PURPOSES, FOR THE MEDICALLY NEEDY. MANDATORY SERVICES
WHICH WOULD MOST LIKELY BE UTILIZED BY AIDS PATIENTS ARE
INPATIENT HOSPITAL SERVICES, OUTPATIENT HOSPITAL SERVICES,
RURAL HEALTH CLINIC SERVICES, OTHER LABORATORY AND RADIOLOGY
SERVICES, SKILLED NURSING FACILITY (SNF) SERVICES, AND
HOME HEALTH CARE FOR INDIVIDUALS AGED 21 AND OVER.
STATES MAY ALSO CHOOSE TO COVER ADDITIONAL SERVICES AS
SPECIFIED IN FEDERAL REGULATIONS. SOME EXAMPLES OF OPTIONAL
SERVICES OFFERED INCLUDE CLINIC SERVICES, PRESCRIBED DRUGS,
INTERMEDIATE CARE FACILITY SERVICES, MISCELLANEOUS DIAGNOSTIC
SERVICES, SKILLED NURSING FACILITY AND HOME HEALTH SERVICES
FOR INDIVIDUALS UNDER 21 YEARS OF AGE, AND OTHER ANCILLARY
SERVICES SUCH AS PERSONAL CARE SERVICES, PRIVATE DUTY NURSING,
PRIVATE PRACTITIONERS' SERVICES, AND REHABILITATION SERVICES.
NEARLY HALF THE STATES OFFER 20 OR MORE ADDITIONAL SERVICES.
CALIFORNIA AND NEW YORK, WHICH HAVE RECORDED ALMOST 60
PERCENT OF ALL AIDS CASES IN THE UNITED STATES, OFFER 30
AND 28 OPTIONAL SERVICES, RESPECTIVELY, TO THEIR MEDICAID
POPULATIONS. THROUGH HOME AND COMMUNITY-BASED WAIVERS,
STATES CAN ALSO COVER A WIDE ARRAY OF NONINSTITUTIONAL
LONG TERM CARE SERVICES THAT ARE NOT OTHERWISE OFFERED.
UNDER CURRENT MEDICAID LAW, STATES ARE NOT PERMITTED TO
OFFER HOSPICE SERVICES. HOWEVER, WITH THE WIDE RANGE OF
OPTIONAL SERVICES OFFERED BY STATES, MANY HOSPICE-RELATED
SERVICES MAY BE MADE AVAILABLE TO AIDS PATIENTS.
MEDICARE IS A FEDERAL HEALTH INSURANCE PROGRAM FOR MOST
AGED AND CERTAIN DISABLED INDIVIDUALS WHO QUALIFY FOR SOCIAL
SECURITY CASH BENEFITS. AN INDIVIDUAL WITH AIDS CAN BE
ELIGIBLE FOR THE MEDICARE PROGRAM IF HE IS:
O AGE 65 OR OVER AND ELIGIBLE FOR SOCIAL SECURITY
PAYMENTS OR ENROLLED ON A PREMIUM-PAY BASIS
UNDER PARTS A OR B OF MEDICARE;
O UNDER 65 AND ELIGIBLE FOR THE SOCIAL SECURITY
DISABILITY INSURANCE (DI) PROGRAM; OR
AFFLICTED WITH END STAGE RENAL DISEASE.
THE STANDARDS FOR DETERMINATION OF DISABLILITY UNDER THE
DI PROGRAM ARE IDENTICAL TO THOSE UNDER SSI. BECAUSE THE
PROGRAM IS TARGETED TO THE LONG-TERM DISABLED POPULATION,
NEWLY ENTITLED DI BENEFICIARIES DO NOT RECEIVE MEDICARE
UNTIL THEY ARE ON THE ROLES FOR TWO YEARS.
