News Briefs
August 1, 1999 7 minutes read
News Briefs
IDS drug assistance programs face budget shortfall generated by better access to drugs
WASHINGTON, DC—State AIDS drug assistance programs (ADAPs) are facing a projected $90.2 million shortfall for fiscal year 2000, advocates testified to Congress in late June.
The projected shortfall is generated, at least in part, by advances in HIV therapy and easier access to medications, said Johns Hopkins University infectious disease specialist Richard Moore, MD.
Total national expenditures for AIDS drug assistance programs in fiscal year 1998 was $510.2 million, of which 76.6% was federal funding and 23.4% was state funding, according to the March 1999 annual report from the National ADAP Monitoring Project. At that time, 26 states reported that they either faced program restrictions or budget shortfalls.
The impact of expanded use of antiretrovirals and other drugs shows up in dramatic improvements in mortality and morbidity associated with HIV. The death rate from AIDS fell 44% from 1996 to 1997, and AIDS is no longer the leading cause of death among Americans ages 25-44, according to 1998 statistics from the Centers for Disease Control and Prevention.
—ADAP Working Group release, June 22; National ADAP Monitoring Project Annual Report, March 1999
Ohio health systems agencies face funding cut in 1999-2001 legislative budget proposals
Funding at about half their current level is the best offer Ohio’s health systems agencies (HSAs) are likely to get as they begin a two-year funding cycle this summer.
The most generous funding proposal for the HSAs as legislators headed into budget conference committee in mid-summer was $300,000 for the fiscal year beginning July 1, 1999, ratcheted back to $150,000 for the subsequent year. The funds would be divided among Ohio’s 10 HSAs, seven of which are active.
"I would just as soon cut them off now," says Dale Van Vyven (R-Sharonville), co-chair of the Health Systems Agency study committee. Despite a study committee recommendation that the HSAs should continue to be funded, Mr. Van Vyven is convinced that the organizations "don’t seem to be players" since Ohio eliminated Certificate of Need regulation in 1996 for all but nursing home expenditures.
The funding recommendation is included in the Senate version of the budget. Neither the House of Representatives nor the Ohio Department of Health recommended funding for HSAs.
—Staff report
U.S. House of Representatives takes up expansion of health services for disabled
WASHINGTON, DC—With a victory in the U.S. Senate behind them, advocates are turning their attention to the House of Representatives in their quest for expanded Medicaid and Medicare benefits for the disabled.
By late June, when the Senate approved 99-0 a bill expanding government health benefits for the disabled who return to work, the legislation already had secured 179 sponsors in the House. A bill nearly identical to the Senate legislation was approved in the House Commerce Committee in late May.
The Senate’s Work Incentives Improvement Act (S. 331) would create several options, including allowing disabled workers to buy Medicaid coverage even if they earned income above Medicaid thresholds or lost cash benefits—which often define eligibility for Medicaid—because of improvements in their medical conditions.
To overcome the objections of Sen. Phil Gramm (R-TX), Democrats agreed that additional costs associated with the bill would be funded from elsewhere in the federal budget, not a tax increase. Advocates long have argued that the tax revenues generated by newly employed disabled workers would offset if not replace expenditures associated with the expanded benefits.
—New York Times, June 17
Rhode Island expected to give regulators, public more oversight in health plan mergers
PROVIDENCE, RI—Regulators and the public would get more of a say in proposed health plan mergers under bills expected to pass both houses of the Rhode Island legislature.
Regarded as the most important health legislation of the year, the bills were submitted in response to Blue Cross & Blue Shield of Rhode Island’s courtship with potential buyers. The plan has nearly 470,000 subscribers in Rhode Island and Massachusetts.
One of the two known suitors for Blue Cross, for-profit Anthem Insurance Companies of Indianapolis, had unsuccessfully sought an amendment that it said would clarify how regulators would decide appropriate profit levels after a sale. The other company expressing interest in Blue Cross is the Blue Cross system in Massachusetts. Like the Rhode Island affiliate, Blue Cross of Massachusetts is nonprofit.
Under the bill, a prospective buyer would have to disclose substantial public information about its current business, as well as its plans for the company it’s buying. The Department of Business Regulation would have veto power over the acquisition, with advice from the attorney general’s office.
The Senate version of the measure passed on a 42-1 vote; a similar bill passed in the House by a vote of 86-0.
