With All Our Might...Elevating Child Health Policy

Isn’t August Supposed to be Quiet?

August is traditionally a quiet month in D.C. when Congress is out on recess, less traffic and many people enjoying the last few weeks of summer before school starts again. However, this year is not traditional.  As we focus on the implementation of health reform, we are working hard to provide policy information/analysis to the Department of Health and Human Services’ (HHS) staff writing guidance and regulation on issues of importance to children’s hospitals and their patients. Since the effective dates for several important provisions are coming up quick, HHS has not taken a break and neither have we. 

On many of these policy issues, we do have the opportunity to make our case with the Centers for Medicare and Medicaid Services (CMS) before policies are developed. Here are some highlights of what is keeping us busy this month:

Medicaid Payment Floor for Primary Care Services:  The application of the Medicaid payment floor to general pediatrics as well as pediatric specialists is a top priority for the Association.  Within the last month, we have met with the CMS staffer assigned to the development of this policy and have shared critical data showing the importance of the inclusion of pediatric specialists. We will continue to reinforce this message in all communication with CMS.

• Medical Homes for Children with Chronic Conditions:  The health reform legislation allows states enhanced Medicaid funding (90 percent FMAP) to establish “health homes” for people with chronic conditions. The effective date of this provision is Jan. 1, 2011. We have heard that CMS is working on guidance to go out in a state Medicaid Director letter to be followed by a regulation. We want to ensure that the guidance provided to states would allow programs focused on children to participate in the enhanced funding.  Of course, establishing health homes would be up to the state. We know several children’s hospitals have medical home programs for children with chronic conditions, many of which have outcome data to show they have reduced costs and improved quality for children.  We are collecting examples of these programs to share with CMS proactively to hopefully influence the policy development on this provision. 

• Non-payment for Hospital-Acquired Conditions:  Beginning in July 2011, CMS has to implement the provision in health reform that prohibits Medicaid funding for health care acquired conditions. CMS has reached out to the Association for input. We are eager to work with CMS to ensure that the conditions will work for children. Medicare has a current policy and we do worry that this policy will be applied wholesale to the Medicaid program. This could be detrimental to children since the Medicare conditions were not developed with kids in mind. We are collecting information from hospitals and plan to provide information to CMS by the end of the month. 

• Private Insurance Reforms:  Although most of the patients cared for at children’s hospitals are insured by Medicaid, some of them do have private insurance. There are also some children who only enroll in the Medicaid program because they have hit annual or lifetime limits imposed by private insurers or have been denied coverage because of a pre-existing condition. These private insurance reforms being developed right now will be positive for children overall, and may also help alleviate some of the financial burden on the state Medicaid programs. We are currently reviewing regulations that will phase out annual limits, end pre-existing condition exclusions and outline which preventive services need to be provided without cost sharing.We will provide comments to HHS on these regulations. Children’s hospitals will receive draft Association comments on these regulation so they can be used if the hospitals would like to submit individually.

And I won’t even mention the combined 1,000+ pages of regulations on payment for end stage renal disease and health information technology that we are reviewing to provide information to children’s hospitals on these final policies. Our August has been a bit busier this year, but we hope our efforts contribute to positive policies for children. When does August end again?

Congress Approves Extension of Enhanced Federal Funds for Medicaid

By Camie Corrigan, assistant director, federal affairs, N.A.C.H.

Since last December, children’s hospitals, and countless other advocates, have been urging Congress to extend the American Recovery and Reinvestment Act’s enhanced federal funding to support states' Medicaid programs (FMAP) for an additional six months. During the last 8 months, the House and Senate have considered and debated several legislative vehicles that would carry the FMAP extension. Advocates remained focused on urging Congress to pass this extension immediately.

Last week the Senate passed H.R. 1586 which included the FMAP extension and today, in a rare return from August recess, the House voted to pass the measure and it is headed to president for his signature.

Unfortunately, the final provision is not the full $24 billion we initially advocated for and rather includes $16.1 billion for states through June 2011. The final provision phases down the general increase in funding for the FMAP extension from the current across-the-board increase of 6.2 percent to 3.2 percent through March 2011 and then reduces the rate to 1.2 percent through June 2011. Still, the enhanced funds will help stabilize state Medicaid programs and prevent states from making deeper cuts to Medicaid on the backs of providers, such as children’s hospitals.

At a time when our country continues to recover from the downed economy and Medicaid experiences rapid increases in enrollment, the extension of the federal funds will allow children’s hospitals to continue to provide the essential services to children and families who rely on Medicaid.
 

Now the Work Begins

 

By Amy Mansue, CEO of Children’s Specialized Hospital

"The passage of the health care reform act was not the hard part—now the work begins." This message was articulated to the congressional staffers who work on Capitol Hill during a recent health care reform briefing.  Over and over again, I, on behalf of NACHRI, drove the point home, as did representatives from the American Academy of Pediatrics and First Focus, a non-provider advocacy organization. The differences between strategies to address the needs of the newly insured children versus strategies to address the needs of adults couldn't be more different. Start with the basic fact that there is a critical shortage of specialists in pediatrics, where the biggest issue facing adults is how to access primary care. There can be a utilization of physician extenders in the short run until more primary care physicians are trained; there is no similar "quick fix" in pediatrics.

When staffers asked "why aren't physicians choosing pediatrics?" the answer was simple—it is all about math. There is no incentive to go through an additional decade of training to get paid less than what a pediatric nurse practitioner is now demanding in my home state of New Jersey. You can't pay your student loans, support your family, let alone live in the way you had hoped if you make this choice. The question isn't why aren't physicians choosing pediatrics. The question is for those who do, how are they affording it? The short answer is us. Children's hospitals are supporting fellowships and employing physicians and then taking on the losses when reimbursement doesn't cover their salaries. In order for us to be able to continue to improve the health of children, we have to be in business. The health care reform package which mandated that the reimbursement adjustment for pediatricians be equivalent to the Medicare floor is a step, but it is not the only step that needs to be made.

In the next 48 months, there will never be a more important time for N.A.C.H.'s voice to be heard and therefore we all must be vigilant in telling our message, over and over again. As the reality of 32 million people accessing the health care system hits us, there will be chaos and probably panic as the system strains to meet this new demand. We know that in these times of crisis that there are opportunities for those who remain steadfast in their message and focus to make progress that we cannot even imagine today.

Whether it’s continued participation in Hill advocacy efforts or other public policy work—never has there been a more important time to ensure that our message of creating the best possible health care system for children is heard above all the other noise in the halls of Congress. The voice of the voiceless will be ours to bear. And if we do it well, we will have invested in this next generation in a way that no other has done before.