The federal-state Medicaid program continues to be the largest single purchaser of public transportation services in the country. When provisions of the health reform legislation begin to kick in, Medicaid is slated to become an even larger purchaser of public transit services. Meanwhile, you may recall that there has been some controversy in the past few years, as the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees Medicaid, made efforts to implement some significant provisions under the Deficit Reduction Act of 2005 (DRA).
So, it's important to take note of a notice published in the April 30, 2010, Federal Register, in which CMS announces its final rules concerning "State Flexibility for Medicaid Benefits Packages." This rule implements a language in the DRA that gives states the option to establish Medicaid services that are "benchmarked" to other forms of insurance, such as the Federal Employees Health Benefits Program, state employees' health coverage, etc.
State Medicaid agencies will be reading this rule in detail from beginning to end. For transportation providers, the most important thing is the new regulation at 42 CFR Section 440.390, which reads "If a benchmark or benchmark-equivalent plan does not include transportation to and from medically necessary covered Medicaid services, the State must nevertheless assure that emergency and non-emergency transportation is covered for beneficiaries enrolled in the benchmark or benchmark-equivalent plan, as required under Section 431.53 of this chapter."
In other words, states continue to be responsible, by CMS regulation, for assuring non-emergency medical transportation for all their Medicaid beneficiaries, regardless of whether those people are in a benchmark plan or are served by "traditional" Medicaid.
This rule concerning "benchmark" plans in Medicaid takes effect July 1, 2010. States' requirement to assure non-emergency medical transportation is nothing new; that has been in place for many years, first as a result of federal court cases, and then as a matter of CMS regulation.
Now that medical transportation providers may be feeling some level of justified comfort that their services are not going to be ended (that was a very real fear in response to CMS' initial proposals on this rule), there are some points of this latest rulemaking that bear careful consideration.
1. "Benchmark" plans are an option that is available to states. There is no requirement that states adopt this optional approach to elements of their Medicaid programs. However, CMS estimates that 90 percent of states will have some form of benchmark programs in place within a year or two. Given the nature and scope of the newest federal health legislation, that number is probably too low, and it's much more likely that nearly every state will have some form of benchmark-like coverage in their Medicaid programs in the near future. Therefore, anyone who's trying to set up systems for the future implementation of Medicaid should read more of today's rule, and see how CMS is beginning to instruct states in their relations with insurance companies, managed care organizations, and other intermediaries.
2. The rule on benchmark plans has some reminders that CMS has an option by which states can provide Medicaid transportation through a brokered program (defined by regulation at 42 CFR Section 440.170(a)(4), in which case these transportation expenses can be covered as "medical services" (and thus reimbursed by CMS at the state's Federal Medical Assistance Percentage rate, instead of the fixed 50 percent reimbursement for Medicaid program administrative costs) even if certain requirements for medical services (such as patient freedom of choice) are not part of the "brokerage." As with the benchmark program, it is very important to remember that such Medicaid transportation brokerages are an option available to states; they are not required.
3. For the first time that I've ever noticed, the benchmark rule has a requirement for public participation in Medicaid planning. It's a narrow window, and simply requires states to solicit public comment if they are preparing a state Medicaid plan amendment in pursuit of creating a benchmark program. Maybe there's always been a requirement for public input; if so, it may be something to be more aggressively publicized.
4. In case people hadn't been following this trend, in both the previous and current presidential administrations, CMS is having options and features of Medicaid being addressed by states through Medicaid plan amendments, and not through waiver requests. Although Medicaid planning is nothing at all like transportation planning, the fact that more process-driven approaches are being dictated by the federal government may give more opportunities for meaningful involvement by stakeholders as states pursue their Medicaid strategies.
5. And for those people who follow federal interagency coordination policies, there is this verbiage, as it appears in the CMS rulemaking notice: "We do not believe that Executive Order 13330, which relates to the coordination of transportation among Federal agencies, is relevant to this rule."
Friday, April 30, 2010
Wednesday, April 14, 2010
More Money for Transit Sustainability Projects
The Federal Transit Administration (FTA) is seeking applicants for its newest round of Transit Investments for Greenhouse Gas and Energy Reduction (TIGGER) and Clean Fuel grants. There's even a little bit of additional money available for applications for Section 5309 bus and bus facility grants that meet certain FTA priorities.
