This week both the House and Senate passed a three-month extension of the Personal Responsibility and Work Opportunity Act. In addition to the Temporary Assistance for Needy Families (TANF) program, the legislation (H.R. 3021) extends the authorization for the 10 percent transfer to Social Services Block Grant, supplemental grants to states, the TANF contingency fund, the Child Care and Development Block Grant, Transitional Medical Assistance (TMA), Abstinence Education Grants, Grants to the territories, and child welfare waiver authority through September 30, 2005. During the House debate, an issue arose over what committee would be responsible for paying for the provision that extends TMA. Under the fiscal year 2006 budget resolution, it is necessary to offset the cost of all the provisions in the extension. The House agreed the Committee on Energy and Commerce, which has jurisdiction over the TMA program, will bear the cost of this and any subsequent extensions.
The Senate Finance Committee held a two-day Medicaid hearing on June 29 and 30 on prescription drugs, fraud, and abuse and oversight of the Medicaid program. Panelists included Ohio Medicaid Director Barbara Edwards, Paul Pickerell, of the Oregon Department of Human Services’ Financial Recoveries Division; Dennis Smith, director of the Center for Medicaid State Operations; and representatives of the Government Accountability Office (GAO). In conjunction with the hearing, both the OIG and GAO issued three new reports related to Medicaid. During the hearing, the GAO suggested that the Centers for Medicare and Medicaid Services (CMS) should increase its focus on Medicaid fraud. They stated that there was no evidence found of a long-term strategy to combat waste fraud and abuse at CMS and that states were given insufficient resources for their initiatives. Smith stated that of 34 states originally identified with questionable Intergovernmental Transfer arrangements, only seven still remain under review. He also highlighted that CMS needs to make certain that Medicaid is not paying for costs that should be covered by other programs. Sen. Charles Grassley (R-Iowa), chair of the Finance Committee, indicated that he would be sending a letter to the nation’s governors inquiring about the use of contingency fee arrangements to hire consultants to maximize federal matching payments. All testimony from the hearing is available on the Senate Finance Committee website at http://finance.senate.gov/sitepages/hearings.htm. The OIG reports are available on the APHSA website at http://www.nasmd.org/medirescs.htm, and copies of select testimony can be accessed at http://www.nasmd.org/medirescs.htm.
On June 24, the U.S. Department of Agriculture (USDA) announced that the Food Stamp Program had lowered the payment error rate to 5.88 percent for FY 2004, a 34 percent improvement since FY 2000. Agriculture Secretary Mike Johanns noted the improvement was a result of program simplification and policy options authorized by the 2002 Farm Bill. The payment error rate is derived from the combined payment error rates for overpayments and underpayments. As a result, the USDA awarded $30 million to 16 states for exemplary administration in four categories: Best Payment Error Rates (South Dakota, New Jersey, North Carolina, Utah, Pennsylvania, Texas, and North Dakota); Most Improved Payment Error Rates (Arkansas, Kansas, and Colorado); Best Negative Error Rates (South Carolina, Nebraska, New Hampshire, and Wyoming); and Most Improved Negative Error Rates (Florida and New York). South Dakota had the lowest combined payment error rate of 1.97 percent, while South Carolina had the lowest negative error rate of 0.37 percent. For more information see the USDA news release at http://www.usda.gov/wps/portal/!ut/p/_s.7_0_A/7_0_1OB?contentidonly=true&contentid=2005/06/0230.xml.
On June 23, Senators Norm Coleman (R-Minn.) and Mary Landrieu (D-La.) introduced S. 1287, the Fostering Adoption to Further Student Achievement Act. The act would amend the Higher Education Act of 1965 to include children who were adopted out of the foster care system at age 13 or older in the definition of independent student. Currently, if a teenager is adopted out of the foster care system, he or she can lose eligibility for federal higher education loans and other financial aid based on their adoptive family’s financial status. If the youth had aged out of foster care, he or she would have remained eligible. Full legislative language can be found at http://thomas.loc.gov/cgi-bin/bdquery/z?d109:s.01287:
On June 30, Senators Charles Grassley (R-Iowa) and Max Baucus (D-Mont.) introduced the Medicare Value Purchasing Act of 2005. This legislation would link a portion of all Medicare payments to the quality of the services delivered by hospitals, physicians, Medicare Advantage plans, End-Stage Renal Disease Program service providers, home health care agencies, and skilled nursing facilities. It would require the secretary of Health and Human Services to develop quality measures relevant across a broad range of providers and geographic areas. It would also reward hospitals for providing certain types of quality data based on performance or performance improvement. The legislation includes a study on telemedicine and calls for GAO studies on the accuracy and completeness of the data submitted by the various provider types.
