A Medical Device Daily
Two new proposed rules that would give states unprecedented flexibility in designing their own Medicaid programs, including adjusting their benefit package to more closely align with beneficiary needs and requiring increased cost sharing by enrollees, were reported by the Centers for Medicare & Medicaid Services (CMS).
The proposed rules would implement provisions of the Deficit Reduction Act of 2005 and the Tax Relief and Health Care Act of 2006. The rules are the latest in a series of regulations to implement the administration’s goals of aligning Medicaid more closely with private market insurance and giving states more control over their Medicaid benefits packages.
“These new rules recognize that states are in the best position to design plans that provide Medicaid beneficiaries better health care for the same or even lower cost,” said Health and Human Services Secretary Mike Leavitt. “The proposed rules will result in patients having more choices and greater control over their healthcare decisions.”
He added, “The flexibility these proposals provide is valuable for the beneficiary and the state. States will now have the opportunity to offer beneficiaries health care that has the same value as plans that are being offered to other populations in the state, through alternative benefit packages called benchmark plans.”
Benchmark plans are models states can use in designing new programs. These benchmark plans are similar to the flexibility provided to states under the State Children’s Health Insurance Program. Benchmark coverage includes:
• The standard Blue Cross/Blue Shield preferred provider option service benefit plan under the Federal Employees Health Benefit Plan;
• State employee coverage;
• Coverage that is offered by the largest commercial health maintenance organization in the state; or
• Coverage that the Secretary of Health and Human Services approves.
These benchmark options provide states with the opportunity to target benefits to meet the specific needs of individuals.
In other Washington news:
• Rates of cognitive impairment among older Americans are on the decline, according to a new study supported by the National Institutes of Health (NIH) comparing the cognitive health of older people in 1993 and 2002. Higher levels of education were associated with better cognitive health.
Researchers said the findings will need to be explored further to see if they can be observed in other studies and to pinpoint factors influencing cognition, or the ability to think, learn, and remember. “These data suggest that we may be experiencing a shift in the cognitive health of older Americans,” said Richard Hodes, MD, director of the National Institute on Aging (NIA). “Continuing to track trends will be critically important both for chronicling changes in brain health and for achieving a better understanding of factors that may play a role.”
The data come from the NIA-supported Health and Retirement Study, a national, longitudinal examination of health, retirement and economic conditions of more than 20,000 men and women over 50. Researchers tested memory and judgment of a large subset of HRS participants to determine cognitive status in two groups of people, those aged 70 and older in 1993 and in 2002. The scientists then followed each group for two years to track death rates.
• Robert Foreman, president of the Kidney Care Council (KCC; Washington) issued a statement that the KCC supports the findings of CMS that the time for a modernized and fully bundled case-mix adjusted prospective payment system for dialysis services is upon us.
“For too long, the dialysis payment system has languished far behind other prospective payment systems in Medicare and has suffered from a lack of an annual updating mechanism,” Foreman said. “We are pleased to see the report recognizes the under-funding of the composite payment rate which cites the average cost of a treatment was $162.00 versus a reimbursement of $143.20.”
The report leaves open some details about the bundle’s basic design features that need to be resolved for a new payment system to be fully successful. Specifically, the success of the revised payment mechanism will depend largely on the establishment of an appropriate rate at the outset as well as the design of an annual update mechanism.