Tag Archives for Medicaid

Scully Selected to Head Federal Health care Agency

Published in the Pawtucket times on May 14, 2001

Thomas A. Scully, a Washington, D.C.-based health care association executive who holds a law degree from Catholic University and has previous experience on Capitol Hill as a senate staffer and as a high-level White House official, has been tapped by the new Bush administration to run the Health Care financing Administration (HCFA), the federal agency providing health care to 74 million Medicare, Medicaid and the State Children’s Health Insurance Program.

The nomination of Scully, president and CEO of the Federation of American Hospitals, a trade group that represents 1,700 for-profit hospitals, went to Capitol Hill in early May.  When confirmed as HCFA administrator by the U.S. Senate, Scully will replace Nancy Min DeParle, who left last October for a teaching stint at Harvard University. With her departure, a string of acting directors temporarily took the reins of the federal agency.

At press time, Jill Kozney, a spokesperson for Chairman Chuck Grassley of the Senate Finance Committee, stated that a confirmation hearing has not been scheduled yet. “Not every piece of paper work is in, but the chairman would like to act on the nomination as soon as possible,” the Senate staffer says.

A Washington Insider

As Washington insider, Scully brings a potpourri of health policy experiences to HCFA. The health care association executive comes with legal expertise gleaned from his legal practice, which focused on regulatory and legislative work in health care. Scully also brings an understanding of the intricacies of Capitol Hill, gained by serving as a staff assistant to U.S. Senator Slade Gorton (R-Wash.), and as associate director of the White House Office of Management and Budget (OMB) and later as deputy assistant to the president and counselor to the director of OMB under the senior Bush administration.

Ties to the former Bush administration were forged when Scully served on the communications staff of the Bush-Quayle campaign in 1988 and as deputy director of the congressional affairs for the president-elect’s transition team.

“Scully is smart, quotable, and politically savvy,” says Edward Howard, executive vice president of the Alliance for Health Care Reform. “He’s described as a problem solver rather than an ideologue,” Howard adds.

Howard expects Scully to turn his attention to internal problems at HCFA, because the agency has “substantial management problems.” He notes that HCFA has lost a number of good people and Congress will most certainly give the agency new tasks to handle.

“At least Scully will not have to spend one and a half years to learn about the programs he supervises, because he knows them well with his past OMB experience and at the Federation of American Hospitals,” Howard adds.

Bill Benson, former deputy assistant secretary for aging and president of the Maryland-based Benson Consulting Group, warns “Don’t look for Scully to, be much of a consumer advocate,” because he will be sympathetic to providers because of his ties to the hospital provider community.

“That does not mean Scully’s going to be in any position to get hospitals any more money but he will be more attuned to less regulation and more flexibility in rules, and regulations or health care providers,” Benson states.

According to Benson, one of Scully’s first tasks will be to carry out Health ad Human Service Secretary Tommy Thomson’s wish to reorganize HCFA because “this agency is one that everyone loves to hate, especially Republicans.”

Providers Rally Around Scully

Meanwhile, provider groups give thumbs up to Scully’s nomination as HCFA administration.

“Tom Scully has a unique combination of both real-world perspective and public service experience,” states Rick Pollack, executive vice president of the American Hospital Association. “That makes him a great choice for HCFA administrator.”

“From crafting Medicare regulation and budgets to building strong relationships with lawmakers on both sides of the aisle, Tom has the right mix of knowledge or the job,” Pollack adds.

In a letter being distributed to U.S. senators, who must vote to confirm Scully, Dr. Charles H. Roadman, II and AHCA Legislative Counsel Bruce Yarwood states: “As HCFA administrator, Tom Scully will have the responsibility for leading dramatic change.”

The opportunity for HCFA reform is the brightest it’s been in years,” Roadman predicted, expressing confidence that the controversial survey and enforcement apparatus will be closely scrutinized by Scully and the Bush White House.

In a public statement, the American Association of Homes and Services for the Aging’s senior vice president Suzanne M. Weiss states that her nonprofit provider group looks forward to working with the new HCFA administrator.

