HJ637: Medicaid; JLARC to study the Commonwealth's program.


HOUSE JOINT RESOLUTION NO. 637
Directing the Joint Legislative Audit and Review Commission to study the Commonwealth's Medicaid program. Report.

 

Agreed to by the House of Delegates, February 27, 2015
Agreed to by the Senate, February 27, 2015

 

WHEREAS, the Commonwealth's program of medical assistance services, also known as the Medicaid program, is the largest program in the Commonwealth's budget, accounting for more than $8 billion in combined state and federal funds in fiscal year 2014; and

WHEREAS, the Commonwealth's Medicaid program has become increasingly complex as coverage has expanded to include services related to long-term care, behavioral health, and developmental disabilities; and

WHEREAS, elderly Virginians and Virginians with disabilities represent a minority of enrollees in the Medicaid program but account for the majority of expenditures for medical assistance services and generally receive services through a fee-for-service rather than a managed care system; and

WHEREAS, a review of the eligibility process, particularly for long-term care services, could lead to strategies that strengthen the integrity of the program, improve efficiencies, and ensure that limited financial resources are directed to the individuals and families who most require assistance; and

WHEREAS, in light of budgetary pressures facing states across the nation, promising models of care and administrative processes have been implemented to lower costs associated with medical assistance services while maintaining and improving patient outcomes; and

WHEREAS, a comprehensive and analytical review of the Medicaid program should build upon and not duplicate the knowledge and findings from completed studies; now, therefore, be it

RESOLVED by the Senate, the House of Delegates concurring, That the Joint Legislative Audit and Review Commission be directed to study the Commonwealth's Medicaid program. In conducting its study, the Joint Legislative Audit and Review Commission shall review (i) the processes used to determine eligibility, including the financial eligibility screening process for long-term care services, whether asset sheltering could be further prevented and asset recoveries improved, and the effectiveness of existing fraud and abuse detection and prevention efforts; (ii) whether the most appropriate services are provided in a cost-effective manner; (iii) evidence-based practices and strategies that have been successfully adopted in other states and could be used in the Commonwealth; and (iv) other relevant issues, and make recommendations as appropriate.

Technical assistance shall be provided to the Joint Legislative Audit and Review Commission by the Office of the Secretary of Health and Human Resources and the Department of Medical Assistance Services. All agencies of the Commonwealth shall provide assistance to the Joint Legislative Audit and Review Commission for this study, upon request.

The Joint Legislative Audit and Review Commission shall complete its meetings for the first year by November 30, 2015, and for the second year by November 30, 2016, and the chairman shall submit to the Division of Legislative Automated Systems an executive summary of its findings and recommendations no later than the first day of the next Regular Session of the General Assembly for each year. Each executive summary shall state whether the Joint Legislative Audit and Review Commission intends to submit to the General Assembly and the Governor a report of its findings and recommendations for publication as a House or Senate document. The executive summaries and reports shall be submitted as provided in the procedures of the Division of Legislative Automated Systems for the processing of legislative documents and reports and shall be posted on the General Assembly's website.


HOUSE JOINT RESOLUTION NO. 637
AMENDMENT IN THE NATURE OF A SUBSTITUTE
(Proposed by the Joint Conference Committee
on February 26, 2015)
(Patron Prior to Substitute--Delegate Landes)
Directing the Joint Legislative Audit and Review Commission to study the Commonwealth's Medicaid program. Report.

