008 rollout.

So if true, that might explain why they stopped offering PFFS thru the agents to slow down enrollment. then again, this was an HMO plan being offered by Aetna....soooo

Aetna may be payng $400/app in 2008 enrollment.....

 

[policy doctor]

Re: The News Hound 8/2/07

U.S. House passes health-care bill

By LARRY LIPMAN

Palm Beach Post Washington Bureau

Wednesday, August 01, 2007

WASHINGTON -- Voting largely along party lines, the House voted 225-204 Wednesday to approve a major expansion of the children's health insurance program and significant changes to the Medicare program.

The bill would expand the children's health program by $48 billion over the next five years. All four area congressmen voted for it.

President Bush has called for a $5 billion expansion, and the Senate is expected to vote later this week on a proposed $35 billion expansion.

Currently, about 6 million low-income children are covered under the State Children's Health Insurance Program (commonly known as SCHIP).

The House bill would cover an additional 5 million children, whereas the Senate bill would cover an additional 4 million children. According to the Congressional Budget Office, about 800,000 children would lose coverage under the Bush plan.

Bush has indicated he would veto either congressional version and has called them an unwarranted expansion of the program that would lead to a government-run health care system.

hea;thUnless Congress and the president can resolve their differences by Sept. 30, the 10-year-old federal-state program will expire.

In Florida, the program helps cover about 224,000 children, more than 80 percent of whom are enrolled in the state's Healthy Kids program, according to Tara Klimek, spokeswoman for Alex Sink, the state's chief financial officer.

There are nearly 720,000 uninsured children in Florida.

Although Florida has not been able to spend all of its federal SCHIP money because of bureaucratic hurdles to enrollment, U.S. Rep. Kathy Castor, D-Tampa, predicted that if changes are made to the state's system, thousands more children would be covered under the House bill. She did not have a more precise estimate.

The Senate bill would be financed through an increase in tobacco taxes. The House bill would be financed by a smaller increase in tobacco taxes plus deep cuts in payments to Medicare providers.

The House bill would cut roughly $193 billion over 10 years primarily by reducing payments to private, managed care Medicare Advantage plans. Those plans currently receive about 12 percent more than providers under Medicare's traditional fee-for-service system.

Eliminating the difference in payments over the next four years would extend the Medicare program's financial solvency by about three years, from 2019 to 2022, according to Medicare's actuaries.

Meanwhile, the bill would increase Medicare spending by about $117 billion over 10 years by eliminating a scheduled 10 percent fee cut for doctors and providing increased subsidies for low-income beneficiaries, free preventive care screenings and higher payments to rural health providers.

There are about 68,500 beneficiaries enrolled in Medicare Advantage plans in Palm Beach County; 8,900 in St. Lucie County and 4,200 in Martin County.

Republicans also warned that the Medicare Advantage cuts would deprive millions of beneficiaries who currently are covered by private managed care plans of their benefits.

Democrats responded that the managed care plans originally had boasted they could provide better care for less money than was provided through the fee-for-service system. They also argued that cutting the Medicare Advantage payments and enhancing preventive care would extend Medicare's financial solvency.

Republican leader John Boehner of Ohio complained the Democrats were abusing their majority power by not letting the minority party offer an alternative proposal. Republicans lost a bid to send the bill back to committee with instructions to come back with a one-year extension of the current program.

Boeher said that while voters sent Congress a message last year when Republicans lost control of both house, "I don't think that message was: I want you to cut my Medicare Ö and I want you to raise my taxes." But Rep. John Dingell, D-Mich., said the bill "is about taking care of our kids. It's about taking care of the future of the country." Rep. Pete Stark, D-Calif., said, "the public is sick of radical ranting. They want health care for kids and seniors."