ACTION ALERT Help Stop Back Door Cuts to Medicaid Services

The outpatient regulation is now at the federal OMB for clearance and is expected to go into effect in the next several weeks unless a moratorium is included in the Tax Extender Bill in the House (see Friday's Action Alert on this issue).

The outpatient regulation, first published on September 28, 2007, has a real and very wide impact reducing funding to many clinics and hospitals. The rule treats visits to a clinic where many services are offered, including outpatient clinical services for people with disabilities, as if they are purely a visit to a doctor's office.

Hospitals will no longer receive reimbursement for outpatient services provided through Graduate Medical Education. They will see their disproportionate share payments reduced and flat rate hospitals will be very negatively impacted.

In the modern approach to medicine we want to encourage preventive services and services outside the emergency room setting yet this rule does just the opposite. It cuts funds to outpatient services. See Table below for some of the services that will be affected by this Regulation.

Service
Medicare Coverage
Impact of Outpatient Rule on Medicaid
Day Treatment
*Medicare does not pay for day programs for individuals with
developmental disabilities.
*Medicare does not pay for day treatment such as intensive
psychiatric rehabilitation.

No funding for day treatment programs for persons with psychiatric or developmental disabilities.

Comprehensive primary care and ancillary services.

*Medicare does not recognize clinics that provide comprehensive
primary care and ancillary services. Therefore it reimburses them as if they were visits to private physicians.

No funding for some clinic services, such as lab and radiology services.

Select Services
*Medicare does not pay at all for certain services such as
vision, psychiatric and dental services (but only dental care received as an exception under the proposed rule.)

No funding for clinics that specialize in mental health services or services for individuals with developmental disabilities.

ACTION NEEDED:

Call Speaker Pelosi, Majority Leader Hoyer, Majority Whip Clyburn and Members of the House Ways and Means Committee (see list below)- TODAY.
Ask them to include a moratorium on the Medicaid regulation IN THE TAX ENXTENDER BILL. Use the Capitol Switchboard to reach your Members at 202-224-3121.