CTAS Legislative Affairs Update   << West View of the US Capitol — Courtesy of the Architect of the Capitol, Washington, D.C.   >> North View of the Texas Capitol — Courtesy of the State Preservation Board, Austin, TX

June 14, 2010

State Agencies Asked to Cut Budgets Another 10 percent
Brings total to 15 percent for Agency Budget Cut Proposals

With an expected budget deficit of $18 billion, and revenue forecasts remaining dire, the state of Texas is pushing forward with cuts that could reach as high 15% percent of current operating budgets. State leaders are expected to hold a number of hearings in the next three weeks directed at identifying budget savings and revenue generators.

The state has not seen this type of budget deficit in the past 20 years. In 2003, the state made drastic cuts in Medicaid rates, privatized many eligibility services, and down-sized health and human service personnel. This deficit is twice the level we faced in 2003.

The legislative alarm is ringing and TAHSA is responding. As TAHSA (Texas Association of Homes and Services for the Aging) prepares for the upcoming session, we are calling on all of our members to actively and aggressively participate in contacting your state legislators.

So, what can you immediately do to get involved:

1. Contact your local state representative by phone and e-mail with this simple message:
   Do Not Cut Medicaid Rates for Nursing Homes and Aging Services in Texas.
   Do Not Cut Health and Human Services in Texas.
2. Invite your legislator to your facility to discuss the existing funding problems facing Medicaid.
3. Let your local civics organizations, religious groups, and other local leaders know about the potential cuts to health and human services.

Now is the time to act!
If we are to preserve the existing funding, we must move forward aggressively and rapidly.

June 10, 2010

Closure of the Doughnut Hole Begins Thursday, June 10, 2010

The Department of Health and Human Services (HHS) will begin sending the $250 rebate checks to consumers in the Medicare drug coverage gap, also known as the “doughnut hole.” This rebate is a result of provisions included in the health reform law. HHS will send an estimated 80,000 checks today to people who have entered the coverage gap since the start of 2010, and will continue to send the rebates on a rolling basis approximately every month to people who newly enter the doughnut hole.

The rebate checks will be sent automatically and there are no forms to fill out. Consumers should protect themselves from fraud, and should not provide personal information, such as Social Security numbers or bank account numbers, to anyone who contacts them about the rebate. People should report potential fraud by calling 1-800-MEDICARE.

The health reform law gradually phases out the doughnut hole. This year, people who enter the coverage gap will receive the one-time $250 rebate check. Beginning next year, consumers in the doughnut hole will receive a 50 percent discount on brand-name drugs and a 7 percent discount on generics. The share consumers pay for both brand-name and generic drugs will decrease until the gap is eliminated in 2020, when consumers will pay the standard 25 percent of the costs for drugs while in the doughnut hole. PDF with more information >>

May 4, 2010

The Honorable Senator Jeff Wentworth was the keynote speaker at the grand opening of the Seniors Community Gardens at Eden Place Apartments on May 4, 2010. CTAS was represented by Secretary Cheryl Craft. Large photos >>

April 12, 2010 - Links Updated

The Kaiser Family Foundation has posted two useful reports summarizing the new Health Care Reform Law and the timeline for its implementation:

• Health Care Reform Law Summary

• Health Care Reform Law Timeline

March 23, 2010

President Barack Obama, in a major victory for his administration, has signed a landmark bill that aims to overhaul the U.S. healthcare system.

February 18, 2010

PECOS IS DELAYED—CMS Postpones PECOS to January 3, 2011
CMS announced today that it will delay until January 3, 2011 the provider enrollment requirements under the Provider Enrollment, Chain and Ownership System (PECOS).

Facing overwhelming enrollment problems, CMS recognized that it was unable to implement PECOS on the scheduled implementation date of April 5, 2010.

AAHomecare has been working closely with CMS to raise awareness about troubling aspects of the program since the issue first arose in October 2009. AAHomecare met with senior CMS officials repeatedly to raise concerns about how this program would adversely affect Medicare HME providers and patients. In a formal letter to CMS, the Association also requested a lengthy delay so patient access to homecare would continue and provider cash flow would not evaporate when the program was implemented on January 5, 2010 – the date for PECOS implementation before the first postponement.

