WASHINGTON - U.S. Senators Chuck Grassley, R-Iowa, and Herb Kohl, D-Wis., today released a report urging the Centers for Medicare and Medicaid Services (CMS) to improve oversight of the new system being created to monitor the quality standards in nursing homes.

The Government Accountability Office (GAO) report, entitled, "Nursing Home Quality: CMS Should Improve Efforts to Monitor Implementation of the Quality Indicator Survey," urges CMS to improve efforts to monitor implementation of the Quality Indicator Survey (QIS) for nursing homes.  The full report can be found here.

CMS started moving toward the QIS process in 2005 after reports indicated a need for improvements in the traditional survey process.  But the agency has decided to temporarily suspend implementation until a number of concerns raised by states and regional CMS offices have been resolved.

"The report shows CMS doesn't do enough to monitor and facilitate states' implementation progress," Grassley said.  "After six years of implementation, 26 states had trained or started training surveyors to use the system, but uncertainty about progress by these states led CMS to suspend implementation for the rest of the country.  If CMS were better tracking state implementation from the beginning, the agency could have identified these problems earlier and helped the states that are struggling."

"There's an obvious need for a clear, consistent and efficient system for monitoring nursing home quality," Kohl said. "QIS has the right goals in mind, and has the potential to make a positive difference in the consistency and accuracy of state survey work across the country -- but implementation needs to be done well, and the agency's goals need to be realized sooner rather than later."

Grassley and Kohl have worked together on nursing home quality for many years.  Most recently, their bill, the Nursing Home Transparency and Improvement Act of 2009, was passed into law.  Through the Senate Special Committee on Aging, the senators have pressed the federal government and states to improve the quality of nursing home care through more rigorous inspections and better information about inspection results for consumers through the federal Nursing Home Compare database.  Kohl is chairman of the Aging Committee.  Grassley is former chairman.  A landmark GAO report from 1998 was the subject of Aging Committee hearings Grassley convened.  The hearings exposed serious quality of care problems in nursing homes, exacerbated in part by highly predictable annual inspections and few citations for serious deficiencies.  After the hearings and at the urging of the Aging Committee, the Clinton Administration took steps to improve the inspection process.  Grassley and Kohl have urged continued attention and refinements.

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WASHINGTON - Sen. Chuck Grassley of Iowa has asked each state for information to help determine whether the states and the federal government are conducting enough oversight of their rate-setting for Medicaid managed care plans.

"In light of the billions of dollars already spent on Medicaid, including managed care, and the planned expansion of Medicaid, it's important to look at whether states are setting their managed care payment rates appropriately and in keeping with federal law," Grassley said. "If the payment rates are out of whack, and scrutiny is lacking, Medicaid money could be ill-spent to the detriment of vulnerable beneficiaries and the taxpayers.  The risk could be especially high when Medicaid provider payment rates are boosted to match higher Medicare rates for two years as Medicaid is expanded under the new federal health care law."

Grassley's inquiry comes after the Government Accountability Office in 2010 found inconsistent scrutiny from the federal government of state rate-setting in this area.  GAO cited two states - Tennessee and Nebraska - as examples of those that received inadequate oversight from the federal Centers for Medicare and Medicaid Services.  Now, the state of Minnesota and its contractor non-profit health plans are drawing scrutiny in the state for what some analysts consider high operating margins. States are required to set rates for Medicaid managed care that are actuarially sound, but it's unclear if the requirement is clearly defined or enforced.

Grassley wrote in his letter to each state, citing the GAO report, "In the 18 months since that report was issued, I have seen nothing to convince me CMS or the states have improved in their ability to confirm that managed care entities are appropriately and correctly reimbursed for the services provided. If an entity is paid too little, the access to and quality of care provided to beneficiaries is jeopardized.  If an entity is paid too much, scarce Medicaid resources are diverted away from providing services to beneficiaries."

Grassley's letter includes questions such as whether states have an independent audit requirement for managed care entities and if so, whether the audit entails certain elements; for a list of all managed care entities operating in the state and an accounting of audit occurrences and results; the state's definition of allowable medical costs under the managed care contracts; and whether states have received any guidance from CMS or sought guidance from CMS on Medicaid managed care rate-setting.

The federal government will spend nearly $4.5 trillion on Medicaid over the next decade.  That's only the federal share.  State governments spend additional, significant amounts of money on Medicaid.  "Every dollar that's spent improperly doesn't help a Medicaid beneficiary," Grassley said.  "Getting a handle on managed care payment rates is necessary for the program's bottom line."

The new federal health care law boosts federal Medicaid payments to primary care physicians for two years, from Jan. 1, 2013, to Dec. 31, 2014.  For that period, the doctors will receive Medicare payment rates, which are higher than Medicaid payment rates.  At the same time, Medicaid programs and providers will cover more patients, as required under the health care law.

A copy of Grassley's letter to each state is available here.  The letters are identical.  The 2010 GAO report is available here.

Center for Rural Affairs analyzes benefits of Medicaid in rural areas
Rural children increasingly reliant on public health insurance

LYONS, NE - Medicaid protects long-term care for millions of seniors, helps people with disabilities live independently and provides health coverage that ensures children can see a doctor when they get sick. The Center for Rural Affairs released a new health care report today, entitled - Medicaid and Rural America - that examines these and other vital roles Medicaid plays in rural areas.

"A variety of unique characteristics of rural communities make Medicaid crucial for rural people and rural places," said Jon Bailey, Rural Research Director at the Center for Rural Affairs and author of the report.