On June 29, the Senate Committee on Indian Affairs passed the American Indian Elderly and Disabled Access to Health Care Act of 2005 (S.1239). According to the Congressional Research Service, the legislation would amend the Indian Health Care Improvement Act to allow the Indian Health Service (IHS), an Indian tribe, and tribal organizations to pay the monthly premium of an Indian who is a Medicare part D (Voluntary Prescription Drug Benefit Program) eligible individual enrolled in a prescription drug plan or a Medicare Advantage-Prescription Drug (MA-PD) plan under Medicare part D. However, upon passage, Sen. Charles Grassley (R-Iowa) raised concerns over the legislation. He explained that as currently drafted, S. 1239 would permit the IHS and tribes to pick and choose who will get premium aid. These concerns will need to be addressed before consideration by the full Senate.
On June 28, the Senate Special Aging Committee, chaired by Sen. Gordon Smith (R-Ore.), convened a hearing on Medicaid. Smith said the purpose of the hearing is to learn about the use of mandatory and optional populations and benefits. He will hold a series of hearings over the next year and a half to provide a medium to share ideas and draft proposals that result in a more efficient and more sustainable Medicaid program. Testifying the hearing was Pam Hyde, secretary of the New Mexico Department of Human Services. She indicated that Medicaid reform cannot be disconnected from Medicare because coordination of benefits between the two programs is often necessary. Hyde also suggested that CMS should consider simplifying the process to allow states to place evidence-based practices into their state plan or waivers and eliminate the two-year waiting period for disabled individuals to become eligible for Medicare. Hyde’s testimony can be found via the APHSA web site at: http://ww.nasmd.org/medirescs.htm
A hearing on June 28 of the House Energy and Commerce Subcommittee on Health focused on the Health Care Choice Act of 2005 (HR 2355), introduced by Rep. John Shadegg (R-Ariz.). The legislation would allow Americans to buy health insurance from any state, thus their choice of plans would not be limited by state regulations and requirements. A copy of the legislation is available online at http://thomas.loc.gov/cgi-bin/bdquery/z?d109:h.r.02355:
On June 29, the Government Accountability Office (GAO) released a report on workforce development. The aim of the report, Workforce Investment Act: Substantial Funds Are Used for Training, but Little Is Known Nationally About Training Outcomes (GAO-05-650), was to determine the extent to which WIA funds were used for training and what challenges local workforce boards encountered in implementing individual training accounts (ITAs). They conducted a survey of 590 local workforce investment boards and found an estimated 40 percent of the WIA funds in 2003 were used to obtain training. The GAO found that most local workforce boards have developed policies to manage the use of ITAs, but many boards have encountered challenges in trying to implement their use. In addition, they found that little is known on a national level about the outcomes of those being trained because of weaknesses in the WIA database system found to be incomplete, unverified, and not comparable across local areas and states. A copy of the report and the survey instrument are available on the web at http://www.gao.gov/special.pubs/gao-05-807sp/
On June 29, the Administration for Children and Families (ACF) announced a request for comments on the Child Care and Development Fund (CCDF) Tribal Plan for FY 2006-2007. Indian Tribes, Tribal consortia, and Tribal organizations operating CCDF programs are required to submit plans describing the Tribe’s child care program biennially using a Tribal plan preprint, ACF-118-A. Comments on modifications to ACF-118-A should be submitted within 30 days. The announcement was published in the June 29 Federal Register (70 FR 37412) and is available at http://www.gpoaccess/fr/index.html.
On June 29, the Administration for Children and Families (ACF) proposed data collection from the Systems of Care demonstration sites to test whether this approach can help states reach child welfare Program Improvement Plan goals. These have been developed in each state as a result of findings from the Child and Family Services Reviews. Data will be collected via interviews, forms, surveys, focus groups, and case file reviews. The announcement was published in the June 29 issue of the Federal Register (70 FR 27411-27412), and is available online at http://www.gpoaccess.gov/fr/index.html .
This week the Kaiser Family Foundation released the results of a public opinion survey assessing Americans attitudes toward Medicaid. Overall, the survey found that the general public holds a positive view of Medicaid, with 74 percent rating it a “very important” government program. When asked about state budget crises, more than half (52 percent “strongly” opposed, and 22 percent “somewhat” opposed cutting Medicaid to balance state budgets. The survey is available at http://www.kff.org/medicaid/pomr062905pkg.cfm.
On June 28, the Pew Commission on Children in Foster Care hosted an event to release a new DVD titled Fostering the Future. The documentary showcases the commission’s recommendations on reforming juvenile and family court systems. At the event it was announced that Senators Mike DeWine (R-Ohio) and Jay Rockefeller (D-W.Va.) are developing legislation that will include the Pew recommendations on the courts. Additional information can be found at http://www.pewfostercare.org.