AAHomecare communicated with CMS officials several times per week leading up to the latest delay in order to keep CMS abreast of actual provider experiences and shortcomings of the PECOS program.

The Association also reached out to the American Medical Association (AMA) and the physician community to work cooperatively in order to obtain a delay in the program. An AMA representative said, “We are getting plenty of calls and emails from physicians saying they are not able to get through to customer service lines like PECOS if they have a question. There are long wait times to get through and general problems getting applications processed.” CMS stated on the call today that it plans to send a letter to all physicians who last enrolled more than six years ago to remind them to re-enroll in PECOS. The agency also said providers will continue to receive informational messages on PECOS, and CMS will make updates to the physician records periodically.

“PECOS is a classic example of the documentation and administrative burden that is part of doing business with Medicare,” commented AAHomecare President Tyler Wilson. “In many cases, the rules and regulations create almost impossible demands for filing claims. AAHomecare was a pit bull in fighting this issue through our contacts with CMS and I am glad to see the agency pull back from the brink of implementing such an impractical requirement.”

While the PECOS program has been delayed, HME providers will continue to see warnings on their claims because the PECOS enrollment process will continue. AAHomecare will push CMS to publicize PECOS requirements with physicians similar to the way it handled the National Provider Identifier (NPI) number issue. During the NPI start-up process, CMS was sending out public announcements several times each week.

AAHomecare Vice President for Government Affairs Walt Gorski said, “Ideally, we would like to see some sort of requirement that ties physicians to the PECOS enrollment process. Their claims were not in jeopardy, but ours were. The burden should not be placed on the HME provider to press physicians to enroll. Nevertheless, this is an excellent outcome.”

Gorski added, “We greatly appreciate the work of the AAHomecare State Leaders’ Advisory Council for developing a PECOS survey to document the extent of the PECOS problems. The delay of implementation of PECOS edits and claims rejections demonstrate the importance of advocacy and action within the home medical equipment sector and also the value of collaboration with other health sectors.”

December 31, 2009

The United States Department of Health and Human Services issued two sets of much-anticipated federal regulations that significantly further the government's healthcare information technology adoption agenda. The first set of regulations lists the “meaningful use” criteria that healthcare providers must meet to qualify for federal IT subsidies based on how they use their electronic health records. The second set of regulations lays out the standards and certification criteria that those EHRs must meet for their users to collect the money.

More Information >>

December 24, 2009

Senate approves health care reform bill
The Senate has approved a massive health reform package, marking the first time in history that both chambers of Congress have passed comprehensive legislation seeking to ensure that nearly all Americans have health coverage.

The final vote came five weeks after the Senate started to vigorously debate the bill and two months after the Finance Committee approved what would become the framework for the legislation.

All 60 members of the Democratic Caucus voted for the bill, which failed to gain a single Republican vote. For providers and insurers, the 10-year, $871 billion package would bring sweeping changes in health care financing aimed at insuring 31 million Americans who currently have no coverage.

More information >>

December 22, 2009

*Senate health-care reform bill passes another hurdle*

The Senate cleared a set of key procedural hurdles on President Obama's health-care legislation early Tuesday with more party-line votes, continuing the effort to pass the $871 billion bill before Christmas.

All 60 members of the Democratic caucus supported votes that set up a third and final 60-vote cloture hurdle for Wednesday, while all 39 Republicans in the chamber voted to block the action.

More at The Washington Post

December 21, 2009

The American Medical Association, the nation’s largest physician lobby has officially endorsed the Senate’s health care reform package after it won assurances from lawmakers that they would work to craft a long-term solution for Medicare payments come January 2010.

More at Modern Health Care

* * * *

At 1:00 am Sunday in a snow covered Capitol the United States Senate voted in lock-step along party lines 60 to 40 to pass a crucial procedural measure to cut-off a Republican filibuster of the Health Care Reform bill. Both parties hailed the vote as seismic. “Democrats said it showed them poised to reshape the health system after decades of failed attempts.”… “Republicans said that the bill was fatally flawed and that voters would retaliate against Democrats at the polls in November.” (source: www.nytimes.com) Several more procedural votes are scheduled and are expected to pass along the same 60-40 partisan lines. The final vote is tentatively scheduled for 7 p.m. on Christmas Eve.

