Grassley Continues Review of Minnesota Medicaid, Calls for Consistent Reporting

of Program Earnings at Medicaid Managed Care Plans Nationwide

WASHINGTON - Sen. Chuck Grassley of Iowa today said the state of Minnesota's payment problems to managed care plans serving Medicaid beneficiaries, combined with inconsistent federal oversight of all state rate-setting in this area, call for consistent reporting standards across the board.

"Purchasers, in this case states, using transparent information about how their dollars are being spent, are best suited to make decisions about the value provided from managed care companies," Grassley said.  "We have legitimate disagreements about many issues in Congress, but on this issue, there can be no disagreement.  We must have a better understanding of where $7 trillion will be spent by the Medicaid program over the next 10 years."

Grassley's comments came in testimony before a joint hearing of two subcommittees of the House Committee on Oversight and Government Reform.  The hearing covered several aspects of payment concerns in Medicaid, including payments to managed care plans in Minnesota.  State officials in Minnesota accepted $30 million for the state from one of Minnesota's contractor managed care plans and until this week, termed the payment a "donation" that did not require sharing with the federal government, which would be necessary under the state-federal Medicaid program.  This week, state officials agreed to give the federal government its share of the $30 million payment.

Information from the four managed care plans serving Medicaid beneficiaries in Minnesota showed that each plan listed excess revenues from Medicaid while showing losses on the state-only plans.  "This suggests the state might have overpaid managed care plans under Medicaid while underpaying the same plans to provide care for individuals covered with state-only dollars," Grassley said.

Grassley said the federal government should make sure states are required to know the medical-loss ratio of every managed care company they contract with specific to the Medicaid beneficiaries they serve.

That medical-loss ratio should be clearly defined by the federal Centers for Medicare and Medicaid Services and consistently implemented across every state that uses managed care, and the medical-loss ratio should be based on independently audited, verifiable encounter data and expense data that make clear what administrative expenses are related to the provision of Medicaid benefits and what administrative expenses are not, Grassley said.

Also today, Grassley wrote to the Minnesota legislative auditor, asking for all correspondence between the auditor and the state government, including state legislators, on the UCare payment.  The state auditor has questioned the candor of state officials who apparently withheld from him - as well as from Grassley - a letter from the federal government questioning the UCare payment.

Grassley's testimony before the House hearing is available here.  Grassley's letter to the Minnesota legislative auditor is available here.

The Fourth Annual Continuing Education Conference will feature nationally recognized lecturers in the field of obesity treatment.

MOUNT LAUREL, NJ – The 2012 Certification Examination for Obesity Medicine Physicians (COMP) will be administered November 3-17, 2012. The examination will test basic knowledge, evaluation and assessment, management and practice issues related to pediatric and adult obesity.

In December 2011, the COMP Steering Committee, composed of 11 professional societies and the American Board of Bariatric Medicine, merged their respective individual exam content, clinical expertise and administrative resources to form the American Board of Obesity Medicine (ABOM). ABOM will administer the certification exam for obesity medicine physicians. The ABOM certification exam is a voluntary certification designed to elevate the professional standard of experience and expertise in the treatment of obesity and influence the future of this vital field. The certification serves as a mark of distinction for physicians treating overweight and obese patients, raising their standing among peers and the public (source: Obesity.org).

Prior to the exam, physicians must have a minimum of sixty (60) credit hours of continuing medical education (CME) recognized by the American Medical Association Physician Recognition Award (AMA PRA) Category 1 Credits on the topic of obesity; at least thirty (30) credit hours must be obtained by participation and attendance at a conference.

The 2012 Weight Conference, "The Science and Business of Weight Management for the New or Experienced Practitioner," will help satisfy 11 CEUs of this requirement. And, during his discussion of Obesity Treatment in Primary Care, Dr. Robert F. Kushner, first chair of the American Board of Obesity Medicine, will be discussing the new certification.

