Senate Finance Committee Hearing on Dual-Eligibles

Senate Finance Committee members on both sides of the aisle appeared to agree that individuals who are eligible for both Medicare and Medicaid need services to be made more efficient and effective in order to save money and improve care.  Testifying was Melanie Bella, the Director of the Medicare-Medicaid Coordination Office created under the PPACA.  She said one example of the lack of incentive for savings is in the case under which Medicaid assigns a case manager to oversee the treatment needs of a dual-eligible to prevent unnecessary hospitalizations.  However, the savings don’t go to the state Medicaid program but to the Medicare program, which pays for the hospital care of the dual-eligibles, thus discouraging state assignment of such case managers.  Members said that dual-eligible services are duplicated, given in needlessly expensive facilities and result in hospitalizations that need never occur because of poor oversight of patients.  Senator Ben Cardin said that bolder approaches are needed.  Senators Orrin Hatch and Charles Grassley agreed that faster action is needed to restructure how services are given to dual-eligibles.  Ms. Bella said that the goal for 2012 is “to have a million of the nine million duals in a coordinated, integrated system of care, and then to keep building year after year, particularly through our demonstrations and our work with states….”  Senator Ron Wyden encouraged the agency to test a model used by the VA that involves delivering services to people in their homes rather than in nursing homes.

HHS/State Partnerships for Exchanges

Given the lack of progress in establishing PPACA health insurance exchanges by many states, HHS announced three “partnership options” under which states can phase-in exchanges to meet the 2014 deadline.  Under the federal-state partnership, states can choose among one of the following models for exchange operations: health care plan management (e.g. selection of health plans, quality monitoring, etc.); consumer assistance (e.g. personal assistance, establish plan navigators, provide outreach, etc.); or both plan management and consumer assistance.  If a state elects such a partnership, then HHS would operate other aspects of the exchange.

HHS Recommendations to Support Mobile Health Initiatives

HHS announced that the Text4Health Task Force has issued a report with seven recommendations to support mobile health programs, as follows: develop and host evidence-based health text message libraries; conduct further research into privacy and security risks associated with text messaging of health information and establish guidelines for managing such privacy and security issues; develop further evidence on the effectiveness of health text messaging programs; and explore and develop partnerships to create, implement and disseminate health text messaging and mHealth programs.  As a result of the report, HHS said a project for a library is to be developed by the National Cancer Institute (NCI) called QuitNowTXT.

CLASS Act: To Be or Not to Be?

The chief actuary for the HHS long-term care CLASS Act program resigned after saying the office would be shut down.  However, HHS responded that their plans have only slowed down (the Senate Labor-HHS-Education appropriations bill omits CLASS Act funding for 2012) and that no decision has yet to be made to terminate the program as being “unsustainable”.

CDC Touts PPACA Increase in Plan Coverage

CDC released a report “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-March 2011” which found that, because of the PPACA provision allowing young adults between 19-25 years old to be kept on their parents coverage, the rate of coverage increased by 3.5% in the period surveyed.

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