December 19, 2009

Sen. Ben Nelson of Nebraska, the lone Democratic holdout on the massive health care overhaul bill, said on Saturday he would vote to move the legislation forward.

December 17, 2009

Passage of Health Care Bill Could Come Christmas Eve

Senators are preparing to pull some late nights and early mornings at the Capitol as Democrats push to pass a bill to retool the nation’s health care system before the end of the year.

With partisan tensions running high, and Majority Leader Harry Reid, D-Nev., still struggling to secure 60 votes to advance the health care bill, it looks increasingly possible that the Senate could be in session on Christmas Eve, and perhaps the week between Christmas and New Year’s Day as well...more>>

Source : CQ Politics

December 14, 2009

Senate Democrats Likely to Drop Medicare Expansion
By CARL HULSE and ROBERT PEAR

WASHINGTON — Senate Democratic leaders said Monday that they were prepared to drop a proposed expansion of Medicare and make other changes in sweeping health legislation as they tried to rally their caucus in hopes of passing the bill before Christmas.

After a tense 90-minute meeting on Monday evening, Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, was asked if Democrats were likely to jettison the Medicare proposal.

“It’s looking like that’s the case,” Mr. Baucus said, indicating that the provision might be scrapped as a way of “getting support from 60 senators.”

Source: New York Times

December 7, 2009

The U.S. Senate voted to pass the Community Living Assistance Services and Supports (CLASS) Act on Friday, December 4th, approving it for inclusion in the healthcare reform bill. The CLASS Act was championed by former Senator Ted Kennedy as a benefit to pay for home care needs for seniors and the disabled.

Top Features of the CLASS Act:

• Funded by Voluntary Employee Participation
• May collect benefits after 5 years
• Benefit paid in cash - average of $75 per day lifetime benefit
• Monthly premium contribution @ $50

Because the benefit is paid in cash, it may be used to pay any senior care provider the person chooses, or spent on other care needs, such as medical equipment and transportation. One goal of the CLASS Act is to prevent the need for nursing home care.

Read the details of the CLASS Act and the Senate floor statement by Senator Kennedy's replacement, Senator Kirk.

Source: Caregiverlist

November 21, 2009

Senate Vote Clears Way for Health Care Debate
The Senate voted on Saturday to begin full debate of major health care legislation, propelling President Obama's top domestic initiative over a crucial, preliminary hurdle — and past the angry opposition of Republicans — in a formidable display of muscle-flexing by the Democratic majority. The 60 to 40 vote, along party lines, clears the way for weeks of rowdy floor proceedings that will begin after Thanksgiving and last through much of December. Source: NYtimes.com

November 19, 2009

Senate Majority leader Harry Reid announced today that the first crucial vote on the $848 billion Senate version of the health-care overhaul package would likely take place Saturday. The vote will be a procedural vote on cloture which will determine if the bill goes to the Senate floor for further debate. All 40 Republican Senators will vote no. Senator Reid will need all 60 Democratic Senators to vote yes to invoke cloture. Three moderate Democratic Senators have not yet agreed to vote yes. An update will be posted after the vote takes place.

November 16, 2009

Curious about the legislative process for health care reform? The Kaiser Family Foundation prepared a PDF which outlines the process so far and what lies ahead.

November 9, 2009

Sweeping health care plan passes House in narrow majority of 220 to 215. The Senate will now become the main battleground in the health care fight as Democrats there ready their own bill for what is likely to be extensive floor debate.

October 14, 2009

The Senate Finance Committee voted today to approve legislation that would reshape the American health care system and provide subsidies to help millions of people buy insurance, as Senator Olympia J. Snowe, Republican of Maine, joined all 13 Democrats on the panel in support of the landmark bill. The vote was 14 to 9, with all of the other Republicans opposed.

With Tuesday's 14-9 vote, five congressional committees now have passed health-reform proposals. Democratic leaders are working to combine those efforts, largely out of public view, before the debate moves to the full House and Senate.

