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| Wilson Moves to Protect Care & Services at NM Hospitals |
March 30, 2007 |
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Opposes Medicaid Rule Change that Could Reduce Services
Washington, DC – Congresswoman Heather Wilson is urging the withdrawal of a proposed Medicaid regulation that could significantly reduce federal payments to hospitals in New Mexico.
Today, Wilson sent letters to the Department of Health and Human Services and the Office of Management and Budget to oppose the proposed change.
“Congress already rejected these changes in 2005 and 2006,” said Wilson. “Medicaid spending changes should not be at the expense of services to our low-income patients in New Mexico hospitals.”
The proposed Medicaid rule (CMS-2258-P) would change several Medicaid funding streams – the same funding hospitals use to provide care to low-income and uninsured patients.
The New Mexico Hospital Association estimates the proposed regulation could reduce federal payments to hospitals in New Mexico by up to $120 million annually, including $30 million at the University of New Mexico Hospital, the only Level 1 trauma center in the state.
“These are substantial changes to the Medicaid program. Good policy should drive the budget, not the other way around,” Wilson said. “New Mexicans depend on our hospitals for quality care.”
Wilson’s letters to Health and Human Services Secretary Michael Leavitt and Office of Management and Budget Director Rob Portman are the latest in actions the Congresswoman has taken to protect Medicaid services for New Mexicans. Wilson joined other Members of Congress in voicing her opposition last year and again with a letter on March 16, 2007. Wilson’s letters today specifically outline the impact these changes would have in New Mexico. For instance, the changes could impact New Mexico’s Sole Community Provider program, a program that provides funding for hospitals that treat uninsured patients in rural New Mexico.
Wilson also announced she is signing onto legislation in Congress that would suspend the rule for two years. That would allow time to analyze its impact and giving hospitals the opportunity to ask state legislatures for additional funding. Without action the regulation becomes effective on September 1, 2007, just months after it was proposed and published in the Federal Register.
Text of letters follows:
Secretary Michael O. Leavitt
U.S. Department of Health & Human Services
Hubert Humphrey Building
200 Independence Ave SW
Washington, D.C. 20201
Dear Secretary Leavitt,
I urge you to withdraw proposed rule CMS-2258-P. This rule may have a severe negative impact on hospital funding in New Mexico and reduce access to hospital care.
In New Mexico we have a unique Sole Community Provider program that uses county-generated taxpayer revenue to fund the state share of an expanded indigent care program. The program provides hospitals around New Mexico with Medicaid funding for uncompensated care provided to uninsured patients in rural communities with only one hospital. The proposed rule imposes a restriction that state and local tax revenue being federally matched for health care services to the indigent would no longer be allowable. The rule would place the entire Sole Community Provider program in jeopardy. This program has been in place for 14 years and was approved by CMS. CMS-2258-P may reduce payments to New Mexico’s hospitals in the Sole Community Provider program by up to $90 million annually. Given the margins in New Mexico’s hospitals in rural communities, the impact of this reduction is likely to cause these hospitals to reduce staff, diminish programs, or reduce the number of uninsured patients they can serve.
The rule also proposes to limit reimbursement for government hospitals to the cost of providing services to Medicaid patients, and restricts states from making supplemental payments to these safety net hospitals through Medicaid Upper Payment Limit (UPL) programs, while not imposing similar requirements on private and for-profit hospitals. Public hospitals are the safety net of our health care system, providing care to a disproportionate number of uninsured and low-income patients. Combined with changes to indirect graduate medical education in this regulation, payments for the University of New Mexico Hospital would be reduced by up to $30 million annually. This would be an 8% reduction in the hospital’s budget, resulting in real reductions in staffing levels, the quality of care provided, and services for the uninsured in the Albuquerque area. The University of New Mexico Hospital also serves a critical role as the state’s only Level 1 trauma center. These changes would have a real effect on our hospitals and the patients they serve.
Additionally, CMS-2258-P would go into effect on September 1, 2007. Given the proposed rule was published on January 18, 2007, I believe this is insufficient time for the impact of this regulation to be fully analyzed, and for hospitals to go to state legislatures for alternative funding sources to offset the reductions this regulation may cause. At a minimum I hope the implementation of this regulation can be delayed so that hospitals can seek alternative funding sources.
These proposed changes were in prior budget requests as proposals requiring legislative approval, but were rejected by Congress despite opportunities for enacting them in the Deficit Reduction Act. CMS subsequently moved ahead with implementing the proposed rule administratively despite resistance from Members of Congress. I joined 81 Republican Members of Congress in sending a letter to you last year asking CMS not to implement these changes, and on March 17, 2007, I again joined 152 Members of the House and 58 Senators in asking you to withdraw proposed rule CMS-2258-P. Additionally, 226 Members of the House and 43 Senators have written to the Chairmen and Ranking Members of the relevant Congressional committees asking them to consider legislative action to prevent the implementation of CMS-2258-P.
