Last Wednesday, Democrats in the House of Representatives failed to override President George W. Bush’s veto of the State Children’s Health Insurance Program (SCHIP) expansion bill. Democrats were 15 votes short of the required 2/3 majority needed to override a presidential veto. (Kaiser Network)

Last year, Bush twice vetoed a bill that would have expanded SCHIP by $35 million over five years. Mike Leavitt, secretary of the Department of Health and Human Services, said the administration would have been willing to sign a bill to increase SCHIP’s funding by only $20 billion over five years. The administration and some Republicans were concerned that the expansion would lead to coverage of children whose families could afford private insurance at the expense of children whose families could not.

In this contentious election cycle, the Democrats likely will use Republican’s “NO” votes as political leverage.

Republican congressman Joe Barton of Texas (pictured) told the Washington Post and CQ Today: “There is no child currently on SCHIP that is going to lose coverage, regardless of the vote…Continue the existing program, perhaps expand coverage somewhat for families above 200% of poverty and cover every child in the country under 200% of poverty.”

Read more SCHIP-related posts.

The following information was obtained from the January 18 edition of the Texas Register:

Open Meetings

On February 4, 2008, the Texas Health and Human Services Commission (HHSC) will conduct hearings on procedure codes relating to two physician-administered drugs, Eculizumab and Nelarabine (10 a.m.), proposed Medicaid payment rates for certain radiological service procedures (1:30 p.m.), and 12 specific DADS nursing facility rehabilitative and specialized services occupational, physical, and speech therapy procedure codes (3 p.m.).

All three hearings will take place in the Lone Star Conference Room of the Health and Human Services Commission, Braker Center, Building H, located at 11209 Metric Blvd, Austin, Texas. See the relevant section of the Texas Register for more information about the hearings.

Proposed Rules

On behalf of DADS, HHSC has proposed amendments to the following sections:

• Mental Retardation Services–Medicaid State Operating Agency Responsibilities
• Nursing Facility Requirements For Licensure And Medicaid Certification
• Nurse Aides

Adopted Rules

HHSC has adopted an amendment to the Texas Administrative Code (TAC), Title 1, Part 15, Subchapter E, Chapter 358, Medicaid Eligibility, §358.465, Income Exclusions, paragraph (3), which will allow a $20 exclusion of unearned or earned income from an individual’s monthly income in determining an individual’s eligibility for community attendant services. See the relevant section of the Texas Register.

The Centers for Medicare and Medicaid Services (CMS) announced policy changes for long term are hospitals. (Source)

According to CMS acting administrator Kerry Weems, the proposed policy changes are designed to increase incentives for long term care hospitals to provide more efficient and high quality care for patients. Almost 400 hospitals would be affected. From the press release:

CMS is proposing a standard Federal rate of $39,076.28 for the 2009 rate year. This is based on a proposed update of 2.6 percent compared with the standard Federal rate for RY 2008, as revised to comply with provisions of the recently enacted Medicare, Medicaid, and SCHIP Extension Act of 2007 (”Medicare Extension Act”). The update represents a 3.5 percent increase in the hospital marketbasket (a measure of inflation in the costs of goods and services used in providing inpatient care), less a 0.9 percent adjustment to offset coding changes in RY 2006 that do not reflect real changes in the severity of the cases treated by these hospitals.

To read the proposed rule, download this 311-page PDF document.

The Texas Department of Aging and Disability Services (DADS) reminded all Long Term Services and Supports Providers that DADS is planning to upgrade its financial accounting system and expects a delay in payment processing for all claims billed while the system is unavailable. Download the letter for more information.

DADS informed Home and Community-Based Services (HCS) Providers and Mental Retardation Authorities about activities that must take place when an HCS provider notifies DADS of their intent to voluntarily terminate an HCS contract. For details, download the letter.

In an information letter to Licensed and Certified Home and Community Support Service Agencies, Community Based Alternatives (CBA), Consolidated Waiver Program (CWP), Integrated Care Management (ICM), and Assisted Living/Residential Care (AL/RC) Providers, DADS clarified requirements of Medicaid and Medicare payments for the same service provided to a dually eligible CBA, CWP and ICM participant receiving AL/RC services. You may download the letter for more information.

One ongoing issue in Congress will be whether the Centers for Medicare and Medicaid Services (CMS) has the authority to prevent states from expanding Medicaid coverage.

President George W. Bush twice vetoed measures that would have expanded the State Children’s Health Insurance Program (SCHIP). According to the Kaiser Network, the administration has restricted states like Ohio, Louisiana, and Oklahoma from expanding SCHIP unless they demonstrate that they’ve enrolled at least 95 percent of children in the state below 200 percent of the poverty level. In other words, CMS wants to make sure children in low-income households are adequately covered before offering coverage to children in higher-income households.

Democrats in both houses of Congress say that CMS does not have the authority to prevent states from expanding Medicaid coverage to more children. Download the four-page press release and legislative letter (PDF) that lays out the arguments.