WHEREAS, the Commonwealth's program of medical assistance services, also known as the Medicaid program, is the largest program in the Commonwealth's budget, accounting for more than $8 billion in combined state and federal funds in fiscal year 2014; and

WHEREAS, the Commonwealth's Medicaid program has become increasingly complex as coverage has expanded to include services related to long-term care, behavioral health, and developmental disabilities; and

WHEREAS, elderly Virginians and Virginians with disabilities represent a minority of enrollees in the Medicaid program but account for the majority of expenditures for medical assistance services and generally receive services through a fee-for-service rather than a managed care system; and

WHEREAS, a review of the eligibility process, particularly for long-term care services, could lead to strategies that strengthen the integrity of the program, improve efficiencies, and ensure that limited financial resources are directed to the individuals and families who most require assistance; and

WHEREAS, in light of budgetary pressures facing states across the nation, promising models of care and administrative processes have been implemented to lower costs associated with medical assistance services while maintaining and improving patient outcomes; and

WHEREAS, a comprehensive and analytical review of the Medicaid program should build upon and not duplicate the knowledge and findings from completed studies; now, therefore, be it

RESOLVED by the Senate, the House of Delegates concurring, That the Joint Legislative Audit and Review Commission be directed to study the Commonwealth's Medicaid program. In conducting its study, the Joint Legislative Audit and Review Commission shall review (i) the processes used to determine eligibility, including the financial eligibility screening process for long-term care services, whether asset sheltering could be further prevented and asset recoveries improved, and the effectiveness of existing fraud and abuse detection and prevention efforts; (ii) whether the most appropriate services are provided in a cost-effective manner; (iii) evidence-based practices and strategies that have been successfully adopted in other states and could be used in the Commonwealth; and (iv) other relevant issues, and make recommendations as appropriate.

Technical assistance shall be provided to the Joint Legislative Audit and Review Commission by the Office of the Secretary of Health and Human Resources and the Department of Medical Assistance Services. All agencies of the Commonwealth shall provide assistance to the Joint Legislative Audit and Review Commission for this study, upon request.

The Joint Legislative Audit and Review Commission shall complete its meetings for the first year by November 30, 2015, and for the second year by November 30, 2016, and the chairman shall submit to the Division of Legislative Automated Systems an executive summary of its findings and recommendations no later than the first day of the next Regular Session of the General Assembly for each year. Each executive summary shall state whether the Joint Legislative Audit and Review Commission intends to submit to the General Assembly and the Governor a report of its findings and recommendations for publication as a House or Senate document. The executive summaries and reports shall be submitted as provided in the procedures of the Division of Legislative Automated Systems for the processing of legislative documents and reports and shall be posted on the General Assembly's website.


HOUSE JOINT RESOLUTION NO. 637
AMENDMENT IN THE NATURE OF A SUBSTITUTE
(Proposed by the Senate Committee on Rules
on February 20, 2015)
(Patron Prior to Substitute--Delegate Landes)
Directing the Joint Legislative Audit and Review Commission to study pathways for determining eligibility for Medicaid-funded long-term care. Report.

WHEREAS, long-term care is expensive, funded mostly by Medicaid, heavily dependent on already strained state and federal revenues, and facing a wave of aging Virginians that will test the adequacy of scarce public resources; and

WHEREAS, in the Commonwealth, Medicaid-funded long-term care services are provided for seven percent of enrollees but account for 35 percent of the Commonwealth's Medicaid expenditures; and

WHEREAS, the Department of Medical Assistance Services provides long-term care services through three models: home- and community-based services, facility-based services, or coordinated programs like the Program of All-Inclusive Care for the Elderly (PACE) and the Commonwealth Coordinated Care program; and

WHEREAS, the Code of Virginia requires that all individuals seeking long-term care services be evaluated to determine their need for long-term care services, including evaluation of both functional eligibility screenings conducted by local preadmission screening teams or hospital discharge planners and financial eligibility screenings conducted by local departments of social services; and

WHEREAS, a review of the long-term care eligibility process could lead to strategies that strengthen the integrity of the program, improve efficiencies, and ensure that limited financial resources are directed to the individuals and families who most require assistance; now, therefore, be it

RESOLVED by the House of Delegates, the Senate concurring, That the Joint Legislative Audit and Review Commission be directed to study pathways for determining eligibility for Medicaid-funded long-term care.

