Item SUPPORTING INFORMATION SIGNIFICANT ITEMS IN HOUSE, SENATE, AND CONFERENCE FY 2002 House Appropriations Committee Report Language (107-229) Managed Health Care Principles--The Committee in the past has encouraged CMS to conduct a demonstration project to evaluate the use of managed health care principles in the delivery of traditional and alternative long-term care services. The Committee continues to support such a demonstration and encourages CMS to begin discussions with interested States and providers. Action Taken or to be Taken Funds were not included in the FY 2002 appropriation to fund this particular project. Item Treating Diabetes Mellitus--The Committee understands that NIH-supported research involving transplantation of insulin-producing cells has shown great promise in treating diabetes and is being expanded into worldwide clinical trials. The Committee urges CMS to collaborate with NIH, FDA and non-profit voluntary health organizations to consider strategies that could hasten the speed for providing this therapy to more patients. The Committee requests that the Administrator be prepared to testify at the fiscal year 2003 appropriations hearing on the status of this initiative. Action Taken or to be Taken CMS has been discussing the potential for a national coverage decision on Islet cells (insulin producing cells) transplants. To date, we have not received a coverage request. However, as part of our mission, we have established relationships with FDA and NIH to allow for the coordination of our respective duties. We will take all steps necessary to stay abreast of the research in this area and to be prepared to process a coverage request as timely as possible when a request is made. Item E-Health--The Committee is aware of the potential for web-enabled technology to improve the coordination and delivery of care among persons with disabilities and severe chronic conditions such as spinal cord injury, diabetes and arthritis, while also reducing transaction costs associated with traditional care delivery mechanisms. The Committee encourages CMS to demonstrate the effectiveness of an e-health tool for managed care nurse case managers in an integrated application with online claims adjudication capabilities which applies a prescription benefits manager to medical equipment, supplies and related products as currently utilized for pharmaceuticals. Action Taken or to be Taken The Medicare Coordinated Care Demonstration involves limited use of web-enabled technology to provide information to beneficiaries and providers on specific diseases. We are planning to do a Disease Management Demonstration mandated by BIPA and SUPPORTING INFORMATION other disease management projects. Web-enabled technology may be incorporated in these projects. Item Quality of Care--Current law allows States to provide incentives and public recognition of high quality skilled nursing facilities. Such programs can be both an important factor in improving the quality of care in many nursing facilities as well as helping consumers to find the best nursing care for family members. The Committee urges CMS to encourage such State efforts. Action Taken or to be Taken CMS supports the use of data to inform consumers so that they may choose high-quality nursing homes that meet their specific needs. CMS is currently implementing a sixState pilot to publicly report selected nursing home performance measures on the CMS website. CMS is working closely with the pilot States to coordinate the CMS initiative with related State efforts. In addition, the peer review organizations which are being renamed Quality Improvement Organizations (QIOs) within the pilot States will collaborate with the State agencies to publicize the performance measures. The QIOS will also be available to provide technical assistance to facilities seeking to improve their performance. Quality measures for every facility in the nation will be released in October 2002. Item Educational Programs--The Committee believes that additional efforts should be made to provide educational programs and materials on innovative care practices to skilled nursing facilities, particularly those in rural areas and those serving low-income populations. The Committee urges CMS to consider conducting periodic educational programs for surveyors and facility staff or to encourage States to do so. Action Taken or to be Taken During FY 2001, we offered three educational programs of interest to surveyors and nursing facility staff: Mental Illness in Nursing Homes (NHs) (July 20, 2001), Flu and Pneumonia Immunization in NHs (August 24, 2001) and Dental Health in NHS (September 21, 2001). Each 21⁄2 hour program was offered free of charge and broadcast live via satellite, then made available for viewing on the Internet for one year following the broadcast date. These programs may be viewed at http://cms.distributedclassroom.org. On an ongoing basis, we plan to continue to offer educational programs of interest to surveyors and the broad nursing facility community. In addition, CMS maintains a website "Sharing Innovations in Quality” that posts best practices in nursing homes that is accessible by nursing home facility staff and health facility surveyors. Item Two-digit Specialty Code--A provision was included in the Health Insurance Portability and Accountability Act to redesign the specialty code system to alpha-numeric; however, implementation of this new system is not final. In the interim, to ensure that SUPPORTING INFORMATION pregnant women receive risk-appropriate care, the Committee urges CMS to work to create an interim two-digit specialty code recognizing maternal-fetal medicine. Action Taken or to be Taken CMS uses specialty codes to obtain provider utilization data used to calculate practice expense relative value units, which are eventually used in the rate calculation for the physician fee schedule. Specialty codes do not reflect the training or credentials of providers and have no effect on the care provided to Medicare beneficiaries. We believe that beneficiaries with at-risk pregnancies are rare in the Medicare disabled population. CMS statistics indicate that infants in initial neonatal intensive care averaged 9 per month for the first nine months in 2001. In 2000, there were only 671 females under the age of 45 participating in the Medicare program. Creating a new specialty code requires a systems change at the contractor level. Nonemergency systems changes cannot be accomplished until July 2002, at the earliest. In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the National Uniform Claims Committee Data Subcommittee has developed standard codes (Taxonomy). These codes, adopted by an industry led consensus-driven process, are scheduled to be implemented in October 2002. Maternal-fetal medicine has an approved taxonomy. Item Rehabilitation Services--Medicare beneficiaries who are blind or visually impaired are eligible for physician-prescribed rehabilitation services from approved health care professionals on the same basis as beneficiaries with other medical conditions that result in