I am sending a similar letter to OMB Director Rob Portman because I believe this rule is being driven as much by the budget and OMB as by policy concerns at CMS. Policy should drive the budget, not the other way around. I would hope that you would work with Director Portman to agree to withdraw CMS-2258-P and maintain access to critical hospital care for the citizens of New Mexico.
Sincerely,
Heather Wilson
Member of Congress
HW: jm
cc: Leslie Norwalk, CMS Acting Administrator
Dennis Smith, Medicaid Director
***************
March 30, 2007
The Honorable Rob Portman, Director
Office of Management and Budget
725 17th Street NW
Washington, D.C. 20503
Dear Director Portman,
I urge you to work with Secretary Leavitt to withdraw proposed rule CMS-2258-P. This rule may have a severe negative impact on hospital funding in New Mexico and reduce access to hospital care.
The desire to curb the growth in entitlement programs such as Medicare and Medicaid is commendable. However, the method in which we make changes in these programs is important because changes can have a real effect on access to health care for low-income and uninsured patients. I believe savings can be achieved in Medicaid by improving the program to encourage prevention, appropriate care coordination and disease management, reducing medical errors, and using technology. CMS-2258-P would administratively make changes in Medicaid funding sources including intergovernmental transfers, certified public expenditures, and Medicaid upper payment limits. I believe these changes were initiated by the Administration as a way to find savings in Medicaid, and would not improve the Medicaid program. The regulation would take important funding sources away from our hospitals for treating low-income uninsured patients.
In New Mexico we have a unique Sole Community Provider program that utilizes county-generated taxpayer revenue to fund the state share of an expanded indigent care program. The program provides hospitals around New Mexico with Medicaid funding for uncompensated care provided to uninsured patients in rural communities with only one hospital. The proposed rule imposes a restriction that state and local tax revenue being federally matched for health care services to the indigent would no longer be allowable. The rule would place the entire Sole Community Provider program in jeopardy. This program has been in place for 14 years and was approved by CMS. CMS-2258-P may reduce payments to New Mexico’s hospitals in the Sole Community Provider program by up to $90 million annually. Given the margins in New Mexico’s hospitals in rural communities, the impact of this reduction would cause these hospitals to reduce staff, diminish programs, or reduce the number of uninsured patients they can serve.
The rule also proposes to limit reimbursement for government hospitals to the cost of providing services to Medicaid patients, and restricts states from making supplemental payments to these safety net hospitals through Medicaid Upper Payment Limit (UPL) programs, while not imposing similar requirements on private and for-profit hospitals. Public hospitals are the safety net hospital care of our health care system, providing care to a disproportionate number of uninsured and low-income patients. Combined with changes to indirect graduate medical education in this regulation, payments for the University of New Mexico Hospital would be reduced by up to $30 million annually. This would be an 8% reduction in the hospital’s budget, resulting in real reductions in staffing levels, the quality of care provided, and services for the uninsured in the Albuquerque area. The University of New Mexico Hospital also serves a critical role as the state’s only Level 1 trauma center. These changes would have a real effect on our hospitals and the patients they serve.
Additionally, CMS-2258-P would go into effect on September 1, 2007. Given the proposed rule was published on January 18, 2007, I believe this is insufficient time for the impact of this regulation to be fully analyzed, and for hospitals to go to state legislatures for alternative funding sources to offset the reductions this regulation may cause. At a minimum I hope the implementation of this regulation can be delayed so that hospitals can seek alternative funding sources.
These proposed changes were in prior budget requests as proposals requiring legislative approval, but were rejected by Congress despite opportunities for enacting them in the Deficit Reduction Act. CMS subsequently moved ahead with implementing the proposed rule administratively despite resistance from Members of Congress. I joined 81 Republican Members of Congress in sending a letter to Secretary Leavitt last year asking CMS not to implement these changes, and on March 17, 2007, I again joined 152 Members of the House and 58 Senators in asking HHS to withdraw proposed rule CMS-2258-P. Additionally, 226 Members of the House and 43 Senators have written to the Chairmen and Ranking Members of the relevant Congressional committees asking them to consider legislative action to prevent the implementation of CMS-2258-P.
CMS has estimated the proposed rule would result in $3.87 billion in savings from projected growth in the Medicaid program over five years, a substantial amount of funding that would primarily come from hospital payments. Such substantial changes in the Medicaid program should originate in Congress and have the support of the majority of Members of Congress as representatives of the people. I am concerned this regulation unilaterally makes changes in Medicaid funding important to hospital care that has been rejected by the Congress.
I am sending a similar letter to Secretary Leavitt asking CMS to withdraw CMS-2258-P. But I believe this rule is being driven as much by the budget and OMB as by policy concerns at CMS. Policy should drive the budget, not the other way around. I would hope that you would work with Secretary Leavitt to agree to withdraw CMS-2258-P and maintain access to critical hospital care for the citizens of New Mexico.
Sincerely,
Heather Wilson
Member of Congress
HW: jm
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