On May 11 the PA Senate Public Health and Welfare Committee voted unanimously to recommend to the full Senate the nomination of Gary Alexander as Secretary of the Department of Public Welfare. Governor Corbett announced the nomination on January 11. The confirmation goes to the full Senate for consideration. During the hearing the Senators questioned acting Secretary Alexander on the House Republican budget proposal and other funding issues. Alexander responded that he thought that savings could be achieved, but he said that he could not state the amount to be saved from reducing errors within the Medical Assistance program until a systematic and careful review of the department was completed. He said that such a review was underway and would be completed in the upcoming months so that the Legislature could make its decisions. Acting Secretary Alexander also commented on a budget proposal requiring monthly copayments from certain families of children with disabilities receiving Medical Assistance services. In response to question about application for a global waiver, he said that people with disabilities were not hurt or disadvantaged by the Medicaid global waiver that was implemented in Rhode Island. Concerning interest in development of statewide Medicaid managed care, he said that it is being actively considered. He said that he would take a hard look at considering ways to restore cuts in the Human Services Development Fund that are proposed in the Governor’s proposed FY 2011-2012 budget. Concerns about the state mental retardation centers and group homes were also raised. FMI: See www.legis.state.pa.us
The FY 2011-2012 state budget proposal (HB 1485 PN 1880) advanced in the PA House of Representatives provides for a 4% cut in Medicaid funding related to Medicaid eligibility, fraud and abuse but does not affect many of the appropriations for mental health services and developmental programs that were recommended by Governor Corbett. The appropriations not affected by the proposed 4% cut are the appropriations for the Intellectual Disabilities (ID) waiver, the ID base appropriation, private ICF/ID appropriation, early intervention appropriation, and the community mental health appropriation. The Human Services Development Fund (HSDF) will receive an 85% restoration, with a funding level next year of $19,956,000 compared to $23,478,000 this year. However, appropriation of $52,220,000 for Behavioral Health Services (BHSI) will be cut by $4,312,000 (or 8.2%), and the Governor’s recommendation of $13,594,000 in state funds for Autism Intervention Services will be reduced by $2,745,000. A $27 million cut in food and housing costs for group homes that was proposed by Governor Corbett is retained in the House budget proposal. The budget approved by the House Appropriations Committee uses the 4% cut in Medicaid programs to increase funds for higher education above the level proposed by the Governor. Higher education programs receive $370 million above the Governor’s proposal. However, the funding restorations are not uniform. Despite restoring some of the Governor’s cuts, the plan would reduce current year higher education funding by $269 million. Only $243 million of the $1.2 billion in cuts to public schools are restored. The House budget adds back only $100 million of a $550 million cut to the basic education subsidy and $100 million of $259 million in Accountability Block Grant funding eliminated in the Governor’s budget. The House plan leaves intact a $224 million cut to the charter school reimbursement. FMI: See www.legis.state.pa.us for HB 1485 PN 1880. Contact PARF at parfmail@parf.org.
On May 11 the PA House of Representatives took a major step in establishing a state budget for FY 2011-2012. The PA House of Representatives Appropriations Committee reported an amended budget bill (HB 1485 PN 1880) to the floor that restores funding to programs that were cut in Governor Corbett’s proposed state budget. The amended budget passed 20-13 on a party line vote. The proposal will be the subject of floor debate in the House beginning on May 23. The House budget incorporates Governor Tom Corbett’s plan to transfer revenue from the Tobacco Settlement Fund into the General Fund. Department of Public Welfare (DPW) programs, including Medical Assistance, County Child Welfare and Behavioral Health, are cut by $471 million from the Governor’s proposed budget. Pennsylvania House Democrats had earlier criticized Governor Tom Corbett and Republicans in the legislature for proposing a state budget that would make severe cuts to critical education and health care programs while refusing to use any of the state’s burgeoning surplus to ease the pain. FMI: See www.pahousegop.com and www.pahouse.com. See also an analysis by the Pennsylvania Budget and Policy Center http://www.pennbpc.org/sites/pennbpc.org/files/PA-House-Budget-Analysis-5-13-2011.pdf
The 2011 PARF Legislative Day and Rally held on May 3 attracted more than 200 people from across Pennsylvania petitioning the Pennsylvania legislature to fund services for people needing emergency help and to restore funding that would be cut from services to people with disabilities. The rally was held in partnership with The Arc of Pennsylvania, The Pennsylvania Waiting List Campaign, and Vision for Equality. The rally featured PA State Senator Andrew Dinniman (D – District 19 – Chester County), PA State Representative Thomas Murt (R – District 152 – Montgomery/ Philadelphia Counties) and PA State Representative Ed Pashinski (D – District 121 – Luzerne County). Self advocates Connie Roushey (Mercer County) and Esther Kuhn (Indiana County) and parent advocate Nancy Richey (York County) offered the perspectives of people needing services. Shelia Stasko – Director, Pennsylvania Waiting List Campaign and Steve Suroviec, Executive Director, The Arc of PA reviewed the major funding campaign issues. PARF Chairperson and President/CEO of Horizon House Jeff Wilush highlighted the impact of funding cutbacks on people living in the community and those who may be forced out of their current homes due to newly proposed limits on costs of residences. PARF President Gene Bianco highlighted the theme of the rally Not Going Back, opposing a return to substandard care and supports. FMI: For copies of rally speeches by PARF representatives contact PARF at parfmail@parf.org. The video presenting the rally with remarks by Senator Andrew Dinniman is available at http://www.youtube.com/watch?v=QNJsm-N_WW0. See also www.pahouse.com.
On May 2 the Centers for Medicaid and Medicare Services (CMS) issued a final regulation for telemedicine services in rural or remote areas that relaxes the process for using certain types of electronic communication. Prior to the new regulation, CMS required hospitals to grant practice privileges to remote-site physicians and other practitioners who were already credentialed in distant-site facilities after they considered qualifications on a practitioner-by-practitioner basis. The regulation will allow physicians to connect with expert specialists even when the patient and specialist are great distances away. FMI: More information about the finalized rule is available on CMS’ website at http://www.cms.gov/CFCsAndCoPs/06_Hospitals.asp and http://www.cms.gov/CFCsAndCoPs/03_CAHs.asp. For the CMS press release see May 2, 2011 entry at http://www.cms.gov/apps/media/press_releases.asp.
On May 6 the Centers for Medicaid and Medicare Services (CMS) published in Federal Register (Volume 76, Number 88) a proposed rule entitled “Medicaid Program: Methods for Assuring Access to Covered Medicaid Services” (pages 26342–26362). The new rule provides federal guidance on how states can assure access to services. Federal officials said that the rule was needed to fulfill the promise of federal law, which says Medicaid recipients should have access to health care at least to the same extent as the general population. The proposed rule would make it much more difficult for states to cut Medicaid payments to providers and put pressure on some states to increase Medicaid payment rates. Several state officials expressed concerns.
Under the new rule states must document in their access review, using data trends and factors, an analysis that demonstrates sufficient access to care. The review must, at a minimum, describe the specific measures that the state uses to analyze access to care and any issues with access that are discovered as a result of the review. The rule states that the experience of Medicaid recipients is “the most important indicator of whether access is sufficient.” The rule also includes provisions addressing the adequacy of payment to providers and requires that any reduction is subject to review and comment by stakeholders. The rule says that states should compare Medicaid payment rates with the amounts paid by Medicare or commercial insurers, with providers’ costs or with their customary charges. Comments are due July 5, 2011. FMI: See www.regulations.gov. See http://www.regulations.gov/#!documentDetail;D=CMS-2011-0062-0001.