“As we look for ways to improve the current nursing home and inspection and enforcement system and reimbursement system.  We hope Mr. Scully will be o pen to our efforts in his new position,” Weiss says.

Bipartisan Support Key for Passage of Aging Proposals

Published in Pawtucket Times on March 19, 2001

The operative word in national legislative circles these days in bipartisianship.

Both sides of the political aisle working together will have to be part of the picture if the long-term care field is going to see any significant legislative changes, policy sources indicate.

Why is that so? In the Senate, “there’s a 50-50 split between the two major political parties,” notes Bill Benson, President of Benson Consulting Group, a Maryland-based organization. What’s more, the division “has resulted in an unprecedented agreement between Senate Democrats and Republicans to share power,” according to Benson, a former top official with the U.S. Administration on Aging.

Democrats and Republicans alike have been following the failing health of Republican Senator Strom Thurmond, 98, of South Carolina.

If Thurmond retires or dies before the end of this term in 2002, it’s likely that his state’s Democratic governor would appoint a Democrat, a move that would shift the majority in the Senate to the Democratic Party.

Yet, Benson says that any legislative proposal would still need bipartisan support to get out of the Senate. “To get a Republican proposal enacted, you will either have to get lots of Democrats to cross party lines, or bring in Vice President Cheney to be a tie breaker,” he noted.

Meanwhile, in the House, the Republican majority holds but a razor thin margin.

“Like in the Senate, if both parties don’t work together in the House, you’re looking at legislative gridlock,” he says.

Benson notes that the Bush Administration is also moving to stall the lengthy regulatory and administrative actions taken by Clinton toward the end of his administration.

One such item that is temporarily halted is Clinton’s guidelines for managed care organizations that serve Medicare beneficiaries.

President Bush campaigned on Medicare reform and wants to bring his proposal to Congress.

His proposal provides a private sector alternative to traditional fee-for-service Medicare by offering block grants to states to help seniors pay for their pharmaceuticals.

This approach may be derailed by the Democratic Party, which added to its seats in Congress during the recent election, Benson explains.

He notes that Senator Charles Grassley (IA), Chairman of the Senate Finance Committee, has declared that he will not push Bush’s Medicare or prescription drug plans because they lack votes for passage.

Yet, Benson also predicts that the fact that Congress is closely divided increases the chance that something will be done about providing prescription drug coverage to seniors through Medicare. Otherwise, Benson adds, Medicare reform will amount to nothing more than talk this year.

Meanwhile, Robert Greenwood, American Health Care Association for Homes and Services for the Aging (AAHSA), says that bold, revolutionary proposals won’t be forthcoming from the nation’s evenly divided Congress.

Instead, legislators will take an incremental approach toward program development.

“A long term care agenda has not emerged yet,” Greenwood observes. “We don’t even have an administrator for the Health Care Financing Administration, the agency that manages the Medicaid program.”

Greenwood says, in the long run,” We’re hopeful that the Bush Administration will take seriously its responsibility to provide long-term care providers with the needed resources to provide quality of care and to fund a regulatory system that allows providers to do their job while still protecting vulnerable residents.”

Mental Health’s Forgotten Constituency

Published in Aging Today in March/April 1996

The principal authors of a new report on mental health nursing homes charge that cutbacks in Medicare and the block granting of Medicaid will have a disproportionately large impact on the funding of mental health treatments. The report, “Achieving Mental Health of Nursing Home Residents: Overcoming Barriers to Mental Health Care,” which this writer helped prepare, calls mentally ill residents long-term care’s “forgotten constituency.”

According to Nancy Emerson Lombardo, one the new report’s authors, mental health experts worry that the situation for mentally impaired elders may worsen if proposals are passed by the 104th Congress to drastically cut Medicare, dismantle the Medicaid program and repeal essential features of the Nursing Home Reform Act.

