In this week’s summary, you’ll find details of Gov. Cuomo’s executive budget proposal, including a provision that will repeal “prescriber prevails” for atypical antipsychotics, new legal challenges to the Affordable Care Act, and more!
2013-2014 Executive Budget
Governor Cuomo released his third Executive Budget proposal this week. All Funds spending is proposed at $142.6 billion, which is an increase of 5.3% from the current budget. The proposal closes a $1.3 billion budget gap without new taxes or new fees. On the health side, the budget adds more populations into managed care, extends the Medicaid 2% across the board reductions for two years and the Medicaid spending cap for one year, or until March 31, 2015 for both. The proposal also amends Medicaid and public health statutes in anticipation of Affordable Care Act implementation.
Additionally, the budget repeals a significant patient protection in the Medicaid program. Last year advocates fought hard to obtain the restoration of “prescriber prevails” for atypical antipsychotic medications in the Medicaid prescription drug program. In the budget proposal unveiled this week, this provision was repealed, leaving individuals with severe mental illness at risk for not receiving the medications they need. Patient and physician groups took immediate action to express opposition to this proposal. Gay Men’s Health Crisis (GMHC), NYS Osteopathic Medical Society and the Association of Hispanic Mental Health Professionals all released statements criticizing the governor for needlessly removing a significant patient protection.
The Governor’s proposed budget could face a major setback as the federal government seeks to reduce how much it pays to care for the state’s severely disabled population. The Wall Street Journal reports that New York budget officials are drawing up plans for a budget shortfall twice as large as the $1.35 billion gap that Governor Cuomo closed in his budget presentation this week. Federal and New York State health officials are negotiating a plan that could cut an additional $800 million to $1.1 billion out of federal Medicaid spending. Currently, New York State receives roughly $2 million a year from the federal government for each developmentally disabled person in state-run facilities. This reimbursement structure has been in place since 1990 but a recent probe by the U.S Department of Health and Human Services Inspector General took issue with the amount of reimbursement (Nahmias, 1/24).
Affordable Care Act
As Congress continues to wrestle with the national deficit, Politico writes that funding for programs in the Affordable Care Act present a tempting option for ways to close the deficit. The Affordable Care Act brings in a lot of new taxes and savings, but it also dishes out as much as $1.7 trillion in new spending over the next decade (Cunningham, 1/22).
Although the Supreme Court upheld the constitutionality of the Affordable Care Act in June of 2012, the Washington Post reports that the next significant legal challenge to the Act is moving quickly to the high court. Employers are bringing a suit that challenges the Act’s requirement that employers without a specific exemption must provide workers with insurance plans that cover a full range of birth-control measures and contraceptive drugs. This case will bring significant questions about religious freedom, gender equality and corporate “personhood” before the Court (Barnes, 1/20).
A major multi-city Medicare quality initiative has reduced hospital readmission by nearly six percent over two years. The findings were published in The Journal of the American Medical Association this week. The study examines a Medicare initiative aimed at smoothing transitions of care through community-based interventions and found that the program successfully lowered 30-day readmission rates and all-cause hospitalization rates among beneficiaries. Led by Medicare quality improvement organizations (QIOs), which contract with the CMS to lead statewide quality-related efforts, the 14-community project relied on patient coaches, medication-management strategies, home health tool kits, enhanced discharge planning and other interventions to keep patients out of the hospital.
A new study published this week in the journal JAMA Pediatrics found that the number of children diagnosed with attention deficit hyperactivity disorder rose 24% during the past decade. The disorder was detected in 3.1 percent of children who received care at Kaiser Permanente Southern California in 2010, compared with 2.5 percent in 2001.
Reuters reports on a second study published in the journal of JAMA Pediatrics this week which found that children are receiving some critical vaccines later than what is recommended by health practitioners. The study found that of the more than 300,000 children born between 2004 and 2008 the percentage that were late on at least one vaccine rose from 42% to 54%. More than 1 in 8 children were undervaccinated because their parents’ choices, researchers said. (Pittman, 1/21).
-Jaime Venditti, 1/25/13