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Medicaid Kids Bill Seen as Bipartisan Rallying Point

By Melanie Zanona, CQ Roll Call

August 26, 205 -- Backers of a plan to ease Medicaid restrictions on treating children with complex medical needs across state lines are trying to make it a bipartisan rallying point after the proposal was dropped from the House-passed "21st Century Cures" bill.

Republican sponsor Joe L. Barton of Texas is pressing for a fall hearing on a measure (HR 546) addressing the effects of the program's state-specific coverage requirements and said it could pass as stand-alone legislation. The Senate companion bill (S 298) is backed by Charles E. Grassley, R-Iowa.

"We wouldn't have the bill if the current system was working hunky dory, it's not," Barton told CQ Roll Call. 

"If you have a child that has multiple complex conditions, there is not a current system that coordinates and brings us under one health care provider."

The measure is a response to reports of Medicaid families running afoul of coverage rules when they travel to neighboring states to obtain specialized care. A child in the New Jersey suburbs of Philadelphia living five miles from the Children's Hospital of Philadelphia may not be covered for care there, advocates say. The health program for the poor is managed by states, which set their own eligibility requirements.

Barton's bill would allow states to set up nationally designated children's hospital networks that would operate across state lines and offer a full array of care, though children's hospitals would serve as anchors. The networks also would gather data on rare medical conditions to determine best practices and care standards.

The measure was introduced comparatively late in the last Congress, in June 2014, and didn't receive a hearing or markup. Advocates say they are nonetheless encouraged by the growing number of cosponsors: The latest House version has 144 cosponsors, with 81 Democrats and 63 Republicans.

"In this post-Affordable Care Act environment, to have a Medicaid bill that's almost evenly split between the two parties is important," said Jim Kaufman, vice president of public policy for the Children's Hospital Association.

The effort was part of early drafts of a biomedical innovation package (HR 6), which was introduced earlier this year and passed the House in July. It was dropped, in part, over concerns about the way it would modify the Medicaid title of the Social Security Act when the Cures bill is primarily aimed at the National Institutes of Health and Food and Drug Administration.

Barton said the plan's inclusion in the draft raised its profile, which could improve prospects for passage. The Texas lawmaker said House Energy and Commerce Chairman Fred Upton, R-Mich., Health Subcommittee Chairman Joe Pitts, R-Pa., and some members of House leadership have been receptive.

"It got a lot of attention that it wouldn't otherwise have, and it showed it was a serious legislative issue," Barton said. "A lot of good things happened by it being in the draft."

The bill appears to have better short-term prospects in the House. A Senate committee aide said the Medicaid children's provision won't be included in the Health, Education, Labor and Pensions Committee's version of a medical innovation bill due this fall, because the health program comes under the jurisdiction of the Finance Committee. The language could still resurface as a floor amendment to a Cures bill.

Advocates estimate that the legislation would save billions of dollars over a decade, by providing more efficient care to the approximately 2 million Medicaid children with complex cases, who rely on access to multiple specialists, therapists and hospitals and account for 40 percent of program spending on children's services.

But some Medicaid administrators remain concerned that the changes would be mandatory and could interfere with some states' ongoing efforts to overhaul their delivery and payment systems. They also maintain that the legislation is not necessary because states already have the power to establish such networks.

"The bill runs contrary to widespread state Medicaid initiatives that are moving beneficiaries away from hospital-based networks and into the least costly, most appropriate setting that provides quality care," the National Association of Medicaid Directors wrote in a letter to congressional staff earlier this year. "While this legislative proposal would seek to serve medically complex children in lower cost settings within a given network, states are concerned that the model ultimately still places hospitals at the center of an individual's care."

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