The Governor’s 2010 Supplemental Budget came out on December 9th with severe cuts in health care, long term care and mental health services and much more. It eliminates the Basic Health program (BHP) and the General Assistance Unemployable (GAU) assistance for low income citizens, the Medicaid Hospice benefit and many more programs that assist the elderly and poor in our state. The pain was felt across the board for the health and human services programs supported by taxpayer dollars. You may access Governor Gregoire 2010 Budget by clicking on Proposed 2010 Budget and Policy Highlights.
The Governor is required by law to present a “no new revenue” budget each December to balance the budget based on existing revenues and caseload predictions. For the record, the Governor does not support this budget. She will be presenting a new budget in early January 2010 with proposed revenue increases. Earlier in 2009, the state faced a $9 billion budget deficit. This fall, the state faces an additional $2.6 billion dollar deficit totaling nearly $12 billion in cuts to state government this biennium. The total state operating budget is around $31 billion dollars. Out of the total budget, roughly 70% are protected funds for K-12 education, state law enforcement and corrections. That leaves about a third of the budget available for cuts and out of that, many of the funds are protected by what they refer to as “maintenance and effort” related to the federal stimulus dollars that the state received in 2009. The state is not allowed to cut many existing programs that received federal stimulus dollars or they risk losing that funding and may have to pay it back.
According to the Governor in her budget presentation (View the Governor's press conference by clicking TVW), many of the programs such as BHP and the GAU assistance will return if the legislature passes a bill with revenues for these programs. As you can imagine, it is already quite contentious as Republicans are digging in against any tax increases and Democrats want to keep the state’s health care infrastructure in place.
One of our main concerns this session will be the Medicaid Hospice Benefit cut and other cuts to in-home services. We will be supporting the delaying of the training initiative (I-1029) implementation. As a lobbyist for HCAW I have met with 15 legislators on the House and Senate Health Care committees so far to discuss the Medicaid Hospice Benefit cuts and our support for the initiative delay. I have also met with Doug Porter, the Assistant Secretary for DSHS/HRSA division. I explained the Room and Board costs were not initially included in the original proposed budget cut. Doug explained to us that this funding is also tied to the federal stimulus funding with the “maintenance and effort” clause that I mentioned above. The Governor’s budget still has the proposed cut of $6.2 million which we believe is a very high estimate. This funding may be replaced in the Governor’s revenue budget.
Here are the biggest health care related proposed cuts, some of which could directly or indirectly affect home health and hospice agencies and their employees. HCAW is still reviewing the implications:
Health Care Cuts
· Eliminate the Basic Health Program, which provides health care coverage for approximately 65,000 individuals. ($160.6 million General Fund-State)
· Eliminate the General Assistance Unemployable Medical Services program, which provides health care for approximately 20,000 individuals. ($118.9 million GF-S)
· Eliminate early intervention and direct client services for 2,500 HIV and HIV-vulnerable clients. ($10.5 million GF-S)
· Reduce eligibility for the Apple Health program from 300 percent of the federal poverty level to less than 205 percent of the federal poverty level, which eliminates health care coverage for 16,000 low-income children. ($11.6 million GF-S)
· Suspend the Medicare Part-D co-payment reimbursement program, which provides prescription drug assistance for more than 85,000 Medicaid-eligible elderly clients. ($7.8 million GF-S)
· Suspend adult hospice care, which provides end-of-life services for 2,600 individuals, beginning Jan. 1, 2011. ($6.2 million GF-S)
· Suspend the following optional Medicaid services for adults:
o Physical, occupational and speech therapies, which serve more than 20,000 clients. ($4.5 million GF-S)
o Non-medical vision services, which provide preventive and corrective services for more than 95,000 clients. ($1.7 million GF-S)
o Podiatry services for more than 14,000 clients. ($996,000 GF-S)
Human Services Cuts
· Reduce home care agency funding by ending parity with individual providers for wages and benefits, as well as reducing health benefit contributions. ($14.1 million GF-S; $18.2 million GF-F)
· Reduce in-home Medicaid personal care services by changing eligibility levels to match the standard for admission to a nursing home. ($5.4 million GF-S, $9.3 million GF-F)
· Reduce the Senior Citizens Services Act state-funded optional services while preserving core activities provided by 13 local Area Agencies on Aging related to information and referrals to those considering elder care. ($7 million GF-S)
· Suspend the Volunteer Chore program, which coordinates 288,000 hours of volunteer services to help elderly people who remain in their homes. ($1.9 million GF-S)
· Delay new mandatory training for long-term care workers from January 2011 to January 2012. ($2.8 million GF-S; $3.7 million GF-F)
HCAW will be teaming up with other impacted groups to fight these cuts in the legislature this session and support some kind of revenue package that will restore these vital programs for our most vulnerable citizens.
