Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.
In this era of polypharmacy—where individuals with multiple conditions take multiple medications—the route to safer, more effective care may lie with how a patient answers this question: What are you taking and how are you taking it?
As one New York area hospital found, this was especially true with outpatients at its cancer care clinic where the rising use of oral anti-cancer drugs could lead to more life-threatening complications related to drug interactions or incorrect use.
The idea of reviewing a patient's medications—finding out what they are using, when they are using them, and how they are using them—of course, is not new. The "brown bag" patient safety campaign, which has been around for years, encourages patients to bring their medications and other medical products to check-ups or pharmacy visits so providers can review their dosage and use.
But as times change, treatments and medications are changing as well. What once may have seemed like "a good idea" may be evolving into something that is a critical aspect of a patient's care. This is what sparked an initiative for outpatients at the Montefiore-Einstein Center for Cancer Care.
"Many of our patients have other co-morbid conditions such as diabetes or a heart condition," says Pragna Patel, PharmD, RPh, who is an oncology investigational pharmacy manager at Montefiore. She, along with Una Hopkins, BSN, MSN, FNP BC, a nurse practitioner with the medical oncology department at Montefiore, created the Medication Therapy Management program.
Their goal was to help cancer patients safely take their oral chemotherapy—along with other prescription medications they need for other conditions—to help avoid what could be adverse interactions or life threatening errors. The idea was to create a personalized plan to support safe and effective use and storage of their prescriptions.
The goal is to assist patients to get a better understanding of their medications—including prescribed and over the counter, along with vitamins or herbal supplements they use, according to Patel.
During their treatment, the cancer center patients are referred to the Medication Therapy Management program by the physicians and nurses for a visit with both Patel and Hopkins. During a 30- to 45-minute session, the clinical team discusses possible side effects associated with the potent anti-cancer drugs. They also will look at possible allergies or adverse reactions the patients may experience or possible drug drug or drug food interactions.
They also discuss proper use of the drugs. For instance, Patel notes one patient who misunderstood her instructions and was taking one pill needed for her treatment five times a day instead of taking all five pills at once. Misuse or improper use of the medications may result in their compounds not working as they should as part of the cancer treatment.
Cost issues can be discussed as well, since many anti-cancer drugs are expensive. Patel and Hopkins underscore the importance of taking the drugs at their prescribed intervals even if the prescriptions are expensive and may not be covered by insurance: Skipping anti-cancer medication could be very problematic in effectively fighting the disease.
At the cancer center, those patients considered to be at highest risk for errors include those who are taking more than five medications at the same time, those with multiple co morbid conditions, those taking oral chemotherapeutics, and those taking long term (five years) hormonal therapy.
To assist the patient, the clinical team creates a "medication action plan" that clearly identifies any important symptoms the patient should look out for—some of which should provoke emergency care. The patient can take this action plan home, share it with his or her family, and show it to other specialty healthcare providers including their pharmacist.
The team sees this service as a way to increase patient satisfaction as well, Patel says. Many seemed pleased because no one before had taken the "time to sit with you and talk about your medications and what happens when you take it," Patel says.
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While U.S. employers may view controlling costs as a healthcare reform priority, only a few of those surveyed this month by Towers Watson, a professional services company, said they believed that reform would slow the tide of rising costs. However, despite these anticipated increases, nearly three fourths of large employers (74%) expect to continue to subsidize healthcare coverage for their active employees.
In terms of how important specific healthcare reform goals are to their organizations, 96% of those surveyed pointed to the containment of healthcare costs as essential or high priority, while 88% cited encouraging healthier lifestyles, and 75% suggested the improvement of quality of care.
However, despite these goals expressed by the employers, most (94%) said they thought that healthcare reform will raise their organization's costs. Also, 61% said reform will have a minimal effect on encouraging healthier lifestyles, and 73% said it will have either a negative or no impact on the quality of care.
"Employers are currently weighing the short term challenges and long term opportunities of the new law," Mark Maselli, North American health and group benefits leader for Towers Watson, said in a statement.
To address anticipated cost increases, many employers said they planned on:
Passing on increases to employees: 88%
Reducing health benefits and programs: 74%
Absorbing costs in the business: 33%
Passing on increases to customers: 20%
Also, the surveyed employers remained committed to many initiatives offered before healthcare reform legislation was introduced. For example, only 12% of employers said they would eliminate or reduce their wellness/health promotion programs in the wake of healthcare reform. Conversely, 48% of employers said that reform would encourage employers to offer wellness programs.
