“Inconsistent” Approach to IGTs
A recent General Accountability Office report applauds the Centers for Medicare & Medicaid for cracking down on some of the “intergovernmental transfers” (IGTs) used by states to help raise revenue for their share of Medicaid costs; however, the agency also had some criticism of CMS’ procedures. From August 2003 through August 2006, CMS reviewed IGTs under which states supplemented their usual Medicaid payments to government providers, which then returned those payments to the states. Such financing arrangements violated federal rules because the providers did not retain the payments made to them, returning all or a portion of those payments to the states, CMS said. As a result of CMS’ review, 29 states terminated certain IGTs. The GAO said that the agency’s initiative was consistent with Medicaid payment principles, but added that the reviews were a departure from the agency’s past approach. The GAO faulted CMS for failing to issue specific written guidance about the change in approval standards for IGTs. According to the GAO, since CMS did not issue written guidance, states interpreted the federal rules in different ways. One state official told the GAO that CMS’ review process had not been applied consistently because some states had been able to negotiate deals with CMS to replace the disallowed IGTs with other financing arrangements. CMS disagreed that its actions were not “transparent” and added that it has taken actions (including a final regulation published in the Federal Register on May 29) that would clarify which financing arrangements are allowed. However, Congress has since placed a one-year moratorium on those rules. The GAO report is at: www.gao.gov/new.items/d07214.pdf.
Texas Takes Aim at Cancer
If Texans vote “yes” on a ballot measure (HJR 90) next November, the Lone Star state will become a leader in cancer research. HB 14 grants the state the authority to issue $3 billion in general obligation bonds over 10 years to create the Cancer Prevention and Research Institute of Texas. The legislation is “one of the most positive actions we can take this session, to cure cancer in our lifetime, and do it in the state of Texas,” Representative Jim Keffer (who proposed the legislation) told the Dallas Morning News. Every year, 35,000 Texans die from cancer and 85,000 Texans are diagnosed, according to KillCancer, the advocacy group that pushed for passage. Lawmakers clashed over how to pay for the investment; with some saying general revenues should be used because they would save the state more than $1.5 billion in finance charges over the next three decades. But others said the Legislature could always choose to fund the initiative using general revenues rather than selling bonds. They say the state can use equity return from patents, royalties and licenses to help pay the interest and retire the bonds.
Battling STDs
Maryland has become the twelfth state to allow a controversial program to reduce sexually transmitted diseases. Signed by the Governor on April 24, SB 349 directs the state to create a pilot “expedited partner therapy” (EPT) program. Advocated by the Centers for Disease Control and Prevention, EPT allows a medical provider who has determined that a patient has an STD to dispense multiple prescriptions for treatment of that STD to the patient. The hope is that the patient will then deliver those prescriptions to his or her sex partner(s). The CDC has found that the EPT approach is a “useful” option for partner STD treatment. EPT trials in several states showed no adverse effects, and in a trial in Seattle, the approach was found to have decreased Gonorrhea reinfection rates by 68 percent. Opponents fear that providing prescriptions without clinical evaluations could increase the incidence of allergic or other potentially harmful drug interactions. Previously, patients received “partner notification cards” that they could then give to their sex partner(s). The cards advised the recipient to get tested for specific STDs. But Dr. Laura Herrera told the Baltimore Sun that notification cards did not work because, “(patients) are not comfortable giving the cards to their partners, but they often continue to engage in sex with them, and they are re-infected weeks later.” As a possible testament to that observation, the rates of Chlamydia cases in Baltimore and greater Maryland have significantly increased since 2000.
DC and CA Needle Exchanges
Congress is considering a bill that would allow the District of Columbia to use its own funds to establish a needle exchange program. The impetus is to help counter an alarming rise in the number of HIV/AIDS cases in D.C. According to the Centers for Disease Control and Prevention, the District had 128 new AIDS cases per 100,000 residents in 2005, compared to the national average of 13.7 cases per 100,000 people. Injection drug use is the second leading cause of new cases among men in the District and accounts for one-third of all new HIV cases. D.C. Mayor Adrian Fenty has said that he will provide the funds for needle exchanges if or as soon as Congress acts. Presently, there is one needle exchange program in the District, Prevention Works!, which is entirely financed through private donations and is believed to reach approximately one-third of the 9,700 injecting drug users in the city. On the other coast, the California Legislature is considering AB 110, which would eliminate a state prohibition against using state funds to purchase clean needles. Meanwhile, California is funding the operating costs of 10 different needle exchange programs throughout the state.
© Copyright 2007, State Health Notes
|
