With All Our Might...Elevating Child Health Policy

Off to the Races at the NCSL 2010 Legislative Summit

By Melissa James, Associate Director, Policy Analysis

Today wraps up the National Conference of State Legislatures 2010 Legislative Summit. The annual Summit brings together legislators and legislative staff from across the country to discuss the biggest policy issues facing the states. N.A.C.H. has partnered with children’s hospitals to exhibit at the Summit for the last four years. The exhibit gives us a chance to get in front of state legislators, their staff and staff from other organizations to talk with them about why children’s hospitals are critical for all children. To say this is a big meeting is an understatement—several thousand people attend, even some who have traveled from overseas. There are always a number of nationally known speakers, learning sessions on a wide set of policy issues and many events that highlight the best the hosting city has to offer; since this year’s Summit was held in Louisville, KY, that meant country music and horse racing.

My colleague Liz Parry and I flew to Louisville early to attend a pre-conference on health care reform. The agenda was jam-packed with sessions on topics that N.A.C.H. is following closely. We heard from several policymakers from Utah regarding their experience with implementing a health insurance exchange pre-health reform. Jay Angoff, director, Office of Consumer Support and Insurance Oversight at HHS (which will be overseeing the private market reforms under health reform) discussed some of the options for state flexibility when designing exchanges. Cindy Mann, director, Center for Medicaid, CHIP and Survey & Recertification at CMS, explained how health reform will shift Medicaid from being a safety net program to a foundation for health care coverage. And health care administrators from a few states talked about challenges to the health care workforce and how they might impact access to care. Although much of the material was familiar to Liz and me, it was a good opportunity to hear what state lawmakers are hearing about health reform. I can only imagine how overwhelmed they were to learn about all the issues that need to be addressed, many of them immediately, to implement the new federal health reform law.

After the health reform pre-conference came my favorite part of the Summit —staffing our “All Children Need Children’s Hospitals” booth in the convention center’s exhibit hall. Over the three days the exhibit hall was open, we greeted hundreds of people as they browsed among all the exhibit booths in the hall. I am always amazed and humbled by the outpouring of support people express for children’s hospitals when they stop by our booth—nearly everyone had a connection of some sort to share. This year we talked to a state legislator whose son’s life was saved by a children’s hospital after staff there attributed his illness to a spider bite, which other providers had failed to discover. Others generally praised the care families or friends had received, which still others relayed their pride in participating in fundraisers for their local hospitals. Working in the booth always underlines for me what an important mission our member hospitals serve in their communities.

Now it’s back to the office, to promote policies that will allow our children’s hospitals to continue serving that important mission. With the sound of the mariachi band that heralded the Summit’s 2011 destination of San Antonio, TX, still ringing in my years, I am already looking forward to exhibiting next year!

N.A.C.H. Attends Unveiling of the Final HIT Regulation

I was welcomed back from a weeklong beach vacation with an 830 page regulation to review on health information technology (HIT). This is the much anticipated final regulation that outlines the rules for doctors and hospitals to be able to receive Medicaid incentive payments for the meaningful use of electronic health records (EHRs). I attended an HHS event that rolled out the regulation and outlined the positives from the agency’s perspective. N.A.C.H. and many provider groups will be spending a large portion of the foreseeable future reviewing and analyzing the regulation for impact on their constituencies.

It will take us some time to review the full regulation, but I wanted to share the major messages delivered by HHS officials, including Secretary Sebelius and the National Coordinator for Health Information Technology, David Blumenthal, M.D.:

• HHS believes that the rule allows more flexibility for doctors and hospitals to meet the meaningful use requirements. The “all or nothing” approach of the proposed regulation that would have required providers to meet all requirements all at once was revised to establish some core measures that providers must meet with additional measure options that providers can choose from.
• Providers can begin to register for the Medicaid and Medicare Health Information Technology incentive payments beginning in January 2011. Under the Medicaid incentive program, states will establish the timeframe for payment.
• HHS reduced the flexibility given states to add to the meaningful use requirements for providers to receive Medicaid incentive payments.
• HHS intends to substantially increase requirements in Stage 2. There will be a rulemaking process that will allow comments on Stage 2. The current regulation outlines requirements for Stage 1.

Now we need to roll up our sleeves and dig into the regulation to see if the concerns and comments we shared with HHS were addressed. Some are addressed above, but others require more analysis. Stay tuned to this blog to learn more about the regulation and the impact on children’s hospitals and their patients.

Inaction on FMAP Means Fireworks Are Likely in States with Shortfalls

By Jan Kaplan, Consultant, Policy Analysis, N.A.C.H.