In conducting its study, the Joint Legislative Audit and Review Commission shall review (i) the Commonwealth's long-term care preadmission screening process, including the process by which individuals access such screenings, the timeliness of such screenings, support for individual choice upon meeting long-term care criteria, and assurance that the assessment teams are neutral and have no financial or legal ties to discharge locations and (ii) state and federal long-term care financial eligibility laws, including the use of annuities to protect assets, transfer of assets, lien and estate recovery, assessing a child as a family of one for eligibility purposes, and the effects of the new Modified Adjusted Gross Income eligibility standards and access to nursing home long-term care services.

All agencies of the Commonwealth shall provide assistance to Joint Legislative Audit and Review Commission for this study, upon request.

The Joint Legislative Audit and Review Commission shall complete its meetings for the first year by November 30, 2015, and for the second year by November 30, 2016, and the chairman shall submit to the Division of Legislative Automated Systems an executive summary of its findings and recommendations no later than the first day of the next Regular Session of the General Assembly for each year. Each executive summary shall state whether the Joint Legislative Audit and Review Commission intends to submit to the General Assembly and the Governor a report of its findings and recommendations for publication as a House or Senate document. The executive summaries and reports shall be submitted as provided in the procedures of the Division of Legislative Automated Systems for the processing of legislative documents and reports and shall be posted on the General Assembly's website.


HOUSE JOINT RESOLUTION NO. 637
House Amendments in [ ] – February 9, 2015
Directing the Joint Legislative Audit and Review Commission to study the Commonwealth's Medicaid program. Report.
Patron Prior to Engrossment--Delegate Landes

Referred to Committee on Rules

WHEREAS, the Commonwealth's program of medical assistance services, also known as the Medicaid program, is the largest program in the Commonwealth's budget, accounting for more than $8 billion in combined state and federal funds in Fiscal Year 2014; and

WHEREAS, state and federal appropriations for the Medicaid program have increased by 85 percent over the past decade, and more than 1.1 million Virginians are now enrolled in the program; and

WHEREAS, elderly Virginians and Virginians with disabilities represent a minority of enrollees in the Medicaid program but account for the majority of expenditures for medical assistance services, and generally receive services through a fee-for-service rather than a managed care system; and

WHEREAS, the Commonwealth's Medicaid program has become increasingly complex as coverage has expanded to include services related to long-term care, behavioral health, and developmental disabilities; and

WHEREAS, no comprehensive and analytical review of the effectiveness and efficiency of the Commonwealth's Medicaid program has been undertaken; and

WHEREAS, in light of budgetary pressures facing states across the nation, promising models of care and administrative processes have been implemented to lower costs associated with medical assistance services while maintaining and improving patient outcomes; now, therefore, be it

RESOLVED by the House of Delegates, the Senate concurring, That the Joint Legislative Audit and Review Commission be directed to study the Commonwealth's Medicaid program. In conducting its study, the Joint Legislative Audit and Review Commission shall (i) analyze the impact of major cost drivers on the growth of Medicaid program expenditures [ , including eligibility ] (ii) identify highest-cost Medicaid recipients and services and assess whether opportunities exist to improve the cost-effectiveness of health care delivery; (iii) examine the efficiency of the administration of the Commonwealth's Medicaid program, including financial processes and controls [ and , ] the recovery of third-party payments, [ eligibility processing, ] and review the implementation status of recommendations made in its 2011 report, "Mitigating the Risk of Improper Payments in the Virginia Medicaid Program," on improper payments and other reports related to improving efficiency and cost-effectiveness; (iv) identify evidence-based practices and strategies that have been successfully adopted in other states and that could be used in the Commonwealth to provide cost-effective care, strengthen patient outcomes, and maximize the efficiency and integrity of internal processes; and (v) review other relevant issues and make recommendations as appropriate.

Technical assistance shall be provided to the Joint Legislative Audit and Review Commission by the Department of Medical Assistance Services. All agencies of the Commonwealth shall provide assistance to the Joint Legislative Audit and Review Commission for this study, upon request.

