Archive for August, 2013

Feds Propose CAH Overhaul and Elimination of Necessary Providers

Tuesday, August 20th, 2013

Texas hospitals are gearing up for a fight! Critical Access Hospitals in Texas and across the country were taken aback late last week with the release of a report from the Office of Inspector General for the U.S. Department of Health and Human Services recommending an overhaul of the CAH program. Most damaging for Texas was a recommendation that all mileage separation waivers be eliminated through a CMS review of every CAH in the country. TORCH and the Texas State Office of Rural Health at the Texas Department of Agriculture are coordinating to determine which of Texas’ 80 CAHs could be in trouble with this plan. Many associated with the Texas CAH program over the years believe that from one-third to one-half of the Texas CAHs gained that designation with the Necessary Provider provisions and a mileage waiver. The plan floated out last week is especially discriminatory against Texas as the Lone Star State was penalized from the inception of the program by the 35 mile base separation rule. As many of Texas so called “square” counties are approximately 30 miles by 30 miles, many rural hospitals ended up being in a 25 to 35 mile range from each other. Without mileage waivers, they would have been barred from participation in the program.

While we await more detailed analysis, TORCH is acutely aware of the financial harm this proposal could do to our hospitals and the setback this would create for the rural health safety-net. TORCH hospitals should be assured that TORCH is already developing a plan to fight this and will be calling upon hospitals for their help. Be watching your email inboxes for Calls to Action.

The actual OIG report can be found here.

TORCH Participates in Meeting With Secretary Sebelius

Thursday, August 8th, 2013

TORCH President David Pearson (far right) listens in as the Secretary of Health and Human Services, Kathleen Sebelius, discusses expanded coverage

The Secretary of Health and Human Services and former Kansas Governor, Kathleen Sebelius, visited with healthcare provider associations today here in Austin, including hospitals, physicians, pharmacists, health plans and other stakeholders. The visit was one of many that the Secretary is making around the state to build awareness and support for the coverage expansion that will be made available to qualified individuals and small businesses starting on October 1st. Texas, like other states that declined to participate in Medicaid expansion or the creation of a state-based exchange, will still become a part of the new national Health Insurance Marketplace. The Secretary said that there is a great deal of confusion in Texas regarding the actual status of the ACA, but that coverage expansion is indeed coming here too and that all our healthcare providers associations and advocacy groups can play a pivotal role in its success. TORCH was privileged to be a part of the conversation and plans to continue to promote expanded coverage and consumer engagement.

In a few short weeks, consumers will be able to choose from a variety of affordable health plans and various coverage options. The open enrollment period will last for six months and according to some initial estimates should lower premiums to individuals by at least 18% before any subsidies are even applied. Further reductions will be granted on a sliding scale depending upon the income of the individual seeking coverage. There are several outreach initiatives funded by HHS to help maximize total enrollment over the next six to eight months. Navigators, enrollment counselors and other outreach campaigns will be coming online very soon, as well as an increasing amount of marketing materials that are to be made available to healthcare providers and community health centers specifically. TORCH will be requesting that HHS also consider utilizing rural-specific federally-designated providers, such as rural health clinics and critical access hospitals as engagement partners in rural areas to ensure that the level of awareness is comparable to that in urban areas.

Sebelius briefly addressed the impact to individuals in states that have refrained from expanding Medicaid from 100% to 133% of FPL, which includes the State of Texas. She pointed out that the administration would be very happy to have Texas participate fully in the ACA and assured those present that door is not closed. While the 100% federal match is only available for the first three years, some states are still considering becoming involved at some point after the program officially begins. She noted that when states fail to expand Medicaid, the increased cost the federal government for covering an Medicaid-eligible individual through the exchange is around $6,000. She also reminded the group that the full scope of the ACA, including Medicaid expansion, is fully funded and contributes no additional cost to the federal budget. States that don’t participate just won’t realize the full benefit of the ACA and its ability to reduce the uninsured population, which in Texas amounts to nearly five million people.

In her closing comments, the Secretary invited all those present to use any tools and resources available to assist the administration in reaching the target market. Unlike the Medicare Part D enrollment initiative, HHS does not have ready access to a list of eligible individuals on which to act. They must rely much more on the providers and their associations to generate interest and maximize participation. TORCH will be passing on any and all marketing materials or resources to our members and encourage you to distribute the information to your patients and the wider community. The Secretary thanked THA for hosting the meeting and left to attend another forum being hosted by Austin Mayor Lee Leffingwell and other civic and business leaders. For the latest information about the ACA, providers, consumers and small businesses can visit to find information on coverage expansion and how to prepare for open enrollment.

For more information, read the U.S. Department of Health & Human Services fact sheet, How the Health Care Law is Making a Difference for the People of Texas