AIDS PATIENTS WHO ARE ENTITLED TO MEDICARE ARE ELIGIBLE
FOR THE SAME RANGE OF SERVICES AND BENEFITS THAT ARE AVAILABLE
TO OTHER SEGMENTS OF THE MEDICARE POPULATION. BENEFITS
THAT WOULD TYPICALLY BE UTILIZED BY AN AIDS PATIENT INCLUDE,
UNDER THE MEDICARE PART A HOSPITAL INSURANCE PROGRAM, INPATIENT
HOSPITAL CARE, MEDICALLY NECESSARY INPATIENT CARE IN A
SNF AFTER A HOSPITAL STAY, HOSPICE CARE, AND HOME HEALTH
CARE. PART B OF MEDICARE WOULD HELP PAY FOR DOCTORS'
SERVICES, OUTPATIENT HOSPITAL CARE, OUTPATIENT PHYSICAL
THERAPY AND SPEECH PATHOLOGY SERVICES, HOME HEALTH CARE,
RADIOLOGY AND LABORATORY SERVICES, AND A VARIETY OF OTHER
HEALTH SERVICES AND SUPPLIES WHICH ARE NOT COVERED BY
THE PART A PROGRAM.
DEPARTMENTAL INFORMATION INTIATIVES
HCFA HAS BEEN INVOLVED IN SEVERAL DEPARTMENT INITIATIVES
TO AID THE PLIGHT OF AIDS VICTIMS. IN COOPERATION WITH
THE SSA, WE HAVE BEGUN A PUBLIC INFORMATION CAMPAIGN THROUGH
THE PUBLIC HEALTH SERVICE (PHS) TO ENSURE THAT PEOPLE
WITH AIDS ARE AWARE OF THE POTENTIAL BENEFITS AVAILABLE
TO THEM UNDER THE MEDICAID AND MEDICARE PROGRAMS. IN ADDITION,
WE HAVE ENCOURAGED STATE MEDICAID DIRECTORS TO PROVIDE
MAXIMUM INFORMATION ABOUT MEDICAID BENEFITS AND SERVICES
TO THE CLIENTS OF THEIR RESPECTIVE AGENCIES. THERE IS
ALSO A TOLL-FREE NATIONAL AIDS HOTLINE OPERATED BY THE
PHS THAT REFERS AIDS VICTIMS, AS APPROPRIATE, TO HEALTH
DEPARTMENTS AND OTHER SUPPORT SERVICES WHICH IN TURN MAY
REFER THEM TO SSA OFFICES FOR SSI, DI, MEDICAID, AND MEDICARE
INFORMATION; TO STATE AND LOCAL WELFARE OFFICES AND TO
HOSPITAL SOCIAL WORKERS; AND OTHER PRIVATE ORGANIZATIONS.
INFORMATION ON THE NUMBER OF AIDS PATIENTS WHO ARE RECEIVING CARE UNDER THE MEDICAID AND MEDICARE PROGRAMS, AND THE AMOUNT OF FEDERAL AND STATE EXPENDITURES FOR THAT CARE,
IS NOT AVAILABLE AT THIS TIME.
UNDER OUR CURRENT STATISTICAL GATHERING CAPABILITIES FOR MEDICAID AND MEDICARE, INFORMATION
ON RECIPIENTS IS REPORTED BY BROAD ELIGIBILITY GROUPS.
MECHANIZED BILLING RECORDS FOR PAYMENT OF MEDICAID AND
MEDICARE BENEFICIARIES' MEDICAL CLAIMS ARE NOT CODED BY
DIAGNOSIS AND THUS PROVIDE NO CLUES TO THE NUMBER OF AIDS
VICTIMS RECEIVING BENEFITS.
IN OUR EFFORTS TO GATHER INFORMATION ON AIDS PATIENTS,
HCFA HAS SIGNED AN INTERAGENCY AGREEMENT WITH THE PHS TO
DEVELOP STATISTICS ON CARE BEING PROVIDED TO AIDS PATIENTS
UNDER MEDICAID. SINCE THE AWARDING OF THE GRANT FROM THE
CENTER FOR DISEASE CONTROL (CDC) ON SEPTEMBER 30, WE HAVE
BEEN LOOKING AT OUR CAPABILITIES FOR GATHERING SUFFICIENT
INFORMATION ON AIDS PATIENTS TO DO A RELIABLE ANALYSIS.
