Policy Corner
A Public Policy Update for Affiliates of the Brain Injury Association of America
May 6, 2003

Contact Information for Government Relations Staff

If you have questions regarding this edition of the Policy Corner, or if you
would like assistance with other legislative or policy issues, please
contact a member of the Government Relations team. We are happy to help you!

-    Tom Coffey, Policy Analyst:
703-236-6000 ext. 141
email:  Tcoffey@...

-    Robert Demichelis, Legislative Liaison
703-236-6000 ext. 119
email:  Rdemichelis@...

Anne Rohall, Director Government Relations
703-236-6000 ext. 120
email:  Arohall@...



Medicare

Hastert Unveils Medicare Reform Proposal Outline

On May 1, House Speaker Dennis Hastert announced principles for legislation to reform Medicare and add a prescription drug benefit to the program.  In a meeting with Hispanic media, Hastert said that Medicare reform legislation should:
§    Allow beneficiaries to participate voluntarily in a Medicare plan that provides prescription drug coverage and negotiates discounts on the price of medications
§    Provide additional help to low-income beneficiaries
§    Provide beneficiaries more options under Medicare
§    Cap out-of-pocket costs for beneficiaries
§    Ensure delivery of health care to beneficiaries in rural and urban areas
§    Enact structural improvements to limit health care costs that could endanger the financial future of Medicare
House and Senate leaders also reiterated again this week the hope to pass a Medicare prescription drug benefit bill before the July 4 recess.  In the White House, aides to President Bush stated that they hope June "will be Medicare month," as Congress considers the Medicare reform framework that President Bush introduced earlier this year.  Medicare beneficiaries would have three options under the framework:
    
     Option 1:  Beneficiaries could remain in traditional fee-for-service Medicare and receive discount cards that they could use at pharmacies to save 10% to 25% on prescriptions, Medicare would provide low-income beneficiaries with $600 per year to help cover prescription drug costs. In 2006, beneficiaries in traditional Medicare also would receive catastrophic prescription drug coverage. 
    
     Option 2:  This option would allow beneficiaries to enroll in a new private system called "Enhanced Medicare," beginning in 2006.  This option provides beneficiaries with expanded prescription drug coverage, full coverage for preventive care and lower out-of-pocket costs for hospital stays.

     Option 3: Called "Medicare Advantage," would be similar to Medicare+Choice, which provides beneficiaries with a selection of private health plans with and without prescription drug coverage but no guarantee of coverage.


Medicaid

Cuts Considered by Several State Legislatures Will Increase Number of Uninsured, Experts Say

The New York Times recently examined how rising medical costs and declining revenues have caused lawmakers in many states to consider eliminating Medicaid benefits, tightening eligibility or lowering physician reimbursements in order to reduce costs. Medicaid costs -- about $250 billion annually in state and federal funding -- have grown 25% in two years and more than 50% since 1997, while the number of beneficiaries is increasing at the fastest pace in a decade.  As a result of the increase in costs and beneficiaries, almost every state has made or plans to make reductions to services, eligibility or reimbursements from its Medicaid program.

Some states such as Florida, California and Ohio plan to reduce benefits, including vision or dental care coverage. Other states, such as Indiana, have made eligibility stricter and lowered the number of beneficiaries. Many states, such as Massachusetts which recently eliminated benefits for about 36,000 unemployed people and is considering ending a prescription drug benefit for about 80,000 seniors, are considering a combination of tactics. The Center on Budget and Policy Priorities has estimated that under current proposals, as many as 1.7 million beneficiaries could lose Medicaid coverage. The current crunch of some states' Medicaid programs stem from the recent economic downturn, and some result from decisions to expand Medicaid programs broadly during the late 1990s.


Mental Health Parity

Budget Provision Renews Parity Push

Backers of mental health parity legislation are getting a boost from a provision in the fiscal year (FY) 2004 budget resolution.  The budget resolution sets aside $5.4 billion in a general health account over the next 10 years to offset lost tax revenues caused by increased premiums, assuming the passage of a mental health parity bill.  The Senate Health, Education, Labor and Pensions Committee may hold a hearing on the legislation, and it could go to the Senate floor for a vote later this summer.

Senator Domenici (R-NM) plans to meet with the House leadership, where support of the legislation has been weak.  He has stated that he may attempt to win over House Members by limiting the scope of the illness covered in the bill, a move he has previously resisted.  Narrowing the scope of the legislation may produce a bill that could win the endorsement of President Bush and members of the House.  Senate backers may go along with the approach in an attempt to win passage of the legislation.