The employers also said they expected healthcare reform to result in increases in adoption of consumer directed health plans, 58%; transparency of provider prices, 37%; and of provider quality, 35%.
The survey noted, though, that retirees may not fare as well. Most employers surveyed (77%) said that reform would encourage a number of large employers to reduce offering employer-sponsored retiree health benefits. Forty-three percent of employers that currently offer retiree benefits plan said they plan to reduce or eliminate them.
This trend seemed more pronounced among those employers likely to be subject to the new excise tax on expensive plans approved under healthcare reform. Of that group, 55% said they were likely to eliminate or reduce retiree medical programs.
"Just as many baby boomers are deciding whether to delay retirement, employers will be determining if it makes financial sense for them to remain in the retiree medical business," said Dave Osterndorf, a senior consulting actuary with Towers Watson.
The House appears close to voting today on the "American Jobs and Closing Tax Loopholes Act of 2010" (HR 4213) that contains a provision to delay a 21% cut in physician Medicare reimbursements—just before the latest deadline expires June 1. However, the actual period proposed for the delay has been whittled down to 19 months—or the end of 2011.
In earlier deliberations in the House this month, a five-year period was discussed, and then a 3½ year period—ending by 2014—was incorporated into the proposed bill late last week. However, legislators concerned about costs ($63 billion over 10 years) associated with a postponement in the sustained growth rate (SGR) formula pointed to a shorter period, which kept the jobs bill costs down.
Under the amendments approved late yesterday by the House Rules Committee, physicians would see an increase in payment rates of 2.2% for the remainder of 2010 and a 1% increase in 2011. Rates would return to present law after 2011. No additional payments would be made for primary or preventive care (as proposed in the earlier bill). Costs are now estimated at $22.9 billion over 10 years.
Other changes in the bill from last week include a program to provide a 65% COBRA health insurance premium subsidy for up to 14 months now through November 2010 (instead of December 2010) for employees who were terminated from their job.
If the bill passes the House, it will immediately move on to the Senate. Senate Finance Committee Chairman Max Baucus (D-MT) said Wednesday that Senate Democrats are expected to have the votes to approve the measure.
The amendment changes came after the American Academy of Family Physicians, the American College of Physicians, the American Osteopathic Association, and AARP had urged Congress in a news conference on Wednesday to keep to its plans for a 3½ year postponement of the SGR.
AAFP President Lori Heim, MD, of Vass, NC, said failure to stop the pay cut after the June 1 deadline could reduce the quality of services—as some physicians will try to shorten office visits to see more patients or be forced to lay off staff.
The Obama administration on Monday asked a federal district court in Richmond, VA, to dismiss the state's lawsuit filed two months ago that said Congress had overreached its powers under the new healthcare reform law by requiring citizens in the 50 states to purchase healthcare insurance.
In a motion filed before the midnight deadline, Health and Human Services Secretary Kathleen Sebelius said that the law is within the scope of the Constitution's Commerce Clause.
The healthcare reform law "merely regulates economic decisions on how to pay for those services—whether to pay in advance through insurance or attempt to do so later out of pocket—decisions that substantially affect the vast, interstate healthcare market," the motion said.
Virginia Attorney General Ken Cuccinelli (R) had filed suit minutes after President Obama signed the reform legislation into law in March. Cuccinelli had said that mandating people to purchase healthcare coverage—or instead pay a fee—exceeded the federal powers limited through the Constitution's 10th Amendment.
Cuccinelli's suit is separate from the Florida suit, which includes 20 states challenging the legislation over similar grounds on the insurance mandate. And, it is also separate from a suit filed in Michigan on behalf of four uninsured individuals who did not plan to buy health insurance and claimed they would be harmed by the monetary penalty when insurance becomes mandatory in 2014.
In the motion to dismiss the suit, Sebelius said that Virginia lacks the standing to sue: "A state cannot...manufacture its own standing to challenge a federal law by the simple expedient of passing a statute purporting to nullify it. Otherwise, a state could import almost any political or policy dispute into federal court by enacting its side of the argument into state law."
The motion adds that: The "minimum coverage provision" that Virginia challenges here—i.e., the requirement that, with specified exceptions, all Americans who can afford it either maintain a minimum level of health insurance coverage or pay a penalty—is a linchpin of Congress’s reform plan.
