 June 5, 2006 Mike O. Leavitt As you know, several of the provisions in the Deficit Reduction Act of 2005 (DRA) provide states with new options as to how they provide benefits in their Medicaid programs. As states decide whether to proceed on these options, it is important that they consult with beneficiaries, health care providers, and other interested groups to explore how these changes would affect beneficiaries and the state’s health care system. We are writing to you because we are concerned about the process that has been followed in one of the first amendments approved by the Centers for Medicare and Medicaid Services (CMS). On May 3, 2006 CMS approved a state plan amendment (SPA) allowing West Virginia to offer alternative benefits to most children and parents enrolled in the state’s Medicaid program. The amendment is dated April 21, and it was approved on May 3. To our knowledge, the contents of the amendment were not made available to the public until after approval of the amendment was announced by the Governor on May 3. To date, the SPA has not been posted on the CMS website, and it was only posted on the state’s website after it was approved. The coverage changes proposed in West Virginia, and others that will likely be proposed by states, will have a major impact on beneficiaries, health care providers, local governments and others. Thus we are asking that you require states to make their proposals available to the public prior to submission to CMS. At a minimum, CMS should not review any proposed SPA that involves changes in covered benefits unless the state Medicaid agency demonstrates it has consulted through a public process with its Medical Care Advisory Committee. In addition, we believe CMS should make any proposed SPAs that change benefits and/or cost-sharing available online immediately upon receipt by the agency. Given the vital services that Medicaid provides to vulnerable populations, as well as the significant federal and state fiscal investment in the program, we believe that changes affecting the benefits to be covered for different populations should not be rushed through without any public process. Sincerely, American Academy of HIV Medicine cc: The Honorable Charles E. Grassley
June 5, 2006 The Honorable Charles E. Grassley Dear Senator Grassley: We greatly appreciate the work you have done to ensure that children enrolled in the Medicaid program continue to receive all the services they need under the Early and Periodic Screening, Diagnostic and Treatment Program (EPSDT) benefit. We therefore believe you will share our concern that one of the first state plan amendments to offer alternative benefits packages approved under the new Deficit Reduction Act (DRA) option appears to limit needed EDSDT services for some children. At best, the recently approved State Plan Amendment (SPA) from West Virginia creates much confusion about the benefits available for children, and this confusion is likely to cause them to lose some benefits they should receive. On May 3, 2006, the Centers for Medicare and Medicaid Services (CMS) approved a state plan amendment (SPA) for the State of West Virginia. The SPA would require all children and parents who are not otherwise exempt from the new benefits flexibility to sign member responsibility agreements. The agreement would be signed by the child’s parent and includes requirements such as ensuring that children receive check-ups, take prescribed medications and gets to appointments on time. Health care providers would be required to monitor and report on compliance of their patients. Until an agreement is signed, a child will receive a basic benefits package that limits prescription drugs to four a month and does not include diabetes care, mental health services, nutrition counseling and other important services. These benefits could also be limited after the agreement is signed if it is determined that the agreement was not followed. While the SPA does list EPSDT benefits as being covered under the basic benefits package, it simultaneously describes a number of benefits that are limited or not covered in ways that are not consistent with EPSDT. Further clarification on the availability of necessary EPSDT services is badly needed, and should have been requested by CMS prior to approval. We enclose a copy of a letter we have sent to Secretary Leavitt expressing concerns about the process of approving the SPA. The SPA was approved in less than two weeks, and it appears that the state did not share its proposal with beneficiaries, health care providers, or other interested parties prior to approval. We know that you have been concerned about the lack of public process on Medicaid Section 1115 waivers; the attached letter highlights these same concerns with respect to the process of approving state plan amendments under the DRA. Again, we appreciate your leadership on these issues and look forward to working with you to ensure that children receive all the benefits guaranteed by EPSDT, and that the process of making far-reaching changes in benefits for all Medicaid beneficiaries includes meaningful public input. Sincerely, American Academy of HIV Medicine |