The legislation (named the Paul Wellstone Mental Health Equitable Treatment Act) closes loopholes in the 1996 legislation banning employers from limiting mental health coverage.  Additional legislation is needed to prevent employer-sponsored health plans from substituting limitations for the limits of the 1996 legislation.  The 1996 bill also expires this year.  Parity law only applies to businesses with 50 or more employees and only applies to businesses that already provide regular health insurance.


Long-Term Services

Senate Aging Committee Holds Hearing on Assisted Living Study

The first recommendations for ensuring quality of care in U.S. assisted-living facilities were presented on April 29 at a hearing of the Senate Special Committee on Aging.  Almost 50 groups of health care professionals, providers, consumer advocates and representatives of the disability community put the Assisted Living Workgroup Report together. The report guidelines are not binding on states, which have complete authority over assisted living. The recommendations include the following:
§    Creation of a national Center of Excellence in Assisted Living to analyze and suggest regulations to states and Congress
§    Written disclosure of all assisted-living facility costs, services and policies, including a minimum notice for any changes or terminations
§    Regulations to make sure that "trained and awake staff are on duty" at all times and that medicines are kept and administered safely
§    Increased federal and state funding for the Long-Term Care Ombudsman Program, which resolves complaints and represents the residents' interests
§    Regulations to ensure that services advertised in brochures are consistent with those listed in residents' contracts
§    Expansion of state regulations for staff training in dealing with Alzheimer's patients who live outside special care units
§    Better public access to regulations, surveys and inspection reports
Although two-thirds of states have passed legislation or issued regulations to license or monitor assisted living, there have been concerns over the treatment of residents at some facilities, which are not subject to the same regulations as nursing homes. Nearly 1 million U.S. residents live in the nation's 36,399 assisted-living facilities, the number of which has increased 48% since 1998.


State Watch

Behavioral Health:  Nevada Panel Approves Funding Increases for Mental Illness and Developmental Disability Service

On April 28, the Nevada Senate-Assembly Budget Subcommittee approved Governor Kenny Guinn's plan to increase funding for state services for people with mental illnesses by 32% and for services for people with developmental disabilities by 36%.  Under the plan, Nevada would spend $193 million for mental health services and $172 million for developmental disability services over the next two years. The subcommittee also approved a 7% increase in reimbursement rates for community-based mental health and developmental disability service providers in FY 2004 and an 8% increase for FY 2005. A recent study found that Nevada's current reimbursement rates for those providers are 30% lower than the national average.


Access and Coverage
One-Third of People with Disabilities Over 50 Have Postponed Care Because of Cost
One-third of people with disabilities over age 50 postponed receiving health care over the past year because they could not pay for services, up from 21% five years ago, according to an American Association of Retired Persons (AARP) survey that was released April 29.  The survey, completed as part of a larger AARP report on disabilities and independent living, polled 1,102 people with disabilities who were at least 50 years old. Of the respondents, 68% had a disability limiting physical mobility, 21% had a disability involving hearing or vision and 18% had a cognitive or emotional disability.  The survey found that "inadequate" health insurance coverage posed a "major problem" among those surveyed.  Participants said specific medical needs such as medical equipment are not covered by their health plan. Forty-nine percent of respondents said they receive regular assistance with daily activities, and 53% said they had been unable to do an activity they needed or wanted to do in the past month.  Nearly half of those surveyed said "more control" over care decisions would improve their quality of life.
The survey points to major gaps in coverage, especially among people who are not eligible for Medicare. In addition, people with disabilities who do receive Medicare coverage still often lack access to medicines they need, or possibly to some assistive technologies. In response to the findings, AARP has recommended more "consumer direction and services" in government-sponsored programs such as Medicaid, more home modifications for people with physical disabilities, more public funding for in-home or community-based care and better community accessibility for people with disabilities.  The survey is available online at: www.http://research.aarp.org/general/beyond_50.html

Brain Injury Association of America, Inc.; 105 North Alfred Street; Alexandria, VA 22314; Ph.703-236-6000, Fax:703-236-6001; www.biausa.org
The mission of the Brain Injury Association of America is to create a better future through brain injury prevention, research, education and advocacy. 