The Joint Legislative Audit and Review Commission shall complete its meetings for the first year by November 30, 2015, and for the second year by November 30, 2016, and the chairman shall submit to the Division of Legislative Automated Systems an executive summary of its findings and recommendations no later than the first day of the next Regular Session of the General Assembly for each year. Each executive summary shall state whether the Joint Legislative Audit and Review Commission intends to submit to the General Assembly and the Governor a report of its findings and recommendations for publication as a House or Senate document. The executive summaries and reports shall be submitted as provided in the procedures of the Division of Legislative Automated Systems for the processing of legislative documents and reports and shall be posted on the General Assembly's website.

HOUSE JOINT RESOLUTION NO. 637

Offered January 14, 2015
Prefiled January 14, 2015
Directing the Joint Legislative Audit and Review Commission to study the Commonwealth's Medicaid program. Report.
Patron-- Landes

Committee Referral Pending

WHEREAS, the Commonwealth's program of medical assistance services, also known as the Medicaid program, is the largest program in the Commonwealth's budget, accounting for more than $8 billion in combined state and federal funds in Fiscal Year 2014; and

WHEREAS, state and federal appropriations for the Medicaid program have increased by 85 percent over the past decade, and more than 1.1 million Virginians are now enrolled in the program; and

WHEREAS, elderly Virginians and Virginians with disabilities represent a minority of enrollees in the Medicaid program but account for the majority of expenditures for medical assistance services, and generally receive services through a fee-for-service rather than a managed care system; and

WHEREAS, the Commonwealth's Medicaid program has become increasingly complex as coverage has expanded to include services related to long-term care, behavioral health, and developmental disabilities; and

WHEREAS, no comprehensive and analytical review of the effectiveness and efficiency of the Commonwealth's Medicaid program has been undertaken; and

WHEREAS, in light of budgetary pressures facing states across the nation, promising models of care and administrative processes have been implemented to lower costs associated with medical assistance services while maintaining and improving patient outcomes; now, therefore, be it

RESOLVED by the House of Delegates, the Senate concurring, That the Joint Legislative Audit and Review Commission be directed to study the Commonwealth's Medicaid program. In conducting its study, the Joint Legislative Audit and Review Commission shall (i) analyze the impact of major cost drivers on the growth of Medicaid program expenditures; (ii) identify highest-cost Medicaid recipients and services and assess whether opportunities exist to improve the cost-effectiveness of health care delivery; (iii) examine the efficiency of the administration of the Commonwealth's Medicaid program, including financial processes and controls and the recovery of third-party payments, and review the implementation status of recommendations made in its 2011 report, "Mitigating the Risk of Improper Payments in the Virginia Medicaid Program," on improper payments and other reports related to improving efficiency and cost-effectiveness; (iv) identify evidence-based practices and strategies that have been successfully adopted in other states and that could be used in the Commonwealth to provide cost-effective care, strengthen patient outcomes, and maximize the efficiency and integrity of internal processes; and (v) review other relevant issues and make recommendations as appropriate.

Technical assistance shall be provided to the Joint Legislative Audit and Review Commission by the Department of Medical Assistance Services. All agencies of the Commonwealth shall provide assistance to the Joint Legislative Audit and Review Commission for this study, upon request.

The Joint Legislative Audit and Review Commission shall complete its meetings for the first year by November 30, 2015, and for the second year by November 30, 2016, and the chairman shall submit to the Division of Legislative Automated Systems an executive summary of its findings and recommendations no later than the first day of the next Regular Session of the General Assembly for each year. Each executive summary shall state whether the Joint Legislative Audit and Review Commission intends to submit to the General Assembly and the Governor a report of its findings and recommendations for publication as a House or Senate document. The executive summaries and reports shall be submitted as provided in the procedures of the Division of Legislative Automated Systems for the processing of legislative documents and reports and shall be posted on the General Assembly's website.