Medicaid plan surfaces, docs avoid hit
Tuesday, May 22, 2012 - Posted by Rich Miller
* The Medicaid restructuring bill popped up yesterday…
The measure, filed as a House amendment to Senate Bill 2840, includes $240 million in payment rate cuts to hospitals and nursing homes. But it spares doctors from rate cuts, along with 51 rural community hospitals and about 20 urban hospitals that care for poor patients.
The legislation eliminates most dental care for adults, but keeps emergency dental care. It limits adult eyeglasses to one pair every two years, pays the same amount for cesarean sections as for vaginal deliveries — unless the C-section is medically necessary — and limits podiatry care to people with diabetes.
The bill would eliminate Illinois Cares Rx, a program that helps nearly 200,000 seniors get prescription drugs, which concerns the AARP. […]
Medicaid payments to many hospitals would be cut by 3.5 percent, but the bill exempts rural community hospitals and safety-net hospitals from the cuts. Association of Safety-Net Hospitals spokeswoman Julie Sznewajs said Latino and black caucus members are “standing strong for their communities” by supporting the exception.
* More features…
* Eliminate coverage for group therapy for nursing home residents, chiropractic care for adults and in-patient detoxification programs.
* Eliminate the Illinois Cares Rx program, which helps seniors pay for prescription drugs.
* Require a $2 copay for prescription drugs
* Cap hearing, speech, occupational and physical therapy at 20 sessions. Eliminate adult dental care except for in emergency situations.
* Limit patients to four prescriptions per month. Three of the prescriptions can be brand name drugs. Limit patients to one pair of eyeglasses every two years ,.
* Require prior approval for the repair or replacement of equipment, such as prostheses and wheelchairs
* The dollar a pack cigarette tax hike is crucial to the plan, but it will be run on a separate bill…
Feigenholtz and Steans said the plan relies on the approval of a cigarette tax. “If the cigarette tax doesn’t pass, we are going to have to go back to the drawing board and cut a lot of human services things that are very important to us, like taking care of the elderly [and] child care. It is going to blow a massive hole into the human services budget.” The proposed $1-a-pack increase is not in Senate Bill 2840. Steans, a Chicago Democrat, said she expects the tax legislation to surface in the next few days. Backers of the proposal also hope to rework the hospital assessment — which is an accounting practice that the state uses to leverage federal funds — to bring in $100 million more next fiscal year, which begins July 1. Steans said she hopes to have the whole plan approved by the end of the week, so lawmakers can move on to considering the budget. “The goal is to do it this week or try to finish it up by the end of this week. We have to turn over the budget by the [May] 31st deadline.”
* The overall Medicaid package has broad support, but there are some holdouts…
Some House Republicans are supporting a proposal from the Illinois Policy Institute, a think tank dedicated to “supporting free market principles,” which they say can cut the Medicaid liability by $2.7 billion without rate reductions or a tax increase. “The governor and the members of the House and the Senate agreed that it was imperative to find $2.7 billion in Medicaid savings. The plan that is being proposed and discussed by lawmakers unfortunately fails to live up to that promise. Instead, tax hikes and rate cuts are being substituted for reform,” Sen. Kyle McCarter, a Republican from Lebanon, said today at a news conference to promote the plan.
Some of the Policy Institute’s proposals are pretty good, but many of their more high-dollar ideas can’t be implemented right away to save enough money in the coming fiscal year. For example…
Implement data analytics and transparency tools. Utilize services to steer beneficiaries to low global-cost providers for all non-emergency, elective inpatient and outpatient services. The state should begin this program on a voluntary participation basis, providing clients with incentives to use the service, while seeking federal approval for mandatory participation in the program.
Potential Savings: $185.0 million
Thoughts?
- Robert - Tuesday, May 22, 12 @ 9:53 am:
Seems like reasonable cuts, except possibly for the limiting of prescriptions to 4 per month; I bet we all know people who need more than 4 prescriptions.
Does the money add up? The SJ-R story states $1.4B in cuts. Cigarette tax, I believe, was worth $700 Million, which totals $2.1B vs. the $2.7B that was needed(?)
- Rich Miller - Tuesday, May 22, 12 @ 10:00 am:
===Does the money add up?===
On paper, yes. You’re missing some other aspects to the bill.
- wordslinger - Tuesday, May 22, 12 @ 10:08 am:
–Some House Republicans are supporting a proposal from the Illinois Policy Institute, a think tank dedicated to “supporting free market principles,” which they say can cut the Medicaid liability by $2.7 billion without rate reductions or a tax increase.–
Of course. It involves unleashing the power of pretty pink ponies.
- Sam - Tuesday, May 22, 12 @ 10:15 am:
I don’t think the numbers add up. Making it hard get the medications a chronically ill person needs to stay out of the hospital may backfire. As can the plan to severely restrict eligibility for the medically fragile technology dependent waiver program which keeps very sick children from living their lives in the hospital. In both cases, you are likely to see much higher hospital costs that are not being accounted for in these numbers, which contain a lot of wishful thinking.
- Waffle Fries - Tuesday, May 22, 12 @ 10:41 am:
One thought, I see evidence of some of the IPI’s proposals in SB 2840…so, compromise and all that…
- Both Sides Now - Tuesday, May 22, 12 @ 11:25 am:
I think the cuts you indicated are OK, but I think a $5 co-pay for drugs would also be reasonable. Allowing 3 of 4 brand name prescriptions instead of generics is generous in comparison to many insurance plans.
