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HCFA estimates that the Medicaid provision in OBRA 89 will increase Federal Medicaid expenditures by $5 million. To the extent that these funds represent increased payment for services, FQHCS will be able to use the additional payments to extend services to additional individuals without adequate finances or insurance coverage.
Question. Who is responsible for utilization review -- HCFA, HRSA, or Medicare carriers?
Answer. The review will be carried out by HCFA's Fiscal Intermediaries. Decisions regarding the specific requirements for FQHCs under Medicare have not yet been finalized. Staff are currently working on draft regulations for Medicare's FQHC benefit. This undertaking is being closely coordinated with the Health Resources and Services Administration in the Public Health Service. Because of the number of organizations involved in the deliberative process, details on the policies that will be employed in administering the FQHC benefit are not yet available.
We have not yet developed specific utilization review standards for related entities, such as Federally Funded Health Centers or Rural Health Clinics, under the Medicare program. These entities fall under the federal utilization review criteria employed by our Medicare Contractors.
We have, however, specified minimum utilization thresholds, called productivity screens, to be employed in determining reasonableness of Medicare reimbursable costs for rural health clinic services. The current screens require that a rural health clinic provide 6,300 visits per year for each full-time-equivalent health care term (one physician and one nurse practitioner or physician assistant).
We are looking at the policies employed in these related programs in developing FQHC provisions. Where the policies have been successful and do not conflict with the intent of the FQHC statute, we will be considering the value of adapting the policy to the FQHC environment.
With regard to Medicaid, State Medicaid agencies are responsible for review of the utilization of services under the surveillance and utilization review (S/UR) process. Under this process, States are responsible for development and implementation of a program that safeguards against unnecessary use of Medicaid services and excess payments, and assesses the quality of services provided to Medicaid recipients.
Question. Several recent reports suggest that caps on Federal Medicaid payments are being instituted in some areas, thereby limited health centers' reimbursement in spite of the law requiring cost-based payment. Does the Administration support spending caps or any other type of payment limitation, as has been reported?
Answer. With respect to the Medicaid program, HCFA policy has been that States have flexibility, until Federal regulations are promulgated, to define a reasonable cost payment system for FQHC services. These methods may contain limits on the amount of costs that States will recognize as reasonable. The issue of Federally
caps will be addressed in HCFA's regulations on FQHC payments. We expect to publish these rules this summer.
We do not think reasonable limits on costs are inconsistent with the statute providing for FQHC payments.
Once again, the budget proposes to eliminate all funding for health professions programs, except for programs for minority students and institutions.
What is the basis for these proposed cuts?
Answer. Very difficult choices among priorities for Federal funds must be made in order to meet budget targets for the FY 1992 budget request. The FY 1992 proposed budget request would provide a well balanced approach to addressing the disparities in the health status of minorities and their underrepresentation in the health professions, and represents BHPr's highest priority.
Question. What evidence exists that minority and disadvantaged health professionals who have received educational assistance through these initiatives are more likely to serve in HPSAs?
Answer. A 1985 study by Stephen N. Keith, et al. and published as a Special Article in The New England Journal of Medicine (December 12, 1985) entitled: Effects of Affirmative Action in Medical Schools (pages 1519-1525) found that significantly more minority physicians than nonminority physicians (12 percent vs. 6 percent) practiced in locations designed as health manpower shortage areas by the Federal Government and had more Medicaid recipients in their patient populations (31 percent for blacks, 24 percent for hispanics, and 14 percent for whites). A mid-1970s study of treatment practices of black and white physicians indicated that 89 percent of all black patient visits were to non-black physicians. However, the patients of black physicians were predominantly black (87 percent). It is estimated that these indicators are similar for hispanics on whom data is not available.
In addition to the fact that a significant number of minority students tend toward primary care specialties, they also account for more than 50 percent of the Exceptional Financial Need Scholarship recipients. This combination makes them particularly strong candidates for the National Health Service Corps (NHSC).
Question. Are the numbers of minorities in health professions representative of the proportion of minorities in the population?
Answer. With regard to Asians, the proportion of Asian health care practitioners is representative of their proportion of the general population.
With regard to the proportion of Black, Hispanic and American Indian health care providers, the percentages remain significantly below percentages of these groups in the general population. In 1985 Blacks and Hispanics constituted about 3 percent each of physicians and 2.7 percent and 1.7 percent respectively of dentists.
These same groups were 12 percent and 7 percent respectively of the general population. Figures are unavailable for American Indians.
HEALTH PROFESSIONS PROGRAMS
Question. Please provide to the Committee detailed information for FY 1988, FY 1989, and FY 1990 on the number of applications made, the number approved, and the number of grants funded for each health professions and nurse training account.
Answer. The information requested follows.
Number of Number Number : Number of Number Number : Number of Nusaber Number
Advanced Nurse Education Programs