Overview of the Joint Commission on Health Care

1
Overview of the Joint Commission on Health Care

• Presentation to VCU MPH Class
• November 28, 2005

Kim Snead Executive Director
2
Background

• The Joint Commission on Health Care (JCHC)
  was created by the 1992 session of the General
  Assembly to continue the work of the Commission
  on Health Care for all Virginians, established in
  1990.
• The purpose of the Joint Commission on
  Health Care is to study, report, and make
  recommendations on all areas of health care
  provision, regulation, insurance, liability,
  licensing, and delivery of services. JCHC seeks
  to ensure that the greatest number of Virginians
  receives quality cost-effective health care and
  long-term care services.

3
Mission of the JCHC

• JCHC focuses on five main policy areas
• health insurance and access to care for the
  uninsured
• health care cost and quality
• health workforce issues
• behavioral health care and
• long-term care.

4
Membership of the JCHC

• Ten members of the House of Delegates, appointed
  by the Speaker of the House.
• Eight members of the Virginia Senate, appointed
  by the Senate Committee on Rules.
• The Secretary of Health and Human Resources is an
  ex officio member.

5
Current JCHC Members

• Del. Harvey B. Morgan, Chair
• Sen. William C. Mims, Vice-Chair
• Del. Clifford L. Athey, Jr. Del. Robert H. Brink
  
• Del. Benjamin L. Cline Del. Franklin P. Hall
• Del. Phillip A. Hamilton Del. R. Steven Landes
• Del. Kenneth R. Melvin Del. John M. OBannon,
  III
• Del. John J. Welch, III
• Sen. Harry B. Blevins Sen. R. Edward Houck
• Sen. Benjamin J. Lambert, III Sen. Stephen H.
  Martin
• Sen. Linda T. Puller Sen. Nick Rerras
• Sen. William C. Wampler
• The Honorable Jane H. Woods

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Role of JCHC Staff

• JCHC has a full-time staff of four an executive
  director, 2 health policy analysts and an office
  manager
• Provide impartial, apolitical analysis of issues
  involving health care, behavioral health care,
  and long-term care
• Identify a range of policy options for
  consideration by the Joint Commission
• Assist in supporting legislation and budget
  amendments that the members introduce on behalf
  of JCHC.

7
Study Process

• Staff research and presentation of Studies
  (May-October)
• Public comments received (after issue brief)
• Public comments summarized (next meeting after
  issue brief)
• Subcommittee meetings conducted (May-October)
• JCHC consideration of decision matrix (Nov.)
• JCHC vote on legislative package (Nov.)
• General Assembly session

8
Review of Federal Funding for HIV/AIDSPrevention
and Treatment in VA

• The 2005 Appropriations Act required JCHC to
  review federal funding on Virginias HIV/AIDS
  prevention and treatment program
• 17,000 individuals are known to be living with
  HIV or AIDS in VA another 25 or 4,200 are
  unaware of being HIV-positive.
• Medicaid is the primary funding source for
  services for individuals with HIV or AIDS
• In 2004, Medicaid expenditures in VA were 6.7
  million with more than 50 for pharmaceutical
  expenditures.
• Other major sources of federal funding for
  services addressing HIV/AIDS include Health
  Resources and Services Administration (HRSA)
  through the Ryan White Comprehensive AIDS
  Resources Emergency (CARE) Act and the Centers
  for Disease Control (CDC)
• Funding from these federal sources has been
  reduced
• Available State matching funds have been reduced
• A deficit of 6.1 million in needed funding is
  projected by the VA Dept. of Health in FY 2007 ,
  if additional funding is not appropriated.

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Review of Federal Funding for HIV/AIDSPrevention
and Treatment in VA

• JCHC members discussed the desire not to take on
  funding of federally-mandated programs that had
  their federal funding reduced, even though many
  of the programs are needed.
• Options presented but not approved included
  budget amendments for
• 285,000 per year for other prevention funding
• 164,000 per year for the Advancing HIV
  Prevention Initiative
• 1 million to stabilize access to HIV primary
  care services in NOVA and SW VA
• 4.3 million to fund projected shortfall in ADAP
  funding for individuals with HIV/AIDS who have
  limited or no coverage for medication .
• JCHC actions approved for the 2006 General
  Assembly Session
• Introduce budget amendment for 265,110 per year
  to expand HIV resistance testing program
• Introduce a resolution encouraging VCU School of
  Dentistry to investigate funding for dental
  services under the Ryan White Comprehensive AIDS
  Resource Emergency Act
• In addition, JCHC will continue to monitor
  funding issues in 2006.