Dr. Kushner joins other distinguished faculty, including, Judith S. Beck, PhD and Deborah Beck Busis, LSW; Thomas Wadden, PhD; John Baker, MD; John Hernried, MD; Susan Baker, MHA; and John Foreyt, MD, to help participants:

• Gain an understanding of the role of obesity care in primary practices and how to establish an effective program
• Learn effective counseling strategies for behavior change to help patients stay on your program longer, achieve successful weight loss results and maintain their goal weight
• Explore the role of the Very Low Calorie Diet (VLCD) and meal replacements in the clinical management of all overweight individuals, including those with co-morbid conditions especially diabetics

The 4th Annual Continuing Education (CME/CEU) Conference, "The Science and Business of Weight Management for the New or Experienced Practitioner," will focus on the operational and treatment skills, techniques, and strategies healthcare professionals need to successfully open a new weight loss facility or enhance a current weight management program.

For more information about the 4th Annual Continuing Education (CME/CEU) Conference, visit www.WeightConference.com, or call Jennifer Eisenhofer at 888.519.1192, ext. 3012.

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Thanks to Baby Boomers and modern medical marvels, more Americans than ever are heading into their senior years, and they're expected to live longer than ever, too. Barely 50 years ago, our average life expectancy was 62.5 years; today that number has risen to 78.2 years, according to the U.S. Census Bureau.

That means that more Americans than ever will also soon be deciding how to handle their eldercare. Steve Casto, Retirement Income Specialist and author of Is Your Retirement Headed in the Right Direction?, (www.stevecasto.com), says there are important questions and answers to consider before making that critical decision.

"The key thing to balance is the difference between what you think you'll need and what you can afford between your liquid assets and insurance coverage," Casto said. "If you don't start by asking yourself the right questions, you'll never get to the answers that will lead to a successful long-term care plan."

Here are some questions - and their answers:

Q. Should I opt for nursing-home or in-home care insurance?
A. When selecting insurance plans, protect against your worst risk first. In-home care is more about maintenance, while care outside the home is focused on crises. Home care is good for when a person needs help getting around. If he has a stroke, he'd need to be cared for outside the home initially, so there is a need for both.

Q. What should I select as my daily allowance?
A. If your health deteriorates, a daily allowance of $100 per day could cover all your care outside the home, but only a third of the care inside the home. Your home-care costs could rocket to more than $400 or more per day, so plan for the worst.

Q. What is an elimination period?
A. Sometimes referred to as the "waiting" or "qualifying" period, this refers to the length of time between the beginning of an injury or illness and receiving benefit payments from an insurer. With long-term care, the typical elimination period is 90 days, which means you are responsible for covering the first 90 days of care on your own. Most people believe that Medicare covers the first 90 days, which is dead wrong. It only covers it under certain conditions, and not all patients meet those conditions, which include :

o A nursing home stay that follows a three-day hospital stay
o Admission to a nursing home within 30 days of hospital discharge
o A Medicare-certified nursing home
o Physician-certified need for skilled care on a daily basis

Your best bet is to be insured through a long-term care policy for that first 90 days.

"These are just a few of the issues," Casto says. "A good starting point for those planning early is to completely discount the idea of getting a dime from Medicare. Even if it is still around when you need long-term care, the restrictions on Medicare are tightening. You'll be lucky to get the program to pay for 10 percent of a nursing home stay.

"The real answer is to get a solid long-term care insurance policy that is based on a sound plan."

About Steve Casto

Steve Casto is founder and president of Strategic Wealth Solutions, Inc. an Omaha, Neb.-based financial firm that manages money for investors in the Midwest. Steve helps clients reduce their tax bill, minimize their risk, and ensure they don't outlive their money. He's the author of Is Your Retirement Heading in the Right Direction? and offers presentations on how to increase income while reducing taxes.

Proposal Saves Medicaid System for Millions

SPRINGFIELD - April 19, 2012. Governor Pat Quinn today announced a plan to stabilize Illinois' Medicaid system and prevent collapse of the program, one of his top priorities this session. The Governor's plan creates $2.7 billion in Medicaid savings - which includes more than $2 billion in Medicaid reductions and federal matching funds from additional revenues on tobacco products. Today's proposal follows weeks of productive talks led by the governor's office with a working group comprised of members from all four legislative caucuses, as well as meetings with numerous provider groups.