Policy Corner
A Public Policy Update for Affiliates of the Brain Injury Association of America
May 6, 2003

Contact Information for Government Relations Staff

If you have questions regarding this edition of the Policy Corner, or if you
would like assistance with other legislative or policy issues, please
contact a member of the Government Relations team. We are happy to help you!

- Tom Coffey, Policy Analyst:
703-236-6000 ext. 141
email: Tcoffey@...

- Robert Demichelis, Legislative Liaison
703-236-6000 ext. 119
email: Rdemichelis@...

Anne Rohall, Director Government Relations
703-236-6000 ext. 120
email: Arohall@...



Medicare

Hastert Unveils Medicare Reform Proposal Outline

On May 1, House Speaker Dennis Hastert announced principles for legislation to
reform Medicare and add a prescription drug benefit to the program. In a
meeting with Hispanic media, Hastert said that Medicare reform legislation
should:
§ Allow beneficiaries to participate voluntarily in a Medicare plan that
provides prescription drug coverage and negotiates discounts on the price of
medications
§ Provide additional help to low-income beneficiaries
§ Provide beneficiaries more options under Medicare
§ Cap out-of-pocket costs for beneficiaries
§ Ensure delivery of health care to beneficiaries in rural and urban areas
§ Enact structural improvements to limit health care costs that could endanger
the financial future of Medicare
House and Senate leaders also reiterated again this week the hope to pass a
Medicare prescription drug benefit bill before the July 4 recess. In the White
House, aides to President Bush stated that they hope June "will be Medicare
month," as Congress considers the Medicare reform framework that President Bush
introduced earlier this year. Medicare beneficiaries would have three options
under the framework:

Option 1: Beneficiaries could remain in traditional fee-for-service
Medicare and receive discount cards that they could use at pharmacies to save
10% to 25% on prescriptions, Medicare would provide low-income beneficiaries
with $600 per year to help cover prescription drug costs. In 2006, beneficiaries
in traditional Medicare also would receive catastrophic prescription drug
coverage.

Option 2: This option would allow beneficiaries to enroll in a new private
system called "Enhanced Medicare," beginning in 2006. This option provides
beneficiaries with expanded prescription drug coverage, full coverage for
preventive care and lower out-of-pocket costs for hospital stays.

Option 3: Called "Medicare Advantage," would be similar to Medicare+Choice,
which provides beneficiaries with a selection of private health plans with and
without prescription drug coverage but no guarantee of coverage.


Medicaid

Cuts Considered by Several State Legislatures Will Increase Number of Uninsured,
Experts Say

The New York Times recently examined how rising medical costs and declining
revenues have caused lawmakers in many states to consider eliminating Medicaid
benefits, tightening eligibility or lowering physician reimbursements in order
to reduce costs. Medicaid costs -- about $250 billion annually in state and
federal funding -- have grown 25% in two years and more than 50% since 1997,
while the number of beneficiaries is increasing at the fastest pace in a decade.
As a result of the increase in costs and beneficiaries, almost every state has
made or plans to make reductions to services, eligibility or reimbursements from
its Medicaid program.

Some states such as Florida, California and Ohio plan to reduce benefits,
including vision or dental care coverage. Other states, such as Indiana, have
made eligibility stricter and lowered the number of beneficiaries. Many states,
such as Massachusetts which recently eliminated benefits for about 36,000
unemployed people and is considering ending a prescription drug benefit for
about 80,000 seniors, are considering a combination of tactics. The Center on
Budget and Policy Priorities has estimated that under current proposals, as many
as 1.7 million beneficiaries could lose Medicaid coverage. The current crunch of
some states' Medicaid programs stem from the recent economic downturn, and some
result from decisions to expand Medicaid programs broadly during the late 1990s.


Mental Health Parity

Budget Provision Renews Parity Push

Backers of mental health parity legislation are getting a boost from a provision
in the fiscal year (FY) 2004 budget resolution. The budget resolution sets
aside $5.4 billion in a general health account over the next 10 years to offset
lost tax revenues caused by increased premiums, assuming the passage of a mental
health parity bill. The Senate Health, Education, Labor and Pensions Committee
may hold a hearing on the legislation, and it could go to the Senate floor for a
vote later this summer.

Senator Domenici (R-NM) plans to meet with the House leadership, where support
of the legislation has been weak. He has stated that he may attempt to win over
House Members by limiting the scope of the illness covered in the bill, a move
he has previously resisted. Narrowing the scope of the legislation may produce
a bill that could win the endorsement of President Bush and members of the
House. Senate backers may go along with the approach in an attempt to win
passage of the legislation.