"The demographics and health care infrastructure of rural America make Medicaid a vital source of insurance coverage, filling gaps in Medicare coverage and the availability of private insurance," Bailey continued.

According to Bailey, rural poverty rates are generally higher. Rural residents have lower rates of employer-sponsored health insurance. And rural areas have a higher proportion of older persons in their total population.

Bailey's report goes on to explain that about 65 percent of families with non-elderly Medicaid enrollees have at least one worker in the family, with nearly half having at least one full-time worker.

"Many perceive Medicaid as the classic 'welfare' program," said Bailey. "That perception is simply not true."

A full copy of the report can be viewed and downloaded at: http://files.cfra.org/pdf/Medicaid.pdf.

The Center for Rural Affairs report makes a detailed case that Medicaid is a critical piece of the rural health care system. The connections between rural areas and Medicaid include :

• The unique rural demographics of an older, lower income, more disabled and less healthy population with lower rates of private health insurance require a well-functioning Medicaid program.
• Medicaid provides health insurance coverage and health care access for rural children and the disabled, both with limited health insurance options.
• Significantly more people in rural areas would be without health insurance without Medicaid coverage.
• Medicaid is a primary financer of long-term care, vital in rural areas with higher rates of elderly population and greater reliance on nursing facilities.
• Medicaid helps expand health services?particularly mental health services?that would otherwise be limited or nonexistent in rural areas.
• Medicaid keeps health care facilities and health care providers in rural areas by providing a significant portion of patient revenue.
• Medicaid enhances the quality of life in rural areas by providing greater access to rural health care services.
• Medicaid helps the rural economy by providing jobs and local revenue.

In the report, Bailey also provides evidence that Medicaid is also vital to the rural health care infrastructure and to rural communities. Health care providers, especially those who serve large percentages of Medicaid patients, rely on Medicaid payments to cover the costs of treating those patients. Federal and state Medicaid dollars contribute to rural economic development by generating health care jobs and other related businesses and services.

"In many respects, Medicaid has become a rural program," explained Bailey.

The most recent data on Medicaid coverage show that 16 percent of rural residents had Medicaid coverage in the past year, compared to 13 percent of urban residents. And a recent analysis of those eligible for Medicaid from state data affirms the importance of Medicaid to rural people.

The data from 35 states and the District of Columbia shows that more rural than urban residents are eligible for Medicaid in 31 states. (New Jersey and the District of Columbia, have no rural counties). In 13 states the rural-urban variation was five percentage points higher for the rural population.

"The importance of Medicaid to certain populations - children, low-income disabled, low-income elderly and pregnant women - in rural America is especially striking," Bailey concluded.

Obesity has become such an epidemic in the United States, the FDA is considering approving a new prescription weight-loss drug - despite safety concerns about it.

It seems the health effects of being overweight override officials' concerns about Qnexa, a drug the FDA rejected two years ago.

That shocks weight-loss expert Don Ochs, who says neither diets nor drugs are effective, long-lasting solutions.

"When you understand the biology behind burning off fat versus packing it on, the whole notion of starving yourself on a low-calorie diet is absurd," says Ochs, developer of the physician-recommended Mobanu Integrated Weight Loss Solution (www.mobanu.com). "And certainly taking a drug that can damage your heart is out of the question."

Here's what people should know about biology and weight loss, Ochs says.

• Your body was designed to temporarily store fat because food was not consistently available to our ancestors. They relied on that stored fat to get them through famines, winters and dry seasons. That worked very well until we made huge advances in agriculture and food supplies became abundant and consistently available.

• When food is plentiful, your body will quickly burn fat deposits - those bulges you want to get rid of - for energy. When food is scarce, it burns fat more slowly, to help ensure your survival. That's why simply eating less is not the best way to lose weight. A low-calorie diet actually tells your body to store fat because food is in short supply.

• You can control whether or not your body stores fat for survival or dumps it for an upcoming time of plenty by sending it the right signals. The types of food you eat, and how much you eat of them, send biologically ingrained messages to your body about whether to store fat or burn it - just like flipping a switch.

• Your body is very efficient at converting certain types of food to fat. These were the foods with natural carbohydrates that were available to our ancestors before a dry season or another winter, such as apples, which ripen in the fall. If you eat these foods, your body interprets it as a signal that lean times are coming so guess what? It starts stocking up on the stored fat.

To address his own weight problem, Ochs spent years studying the biology of fat burning versus fat storing based on research conducted at The Mayo Clinic and the National Institutes of Health. From that perspective he figured out how to recognize when the foods he ate were signaling his body to produce a lot of insulin, which results in storing fat instead of burning it off.

"When you feel very sleepy after a meal, or when you're full and yet you still crave food, those are signals that you've flipped the switch and turned on your insulin production," he says. "How many carbohydrates flip that switch is different for every person based on genetics.

Losing weight by working with biology and your own individual, genetically encoded insulin triggers is natural and a prescription for long-term success. It doesn't mean you can eat whatever you want and never exercise, but it does mean you'll feel full and satisfied and have lots of energy. And keep the weight off.

About Donald Ochs

Donald Ochs is a Colorado entrepreneur, the president and CEO of Ochs Development Co. and M4 Group, an inventor and sports enthusiast. He developed the Mobanu weight loss system based on research conducted at The Mayo Clinic and the National Institutes of Health. The program is endorsed by physicians, nutritionists and exercise experts.