Clean Fuels (Section 5308) and Section 5309 applications are due June 14, 2010. FTA has combined some funding in these accounts for a total of $81.2 million in available funding.
TIGGER applications are due August 11, 2010. There's a total of $75 million available for these grants, with MINIMUM project costs of $1 million per project, and a maximum of $25 million per project.
In all these, applicants must speak directly to three federal priorities: (a) breaking dependence on oil, (b) producing more energy at home, and (c) promoting energy efficiency. FTA wants to see high-value, technologically innovative, projects funded under TIGGER, with more mundane (that's my word, not FTA's) projects to be funded under Clean Fuels/bus & bus facilities. These FTA funds can cover up to 90 percent of project costs under these grants.
The only eligible applicants are public transit agencies (defined as units of state or local govt that are engaged in providing public transit services) and state departments of transportation. Nonprofit transit entities are not eligible to apply (but could benefit from states' or others' applications); it would appear that public agencies not engaged in carrying out transit probably can't apply for these funds, either.
This information appears in the April 13, 2010, Federal Register. Additional information is on FTA web site, at www.fta.dot.gov/tigger.
Clean Fuels (Section 5308) and Section 5309 applications are due June 14, 2010. FTA has combined some funding in these accounts for a total of $81.2 million in available funding.
TIGGER applications are due August 11, 2010. There's a total of $75 million available for these grants, with MINIMUM project costs of $1 million per project, and a maximum of $25 million per project.
In all these, applicants must speak directly to three federal priorities: (a) breaking dependence on oil, (b) producing more energy at home, and (c) promoting energy efficiency. FTA wants to see high-value, technologically innovative, projects funded under TIGGER, with more mundane (that's my word, not FTA's) projects to be funded under Clean Fuels/bus & bus facilities. These FTA funds can cover up to 90 percent of project costs under these grants.
The only eligible applicants are public transit agencies (defined as units of state or local govt that are engaged in providing public transit services) and state departments of transportation. Nonprofit transit entities are not eligible to apply (but could benefit from states' or others' applications); it would appear that public agencies not engaged in carrying out transit probably can't apply for these funds, either.
This information appears in the April 13, 2010, Federal Register. Additional information is on FTA web site, at www.fta.dot.gov/tigger.
Friday, March 19, 2010
One Extension Done, Others Still in Play
Earlier this week, Pres. Obama signed HR 2847, the "HIRE Act," into law. This legislation extends SAFETEA-LU highway and transit authorizations through December 31, 2010, making sure that about $20 billion is made available to cover existing appropriations (and anticipated appropriations for the first quarter of FY 2011). It also continues the increased federal share of Medicaid costs that were first established under the American Recovery and Reinvestment Act.
Back payment to US DOT employees affected by last month's short-term furlough during the lapse in authorizations remain up in the air. The House has passed a couple of measures to address this question, but Senate action has not yet occurred. The House attached the latest such back pay provision to HR 4851, the "Continuing Extensions Act," which otherwise addresses lapsing unemployment, COBRA and other provisions.
Returning to the HIRE Act, there was a bit of a conniption over how to treat the FHWA accounts that had been used to fund some high-dollar highway projects under SAFETEA-LU. Basically, the question was whether these accounts still need extension, even after those Congressionally designated projects had been funded. But in the urgent need to do something, that extension occurred.... Now, Congress is trying to set things straight, having attached a bit of correcting language to another bill, HR 4853, the FAA Extension Act (yes, the federal aviation program also has expired and needs reauthorization), which it passed and sent on to the Senate this week.
Back payment to US DOT employees affected by last month's short-term furlough during the lapse in authorizations remain up in the air. The House has passed a couple of measures to address this question, but Senate action has not yet occurred. The House attached the latest such back pay provision to HR 4851, the "Continuing Extensions Act," which otherwise addresses lapsing unemployment, COBRA and other provisions.