HCFA WILL BE UTILIZING AN ONGOING RESEARCH EFFORT, KNOWN
AS THE MEDICAID TAPE-TO-TAPE PROJECT, WHICH HAS DEVELOPED
THE CAPABILITY TO ANALYZE PERSON-LEVEL DATA ON PROGRAM
ENROLLEES, SERVICES, EXPENDITURES, AND PROVIDERS IN FIVE
STATES (INCLUDING CALIFORNIA AND NEW YORK). AS MEDICAID
DATA FROM 1983 AND 1984 IS SUBMITTED BY THE STATES LATER
THIS YEAR, WE WILL HAVE MORE CURRENT INFORMATION ON AIDS
TO STUDY. IN ADDITION, A NUMBER OF STATES HAVE INDICATED
THAT THEY HAVE BEGUN TO ASSEMBLE STATISTICS ON SOURCES
OF PAYMENT FOR AIDS VICTIMS AND WE WILL CONTINUE TO MONITOR
AND COLLECT ANY SUCH DATA FOR OUR RESEARCH EFFORTS.
THE ADDITION OF AIDS TO THE PRESUMPTIVE DISABILITY LISTING
UNDER THE SSI AND DI PROGRAMS EARLIER THIS YEAR HAS HELPED
EXPEDITE THE ELIGIBILITY PROCESS SO THAT PERSONS WITH THE
DISEASE CAN RECEIVE NEEDED HEALTH CARE BENEFITS.
SYSTEMS IN PLACE WITHIN THE DEPARTMENT HAVE BEEN MAKING
SIGNIFICANT CONTRIBUTIONS IN DIRECTING AIDS SUFFERERS TO
PUBLIC AND PRIVATE SOURCES OF HELP AND IN DISSEMINATING
COMPREHENSIVE PUBLIC INFORMATION.
WE SUPPORT THE CONTINUED PROVISION OF HEALTH CARE SERVICES
UNDER MEDICAID AND MEDICARE WITHIN CURRENT PROGRAM REQUIREMENTS.
WE BELIEVE THAT MAJOR ELIGIBILITY CHANGES TO MEDICAID AND
MEDICARE LAW TO ALLOW SPECIAL TREATMENT OF AIDS SUFFERERS
ARE NOT NEEDED. UNDER CURRENT MEDICAID LAW, STATES HAVE
SUFFICIENT FLEXIBILITY TO PROVIDE NECESSARY SERVICES TO
CERTAIN AIDS SUFFERERS WHO HAVE NO OTHER SOURCES OF PAYMENT.
WE ARE OPPOSED TO ANY ATTEMPTS TO ALTER MEDICARE ELIGIBILITY
REQUIREMENTS TO INCLUDE SPECIFIC DISEASE DIAGNOSIS AS A
BASIS FOR COVERAGE: THE MEDICARE PROGRAM WAS DESIGNED TO
PROVIDE ACUTE HEALTH CARE SERVICES TO BROAD GROUPS OF ELDERLY
AND DISABLED INDIVIDUALS AND WE CONTINUE TO SUPPORT THIS
AIDS IS A MENACING PUBLIC HEALTH PROBLEM THAT THE FEDERAL
GOVERNMENT WILL CONTINUE TO FIGHT UNTIL THE MYSTERY OF
THE DISEASE IS UNRAVELED. BY THE END OF FISCAL YEAR 1986,
APPROXIMATELY $400 MILLION IN FEDERAL FUNDS WILL HAVE BEEN
EXPENDED FOR RESEARCH TO ELIMINATE AIDS. OUR COMMITMENT
TO BATTLE AIDS IS WELL ESTABLISHED AND WE INTEND TO CONTINUE
UNTIL AIDS IS ELIMINATED AND THE SUFFERING HAS ENDED.
I WILL BE HAPPY TO ANSWER ANY QUESTIONS YOU MAY HAVE.
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