September 29, 2009

Side-by-side comparison of the House and Senate health care reform bills courtesy of the Kaiser Family Foundation: View, download, and/or print the PDF.

September 17, 2009

FDA Approves Vaccines for 2009 H1N1 Influenza Virus
Approval Provides Important Tool to Fight Pandemic

September 16, 2009

Senate Finance Committee chairman Max Baucus (D-Montana) has released the first draft of the committee's mark up of the health care reform act.

It is a mere 223 pages compared with the over 1000 page House version.

Quick notes:

• Trimmed down price tag of $853 billion vs over one trillion for House version.
• Covers 30 million uninsured (if they can afford it)
• Will cost on average about 13% of family income
• Broadly expands Medicaid, the state-federal insurance program for the poor, and provides government subsidies to modest-income individuals and families to help them buy coverage.
• The bill would also create new, state insurance marketplaces, or exchanges, were consumers could shop for insurance and compare plans.
• All of the insurance plans in the exchange would have to meet strict new government requirements. Insurance companies could not bar coverage based on pre-existing medical conditions, and could only increase the cost of premiums based on a small number of factors, like age, tobacco use and whether a plan is for an individual or a family.

September 14, 2009

HHSC Gets Grant to Help Employees Pay for Health Coverage

AUSTIN – The Texas Health and Human Services Commission (HHSC) has received a $50 million grant to provide cost sharing accounts to help low-income working Texans purchase health insurance. The grant through the federal Health Resources and Services Administration covers five years at up $10 million a year, and the state will contribute a 20 percent match. HHSC will use the funding to create cost savings accounts for Texans earning up to 300 percent of the federal poverty level, or about $66,000 for a family of four. Read the news release >>

CTAS Legislative Affairs Committee Report – September 2009 Report

HR 3200, America’s Affordable Health Choices Act of 2009 aka The Health Care reform Bill continues to work its way through the U.S. Congress. The bill has been referred to the following committees:
House Energy and Commerce -- Bill Text Revised
House Ways and Means -- Bill Text Revised
House Education and Labor -- Bill Text Revised
House Oversight and Government Reform
House Budget
Senate Finance Committee

The major issues concerning the health care reform bill currently being debated include: cost, coverage, and quality. The following is a quote from the non-partisan Congressional Budget Office (CBO) report on the health care reform bill as originally proposed in July, 2009.

“Collectively, those provisions would yield a significant increase in the number of Americans with health insurance. By 2019, CBO and the staff of JCT estimate, the number of nonelderly people without health insurance would be reduced by about 37 million, leaving about 17 million nonelderly residents uninsured (nearly half of who would be unauthorized immigrants). In total, CBO estimates that enacting those provisions would raise deficits by $1,042 billion over the 2010-2019 period.”

Some of the more salient points of the current health care reform bill include:

• Extending health care coverage to uninsured legal US residents
• Grandfathering in existing health care plans so that individuals happy with their current coverage can keep their plans
• Setting up government run health care exchanges where uninsured individuals could purchase “affordable” coverage
• Prohibit insurance companies from denying health insurance coverage based on pre-existing conditions
• Prohibiting insurance companies from dropping coverage when individuals become sick
• Prohibit insurance companies from setting annual or lifetime caps on coverage
• Require individuals to have insurance, enforced through tax penalty with hardship waivers. The penalty is 2.5 percent of income
• Require employers to provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payroll under $250,000 annually are exempt
• Individuals and families with annual income up to 400 percent of poverty level ($88,000 for a family of four) would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013
• Individuals could choose their insurance through a new Health Insurance Exchange open to individuals and, initially, small employers; it could be expanded to large employers over time. States could opt to operate their own exchanges in place of the national exchange if they follow federal rules.
• A committee would recommend an "essential benefits package" including preventive services, mental health services, oral health and vision for children; out-of pocket costs would be capped. The new benefit package would be the basic benefit package offered in the exchange and over time would become the minimum quality standard for employer plans. Insurers wouldn't be able to deny coverage based on pre-existing conditions.
• GOVERNMENT-RUN PLAN: A new public plan available through the insurance exchanges would be set up and run by the secretary of Health and Human Services. On average it would pay Medicare rates plus 5 percent to doctors.
• CHANGES TO MEDICAID: The federal-state insurance program for the poor would be expanded starting in 2013 to cover all non-elderly individuals with incomes up to 133 percent of the federal poverty level ($14,404)
• HOW IT'S PAID FOR: Revenue-raisers include: $544 billion from a new income tax surcharge on single people making $280,000 a year and households making $350,000 and above; $37 billion in other tax adjustments. About $500 billion in cuts to Medicare and Medicaid. About $200 billion from penalties paid by individuals and employers who don't obtain coverage.

