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Published by rkarlin

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Published by: rkarlin on Jun 04, 2010
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Emergency Bill
Eliminate 2010 Trend Factor 
. The remaining share of the calendar year 2010 trendfactor (1.7 percent) would be eliminated for hospitals, nursing homes (excludingpediatric nursing homes) and home and personal care providers. (2010-11 Savings:$99.1million)
Reduce Indigent Care Reimbursement
. Total payments for indigent care will bereduced. (2010-11 Savings: $72.2 million)
Limit Payments for Preventable Readmissions.
State would establishreadmission benchmarks for non-mental health care services and reducereimbursement to hospitals that have a higher than expected level of preventablereadmissions for the same condition. (2010-11 Savings: $10.0 million)
Limit Rate Appeals and Authorize Settlements
. A statutory cap would beestablished on the processing of nursing home rate appeals and DOH would beauthorized to negotiate settlements where appropriate. (2010-11 Savings: $16.5million)
Reduce Reimbursement for Bed Hold Days
. Payments to nursing homes for holding beds vacant would be reduced to 95 percent of operating rates andreimbursement would be limited to 14 days annually for hospitalization and ten daysannually for therapeutic leaves. (2010-11 Savings: $6.9 million)
Remove Drug Costs from Nursing Home Rate
. Remaining prescription drug costswould be excluded from nursing home rates and reimbursed on a fee-for-servicebasis. This would allow the State to collect rebates on these drug costs. (2010-11Savings: $2.4 million)
Authorize Additional Home Care Efficiencies.
Statutory requirements would bemodified to extend the time period for long-term home health care programreassessments from 120 to 180 days, allow these programs to provide joint casemanagement services to avoid duplication and participate in a demonstrationprogram to serve dual-eligible population (e.g., individuals that are eligible for bothMedicare and Medicaid services). (2010-11 Savings: $0.6 million)
Reduce Managed Care Premiums
. Premiums for Medicaid Managed Care andFamily Health Plus plans would be reduced by 1.7 percent. (2010-11 Savings: $61.4million)
Eliminate Medicare Part D Drug Wrap.
Medicaid coverage for anti-depressants,atypical anti-psychotics, anti-retroviral and anti-rejection drugs for dual eligibleenrollees is discontinued, as these drugs are already covered through Medicare.Wrap-around coverage will continue for drugs not covered by Medicare Part D (e.g.,barbiturates, benzodiazephines).
(2010-11 Savings: $4.3 million).
Discontinue Exemptions under Preferred Drug Program.
The Preferred DrugProgram exemption for anti-depressants, atypical anti-psychotics, anti-retroviral and
anti-rejection drugs will be discontinued in order to collect supplemental drug rebatesfor these drug classes. However, these drug classes will not be subject to prior authorization. (2010-11 Savings: $2.1 million)
Expanding the List of Physician Administered Drugs.
The State would beallowed to collect rebates on all drugs administered in physicians’ offices. (2010-11Savings: $2.9 million)
Enhancing Dispute Resolution Services.
Additional resources would bededicated to shorten the timeframe for pharmacy dispute resolution to increaserebate collections. (2010-11 Savings: $1.2 million).
Accelerate Pharmacy and Therapeutics Committee Notice Requirements.
Thetime period before final recommendations of the Pharmacy and TherapeuticsCommittee can be implemented is reduced from 30 days to 5 days to allow for theaccelerated collection of supplemental rebates. (2010-11 Savings: $0.8 million)
Discontinue Special Pharmacy Reimbursement.
The higher special pharmacyreimbursement for HIV pharmacies will be discontinued. (2010-11 Savings: $0.6million)
Reinstitute Prior Approval of Health Premium Increases.
Since prior approval of health insurance premiums was phased out, health insurance premiums have grownby double-digits, increasing nearly 14 percent annually in HMO small group market.While many legitimate factors contributed to this growth, the Insurance Departmentwill again be authorized to review health insurance premiums to protect consumersfrom unnecessary increases. Medical loss ratios will also be increased to ensurethat a greater percentage of premium revenues are used to pay medical claims.Savings is expected to result by reducing the number of consumers with employer-based coverage that transfer to public health insurance programs. (2010-11Savings: $70 million)
Combat Medicaid Fraud.
The Medicaid Fraud Target is increased from $870million to $1.17 billion. (2010-11 Savings: $300 million)
Establish Transportation Managers.
The Department will contract with an externalorganization to manage non-emergency transportation service. (2010-11 Savings:$8.3 million)
Control Physical and Occupational Therapy Spending.
Prior approval of certainphysical therapy and occupational therapy services will be required. (2010-11Savings: $3.5 million)
Apply Additional Utilization Review Controls.
Additional controls will be placedon the utilization of medical supplies, including incontinence supplies; wheeledmobility products and accessories; shoes; diabetic needle supplies; hearing aids;and oxygen delivery systems. (2010-11 Savings: $1.9 million)
Discontinue Spending for Selected HCRA Programs.
Funding for GraduateMedical Education Innovations ($37.4 million), Long Term Care Education andOutreach ($1.3 million), disease management demonstrations ($1.8 million) and anti-tobacco funding for Roswell research ($13.6 million) will be eliminated. (2010-11Savings: $54.1 million)
Consolidate Poison Control Centers.
Currently, there are five Poison ControlCenters operating in the State. The operations of these centers will be consolidatedinto two centers. (2010-11 Savings: $2.5 million, 2011-12 Savings: $2.5 million).
Require All Pre-Need Funeral Accounts to be Irrevocable.
Require pre-needfuneral accounts established for consideration in a Medicaid eligibility determination,including those for a spouse or family members, to be irrevocable. (2010-11Savings: $1.0 million).
Require EPIC Participants to Exhaust Medicare Part D Appeal Process prior toAccessing EPIC Drug Coverage.
EPIC will not automatically provide drug coveragewhen Medicare denies a prescription. Instead, the prescriber will be notified to either begin an appeals process or change the prescription to a covered drug. During theappeals process, patients will receive up to a 90 day supply of the drug, and if theappeal is ultimately denied, the patient will continue to receive drug coveragethrough EPIC. (2010-11 Savings: $11.9 million)
Require Early Intervention Preferred Assessment Tools.
Evaluators for theprogram would be required to use assessment instruments from a DOH list of preferred instruments to determine eligibility. The current lack of standards hascreated wide variation in diagnosis and associated services. (2010-11 Savings: $0.8million)
Modify Early Intervention Speech Standards.
Evidenced-based criteria would beused to determine a child’s eligibility for speech and language services. (2010-11Savings: $1.4 million)
Allow Paraprofessional Behavioral Aides for Children with Severe Disabilities.
Paraprofessional behavioral aides would be allowed to deliver applied behavioralanalysis intervention programs to children with autism spectrum disorders and other severe disabilities. (2010-11 Savings: $1.5 million)
Revise Early Intervention Home and Facility-based Rates.
Rates for home-basedvisits would be decreased and the rates for facility or clinical-based services wouldbe increased to ensure more appropriate delivery of services. (2010-11 Savings:$2.4 million)
Audit Early Intervention Providers.
Audits of certain providers would be conductedto ensure appropriate payment. (2010-11 Savings: $0.5 million)
Restructure General Public Health Work.
The General Public Health Workprogram would be restructured by discontinuing reimbursement for certain optionalservices, including laboratories, home health care programs, and hospice and Early

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