—Providence Journal, June 25
Merger with Columbia/HCA turns around strapped Oklahoma teaching hospitals
TULSA, OK— The first 11 months of a controversial joint operating agreement with Columbia/HCA has given the state-owned University Hospitals a $10.3 million profit, reversing a flood of red ink that helped spur the February 1998 agreement.
University and Children’s Hospital of Oklahoma lost $15 million in the seven months before the agreement, Oklahoma University College of Medicine Dean Jerry Vanatta told university regents in late June. He attributed the turnaround to $10 million in cuts in benefits packages and "significant" reductions in middle management staffing.
—Tulsa World, June 23
Report: HIV patient care inferior’ for blacks, Latinos, uninsured
CHICAGO—Quality of care among HIV patients in the United States is improving but remains "inferior" for large segments of the population, says an analysis in the June 23-30 issue of the Journal of the American Medical Association.
Three interviews with more than 2,000 HIV-infected individuals between January 1996 and January 1998 suggested that "inferior patterns of care" were seen for blacks and Latinos compared with whites, the uninsured and Medicaid-insured compared with the privately insured, women compared with men, and other risk and/or exposure groups compared with men who had sex with men. The disparity persisted even after adjustments for variations in CD4 cell count.
Outcome measures were patterns of ambulatory and emergency room visits and receipt of antiretroviral therapy and prophylaxis against Pneumocystis carinii pneumonia.
—JAMA 1999; 281:2,305-2,315.
OIG encourages states, HCFA to boost efforts to combat Medicaid managed care fraud
WASHINGTON, DC—"Confusion and disagreement" mark states’ efforts to handle fraud and abuse among their Medicaid managed care programs, says a recent report from the Department of Health and Human Services Office of the Inspector General (OIG).
The study of 10 states with Section 1115 waivers found there is "limited" activity in developing or actively pursing and referring fraud and abuse cases in the Medicaid managed care program. While eight of the 10 states had systems to detect and refer fraud cases, two states, Arizona and Tennessee, accounted for 97% of all the managed care referrals during the time period studied.
The Inspector General recommends that the Health Care Financing Administration take the following steps, with coordination with the OIG:
• establish guidelines for states and managed care organizations to follow in developing and carrying out proactive fraud and abuse detection and referral activities;
• ensure that states monitor managed care organizations’ fraud and abuse programs for compliance with its guidelines;
• continue to develop, sponsor, and emphasize detection and referral training for states and Medicaid managed care organizations.
The OIG report is available at www.dhhs.gov/progorg/ oei/whatsnew.html.
—Staff report
Trauma care access problems in Florida generate care guidelines but no more money
Florida legislators have taken the first step toward reviving the state’s moribund trauma system.
Representatives from four state agencies are meeting to create guidelines on how the state can develop a "necessary continuum" of care for the trauma victim from injury to final hospital discharge under legislative mandate approved in the 1999 session. Agencies involved are the Department of Health, the Agency for Health Care Administration, the Board of Medicine, and the Board of Nursing.
The legislation is spurred by a high-profile death in 1997 in which a two-year-old sexual assault victim never was transferred to a trauma center. The case caught the attention of State Sen. William "Doc" Myers (R-Stuart) and convinced legislators to fund a study about the problem.
"There has been a lack of timely access to trauma care due to the state’s fragmented system," legislators conceded in the 1999 legislation. While policy-makers long have complained that trauma system development is hampered by the lack of a stable revenue source, the 1999 legislation addresses the issue by merely directing the Department of Health to implement a statewide trauma system "as funding is available."
—Staff report
Pennsylvania restores Medicaid to 32,000 residents inadvertently dropped in move from welfare to work
PHILADELPHIA—Some 24,000 children are among the 32,000 Pennsylvania residents coming back on the Medicaid rolls after state officials mistakenly kicked them off.
The children lost Medicaid coverage as their parents moved off welfare and into paying jobs. The state in early July planned to mail to the dropped enrollees insurance cards pre-programmed with two months of coverage. After that, residents will have to fill out necessary application forms to continue coverage.
Pennsylvania’s efforts to find and enroll Medicaid members represent "meaningful, broad reform," said Claudia Schlosberg, a Washington, DC-based staff attorney for the National Health Law Program. "Pennsylvania has done something that all states should be doing."
Another 34,000 Pennsylvania residents had been incorrectly dropped from the Medicaid rolls since 1997, but have since found their way back to the program.
—The Inquirer, July 1
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