Returning to the HIRE Act, there was a bit of a conniption over how to treat the FHWA accounts that had been used to fund some high-dollar highway projects under SAFETEA-LU. Basically, the question was whether these accounts still need extension, even after those Congressionally designated projects had been funded. But in the urgent need to do something, that extension occurred.... Now, Congress is trying to set things straight, having attached a bit of correcting language to another bill, HR 4853, the FAA Extension Act (yes, the federal aviation program also has expired and needs reauthorization), which it passed and sent on to the Senate this week.
Thursday, March 11, 2010
"Jobs" bills -- a playcard
Turn to just about any news media this month, and you'll see or hear something about job creation legislation being passed or debated in Congress. There are a number of bills in play, all of which have something or another to do with transportation and the programs that depend upon transportation. Here's the mid-March rundown:
HR 2847, Hiring Incentives to Restore Employment Act
This bill has experienced a long and convulsive path through the Capitol. In its current form, House and Senate are using it as one of their job creation measures. As far as providers or stakeholders of public transportation are concerned, the leading feature of this bill is that it calls for extending current SAFETEA-LU authorizations through December 31, 2010. An earlier House-passed version of this bill included additional money, on top of SAFETEA-LU, for transit, as well as supplemental grants for job training, and an extension of the increased federal share of Medicaid costs, but all those provisions - other than the SAFETEA-LU extension - seem to have been jettisoned by the bills passed by the Senate on February 24, and by the House on March 4. At this point, the House and Senate legislation is not too divergent; it's possible that they can reach agreement on this bill (which mainly has $150 billion or so in tax provisions that are hoped to stimulate employment) and send it to President Obama for signature.
HR 4213, Tax Extenders Act of 2009
Every year, there are a number of provisions and features in the Internal Revenue Code that expire unless extended. This becomes a convenient, "must-pass" vehicle for other morsels of legislation. This year's Tax Extenders bill passed the House in December as a "clean" bill (ie, just extending expiring tax stuff, with nothing else attached). This week - on March 10 - the Senate passed its version of an extenders bill that included $140 billion of other stuff, including provisions that would extend the increased federal share of Medicaid (enacted under the American Recovery and Reinvestment Act) for another year.
HR 4691, Temporary Extension Act of 2010
As previously reported here and elsewhere, the main transportation feature of this bill was the short-term extension of SAFETEA-LU authorizations through March 28, 2010.
HR 4812, Local Jobs for America Act
This bill was just introduced yesterday by Congressman George Miller (D-Calif), chair of the House Education and Labor Committee. The main feature, as touted by Congressman Miller's press release, is the authorization of $100 billion to help state governments ($25 billion) and local governments ($75 billion) carry out infrastructure projects, keep education systems open, pay salaries of firefighters and other essential personnel, et al. Although it speaks directly to the expressed needs of state and local governments, they shouldn't run out and spend that money right away; it's far too soon to say whether this bill, or its provisions, will advance through the legislative process.
HR 2847, Hiring Incentives to Restore Employment Act
This bill has experienced a long and convulsive path through the Capitol. In its current form, House and Senate are using it as one of their job creation measures. As far as providers or stakeholders of public transportation are concerned, the leading feature of this bill is that it calls for extending current SAFETEA-LU authorizations through December 31, 2010. An earlier House-passed version of this bill included additional money, on top of SAFETEA-LU, for transit, as well as supplemental grants for job training, and an extension of the increased federal share of Medicaid costs, but all those provisions - other than the SAFETEA-LU extension - seem to have been jettisoned by the bills passed by the Senate on February 24, and by the House on March 4. At this point, the House and Senate legislation is not too divergent; it's possible that they can reach agreement on this bill (which mainly has $150 billion or so in tax provisions that are hoped to stimulate employment) and send it to President Obama for signature.
HR 4213, Tax Extenders Act of 2009
Every year, there are a number of provisions and features in the Internal Revenue Code that expire unless extended. This becomes a convenient, "must-pass" vehicle for other morsels of legislation. This year's Tax Extenders bill passed the House in December as a "clean" bill (ie, just extending expiring tax stuff, with nothing else attached). This week - on March 10 - the Senate passed its version of an extenders bill that included $140 billion of other stuff, including provisions that would extend the increased federal share of Medicaid (enacted under the American Recovery and Reinvestment Act) for another year.