Cuccinelli said in a statement in response to the motion that federal laws usually trump state laws. However, he said the conflict between the federal law and Virginia law gave him a duty to file suit. Virginia has until June 7 to file a response.
While news about the proposed so-called "doc fix"—a proposed delay for three more years for any physician payment cuts using the Sustainable Growth Rate formula—has dominated discussions in the $190 billion jobs and tax bill (HR 4213) the House plans to vote on this week, numerous other healthcare-related provisions have been attached to the bill as well.
COBRA assistance extension. In February 2009, the economic stimulus package created a program to provide a 65% COBRA health insurance premium subsidy for up to 15 months for employees who were terminated from their job. Under current law, eligibility for the COBRA premium assistance program was scheduled to terminate after May 31, 2010. A bill proposal would extend eligibility for the program for those terminated on or before Dec. 31, 2010. The federal cost of extending the benefit is $7.8 billion.
Fraud detection. The Centers for Medicare and Medicaid Services and Internal Revenue Service would create a new data match program to identify fraudulent providers. Under the current law, CMS and IRS are not authorized to exchange data for the purposes of addressing Medicare fraud and screening potential new providers. CMS will use the IRS data to identify possibly fraudulent providers sooner by determining whether providers applying to enroll or re enroll in Medicare have failed to file federal tax returns or have delinquent tax debts. This provision is estimated to save $400 million over 10 years.
Federal Medicaid Matching Rate extension. Under current law, the federal Medicaid matching rate is increased by 6.2% for all states (with additional percentage increases for states with high unemployment). These temporary increases were enacted under the economic stimulus bill last year in response to increased Medicaid caseloads and decreased state revenues. The increase was scheduled to expire on Dec. 31, 2010, which was problematic for most states now in the process of producing their current budgets for 2011. The bill would extend these increases for 6 months through June 30, 2011. The provision is estimated to cost $24 billion over 10 years.
Collection of employment taxes loophole. Social Security taxes are imposed on compensation and self employment income up to the Social Security wage base (currently $106,800), and the Medicare tax is imposed on all self employment and compensation income. However, some professionals, including physicians and other healthcare professionals, have avoided Medicare and Social Security taxes by routing their self employment income through an S corporation. The bill would clarify that those engaged in professional service businesses are unable to avoid employment taxes by routing their earnings through a limited liability corporation or a limited partnership. This proposal is estimated to raise almost $10 billion over 10 years.
Funding for claims reprocessing. Extensions of Medicare payment policies for 2010 were enacted into law on March 23, 2010, requiring CMS to reprocess Medicare claims back to Jan. 1, 2010. The bill would provide funding for CMS to reprocess these claims. This provision costs $175 million over 10 years.
Waiver of coinsurance for preventive services. The bill would clarify that waivers of cost sharing and deductibles for Medicare preventive services apply when those services are furnished at federally qualified health centers and rural health clinics. This provision has no cost.
Addition of inpatient drug discount program. Under current law, drug manufacturers are required to provide certain hospitals and other entities treating low income and uninsured patients—including certain public hospitals, critical access hospitals, children's hospitals, and cancer hospitals—with discounts so the cost of outpatient drugs for these entities does not exceed the Medicaid price for the same drug. The bill would extend these discounts for certain 340B eligible federal entities to inpatient drugs for use by patients who are uninsured or who do not have insurance that provides prescription drug coverage. This provision is estimated to cost $35 million over 10 years.
Orphan drugs. Inclusion of orphan drugs in definition of covered outpatient drugs with respect to children's hospitals under the 340B drug discount program would continue. This provision would clarify that eligible children's hospitals retain access to federal 340B drug discounts on orphan drugs. This provision has no cost.
Young adults between the ages of 19 and 29 have represented one of the largest segments of the U.S. population without health insurance—accounting for up to 30% of the 46 million uninsured people under age 65. But this could be changing soon as many of the 13.7 million currently uninsured young adults gain coverage under the new healthcare reform law, according to a new study from The Commonwealth Fund.
"This is a graduation gift to many young adults," said Sara Collins, PhD, the lead author and Commonwealth Fund vice president for affordable health insurance. In particular, the report found that 42% of young adults who were covered under their parents' employer plans lost or had to switch their health insurance when they graduated from or left high school; of that group, 46% were uninsured for two years or more.
In addition, 75% of young adults who were insured under their parents' employer plans lost or switched their health insurance when they graduated from or left college. Of those that had a gap between losing and gaining coverage or were uninsured after college, 23% were uninsured for two years or more.