10
Reconsideration of MedicaidAsset Transfer Policy
in Virginia

• HB 2601 (2005) would have allowed DMAS to seek a
  waiver from the federal government to establish
  more restrictive asset transfer limits for
  qualifying for Medicaid long-term care services.
• Federal restrictions addressing the issue of
  improper asset transfers in order to qualify for
  Medicaid long-term care services, were first
  enacted as part of the Boren-long Amendments to
  the 1980 Omnibus Reconciliation Act.
• On the national level, Medicaid is now the
  largest purchaser of nursing facility services
• 51 billion in 2003.

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National Distribution ofNursing Facility Funding
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Overview of Medicaid Long-Term Care

• States are not required to provide Medicaid
  programs. However, if they do, they must
  provide certain services to individuals
  classified as categorically needy.
• Long-term care services that a state must provide
  include
• Home health (which at a minimum includes
  intermittent or part-time nursing services, home
  health aides, and medical supplies and appliances
  for use in the home)
• Nursing facility services for beneficiaries age
  21 or older.
• In Virginia, nursing facility (NF) reimbursement
  cost 547,287,699 in 2003 (VAs Medicaid funding
  requires a 50 match of State funds)
• 76 of NF expenditures were for individuals
  classified as aged
• Clearly this figure is likely to increase with
  the aging of baby boomers, if action is not taken.

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Increasing Medicaid CostsAre a National Concern

• In response to projections showing significant
  increases in the cost of Medicaid LTC expenses
  (51 billion in the US in 2003), groups such as
  the National Governors Association have
  considered methods for restricting asset
  transfers including changes in the look-back
  period and penalty provisions
• Look back period is the time period examined for
  an improper asset transfer currently 36 months
  for all transfers except trusts which involves a
  60-month look back period
• Penalty period is the time period that an
  individual is ineligible for Medicaid LTC
  payments due to an improper asset transfer
• Penalty period Uncompensated value of assets
  transferred
• Avg. monthly cost private pay NF at
  application

14
Reconsideration of MedicaidAsset Transfer Policy
in Virginia

• A number of Options were presented for JCHC
  consideration
• Actions to encourage purchase of LTC insurance
• Introduce legislation to provide a 10 tax credit
  rather than a tax deduction for purchase of LTC
  insurance
• Introduce legislation to provide a tax credit for
  employers who provide LTC insurance for their
  employees.
• Actions to further restrict asset transfers
• Introduce legislation authorizing DMAS to apply
  for a waiver to implement more restrictive asset
  transfer restrictions (as HB 2601 of 2005 would
  have provided).
• Actions that require study
• Introduce a resolution requesting a JLARC study
  of the incidence of and methods used to shelter
  assets in order to qualify for Medicaid.

15
Review of Health Savings Accounts

• HSAs were created in Medicare legislation signed
  into law in December 2003
• HSAs are accounts in which money is placed to pay
  for medical expenses the accounts must be paired
  with qualifying high-deductible health plans
• HSA funds are tax deductible and owned by the
  individual even though employers can contribute
  into the accounts
• Covered individuals cannot be eligible for
  Medicare or have other health insurance (except
  for the required high-deductible insurance and
  specific types of coverage such as accident,
  disability, dental, vision, LTC)
• Maximum contributions currently are the lesser or
  2,650 for individuals and 5,250 for families or
  the amount of the deductible in the
  high-deductible health plan
• HSA funds can be used for medical expenses,
  qualified LTC insurance, COBRA coverage, health
  insurance while unemployed, and in a few other
  specific situations.

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Review of Health Savings Accounts

• Potential advantages of HSAs
• Encouraging savings for future needs which may
  provide a source of funding for non-covered
  services, health insurance while unemployed, LTC
  needs, medical expenses after retirement but
  before Medicare coverage
• Unspent funds in HSAs can be rolled over from
  year to year
• For some populations, including young adults who
  can no longer receive coverage on their parents
  policies and lower-income self-employed
  individuals, HSAs may be the only type of health
  care coverage they can afford.
• Potential disadvantages of HSAs
• Several studies found that while employees who
  have to pay a large share of their medical care
  eliminated 1/4th of unnecessary visits to their
  doctors, they also eliminated 1/3rd of crucial
  visits
• HSAs may attract the healthy and wealthy making
  comprehensive coverage for others more expensive
• The number of uninsured and underinsured
  Americans could increase if more employers and
  employees choose not to offer/have comprehensive
  health insurance.

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Joint Commission on Health Care

• JCHC Internet website
• http//legis.state.va.us/jchc/jchchome.htm
• Includes meeting schedules, studies, reports, and
  legislation.
• Joint Commission on Health Care
• 900 E. Main Street, Suite 3072E
• P. O. Box 1322
• Richmond, VA 23218
• 804-786-5445/(FAX) 804-786-5538
• ksnead_at_leg.state.va.us
• JCHC Staff
• Kim Snead, Executive Director
• April R. Kees, Principal Health Policy Analyst
• Catherine W. Harrison, Senior Health Policy
  Analyst
• Mamie V. White Jones, Office Manager