HR 4691, Temporary Extension Act of 2010
As previously reported here and elsewhere, the main transportation feature of this bill was the short-term extension of SAFETEA-LU authorizations through March 28, 2010.
HR 4812, Local Jobs for America Act
This bill was just introduced yesterday by Congressman George Miller (D-Calif), chair of the House Education and Labor Committee. The main feature, as touted by Congressman Miller's press release, is the authorization of $100 billion to help state governments ($25 billion) and local governments ($75 billion) carry out infrastructure projects, keep education systems open, pay salaries of firefighters and other essential personnel, et al. Although it speaks directly to the expressed needs of state and local governments, they shouldn't run out and spend that money right away; it's far too soon to say whether this bill, or its provisions, will advance through the legislative process.
Wednesday, March 3, 2010
DOT: Back in Business, at least for a few weeks
Late last night (March 2), President Obama signed the "Temporary Extension Act of 2010" into law. Among other things, this legislation extends the SAFETEA-LU highway and transit authorizations to a new deadline of March 28, 2010.
As was widely reported among the DC news media, and in the transportation press, there was a bit of an issue, in that the Senate did not pass this extension bill before the February 28 expiration of the last SAFETEA-LU extension. As a result, there were a couple of days in which many DOT employees were on a furlough, work on some federally involved transportation projects was suspended, and there was a lot of blogging and finger-pointing about this delay.
But once TEA-2010 was signed into law, DOT Secretary Ray LaHood was on hand at his agency's headquarters, welcoming the employees back to work.
Note, though, that this latest transportation extension is only for a few more weeks. It's too soon to tell what may happen later this month. In the meantime, Senator Barbara Boxer (D-Calif.), chair of the Environment and Public Works Committee, convened a hearing today (Mar. 3) at which she vowed to have her committee do its part on a SAFETEA-LU renewal -- not another extension -- before the year is up.
As was widely reported among the DC news media, and in the transportation press, there was a bit of an issue, in that the Senate did not pass this extension bill before the February 28 expiration of the last SAFETEA-LU extension. As a result, there were a couple of days in which many DOT employees were on a furlough, work on some federally involved transportation projects was suspended, and there was a lot of blogging and finger-pointing about this delay.
But once TEA-2010 was signed into law, DOT Secretary Ray LaHood was on hand at his agency's headquarters, welcoming the employees back to work.
Note, though, that this latest transportation extension is only for a few more weeks. It's too soon to tell what may happen later this month. In the meantime, Senator Barbara Boxer (D-Calif.), chair of the Environment and Public Works Committee, convened a hearing today (Mar. 3) at which she vowed to have her committee do its part on a SAFETEA-LU renewal -- not another extension -- before the year is up.
Thursday, February 25, 2010
Extensions remain out of sync
In the bigger picture, it's not a huge issue. But if you're a state DOT or a transit agency, there's a dire need to know what's up with the extension of SAFETEA-LU, the current highway and transit authorization.
The Senate's just-passed job-creation legislation would extend these programs through December 31, 2010.
It's not clear what the House is going to do with this latest bill from the Senate. Therefore, the House just passed a measure that would provide short-term extensions for a number of things, including federal payments for unemployment benefits, Medicare payments for doctors, enhanced COBRA benefits, and a short-term extension of SAFETEA-LU. In this latest House bill, the highway and transit programs' authorizations would go through March 28, 2010.
In brief, though, there are pockets of resistance to the Senate bill among House members, and there are pockets of resistance to this House bill among Senate members.
The clock runs out on the current transportation bill in less than a week. Inevitably, Congress and the White House will come to terms on another extension, but there will be some moments of continued dispute and uncertainty until the 11th hour.
The Senate's just-passed job-creation legislation would extend these programs through December 31, 2010.
It's not clear what the House is going to do with this latest bill from the Senate. Therefore, the House just passed a measure that would provide short-term extensions for a number of things, including federal payments for unemployment benefits, Medicare payments for doctors, enhanced COBRA benefits, and a short-term extension of SAFETEA-LU. In this latest House bill, the highway and transit programs' authorizations would go through March 28, 2010.