She noted that while young adults are relatively healthy, the health and financial consequences of such high rates of uninsurance were "substantial." In a Commonwealth Fund Survey of Young Adults from last year, it was found that 76% of these uninsured young adults were not getting needed care because of cost.
Nearly a third (32%) of uninsured young adults and 46% of uninsured young adults with chronic health problems reported that their condition even worsened in the last 12 months because they did not get the healthcare they needed soon enough. In addition, despite high rates of avoided care, nearly 60% of young adults who had been uninsured in the past year reported problems paying medical bills—more than double the rate of those who had insurance all year.
As proposed by HHS, the new rule addressing parental coverage would take effect on the first day of the first plan year beginning after Sept. 23 of this year. However, 65 health plans—including large national plans such as WellPoint, Aetna, UnitedHealth Group, Kaiser Permanente, and Blue Cross and Blue Shield plans—have volunteered to put the requirement into effect now so gaps in their coverage are avoided.
Also, major expansion in eligibility for Medicaid for adults—plus premium and cost sharing subsidies available for comprehensive private health benefits—in 2014 will have a major impact on young adults' to obtain health insurance, Collins said.
The report also found:
More than half (52%) of uninsured young adults are in families with incomes that will make them newly eligible for Medicaid under the new law.
About 29% are in families whose incomes will qualify them for health insurance premium subsides. This means that they will have to spend no more than 3% to 8% of their income on health insurance premiums.
Also, 12% of uninsured young adults are in families whose incomes will qualify them for health insurance premium subsides so that they won't have to spend more than 9.5% of their income on premiums.
Several major medical groups are expressing mixed reactions about a congressional proposal to delay a 21% cut in Medicare reimbursements when the latest exemption to the sustainable growth rate payment cut runs out June 1. Under the measure inserted in HR 4213, the "American Jobs and Closing Tax," the SGR cut in Medicare payment would be delayed until 2014.
As proposed, the measure calls for a 1.3% increase for physicians beginning June 1, followed by a 1% payment update starting Jan. 1, 2011. For 2012 to 2013, the bill would use new payment targets from another bill (HR 3961), which passed the House last November: one would provide a conversion factor based on the gross domestic product, plus a 2% increase for primary care and preventive health services, while the other has a conversion factor of the GDP plus a 1% increase.
By 2014, the payment formula would go back to the SGR. A move earlier this week in Congress to stall the cuts for five years was dropped. A vote on the provision is expected in the House and Senate the last week of May.
Congress' move to delay "a looming Medicare physician payment cut will provide temporary stability for seniors and their physicians," said American Medical Association President J. James Rohack, MD, in a statement. However, the organization was "deeply disappointed that Congress will once again fail to permanently correct the Medicare physician payment formula that Republican and Democrat members of Congress, President Obama and policy experts have said should be repealed."
Writing in his blog on Friday, Rohack said that the newest proposal "treats the symptoms—it's not a cure for the disease" and that "Congress must act well before the next deadline to fix this problem once and for all to preserve access to care."
In his prepared statement, Ted Epperly, MD, board chair of the American Academy of Family Physicians said the new payment provision in HR 4213 "recognizes the importance of allowing for growth in the services provided by primary care physicians, especially if we are to respond to the increased demand for these services as more Americans get covered by insurance."
"The data are clear that healthcare based on primary care will be both more efficient and more effective," Epperly said. The pending legislation "builds on the recent efforts of Congress to recognize the value of primary care and provides stability of payment for several years."
"While we are disappointed that the bill does not provide the permanent payment reform that we and the physician community have been seeking, it takes a step in the right direction," Epperly added. "We will continue to work with Congress to find a permanent payment formula that includes the precedent of improved and differential payment for primary care physicians."
Noting opposition to the proposal earlier this week in the Senate because the payment formula was not paid for through reductions in spending or increases in revenues, AAFP is calling for its members to contact their senators to tell them to ensure the pending 21% reduction does not go into effect on June 1.
American College of Physicians President J. Fred Ralston, Jr., said that ACP was "particularly pleased" that for 2012 and 2013 the update for all physician services will be "held to a growth rate that is higher than the current SGR formula" and that "an extra allowance for primary and preventive care" will be included, with a statutory guarantee that payments could not be reduced in 2012 or 2013.