I hit the link to read and find out for myself, but a 474 page amendment is more than daunting - are co-pays for ER also included as proposed? In my opinion, what was proposed ($10) is also WAY LOW!
By the way, with the size of the bills and amendments, how do the Legislators have time to read/comprehend & have any idea of what they are REALLY voting on?!
- steve schnorf - Tuesday, May 22, 12 @ 11:41 am:
Sides, remember the Medicaid patient can’t be required to pay the co-pay, so co-pays are at least partially rate cuts
- Mark Peysakhovich - Tuesday, May 22, 12 @ 11:50 am:
The whole issue of the “free market” is problematic when talking about healthcare. Isn’t the free market based on an assumption that all independent market actors evaluate cost and make RATIONAL decisions? OK, now think about a loved one getting really sick. How rational will my choises be if my kid is in the hospital? I can telly you now: Not at all! Whatever the cost, just save my bably!!! Can we have a free market approach to issues that will never be evaluated rationally? No!
- cermak_rd - Tuesday, May 22, 12 @ 12:24 pm:
Why would a doctor provide a C-section if it WASN’T medically necessary? Isn’t it usually more complicated than a normal delivery?
- Both Sides Now - Tuesday, May 22, 12 @ 1:03 pm:
@Steve - interesting point about the co-pays. I had not considered that so thanks for passing along the info.
My biggest frustration on the Medicare debate is the use of the Emergency Rooms for non-emergencies because the patient either can’t get into a doctor/clinic or it’s too easy to go to ER because the hospital can’t turn them away. I took my spouse to the ER recently for a potential life-threatening emergency on orders of our doctor. He got in right away but the rooms were full and he was parked on a gurney by the nurse’s station for an hour. Not hooked up to any monitors - so if he had a heart attack, they wouldn’t have known it!
A friend recently visited the ER for a broken arm and waited for 45 minutes before leaving for a differenct hospital. In the meantime, a man who said he’d been constipated for 3 days was seen. Constipation is NOT AN EMERGENCY!
Folks, there has got to be a logical, common-sense, better way!
- Fed up - Tuesday, May 22, 12 @ 1:07 pm:
Both sides,
The point about the miss use of emergency rooms is spot on. Many emergency rooms are overflowing with non emergency patients who have no where else to go.
- Demoralized - Tuesday, May 22, 12 @ 1:18 pm:
Fed up:
In all seriousness, if you find the solution to that problem you will be crowned King.
- seriously? - Tuesday, May 22, 12 @ 2:45 pm:
Limiting prescriptions to 4 per month is ridiculous. A common scenario: an elderly person with high blood pressure, alzheimer’s disease, and cardiac problems. That easily amounts to 4 meds. So what happens if they get an infection? Sorry, you’ve met your quota of meds.
- zatoichi - Tuesday, May 22, 12 @ 4:11 pm:
If the docs are spared a hit, who does take the hit to make up those dollars? Sure seems like if you have dental problems, a bad foot, take 7 meds, use a chiropractor, and smoke, your life just took a sharp turn.
- Yellow Dog Democrat - Tuesday, May 22, 12 @ 4:20 pm:
Um, next time, since you need House Republican votes, try this sound bite:
“If the cigarette tax doesn’t pass, we are going to have to cut doctors’ reimbursement rates.”
- Confused - Tuesday, May 22, 12 @ 5:24 pm:
“I took my spouse to the ER recently for a potential life-threatening emergency on orders of our doctor. He got in right away but the rooms were full and he was parked on a gurney by the nurse’s station for an hour. Not hooked up to any monitors - so if he had a heart attack, they wouldn’t have known it!
A friend recently visited the ER for a broken arm and waited for 45 minutes before leaving for a differenct hospital. In the meantime, a man who said he’d been constipated for 3 days was seen. Constipation is NOT AN EMERGENCY!”
Sounds like pretty lousy triage procedures. Not likely to be fixed with Medicaid reform.
- Skeptic - Tuesday, May 22, 12 @ 6:50 pm:
This stuff about Medicaid savings from reducing fraud… well, it polls well with voters, sounds easy in press pops, but it’s really a sham. No way the fraud level (among patients, anyhow, clinics may be different) is high enough to be anything but a spit in the ocean of the overall debt. Moreover, the cost of chasing down that fraud will likely consume most of the “savings” recovered.
We saw this in Florida when they went against all expert studies and advice and instituted mandatory drug testing for public aid recipients. The number of positives “caught” was statistically nearly insignificant, and the testing program costs meant the program lost MORE money overall, in the end, than if they had not demanded the drug testing. The clamor for the testing came from lobbyists painting the single welfare moms as all drug addicts. I guess it didn’t hurt that the program was run by the Governor’s wife. That sounds almost devious enough to have been an Illinois con.
Anyway, catching “frauds” among Medicaid patients and clinics was the job of various Illinois agencies like DPR and DHS, but as an austerity move, enforcement budgets were cut, so, I guess, what, to carry out this “reform”, the free market will come in and charge more than the state workers cost to do their job. As long as those costs show up on a different balance sheet, who cares that it’s the same money. Yep. makes perfect sense to me.
- Ethanol74 - Wednesday, May 23, 12 @ 8:39 am:
No one is talking about the massive overhaul of Medicaid rules that will affect long term care that are shoved in this bill. Here’s one: currently, when H goes into skilled nursing facility (SNF), then W can stay at home in her home and keep 113K. generous standard. after SB 2840? now W living in community is forced to spend down to 22K before H will get assistance to pay for $7500/month SNF cost. how does mom get by on 22K if she outlives H by 5-10 years? in Chicago?