Increases in program costs from FY 1976 to FY 1977 of 13.56% 20 Factor for the total increase 1.1202 x 1.0168 x .9970 = 1.1356 (or 13.56 percent) 1/ Outpatient includes Clinic Services and Outpatient Hospital Services. 2/ Other includes Other Practitioners Services, Laboratory and Radiological Services, Home Health Services, SMIB, Family Planning, and Other Services. a/ Although based on FY 73 statistical data, it is not expected that significant deviations from this distribution would appear. Source: NCSS B-4 (FY73) Number of Recipients: The following is the estimated number of different individuals, by basis of eligibility, receiving Federal medical assistance. Accomplishments, 1975-1976; Program Plans for 1977: The objectives of the program for FY 1977 have not changed from the last year. Since the program is large and complex, it requires investment of significant resources in a timely manner, just to begin to see improvements. These objectives are: Persons eligible for and in need of health care need to be assured that they have access to services and that services are used appropriately; persons eligible need to understand their rights and responsibilities in using services. Health services provided to eligible persons must meet standards of quality for adequate health care equivalent to what is available to the rest of the population. Funds must be used in positive ways to influence improved methods of delivery and financing health care. Providers of health service should understand their rights and responsibilities under the program and be persuaded to participate and receive prompt compensation. Accountability to the public for expenditures of tax dollars must be assured through application of necessary and appropriate administrative controls over eligibility for services, program costs and program services. EPSDT: Despite continuing problems in some states, there are steadily increasing numbers of children screened each quarter. We expect this trend to continue. Penalty regulations are under revision to clarify basic program requirements. Two other activities are underway to correct data and tracking problems: (1) Statistical reporting requirements are being revised to include eligibles, diagnosis and treatment, and costs. (2) A general systems design of a State-oriented EPSDT management information system will be available to assist States by the start of FY 1977. Utilization Review: New requirements were issued by the Department requiring review of the utilization of institutional services for persons covered under Medicare and Medicaid. With the emergence of PSRO's at the local level, waivers of the Department's UR requirements will be made to let the PSRO assume the administrative functions of performing UR. 21 22 Increasing State Capabilities: Improved State management of the program requires transferring good management practices to other States; strengthening the planning and budgeting process, following through on third party liability, more effective utilization control, and improving the delivery of health services to eligibles. Improved Monitoring of State Operations: By FY 77 we will have implemented an improved system for data collection and monitoring of State programs. Without this activity it would be impossible to systematically increase State capability. The program review process will continue and provider fraud and abuse will be identified and prosecuted. Rural Health and Demonstrations: As a response to the growing disparity in rural and urban health delivery systems, the decreasing number of primary care physicians in rural areas, the inequities in the availability of health care services to the Medicaid eligible population in rural areas, and in preparation for a future National Health Insurance, grants of $3,299,000 of FY 1975 title XIX program funds were made to 9 projects to provide innovative research and demonstration models of rural health care. Up to $10 million will be used in FY 1977 to provide new and continuation grants for this activity, with up to $400,000 of this amount for contracts to provide technical assistance for contracts necessary to manage the program effectively. These models will provide primary medical care services to Medicaid eligibles. Other members of the rural communities served by these projects will also be able to receive these services on a fee-for-service or other reimbursable basis. There will be particular emphasis on maternal and child health services, the early and periodic screening, diagnosis and treatment of children and pap smear testing, and breast cancer detection for women. These models will demonstrate the effective use of preventive health services and health education in reducing utilization and improving health status. They will also do research on, and demonstrate the viability of recruiting and attaching various patterns of physician extenders and use of telecommunications technology in delivering effective health care services to rural populations. The projects will demonstrate the ability to attract primary care physicians to these innovative settings. These projects are a coordinated effort between the Medical Services Administration, the Maternal and Child Health Program, the National Cancer Institute and the National Library of Medicine. These projects are to be instituted in diverse geographical settings throughout the United States in order to provide a set of models applicable to most rural settings in the United States. Under Title XX of the Social Security Act, grants are made to States to provide social services which will assist eligible persons to become or remain economically self-supporting and self-sufficient; to protect children and adults who cannot protect themselves from abuse, neglect, and exploitation, and to help families stay together; to prevent or reduce inappropriate institutional care by providing for communitybased care, home-based care, or other forms of less intensive care; and to arrange for institutional placement, when appropriate, and for services to individuals in institutions. A ceiling of $2,500,000,000 is placed on Federal funding with each State receiving an allocation in proportion to the percentage of its population to the National population. Grants are made to States based on matching rates of 75 percent for all services except family planning services which are matched at 90 percent. Unused State allocations up to $16,000,000 may be reallotted to Puerto Rico, $15,000,000; Guam, $500,000; and the Virgin Islands, $500,000. This special allocation is in addition to the amounts available to these Territories subject to other legislative limitations. Title XX places increased authority in and responsibility on States and their citizenry to develop social services programs that meet the needs of people in local communities. This new legislation brings about major changes in program eligibility, program planning, and accountability. The objectives of Title XX are: to focus social services funds on low income persons who most to ensure clear administrative accountability for planning to ensure fiscal responsibility by providing States with a to allow States maximum flexibility in the definition of 23 |