From: ADAPT <cyanosis@igc.org>
Subject: 03/92 INCITEMENT: LEGISLATIVE NEWS
Followup-To: alt.activism.d
Originator: rich@pencil.cs.missouri.edu
Organization: University of Missouri
Resent-From: ADAPT <cyanosis@igc.org>
Date: Mon, 13 Apr 1992 20:15:04 GMT

                     LEGISLATIVE NEWS

     The Hill Takes a Look at Attendant Services Legislation

     Senator Brock Adams of Washington state, Chair of the 
Subcommittee on Aging, has introduced a bill, S. 2193 Long- Term 
Home Care Act, includes a full range of long term home care 
services like: medical supplies (other than drugs), respite care, 
adult  day care, homemaker/home health aid services, personal 
care aides, certain meals, rehabilitation services, and patient 
and care-giver education, training and counseling.  
Congressperson Ed Roybal of California has introduced a companion 
bill in the House, HB 3180.  While Adams has targeted home and 
community based services because this is what he has heard from 
constituents is the preferred way, he is working to include 
nursing home services as well. A consumer's bill of rights, 
training and supervision, sanctions against out of compliance 
providers, monitoring by peer review organizations, and a state 
Consumer Board are all quality assurance measures are contained 
in the bill.  Two demonstration projects would look at the 
feasibility of extending coverage to more individuals and at the 
effectiveness of various case management models.

     Senator George Mitchell of Maine and Congressman Henry 
Waxman of California have organized a Democratic working group to 
develop legislation which comprehensively addresses long-term 
care services.  This group wants to provide coverage for nursing 
home and home and community based care and coverage for all 
eligible people, regardless of age.  Adams is a member of this 
group and is coordinating his efforts with theirs.


           Health Care Finance Administration and
        States Battle Over Access to Medicaid Dollars

     Tennessee ADAPT is embroiled in a battle which is also being 
fought by states around the nation.  Proposed slashes in the 
Tennessee Medicaid budget are echoed across the US.  Why?  The 
feds have outlawed a practice started by Tennessee and several 
other states to increase Medicaid funding for health and long 
term care.  These states created taxes, license fees and similar 
funding sources for hospitals and nursing homes to pay. According 
to a recent article in the Banner, a Nashville newspaper, the 
money raised in this way was around $300,000 million in 
Tennessee.  It was then used by Tennessee to draw down more 
federal Medicaid dollars (about $700,000 million for a total of 
$1.1 billion) to pay for health and long term care services 
provided by these institutions and similar providers.  The tax 
paying hospitals were reimbursed with Medicaid funds raised by 
the tax.

     In the past the tax was put on institutions which provided 
services to Medicaid users.  Now HCFA has said all hospitals must 
be taxed equally.  "Guess who doesn't want to pay?" said ADAPT of 
Tennessee organizer Diane Coleman in recent testimony. "The same 
hospitals who haven't paid before [the big hospital corporations] 
who control the hospital lobbyist group."  In Tennessee the lobby 
efforts against such a uniform tax are likely to lead to a $1.1 
billion budget shortfall next year, about half of their current 
Medicaid budget, with devastating results for the 900,000 folks 
who currently rely on Medicaid funded services.  "If these cuts 
should happen... people would not be able to obtain care and 
people would die"  Tony Garr, executive director of the Tennessee 
Health Care Campaign, told Bill Snyder of the Banner.

     This problem is not unique to Tennessee.  Many states around 
the nation have tried to maximize federal Medicaid dollars in 
this way, and are facing similar problems.

     "If you were trying to put together a system which would be 
the most expensive, you would be hard pressed to design one more 
expensive than what we now have in this country."     -- Gail 
Wilensky, speaking to a republican fundraiser in Nashville 
shortly before she was bumped from her directorship of the 
Health Care Finance Administration

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