As the first week of July comes to a close and the noise of July 4 fireworks become a memory, many states are winding down the first week of their fiscal year. In more than half of the states, the noise of the fireworks has become the noise of many voices trying to grapple with a fiscal crisis made worse by the failure of Congress to extend enhanced federal Medicaid matching funds (FMAP) for states. Right before leaving Washington for its annual Independence Day recess, Senate leadership was unable to move ahead with legislation to extend unemployment benefits, tax credits and the enhanced FMAP after a procedural motion was defeated. The bill also included another N.A.C.H. priority—a legislative correction to ensure that free-standing children’s hospitals are eligible to receive discounts for orphan drugs under the federal 340B Drug Discount program. After the vote, many senators went home to a fiscal mess of historic proportions.

The extra federal matching funds have helped stabilize state Medicaid programs and prevent cash-strapped states from cutting health care coverage at a time when the need for coverage is growing. Almost two-thirds of the available funds have already been used and the majority of states have incorporated the enhanced FMAP funds in their FY 2011 budgets. Unless Congress acts, the funds will expire on Dec. 31, right in the middle of states’ fiscal year. The funds will disappear at a time when states’ tax revenues continue to decline, most states have used up any budget reserve funds that they might have had and, according to the National Governors Association, states face a collective $55.4 billion budget shortfall. The loss of the enhanced FMAP after December is expected to increase state Medicaid spending by seven percent.

How will states balance their budgets, which they must do, despite the expected increase in Medicaid spending and the loss of the federal dollars? Even with the FMAP funds, governors’ FY 2011 proposed budgets already included stringent Medicaid cost savings proposals, which focused first on cuts to provider rates. In fact, 48 governors included provider payment freezes or reductions in their FY 2011 budgets. Another 25 governors proposed reductions in benefits, and some wanted to delay coverage expansions or impose other cuts. Governors and their counterparts in the state legislatures are already having very noisy discussions about ways to further reign in the soaring costs of their Medicaid programs to address the budget hole that is left if the enhanced FMAP is not extended.

State lawmakers are between a rock and a hard place. They must provide Medicaid to those in need, but they must also balance their budgets. Congress needs to step in and provide states with fiscal relief through the continuation of the enhanced federal matching funds for at least another six months. Let’s hope that Congress has the courage to take this action in the next few weeks so that states can continue to provide essential services to children and families who rely on Medicaid. N.A.C.H. and the nation’s children’s hospitals will certainly do everything they can to urge members of Congress to act.

An Education from a Young Advocate

By Camie Corrigan, Assistant Director, Federal Legislative Affairs

Educating Hill staff is a tall order even for the best in this business, but for Salena Williams, a patient representing Rainbow Babies & Children’s Hospital in Cleveland, OH, her first visit to Washington, DC left quite an impression on members of Congress and their staff when she shared her struggle with her health and weight.

Last week, Rep. Marcia Fudge (D-OH) hosted a congressional briefing on childhood obesity and hunger disparities in underserved communities to educate her peers and their staff about the specific health needs of this population that require a national commitment to improvement. A thoughtful panel of advocates, which included Salena, highlighted the challenges and opportunities disproportionately facing minority populations and underserved communities.

The audience of more than 250 gained perspective from the American College of Sports Medicine, Feeding America, National Council of La Raza, NAACP and the National Indian Health Board. Most pressing were statistics that indicate low-income and traditionally underserved minority populations are disproportionately at risk of being obese or malnourished. Each organization took a moment to share with Hill staff the specific needs of the population they represent and what they are doing to improve their communities’ health outcomes.

Rose Gubitoski-Klug, MD, a pediatric endocrinologist from Rainbow Babies & Children’s Hospital, spoke to the unique role children’s hospitals play in the treatment of children struggling with obesity. She placed a strong emphasis on the multi-disciplinary approach to care necessary to deliver the best outcome for her patients and stressed how critical it is that families are involved from the very beginning.

Since Salena couldn’t attend her Washington, DC trip in eighth grade because she had just been diagnosed with type 2 diabetes, she took matters into her own hands with the help of her pediatricians and family. Traveling from Ohio to DC, she graciously shared her story of living with and managing type 2 diabetes and how hard she has worked to reduce her above-average Body Mass Index (BMI). Salena thanked her physician from Rainbow Babies & Children’s Hospital for all of the support she has provided to her over the years and imparted a sense of encouragement and hope with the entire audience. 

This briefing served as one of several opportunities where children’s hospitals will continue to educate Congress and their staff on the responsibility we have to ensure that all children have access to the multi-disciplinary medical treatments needed to end childhood obesity.