However, "permanent repeal of the SGR remains essential," Ralston said. "We are committed to working with Congress to ensure that a new payment framework, including more appropriate spending targets for all services and increased allowances for primary care and preventive services, is permanently enacted into law before payments revert to the current law formula in 2014."
American College of Cardiology President Ralph Brindis, MD, said that while his organization will continue to "push for a permanent payment solution," they are encouraging the House to pass the "SGR improvements."
“Four years of positive updates will provide physicians with the stability needed, while we look at real ways for true payment reform and eliminating the need for the SGR," he said.
Tucked into the new healthcare reform law are provisions to test accountable care organizations (ACOs)—groups of providers receiving set fees to deliver coordinated quality care to a select group of patients. But before most people even knew what ACO stood for, Vermont was ahead of the curve—putting together a strategy to launch three community-based ACOs by 2012.
In 2008, the Vermont legislature instructed its Health Care Reform Commission to assess the feasibility of piloting at least one ACO model as the next phase of payment reform. Along the way, it had some help from the nearby Dartmouth Institute for Health Policy and Clinical Practice, in Lebanon, NH, says Jim Hester, PhD, the commission's director.
Working with Dartmouth's and the Brookings Institution's 50-plus member ACO Learning Network, three ACO pilots have emerged in Vermont. The ultimate goal, as stated in a new report from The Commonwealth Fund on the "Vermont ACO Pilot," is to "achieve delivery system reform based on the development of a true community health system that both improves the health of the population it serves and manages medical costs at a population level."
The project started off by communicating with the providers. "We met with all [13] hospitals in the state at one point or another," Hester says. While several of the hospitals—including those doing medical home pilot work or additional medical work—turned down the initiative, others expressed interest—and became part of finding the way to "bend the medical cost curve" at the community level.
So how to finally pull an ACO together? A working design was developed for each ACO pilot that was built on three major principles:
Local accountability. “Given the natural care patterns of patients and provider referral patterns," no "lock in" of patients to the ACO would be necessary. Instead, the ACO patient population would be determined through "historical patterns of patients" who visited providers in the ACO—using a methodology developed by Dartmouth.
Payment reform. To address misaligned incentives "between fee for service payments and the need to better support providers taking steps to improve quality at a lower overall cost," the ACO model should include payment reforms based on shared savings, the report says. However, this shared savings should reflect an ACO's "varying stages of integration and sophistication.
For instance, the simplest option would be just shared savings—where providers do not assume any of the risk for above target spending. This option is designed for "newly formed entities with little experience managing care or risk."
However, more sophisticated provider organizations—such as Vermont Managed Care (in northwestern Vermont) or the United Health Alliance (in Bennington)—could consider "shared savings plus risk." Here, providers would assume a portion of the risk for above target spending (e.g., 20%) and are eligible to keep a greater portion of the savings.
Performance measurement. Measuring more than just medical expenses will be essential to ensure that appropriate care is being delivered and that cost savings are not the result of limiting necessary care, the report says. ACOs will be reporting patient experience data, in addition to clinical process and outcome measures.
Through Vermont's earlier "Blueprint for Health" initiative for chronic care patients and the state's collaboration with the Dartmouth Population Health Research Center," Vermont has been exploring additional sets of population health based measures for its ACO pilots, Hester notes.
Any ACO pilot also will need to have threshold capabilities in five areas to get started, the report said.
First, the ACO must be able to manage the full continuum of care settings and services for its assigned patients—both public and private—beginning with a patient centered medical home approach to primary care.
It must be financially integrated with both commercial and public payers (Medicare would begin in 2012). All payers will need to participate, so that at least 60% to 70% of patients in a provider's practice can be eligible for inclusion in a shared savings model.
A health information technology platform that connects providers in the ACO—and allows for proactive patient management is essential—along with a strong financial database and reporting platform for managing the global medical budget. This information starts at the practice level with a Web based clinical tracking system, which provides flow sheets for individual visits, a registry for chronic illnesses, and population based reports.
In addition, Vermont has an all-payer claims database that all commercial payers already are "syncing into a common system" and then generating reports, Hester notes.
Physician leadership—as well as the commitment of the local hospital CEO and leadership team—will be vital to driving changes in process, cost structure, and mission.
And, it must have process improvement capabilities to change both clinical and administrative procedures to improve the ACO's performance to achieve financial and quality goals.
But what will the ACOs eventually look like? Probably if you're seen one pilot ACO in Vermont—you've seen one. Achieving the necessary critical mass of patients that would support statistically meaningful measures of performance may require either a consolidated performance pool involving multiple payers—or expanding the ACO to include multiple hospitals.