reduced physical functioning. The Committee urges CMS to direct its carriers to inform physicians and other providers about the availability of medically necessary rehabilitation services for these beneficiaries. Action Taken or to be Taken CMS will take steps to ensure that physicians and other providers are aware of these services. Our usual procedure for this type of education is to prepare a standard article that delineates coverage, reimbursement, and billing information; distribute this article to all of our Medicare carriers with instructions to publish it in their next quarterly provider bulletin, and post it on their web sites; and post the article on CMS's primary provider education web site (www.cms.hhs.gov/medlearn). Item Oral Health--Medicaid and SCHIP are a major source of dental care provided to the nation's poor children. However, according to the U.S. Surgeon General's report, Oral Health in America, fewer than one in five Medicaid-covered children received a single preventive dental visit in a year. Left untreated, dental disease is inevitable and will not abate. Therefore, the Committee believes it is important that CMS maintain a distinct focus on oral health and urges CMS to retain a position of Chief Dental Officer reporting directly to the Director of the Center for Medicaid and State Operations. SUPPORTING INFORMATION Action Taken or to be Taken We intend to continue our activities in the area of oral health including our relationship with HRSA oral health experts, working through our regional dental coordinators and participating in the National Oral Health Conference in April 2002. CMS's Chief Dental Officer retired in December 2001 and we will continue to evaluate the Chief Dental Officer position along with the other oral health initiatives we implemented. Item Expanding Eligibility for Medicaid Coverage--The Committee notes with interest the number of applications received by the Centers for Medicare and Medicaid Services for 1115 waivers requesting permission to expand eligibility for Medicaid coverage to nondisabled individuals living with HIV disease. Such expansions would improve access to critically needed life-prolonging treatments. In considering the budget neutrality aspects of these waiver applications, the Committee anticipates that CMS will work with the Office of Management and Budget and other interested parties to develop methodologies to take into account savings that might be achieved in non-Medicaid entitlement programs, such as Medicare, Social Security Disability Insurance, Supplemental Security Income, due to earlier access to treatment for HIV disease. Consideration should also be given to the impact on discretionary programs such as the Ryan White Care Act. Action Taken or to be Taken CMS will collaborate with other relevant parties to discuss developing the Federal capacity to accurately assess the costs and savings of Medicaid demonstrations to other Federal programs. Item Effects of Nursing Home Lawsuits on Medicare and Medicaid Cost--There is concern about the increase in lawsuits against nursing homes nationwide, the high costs of insurance, and the increases in bankruptcies and operating costs associated with these lawsuits. The Committee encourages the Secretary to study the effects of nursing home lawsuits on the costs to Medicare and Medicaid, its effects on the access to care by beneficiaries, and its effects on the facility and its ability to hire qualified and dedicated worker professionals. The Committee notes that the Center for Medicare and Medicaid Services is seeking this data through its regulatory call to determine data sources. The Secretary should be prepared to provide a status report on what extent these costs are significant and what extent Medicare and Medicaid reimbursement is disproportionately paying for insurance at the fiscal year 2003 appropriations hearing. Action Taken or to be Taken In August 2001, several staff from the Centers for Medicare & Medicaid Services (CMS) participated in a conference call with a member from Representative Dan Miller's staff. The parties discussed Representative Miller's interest in a study on the effects of lawsuits on nursing home closures and access to nursing home services in Florida. After that meeting, CMS conducted a review of existing Medicare and Medicaid data to assess whether they might provide information on this question. On SUPPORTING INFORMATION November 30, 2001 a letter from the CMS Administrator, Mr. Tom Scully, was mailed to Congressman Miller transmitting a paper with the results of our examination. Our analysis of Medicare cost data indicated that skilled nursing facilities' (SNFs) liability costs in Florida did exceed the national average and increased rapidly between 1998 and 1999. Our available cost data suggest that the average liability cost for malpractice premiums for Florida SNFs increased 46 percent between fiscal years 1998 and 1999, and were more than 2.2 times the national average for SNFs in 1999. However, our analysis found no evidence of a reduction in access to nursing home services in Florida: --There was an increase in the number of SNFs participating in both the Medicare and Medicaid programs, and the number of skilled nursing facility beds available for Medicare and Medicaid beneficiaries has increased. --The number of Medicaid nursing home users in Florida has increased at a rate similar to the national annual rate of change for both 1997 and 1998. The gap between Florida's and the national Medicaid average length of nursing home stay has narrowed dramatically. --Between 1996 and 2000, Medicaid nursing home expenditure growth in Florida exceeded overall U.S. growth (39.8 percent versus 27.5 percent) and now nursing home expenditures represent a larger share of total Medicaid expenditures in Florida than in the U.S. as a whole. --During the period 1996-2000, Medicare beneficiaries in Florida do not appear to have been disadvantaged relative to the Nation, based on the admission rate per 1,000 enrollees or covered days of care per admission. On the contrary, the number of covered admissions per 1,000 enrollees in Florida continued to increase over the period, reaching 68 in 1998 and remaining in that vicinity while the national average fluctuated and has declined to 59. Item Blood Lead Screening--The Committee is concerned by reports of widespread noncompliance with requirements of blood lead screening of children served by Medicaid, and is distressed that little progress has apparently been made since GAO's 1999 report on the subject. The Committee expects CMS to increase its support for outreach and education and to report steps taken and progress made to the Committee by September 1, 2002. The Committee also urges CMS to permit Medicaid reimbursement for laboratory analysis of environmental samples needed to identify the source of lead exposure for children with lead poisoning. Action Taken or to be Taken CMS continues to collect data on lead screening of children under the age of 6 on the HCFA-416, the annual EPSDT reporting form. These data have been collected since |