And what about those infamous government mandated “Death Panels”? Happily, they don’t exist. The relevant section of the current House bill is sec. 1233 pgs, 424 – 434 “Advance Care Planning Consultation”: which mandates that practitioners provide individuals with “an explanation of:

• Advance care planning, including key questions and considerations, important steps, and suggested people to talk to
• Advanced directives, including living wills and durable powers of attorney, and their uses
• The role and responsibilities of a health care proxy [medical power of attorney]
• A list of national and State-specific resources to assist consumers and families with advanced care planning
• The continuum of end-of-life services and supports available, including palliative care and hospice

HR 3200 will continue to be hotly debated. The next main step is for the Senate Finance Committee to come out with their revisions to the House bill and for the debate to return to the floor of the House of Representatives.

Other Legislation of Interest

4/2/2009—Introduced by Rep. Rodney Alexander (R-LA)
Sunset of Life Protection Act of 2009 - Amends the Internal Revenue Code to allow a deduction from gross income for 50% of long-term care premiums without regard to the 7.5 % adjusted gross income limitation applicable to other medical or dental expenses. Allows individual taxpayers to claim such tax deduction regardless of whether they itemize other deductions. Referred to the House Ways and Means Committee.

3/25/2009—Introduced by Rep. Frank Pallone (D-NJ )
Community Living Assistance Services and Supports Act or the CLASS Act - Amends the Public Health Service Act to create a national, voluntary disability insurance program (CLASS program) under which:

• all employees are automatically enrolled, but are allowed to waive enrollment
• payroll deductions pay monthly premiums
• two-tiered benefits are provided, based on the level of disability, to purchase nonmedical services and supports that the beneficiary needs to maintain independence.

Establishes the Independence Fund within the Treasury. Requires the CLASS program to be treated for tax purposes in the same manner as a qualified long-term care insurance contract. Amends the Social Security Act to require each state to:

• assess the extent to which personal care services providers are serving or able to serve as fiscal agents, employers, and providers of employment-related benefits for personal care attendant workers, who provide personal care services to individuals receiving benefits under this Act
• designate or create entities to serve such purposes
• ensure that such entities will not negatively alter or impede existing programs, models, methods, or administration of service delivery that provide for consumer controlled or self-directed home and community services, impede the ability of individuals to direct and control their home and community services, or inhibit individuals from relying on family members for such services.

Requires the Secretary of Health and Human Services to establish a Personal Care Attendants Workforce Advisory Panel to examine and advise the Secretary and Congress on workforce issues related to personal care attendant workers.

Amends the Internal Revenue Code to allow:

• a deduction for premiums paid for the CLASS program
• a credit CLASS program enrollees with low income
• a credit for employers for the cost incurred to automatically enroll employees and withhold monthly premiums.

4/23/2009—Introduced by Rep. Michael Thompson (D-CA)
Medicare Telehealth Enhancement Act of 2009 - Amends title XVIII (Medicare) of the Social Security Act regarding telehealth services (furnished via a telecommunication system by a physician to an enrolled individual).

Removes current geographic restrictions on the provision of such services. Extends the meaning of store-and-forward technology, for any federal telemedicine demonstration program in Alaska or Hawaii, to include any telehealth program that has received any federal support from the Centers for Medicare & Medicaid Services (CMMS), the Indian Health Service, or the Health Services and Resources Administration (HSRA).

Authorizes a renal dialysis facility to participate in the telehealth program.

Authorizes payment of eligible telehealth providers or suppliers other than a physician or telemedicine practitioner.

Declares that any telemedicine practitioner credentialed by a hospital in compliance with the Joint Commission Standards for Telemedicine shall be considered in compliance with Medicare condition of participation and reimbursement credentialing requirements for telemedicine services.