Big Battle

Lombardo emphasized in an interview that, given present efforts in Washington to reduce Medicare and Medicaid spending. “It will take a big battle to restore mental health funding even to the inadequate levels of a few years ago, let alone bring it up to par with payments for treatment of other medical problems.”

She said that adding to the difficulties facing mental health advocates is evidence that many managed care programs taking over Medicare benefits for elders have greatly reduced mental health services.

Evidence has mounted in recent years, some from federal investigators, that physical illnesses of people especially frail elders, cannot be treated separately from mental illness. The report quotes a 1982 Government Accounting Office report that stated, “Left undiagnosed and untreated, mentally ill residents have limited prospects for improvement, and their overall conditions m ay decline more rapidly and ultimately place greater demands on the health care system.”

Achieving Mental Health…is being published this spring by the nonprofit Hebrew Rehabilitation Center for the Aged’s (RCA) Research and Training Institute in Boston, in conjunction with the Mental Health Policy Resource Center (MHPRC) in Washington, D.C. It is based on a 1993 invitational conference that brought together more than 130 experts in mental health and aging. Besides being released as an HRCA issue brief, the 50-page paper will be simultaneously published in the Journal of Mental Health and Aging (New York: Springer Publishing Company). The findings are being presented at the American Society on Aging’s 42nd Annual Meeting in Anaheim, Calif., in March.

The report enumerates a variety of obstacles to the provision of appropriate mental health services.  These include a shortage of mental health professionals trained in geriatrics; lack of in-service training in nursing homes to teach facility staff to treat behavioral and functional consequences of mental health or dementia; and inadequate Medicare payments and reimbursement rules that do not reflect the relative costs of preferred treatments.

Model Programs Recommendation

The report also notes that, in spite of these hurdles, model mental health programs do exist in some nursing homes; they are funded by an array of federal and state agencies, nonprofit foundations and even by some of the facilities themselves, drawing upon nonfederal funds.  The issue brief recommends that such programs be identified, cost-benefits calculated and the results widely disseminated to nursing homes for replication.

However, mental health experts involved in the issue brief agree that progress is slow and good mental health care in nursing homes is still exception rather than the rule.

Key recommendations in the report include:

  • Additional funding for research, staff training, and consumer education initiatives;
  • Improved Medicare and Medicaid reimbursement to pay for psychiatrists to train nursing home staff members in mental health services;
  • Sthe “unbundling,” or separating, of mental health services from nursing home per diem rates, so that funding intended for such assistance cannot be buried in lump-sum reimbursements for care and forgotten;
  • Full implementation of all federal nursing home reform mandates passed in 1987 and 1989, such as those requiring training for nursing home staff and strictly limiting the use of psychotropic drugs and physical restraints with residents;
  • Increasing the percentage of mental health services paid for by Medicare and other federal and private insurance to match that paid for other medical services.

Further, the report recommends that reimbursement incentives to be redirected to recognize  behavioral methods and deemphasize “medication-only” treatment.

The report’s authors added that Washington has failed to recognize cost-effective but humane alternatives to wholesale budget cuts.

For example, given the current antiregulatory mood in Congress, report cards for consumers can be one solution to assist family members in choosing a nursing home that provides adequate mental health training to its staff, said another of the report’s authors, Gail K. Robinson, deputy director of the MHPRC.

She suggested, “With such ratings, consumers and their families can be more selective in choosing a nursing home that provides better quality mental health care. Moreover, facilities could use the ratings to identify their weaknesses and correct them.”

According to Lombardo, there are less costly ways to improve mental health services than obtaining psychiatric specialists care for most residents. For example, she said, “The facility’s in-service training budget could easily be used to bring in experts to teach staff how to care for residents with mental illness or behavioral problems.” This redirection of funds would allow specialists to serve as trainers and troubleshooters, rather than as  consultants for individual residents.

Lombardo also called on nursing home administrators to support simple changes in their in-service training philosophies: “Administrators must realize the actions of all staff members in their facilities affect the mental health of residents either positively or negatively. Therefore, every person should attend training on mental and behavioral issues.”