The former is more likely, Hester says. "You'll need a certain critical mass in order to make the shared savings pools work," Hester says. It probably would have to be in the area of at least 15,000 patients. The latter could greatly complicate implementation issues, particularly governance. "We have a lot to learn and a lot of experimentation [to do] in terms of what kind of structures it can support, Hester says.
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The average manufacturer price increases for popular name brand and specialty prescription drugs used by Medicare beneficiaries rose faster than other consumer goods and services in the 12 months ending March 2010, according to a report from AARP's Public Policy Institute.
On the other hand, average manufacturer prices for well-known generic drugs fell during that same time period. These combined trends resulted in an average annual rate of increase of 5.3% for manufacturer drug prices during the 12-month period—despite a low general inflation rate, according to the AARP Rx Watchdog Report.
Overall, consumers saw a 9.7% rise in brand name drug prices over the 12-months: This rise was the largest 12-month spike since AARP began tracking drug prices in 2002, the report said. In comparison, inflation during the same period remained nearly flat at 0.3%.
AARP's Public Policy Institute also found that prices for specialty drugs—a group of drugs which includes biologic and injected drugs that are often used by Medicare beneficiaries to treat cancer, multiple sclerosis, and other serious chronic conditions—climbed 9.2%, or nearly as fast as brand name drugs. Specialty drug costs can range in cost from $1,000 to more than $20,000 per month.
Of the top 25 brand name drugs reviewed by AARP, the drugs showing the biggest increases in price during the 12-month period were a 27.6% price hike for Boehringer Ingelheim's prostate drug Flomax; a 15.6% hike for AstraZeneca's antipsychotic drug Seroquel; and a 13.9% rise for Eisai's Alzheimer's disease drug Aricept.
The prices of generic drugs, though, fell by 9.7% during the 12 months. The average annual cost of therapy for a person taking three generic medications, for instance, decreased by $51 during one-year period, compared with a $706 increase experienced by a person taking three brand name prescriptions, according to the report.
"Generic drugs have long been a bright spot among the dark clouds, with prices falling nearly as quickly as brand names are rising," said AARP Executive Vice President John Rother.
The report also noted that the new healthcare reform legislation has provisions that will eliminate Medicare Part D coverage gap through discounts on brand name, biologic, and generic prescription drugs. However, Part D enrollees will "continue to be exposed to the effects of the doughnut hole until the legislation's provisions are fully implemented in 2020."
In response to the report, the Pharmaceutical Research and Manufacturers of America called it "misleading" since it didn't incorporate discounts and rebates that drugmakers often negotiate with payers.
Over the past several days, healthcare groups—ranging from the American Hospital Association to the American Health Care Association—have been urging Congress to quickly approve a six-month extension of the Medicaid Federal Medical Assistance Percentage.
More than a year ago, the economic stimulus package provided a nearly $87 billion increase in additional Medicaid matching funds to the states. The current funding is due to expire Jan. 1, 2011, which has proven problematic to cash-strapped states that are now preparing and finalizing their fiscal 2011 budgets.
With at least 47 states facing "massive budget shortfalls" in the coming fiscal year, extending FMAP funding will be "critical to ensuring Medicaid patients have access to care at America's hospitals and other healthcare providers," said the letter from the hospital groups that include AHA, Catholic Health Association of the United States, Federation of American Hospitals, National Association of Children's Hospitals, and National Association of Public Hospitals and Health Systems.
In addition, the hospital groups told House and Senate leadership that without the additional funding, "many states will be forced to make significant reductions in Medicaid costs through cuts to eligibility, benefits and already low provider payment rates."
In a separate letter, AHCA and the Alliance for Quality Nursing Home Care said that Medicaid resources that "seniors require to maintain access to quality care" would face cuts, and that "key frontline care jobs that make a vital difference in patient outcomes are in jeopardy."
The House and the Senate actually had approved separate legislation to extend the Medicaid enhanced rate for six more months from Jan. 1: On March 10, the Senate passed a six month extension of enhanced Medicaid payments as part of HR 4213, and the House passed similar provisions in two separate pieces of legislation last year. However, no further action has been taken.
The movement has received strong congressional bipartisan support. In a letter signed by 219 congressman earlier this month, House leaders were urged to "quickly settle outstanding differences" and to "get a final bill to the President for signature without further delay."
