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- CMS EXEMPTS MR/DD FROM MEDICAID CITIZENSHIP LAW
- HHS HIPAA PRIVACY DECISION TOOL FOR EMERGENCY PREPAREDNESS PLANNING
- MORE INFO ON CHANGES TO WRAP-AROUND COVERAGE FOR MEDICARE PART D
- UPSTATE NEW YORK EMERGING LABOR MARKET
CMS EXEMPTS MR/DD FROM MEDICAID CITIZENSHIP LAW
CMS administrator, Dr. Mark B. McClellan said on Thursday, July 6, that more than 8 million of the 55 million Medicaid recipients would be "exempt from the new documentation requirement" because they had established their citizenship when they applied for Medicare or Supplemental Security Income (SSI). The action was apparently intended to pre-empt a ruling by a federal judge who is scheduled to hold a hearing on Friday on a lawsuit challenging the new requirement, which took effect on July 1, 2006. About six million people receive Medicare and Medicaid, and in most states as in New York, people receiving SSI are entitled to Medicaid.
The new documentation requirement is part of the Deficit Reduction Act, signed by President Bush on Feb. 8, 2006. In the new ruling CMS affirmed that Congress intended to exempt people with disabilities, but there was a technical error in the bill that failed to carry out that exemption.
Ronald F. Pollack, the executive director of Families U.S.A., a consumer group working with plaintiffs in the court case, said: "The exemption of seniors and people with severe disabilities from the citizenship verification requirement is a commendable development. But many other people who need health care the most and can't come up with the required documentation — such as foster children and homeless people — may still lose Medicaid coverage and join the ranks of the uninsured. This should be corrected."
HHS HIPAA PRIVACY DECISION TOOL FOR EMERGENCY PREPAREDNESS PLANNING
The U.S. Department of Health and Human Services (HHS) today published a new Web-based interactive decision tool designed to assist emergency preparedness and recovery planners in determining how to access and use health information about persons with disabilities consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule.
“Being able to coordinate health information appropriately and in advance will help save lives,” HHS Secretary Mike Leavitt said. “This new tool strengthens America’s ability to better prepare for emergencies such as manmade and natural disasters.”
The tool will guide emergency preparedness and recovery planners through a series of questions regarding how the HIPAA Privacy Rule applies to a particular disclosure. By helping users focus on the source of the information being disclosed, to whom it is being disclosed, and for what purpose, users will better meet the needs of the elderly or persons with disabilities in the event of an evacuation.
While the tool’s initial purpose focused on emergency planning for persons with disabilities, it is applicable to most emergency planning efforts. The intended audiences include covered entities as well as emergency preparedness and recovery planners at the local, state and federal levels.
The Decision Tool: HIPAA Privacy Rule & Disclosures for Public Health -- Emergency Preparedness is readily accessible on the OCR Web site at http://www.hhs.gov/ocr/hipaa/decisiontool/
MORE INFO ON CHANGES TO WRAP-AROUND COVERAGE FOR MEDICARE PART D
As NYSACRA mentioned in its last News & Views, that due to recent legislative actions, the wrap-around program will continue to include all covered medications until January 1, 2007. On January 1, 2007, Medicaid plans to limit its wrap-around coverage for drugs not covered by a Medicare Part D plan to four drug categories. As of that date, the wrap-around benefit will be limited to the following four categories of drugs:
1. atypical antipsychotics,
2. antidepressants,
3. antiretrovirals, and
4. anti-rejection drugs used in the treatment of tissue and organ transplants.
As with all Part D wrap-around claims, Medicaid should only be billed for these categories of drugs after billing Medicare Part B (when appropriate) or a Medicare Part D plan. NYS Medicaid still remains the payor of last resort.
NYS Medicaid continues to cover certain drugs which are excluded from the Part D benefit, such as barbiturates, benzodiazepines, some prescription vitamins, and non-prescription (OTC) drugs which can be billed directly to NYS Medicaid.
Below is a link to the NYS DOH website to find their latest July 2006 State DOH Medicaid Update. Included is a series of Q&A’s pertaining to the new Medicaid Preferred Drug Program. This Program started on June 28th and impacts individuals with Medicaid only [not Part D]. The issue also notes that the state wraparound for Part D, which was scheduled to end on July 1st, was continued until January 1, 2007. Additionally, there is some information on page 16 about restructuring long term care in NYS.
Find the update at: http://www.nyhealth.gov/health_care/medicaid/program/update/2006/jul2006.htm.
UPSTATE NEW YORK EMERGING LABOR MARKET
Roughly half a million upstate workers are projected to retire between 2000 and 2010, and nearly 800,000 more will stop working between 2010 and 2020. That means that even a region that has seen little job growth in recent years will experience a demand for new workers. Nearly 20 percent of managers and 19.2 percent of community services workers are expected to retire by 2012, while about 13.5 percent of health care employees will stop working upstate, according to the report by economist Richard Deitz.
The report said employers seeking workers in services used by an aging population and provided through personal contact, such as health care and personal care and service, will have the toughest time filling vacancies. "In fact," the report said, "upstate New York may begin to face labor market pressures in an environment of little overall economic growth as it competes with other parts of the country for key workers in high-demand occupations."
The report is available on the Federal Reserve Bank of New York website and can be directly accessed at: www.ny.frb.org/research/regional_economy/reg_rev1-1.pdf.
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