Agency Rulemaking
The telehealth bill rulemaking is proceeding to the next phase for permanent rulemaking. DSHS also plans to submit Emergency Rulemaking so that the provisions for billing for the telehealth services begins in January 2010 so our members who have the equipment can start billing for their services. The WAC amendments are required to implement SHB 1529 which authorizes deliver of home health services through telemedicine. The department is also using this opportunity to incorporate minor housekeeping changes such as “Medical Assistance Administration” to “the department” and any changes in terms required to be consistent with the implementation of the new Provider One system will also be incorporated at this time. Comments are due by close of business on December 30, 2009. Please send any comments on the proposed rule to: Wendy Boedigheimer, Rules Program Manager via e-mail at: boediwl@dshs.wa.gov or Fax to (360) 586-9727.
Rulemaking associated with I-1029 at DSHS and DOH appears to be on hold while the legislature debates delaying the implementation of the initiative. The rules for the SEIU Training Partnership to provide training to IPs will take effect in January 2010. This will transfer the training responsibility from the AAA’s to the Training Partnership.
Other issues of interest are that Medical Quality Assurance Commission received a petition to add bipolar disorder, severe depression and anxiety related disorders, specifically social phobia to the medical conditions for which medical marijuana would be beneficial and that are permitted under state law RCW 69.51A.010(4).
Nursing Care Quality Assurance Commission (NCQAC)
The Continuing Competency (CC) rulemaking is a work in progress. There is a stakeholder workshop on December 18th with the DOH to further refine the draft rules. So far there has been little concern from the nursing profession. For ARNP’s there is no impact as the already do CC and the requirements for the RN’s is fairly low impact as most nurses appear to get some kind of CC during a 3 year period. They would have to track what they took during that period. The number of audits is really small, so the chances of getting audited for CC are pretty remote. If you do get an audit, the NCQAC will bend over backwards to help the nurse get up to speed to meet the requirements. It’s not meant to be punitive unless a nurse completely blows them off and is unresponsive of unwilling to comply. At that point, disciplinary action could kick in. Chuck Cominsky is back at DOH after serving on military duty for the past year and will be taking over the rulemaking efforts in 2010.
NCQAC is proposing a licensing fee increase of up to $20.00 for additional staffing for investigations and support for the WHPS program for substance abuse. They have a pretty serious backlog of complaints that they are currently unable to investigate in a timely manner. It was a little shocking to hear that up to 200 nurses are practicing with a substance abuse complaint filed against them at any given time because they do not have adequate staffing to investigate. This is a liability for the state and the profession. In reviewing the nursing fees from other states at a recent meeting I attended on this issue, Washington State is much lower than many states nursing fees.
Also, there is a proposal from the NCQAC to lower the $20.00 fee for the HEAL-WA information portal to $5.00. If that happened, the increase in fees would be closer to an overall $5.00 increase. After discussion with members of WSHPCO, this increase was considered a reasonable request after the review of the need for additional investigators.
2010 Legislative Session
Medicine Return bill will be back this session. Rep. Dawn Morrell plans to pull the bill back up from last year and move it to the floor of the House for a vote early in session. HCAW has been working closely with the King County Hazardous Waste staff to promote the bill. A recent survey was done with hospice agencies around the state requesting stories about the difficulties of unused drug disposal and discussing current practice for disposal. Law enforcement agencies are very involved in a number of counties that are assisting with the disposal of controlled substances in particular to get them off the streets and out of residential medicine cabinets.
Overview of the Secure Medicine Return Bill (2SHB 1165):
· Requires producers of prescription and over-the-counter medicines sold in Washington State to provide and pay for a statewide medicine return program in Washington.
· Covers return of all over-the-counter and prescription drugs, including narcotic and other legally prescribed controlled substances.
· Gives the WA State Board of Pharmacy authority to license the medicine return program and to ensure that collection, transportation, and disposal of collected medicines is safe and secure.
· Convenient collection options must be provided in every county of the state and every city of more than 10,000 people.
· Collected medicines will be disposed of at a hazardous waste facility to ensure the highest level of protection.
· Does not require any money from the state or local governments. Drug producers will fund all costs, including collection, transportation, and disposal. All costs for state agencies providing oversight (Board of Pharmacy and Ecology) will be fully recovered through a fee on drug producers.
· The Vulnerable Adult bill that was proposed last session by the Attorney General’s office has been reintroduced this session. It does not involve end-of life care issues at this time. The referral to the WA Natural Death Act has been removed from the legislation since this bill deals more with sentencing guidelines.
· Rep. Jim Moeller of Vancouver has pre-filed a bill requiring pain management training for all health care providers (HB 2391) who are licensed to dispense controlled substances. He did not coordinate this effort with WSHPCO, so we look forward to seeing what his intentions are with this legislation.
Thanks for your support and I look forward to working with you this session to advocate on behalf of home health and hospice agencies in Washington State!