The legislation (named the Paul Wellstone Mental Health Equitable Treatment Act)
closes loopholes in the 1996 legislation banning employers from limiting mental
health coverage. Additional legislation is needed to prevent employer-sponsored
health plans from substituting limitations for the limits of the 1996
legislation. The 1996 bill also expires this year. Parity law only applies to
businesses with 50 or more employees and only applies to businesses that already
provide regular health insurance.


Long-Term Services

Senate Aging Committee Holds Hearing on Assisted Living Study

The first recommendations for ensuring quality of care in U.S. assisted-living
facilities were presented on April 29 at a hearing of the Senate Special
Committee on Aging. Almost 50 groups of health care professionals, providers,
consumer advocates and representatives of the disability community put the
Assisted Living Workgroup Report together. The report guidelines are not binding
on states, which have complete authority over assisted living. The
recommendations include the following:
§ Creation of a national Center of Excellence in Assisted Living to analyze
and suggest regulations to states and Congress
§ Written disclosure of all assisted-living facility costs, services and
policies, including a minimum notice for any changes or terminations
§ Regulations to make sure that "trained and awake staff are on duty" at all
times and that medicines are kept and administered safely
§ Increased federal and state funding for the Long-Term Care Ombudsman
Program, which resolves complaints and represents the residents' interests
§ Regulations to ensure that services advertised in brochures are consistent
with those listed in residents' contracts
§ Expansion of state regulations for staff training in dealing with
Alzheimer's patients who live outside special care units
§ Better public access to regulations, surveys and inspection reports
Although two-thirds of states have passed legislation or issued regulations to
license or monitor assisted living, there have been concerns over the treatment
of residents at some facilities, which are not subject to the same regulations
as nursing homes. Nearly 1 million U.S. residents live in the nation's 36,399
assisted-living facilities, the number of which has increased 48% since 1998.


State Watch

Behavioral Health: Nevada Panel Approves Funding Increases for Mental Illness
and Developmental Disability Service

On April 28, the Nevada Senate-Assembly Budget Subcommittee approved Governor
Kenny Guinn's plan to increase funding for state services for people with mental
illnesses by 32% and for services for people with developmental disabilities by
36%. Under the plan, Nevada would spend $193 million for mental health services
and $172 million for developmental disability services over the next two years.
The subcommittee also approved a 7% increase in reimbursement rates for
community-based mental health and developmental disability service providers in
FY 2004 and an 8% increase for FY 2005. A recent study found that Nevada's
current reimbursement rates for those providers are 30% lower than the national
average.


Access and Coverage
One-Third of People with Disabilities Over 50 Have Postponed Care Because of
Cost
One-third of people with disabilities over age 50 postponed receiving health
care over the past year because they could not pay for services, up from 21%
five years ago, according to an American Association of Retired Persons (AARP)
survey that was released April 29. The survey, completed as part of a larger
AARP report on disabilities and independent living, polled 1,102 people with
disabilities who were at least 50 years old. Of the respondents, 68% had a
disability limiting physical mobility, 21% had a disability involving hearing or
vision and 18% had a cognitive or emotional disability. The survey found that
"inadequate" health insurance coverage posed a "major problem" among those
surveyed. Participants said specific medical needs such as medical equipment
are not covered by their health plan. Forty-nine percent of respondents said
they receive regular assistance with daily activities, and 53% said they had
been unable to do an activity they needed or wanted to do in the past month.
Nearly half of those surveyed said "more control" over care decisions would
improve their quality of life.
The survey points to major gaps in coverage, especially among people who are not
eligible for Medicare. In addition, people with disabilities who do receive
Medicare coverage still often lack access to medicines they need, or possibly to
some assistive technologies. In response to the findings, AARP has recommended
more "consumer direction and services" in government-sponsored programs such as
Medicaid, more home modifications for people with physical disabilities, more
public funding for in-home or community-based care and better community
accessibility for people with disabilities. The survey is available online at:
www.http://research.aarp.org/general/beyond_50.html

Brain Injury Association of America, Inc.; 105 North Alfred Street; Alexandria,
VA 22314; Ph.703-236-6000, Fax:703-236-6001; www.biausa.org
The mission of the Brain Injury Association of America is to create a better
future through brain injury prevention, research, education and advocacy.