In brief, though, there are pockets of resistance to the Senate bill among House members, and there are pockets of resistance to this House bill among Senate members.
The clock runs out on the current transportation bill in less than a week. Inevitably, Congress and the White House will come to terms on another extension, but there will be some moments of continued dispute and uncertainty until the 11th hour.
Wednesday, February 24, 2010
Does White House Health Care Bill Affect Transit?
After the nation witnessed Congressional action on health reform reach near-paralysis in the Senate, President Obama announced a White House summit on health reform for February 25, and issued what was touted as his administration's own legislative proposal for health reform.
In contrast to the Clinton-era health reform efforts, Mr Obama's proposal does not exist in detailed legislative language. Instead, he and his team have published many pages of bullet-pointed priorities on the White House web site.
There are many important and complex issues being considered in the health reform discussion. Most of these affect individuals, employers, and - of course - the medical and insurance industries.
Thus far, the main thing in the health care debate that would affect public and community transportation providers is an expansion of who's eligible for coverage under the federal-state Medicaid program. Both the House- and Senate-passed health reform bills would guarantee Medicaid benefits for a lot more people than the 40+ million low-income people currently covered. The President recommends this expansion, as well, and would have the federal government underwrite the full cost for this expansion in the first few years of enacted reform. After that, there would be a phase-down period of a few years, during which states would be expected to pick up a gradually increasing share of these increased Medicaid costs.
The reason this Medicaid issue is important to transit is two-fold. For one, Medicaid payments continue to be the largest single federal investment in public transit operating costs, as Medicaid requires states to assure access - and transportation - to non-emergency medical services. Although proposed Medicaid expansions are likely to bring in young adults and low-income working families, as opposed to the more-traditional populations of non-working, elderly and otherwise disadvantaged persons long covered under this program, there are bound to be some increased riders - and payments - for transportation services under this expansion.
From the transportation industry's perspective, that's the good news in proposed Medicaid expansion. The second point of concern, though, is that there eventually would come a time when states have to pick up more of the costs of the expansion. However, all budgetary evidence shows that the price tag for this Medicaid increase will hit states' coffers several years before they can expect to begin enjoying the fruits of any economic recovery, even under the rosiest scenarios currently at play. Drains on state budgets put a lot of transportation needs at risk, including social services, workforce development, and even the ability of states to assist with the capital and operating costs of public transit.
In contrast to the Clinton-era health reform efforts, Mr Obama's proposal does not exist in detailed legislative language. Instead, he and his team have published many pages of bullet-pointed priorities on the White House web site.
There are many important and complex issues being considered in the health reform discussion. Most of these affect individuals, employers, and - of course - the medical and insurance industries.
Thus far, the main thing in the health care debate that would affect public and community transportation providers is an expansion of who's eligible for coverage under the federal-state Medicaid program. Both the House- and Senate-passed health reform bills would guarantee Medicaid benefits for a lot more people than the 40+ million low-income people currently covered. The President recommends this expansion, as well, and would have the federal government underwrite the full cost for this expansion in the first few years of enacted reform. After that, there would be a phase-down period of a few years, during which states would be expected to pick up a gradually increasing share of these increased Medicaid costs.
The reason this Medicaid issue is important to transit is two-fold. For one, Medicaid payments continue to be the largest single federal investment in public transit operating costs, as Medicaid requires states to assure access - and transportation - to non-emergency medical services. Although proposed Medicaid expansions are likely to bring in young adults and low-income working families, as opposed to the more-traditional populations of non-working, elderly and otherwise disadvantaged persons long covered under this program, there are bound to be some increased riders - and payments - for transportation services under this expansion.
From the transportation industry's perspective, that's the good news in proposed Medicaid expansion. The second point of concern, though, is that there eventually would come a time when states have to pick up more of the costs of the expansion. However, all budgetary evidence shows that the price tag for this Medicaid increase will hit states' coffers several years before they can expect to begin enjoying the fruits of any economic recovery, even under the rosiest scenarios currently at play. Drains on state budgets put a lot of transportation needs at risk, including social services, workforce development, and even the ability of states to assist with the capital and operating costs of public transit.
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