Status of BBA relief… The BBA Relief package proposed by the House and Senate was the subject of discussion between the White House and Congressional leaders recently. The current Congressional BBA relief proposal totals approximately $28 billion over five years and includes a full market basket update to Medicare inpatient and outpatient services for FY01 and market basket minus.55% in FY02 for inpatient services (currently slated at market basket minus 1.1%); freezes the IME adjustment at 6.5% for next year and 6.375% the following year; modifies scheduled Medicare DSH reductions from 3 to 2% in FY01; eliminates FY01 Medicaid DSH reduction; establishes minimum per resident amounts of 85% of the national average for DGME; and includes a full market basket update for skilled nursing services for FY01.
The White House continues to push for a two-year full market basket update and securing a few more years on the IME adjustment. The delay in a final package is due in part to the White House's criticism that the Congressional package contains too much spending on managed care plans and doesn't provide enough relief for hospitals.
HHS Proposed New Accounting Rule . . .A new federal rule designed to end an accounting practice enabling states to divert Medicaid funds to non-health care activities may not negatively affect Massachusetts. The proposed rule revises current regulations that give states broad flexibility in setting Medicaid rates paid to health care providers. Some states have used this flexibility to pay excessive rates to county or municipal facilities, claim matching federal funds based on the excessive payments, and then use the federal funds for non-health care purposes. Massachusetts, on the other hand, channels funds to hospitals that serve a disproportionate share of low-income patients. Because the rule gives states flexibility, Massachusetts' policy should withstand federal scrutiny.
In Massachusetts:
Health Care Task Force . . . The State's Health Care Task Force received a report of the Finance Working Group entitled "An Update on the Financial Condition of Hospitals in the Commonwealth of Massachusetts," which outlines preliminary policy recommendations to respond to the financial conditions of hospitals: (1) creation of a commission to improve the financial stability and efficiency of the health system of the commonwealth (modeled after MedPAC); (2) potential increase in Medicaid rates based upon an independent evaluation of the Medicaid hospital payment system; (3) potential creation of a special fund for financial assistance to seriously distressed hospitals created with contributions from all payment sources including the state, private payers and Medicare; and (4) creation of a Hospital Revolving Reinsurance Fund established within the hospital sector with required paybacks from hospitals that use the fund and eventually return to profitability. The Task Force also received a preliminary report from its Health Care Quality Working Group, emphasizing the report's very preliminary nature. The group intends to continue its work based on the input of the Task Force members and resources it has identified. The group cited the new managed care law as one approach available to policy makers to ensure health care quality. For a copy of either report, contact Tish McMullin in Government Relations at 617-278-0544 or pmcmullin@partners.org.
Public Health Council . . . On October 24, DPH staff reported on implementation of the new managed care law at the Public Health Council meeting. Following that, they presented a report entitled “A Profile of Health Among Massachusetts Women, 1998.” The Council also heard about emergency promulgation of rules to implement the new needlestick injury prevention law, and on proposed amendments to Determination of Need regulations governing transfer of site procedures (105 CMR 100.720). (Tuesday, 10:00 am, 250 Washington St., Boston). For a copy of the proposed regulatory changes, contact Tish McMullin in Government Relations at 617-278-0544 or pmcmullin@partners.org.
Worth Noting . . . The special legislative commission investigating the quality of nursing in Massachusetts meets Tuesday in Brockton, in the last of six statewide hearings. The commission plans to file legislation to address concerns they’ve heard. . . An industry-sponsored health care conference is set for Wednesday in Boston. HealthMart 2000 is the annual New England meeting of employers, care providers, insurers and information service managers and will feature leaders in government and private sector health care fields . . . Continuing to campaign against proposed tax cuts, the Coalition to Protect Quality Health Care will hold a press conference on Thursday, October 26, at 1 p.m. at Springfield City Hall.