The following information was obtained from the January 11 edition of the Texas Register:

Open Meetings

The Texas Health and Human Services Commission (HHSC) will hold a public hearing on January 30, 2008, at 1:30 p.m. in the Lone Star Conference Room of the Health and Human Services Commission, Braker Center, Building H, located at 11209 Metric Blvd, Austin, Texas. HHSC will receive public comment on proposed Medicaid payment rates for eye surgery by laser and bariatric surgery procedures.

HHSC also announces its intent to submit Transmittal Number 08-003, Amendment Number 807 to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. See the relevant section of the Texas Register for more information about the hearing and amendment.

Adopted Rules

HHSC has adopted a new §355.313, concerning the Reimbursement Methodology for Rehabilitative and Specialized Services, in its Reimbursement Rates Chapter. The new section revises reimbursement methodology rules to update nursing facility rehabilitative and specialized services rates. See the relevant section of the Texas Register for more information.

HHSC adopted amendments to §§10.311, 10.315, and 10.321 in Chapter 10, Guardianship Services, which will update contractor employee qualifications regarding certification by the Guardianship Certification Board (GCB). The Texas Code requires that a guardianship contractor’s case manager be certified by the GCB, effective September 1, 2007. For more information, see the relevant section of the Texas Register.

The Kaiser Network has released a reported titled “Financing Medicare: An Issue Brief,” which gives an overview of Medicare’s future, including funding issues and challenges.

In other Medicare news, lawmakers say they will resume the business of Medicare, State Children’s Health Insurance Program (SCHIP), and Medicaid policy changes in 2008. One issue on the list is preventing a 10 percent cut in Medicare physician fees. Other issues include genetic non-discrimination and discussing the Bush administration’s policy that prevents states from expanding Medicaid eligibility. (Kaiser Network)

Critical of the Bush administration’s stance on SCHIP, Republican senator Olympia Snowe told CongressDaily that the “administration has failed to recognize the way to achieve results for uninsured children is through building legislative consensus, not executive fiat.”

According to a report issued by the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS), only 55 percent of physician-owned specialty hospitals had emergency departments and 7 percent didn’t meet Medicare requirements that an RN be present at all times or that a doctor be on call if none are present on site. (Kaiser Network)

The OIG concluded that physician-owned specialty hospitals are “poorly equipped” to handle emergency care. Molly Sandvig, executive director of Physician Hospitals of America (PHA), disagreed with the report.

According to a PHA press release, Sandvig said the study is limited “because it does not address the most significant issues: Was there any impact on the quality of patient care as a consequence of the IG’s findings? And how do these findings compare to the practices of comparable general hospitals?”

The Texas Department of Aging and Disability Services (DADS) informed Community Based Alternatives and Consolidated Waiver Program Providers about the addition of Specialized Nursing Services and associated rates. From the letter:

The addition of specialized nursing services is completed as a revision to the individual service plan (ISP) according to current policy and in the same manner as any other ISP change. Providers update and send the following documents to the DADS case manager:

• DADS Form 2067 requesting authorization of specialized nursing services;
• DADS Form 3671-C detailing the new nursing services plan.

The DADS case manager will document the authorized nursing unit rate on DADS Form 3671-1.

You may download the letter here for more information.

DADS informed Home and Community-based Services (HCS) Program Providers, Texas Home Living Program Providers (TxHmL), and Executive Directors of Mental Retardation Authorities that Senate Bill 744, 80th Texas Legislature, Regular Session, 2007, added §48.358 to Subchapter H, Chapter 48 of the Human Resources Code, regarding retaliation. For more information, download the letter here.

Additionally, DADS informed HCS and TxHmL providers about a change to the Client Assignment and Registration System Waiver Data Entry Training Agenda for 2008 classes. To see a list of changes to the agenda, download the three-page letter here.

The following information was obtained from the January 4 edition of the Texas Register:

Public Notice

The Texas Health and Human Services Commission (HHSC) has issued notice of a contract awarded to Public Strategies, Inc. The contract was executed on December 12, 2007, and will expire on August 31, 2008, unless extended or terminated sooner by the parties. The value of the contract is $2,650,000. See the relevant section of the Texas Register for more information.

Adopted Rules

HHSC has adopted the repeal and replacement of §351.3, Purpose, Task, and Duration of Advisory Committees. The former section had outdated language. The new section lists the advisory committees and complies with the requirements set out in the Government Code, §2110.005, Agency-Developed Statement of Purpose and Tasks; Reporting Requirements and §2110.008, Duration of Advisory Committees.

See the relevant section of the Texas Register for more information.

The Texas Board of Nursing (BON) has adopted several amendments relating to Witness Fees and Expenses, Vocational Nursing Education, Professional Nursing Education, Continuing Education, and Advanced Practice Nurse Education. To read about the amendments, follow this link and scroll down for each entry.