VA--National Association of Children's Hospitals

The National Association of Children’s Hospitals (N.A.C.H.) appreciates the additional opportunity to submit comments to the Centers for Medicare and Medicaid Services (CMS) on its final rule on state flexibility for Medicaid benefit packages published in the December 3, 2008 Federal Register. We understand that this regulation implements provisions enacted in the Deficit Reduction Act of 2005; however, the regulation includes provisions of serious concern to children’s hospitals and the children they serve. Medicaid is the single largest payer for children’s hospitals and the single largest insurer for children. Children’s hospitals devote more than half of their care to children insured by Medicaid and more than three-fourths of their care to children with chronic or congenital conditions. More than one-fourth of all children and one- third of all children with disabilities are insured by Medicaid. The patients at children’s hospitals rely on the medically necessary services that Medicaid provides. We are troubled by this policy change and the potential impact on children’s access to medically necessary services. We are happy that Congress recognized the importance of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit for children by including a technical fix in the Children’s Health Insurance Program Reauthorization Act of 2009 that makes it clear that Medicaid children enrolled in benchmark insurance plans still must receive all medically necessary services. We have the following specific comments on the rule: • Section 440.345: EPSDT Services Requirement. The EPSDT benefit is critically important to children treated by children’s hospitals. We appreciate the provisions in the regulation that require states to assure access to these services. However, we are concerned about the requirement that “individuals must first seek coverage of EPSDT services through the benchmark or benchmark equivalent plan before seeking coverage of such through wrap around benefits.” This statement seems to put the onerous of navigating this complicated system on the child’s family. We believe that the coverage provided to children in Medicaid should be as seamless as possible for families. States should be required to assist beneficiaries in accessing any and all medically necessary services whether through the benchmark plan or the traditional Medicaid program. In addition, states should be required to provide outreach to beneficiaries on how they can continue to access all medically necessary services through the EPSDT benefit. Every child’s family and pediatric providers should have the information they need to access medically necessary services whether it is through the traditional Medicaid program or an alternative benefit package. We appreciate the opportunity to present our comments and would be pleased to discuss them further. For additional information, please contact Aimee Ossman at 703/797-6023 or aossman@nachri.org. Thank you for your consideration. Sincerely, M. James Kaufman, PhD Vice President, Public Policy