"We must act quickly to save the entire Medicaid system from collapse, and protect providers and the millions of Illinois residents that depend upon Medicaid for their healthcare," Governor Quinn said. "This proposal will fundamentally restructure our Medicaid system, alleviate the pressures on the rest of our budget, and ensure the program is sustainable for years to come."

Medicaid provides healthcare to 2.7 million people in Illinois and coverage for half of all births. In his February budget address, the Governor highlighted the urgent need for a $2.7 billion reduction in the Medicaid program to prevent systemic collapse. At the end of the current fiscal year (FY 2013), Illinois will have $1.9 billion in unpaid Medicaid bills. The Civic Federation projects $21 billion in unpaid Medicaid bills by 2017 if Illinois' Medicaid system is not fundamentally and immediately restructured.

The Governor convened a working group - comprised of members from each of the four legislative caucuses - to explore all options and develop a framework to save our Medicaid system. The working group met with and incorporated suggestions from many provider groups, including: hospitals, podiatrists, durable and disposable medical equipment companies, long-term care providers, dentists, pharmacists, and hospice providers.

Governor Quinn's proposal reduces Illinois' Medicaid liability by $2.7 billion, with three-quarters of the plan comprised of cuts, reductions and efficiencies, one-eighth in state revenue, and one-eighth in federal matching funds:

·         Cuts, reductions and efficiencies to 58 separate items totaling $1.35 billion (50 percent)

·         Rate reduction to providers totaling $675 million - (25 percent)

·         Additional revenue through a $1 per pack increase in the cigarette tax totaling $337.5 million (12.5 percent)

·         100 percent federal match funding from the increased cigarette tax totaling $337.5 million (12.5 percent)

"The status quo is not an option, and I want to thank the members of the working group, who have worked diligently with us to find real solutions to this problem, "Julie Hamos, Department of Healthcare and Family Services director, said. "What we are presenting today is a balanced approach that targets fraud and abuse, continues our move to coordinated care for Medicaid clients, and takes advantage of federal matching funds to make every dollar go further."

The cuts, reductions and efficiencies across 58 separate items in the Governor's proposal include :

·         Program integrity to prevent client and provider fraud

·         Elimination or reduced coverage of certain optional populations and services

·         Controls on use of Medicaid services to prevent over-use or waste

·         Adjustments to rates that are outdated or do not reflect budget realities

·         Expanded cost-sharing by clients

·         Redesigned healthcare delivery system through Coordinated Care

·         Complete implementation of all reforms in 2011 Medicaid reform law

To access more funds from the federal government, the Governor's plan to limit Medicaid liability includes a tobacco revenue increase. By including a tobacco revenue increase, which amounts to just one-eighth ($337.5 million per year) of the $2.7B savings we must find in the Medicaid program, the state will be eligible for an additional 100 percent in federal matching funds ($337.5 million per year).

In addition to the direct revenue, raising the cost of cigarettes by a dollar will improve the health of the people of Illinois, reducing tobacco-related Medicaid and health care costs over the long-term. According to the American Cancer Society, tobacco use cost Illinois $1.5 billion in Medicaid spending last year. Increasing the cigarette tax by a dollar a pack will prevent more than 70,000 children from becoming addicted adult smokers, decrease youth smoking by 11 percent and save more than 38,000 Illinois residents from premature, smoking-caused death.

"The American Cancer Society is pleased to see the Governor combining smart fiscal and public health policy with this proposal," said Katherine L. Griem, M.D., President of the American Cancer Society, Illinois Division. "Smoking remains the leading cause of cancer and this proposal will not only reduce the burden on the state's Medicaid program for years to come, but more importantly, it will save lives and improve the health of people across Illinois, particularly in curtailing youth smoking."