Directs the Secretary of Health and Human Services to treat telehealth services furnished by a home health agency as a home health visit for Medicare purposes.

Authorizes coverage of remote patient management services, including home health remote patient management services, for certain chronic health conditions.

Directs the Secretary to establish a fee schedule for home health remote patient management services.

Expresses the sense of the Congress that the CMMS Administrator should be encouraged to:

1. expand the types of medical conditions for which remote patient management services are reimbursed under Medicare
2. provide for separate, non-bundled Medicare payment for such services; and
3. create, revise, and adjust codes for the accurate reporting and billing for such payment.

Establishes the Telehealth Advisory Committee.

Requires the Secretary to take its recommendations into account when adding or deleting telehealth services and in establishing related CMMS policies.

Directs the Secretary, acting through the Director of the HSRA Office for the Advancement of Telehealth, to make grants to expand access via telehealth to health care services for individuals in medically underserved rural, frontier, and urban areas.

Amends the Public Health Service Act to reauthorize telehealth network and telehealth resource centers grant programs.

Referred to: House Energy and Commerce, House Ways and Means

The Legislative Affairs Committee will continue to monitor Legislation State and Federal legislation of interest to seniors and organizations that serve seniors and provide updates and alerts to the members of CTAS.

CTAS Legislative Affairs Committee Report - August 2009

S 700, HR 1708 Ending the Medicare Disability Waiting Period Act total of 96 sponsors now.

TX State Legislature has approved an $0.80/hr increase in the funding rate for the attendant portion of rates for Medicaid community care programs as part of the 2010-11 General Appropriations Act; however, there are a few funding

issues that have not been resolved. Minimum wage increases to $7.25 per hour on Friday, July 24th.

Plans to expand health care coverage to all Americans continues to be a hot issue. Funding issues being a focal point. Most proposals rely heavily on deep provider cuts in Medicare programs ($51 billion over the next 10 years). The activities of three key House Committees are being holding hearings;

• Ways & Means
• Energy and Commerce
• Education and Labor

A bill is expected to be introduced soon.

The Senate Finance Committee Chairman Max Baucus (D-Mont) and ranking member Charles Grassly (R-Iowa) have been working behind the scenes to craft a bi-partisan approach to health care reform which will have the support of both parties. Another big issue surrounding health care reform is whether to include a public plan option. Lots of press on this issue this past week.

Representative Linda Sanchez (D-CA) introduced the Medicare Adult Day Services bill in congress on June 25^th CTAS LAC sent letters and emails in support of this bill.

Fifteen (15) Senators have called on Secretary of Labor Hilda Solis to work with Congress to close loopholes in the Fair Labor Standards Act exempting home-care health and companionship employees from wage-and-hour standards. Federally mandated wage rates for home health and companionship workers could have a deleterious effect on home health and non-medical custodial care businesses. Market based works best . CTAS LAC will follow this issue

The Senate Health, Education, Labor and Pensions (HELP) Committee declared with much fanfare last week that it was able to come up with S 697 and companion House bill HR 1721 named the Community Living Assistance Services and Supports Act (CLASS Act.) that would only cost the nation $61 billion dollars over ten years. To get to that relatively low estimate however, Senators resorted to a lot of fiscal sleight-of-hand, such as dumping much of the cost of covering uninsured on the States through Medicaid programs. The CLASS Act. Is aimed at the 2/3rds of senior citizens who will end up needing long term care. The voluntary plan would provide up to $50 per day ,depending on need, for in-home or nursing home care. Enrollees would pay a top premium of $65 per month. CBO estimates the program would drop into the red in 10 years as baby boomers retire. CBO will re-estimate costs over a 75 year period rather than 20 and premiums will be adjusted accordingly. See Kaiser Health News for more information

New Legislation and Its Impact on Your Selection Process — New Rules Under the Obama Administration — webcast
Details will be presented at the next CTAS meeting

THIS SUMMER WILL BE A VERY ACTIVE TIME FOR FEDERAL LEGISLATION RELATED TO HEALTH CARE REFORM. STAY TUNED.