Right Wing, Left Wing: Does It Equal a More Balanced Senate Bill 744?

Our Senate put forth Senate Bill 744 with radical and shocking changes to our Medicaid system. However, one section of our General Assembly cannot create law. Both sides,the Senate and the House, much agree on a Bill in order to create law.

Senate sent SB 744 to the House on May 31, 2014. Between May 31 through June 13, 2014, the House revised, omitted, and added language to SB 744, making SB 744 a much different document than what the Senate had fashioned. Today, SB 744 is back in the Senate for more revisions. The end result will be a law that appears nothing like the initial SB 744 brought to the Senate on May 15, 2014.

The “ping pong” revision system between the Senate and the House that our founding fathers installed in order to generate actual laws is a well-crafted, finely-tuned balancing machine. It is an effort to keep all ideological agendas in-check. When one side dips too low, the other side counters in an effort to maintain balance. It reminds me of a bird in flight.

Our nation’s symbol is the bald eagle. I am sure everyone knows that, right? But did you also know that the bald eagle is not named the bald eagle because its white head gives the appearance that it is bald? No, bald eagle, in Latin, is haliaeetus leucocephalus (from Greek hali-, which means sea; aiētos , which means eagle; leuco-, which means white, and cephalos, which means head). So, literally its name means “sea eagle with white head.”

Even more important about the bald eagle is its set of wings. A bald eagle has a right wing and a left wing, and without both, the bald eagle would not be able to fly.

We need both the right and the left wings in order to maintain balance in our government. Both sides are necessary, and, yet, it seems that nowadays the left and right sides are at war with each other. Politics has become so polarized that the right wing and the left wing forget the attributes of the other.

The result of the ping pong revision system, in theory, is that, by the time a bill is brought into final shape and enacted into law, all polarized ideations have been balanced out in order to move forward. It does not always work that way, and it becomes increasingly difficult to balance the sides when the sides become more and more divided.

The Senate created SB 744, the House has made its alterations…and, if SB 744 passes, it will pass after many more modifications, no doubt.

When our state Senate passed Senate Bill 744 and sent it to the House, I blogged about the shocking ramifications to Medicaid had that bill been passed.

I listed the most shocking changes included within SB 744:

1. DHHS must immediately cease all efforts to transition Medicaid to the affordable care organizations (ACOs) system that DHHS had touted would be in effect by July 2015;
2. DHHS, DMA will no longer manage Medicaid. Instead a new state entity will be formed to manage Medicaid. (A kind of…scratch it all and start over method);
3. All funds previously appropriated to DHHS, DMA will be transferred to Office of State Budget and Management (OSBM) and will be used for Medicaid reform and may not be used for any other purpose such as funding any shortfalls in the Medicaid program.
4. Categorical coverage for recipients of the optional state supplemental program State County Special Assistance is eliminated.
5. Coverage for the medically needy is eliminated, except those categories that the State is prohibited from eliminating by the maintenance of effort requirement of the Patient Protection and Affordable Care Act. Effective October 1, 2019, coverage for all medically needy categories is eliminated.
6. It is the intent of the General Assembly to reduce optional coverage for certain aged, blind, and disabled persons effective July 1, 2015, while meeting the State’s obligation under the Americans with Disabilities Act and the United States Supreme Court decision in Olmstead v. L.C. ex rel. Zimring, 527 U.S. 581 (1999).
7. Repeal the shared savings program and just reduce the reimbursement rates by 3%.
8. DHHS shall implement a Medicaid assessment program for local management entities/managed care organizations (LME/MCOs) at a rate of three and one-half percent (3.5%).
9. Additional notices as to State Plan Amendments (SPAs), DHHS must post the proposed SPAs on its website at least 10 days prior to submitting the SPAs to the Center for Medicare and Medicaid Services (CMS).
10. Reimbursement rate changes become effective when CMS approves the reimbursement rate changes.
11. The Department of Health and Human Services shall not enter into any contract involving the program integrity functions listed in subsection (a) of this section that would have a termination date after September 1, 2015.
12. The Medicaid PROVIDER will have the burden of proof in contested case actions against the Department.
13. The Department shall withhold payment to any Medicaid provider for whom the DMA, or its vendor, has identified an overpayment in a written notice to the provider. Withholding shall begin on the 75th day after the day the notice of overpayment is mailed and shall continue during the pendency of any appeal until the overpayment becomes a final overpayment (can we say injunction?).

Since my last blog about Senate Bill 744 (the Appropriations Bill), Senate Bill 744 has reached its 7th revision.

The House took it upon itself to delete many of the shocking changes in the Senate Bill. Just like the bald eagle using its right and left wings to balance out.

First, the General Assembly’s proposed cease and desist order that would have stopped Gov. McCrory and Sec. Wos from implementing Medicaid reform and the accountable care organizations (ACOs), is deleted from the current version of the bill. Gone too is the “new state agency” created to manage Medicaid. Medicaid services are no longer eliminated. The Office of State Budget and Management (OSBM) is no longer receiving all funds appropriated for the Department of Health and Human Services (DHHS), Division of Medical Assistance (DMA).

On June 13, 2014, the House finished its revisions to SB 744 and sent the revised bill back to the Senate. On June 18, 2014, the conference committee for SB 744 was formed and includes:

  • Sen. Harry Brown, Chair
  • Sen. Andrew C. Brock
  • Sen. Kathy Harrington
  • Sen. Tom Apodaca
  • Sen. Ralph Hise
  • Sen. Neal Hunt
  • Sen. Phil Berger
  • Sen. Brent Jackson
  • Sen. Wesley Meredith
  • Sen. Louis Pate
  • Sen. Bill Rabon
  • Sen. Shirley B. Randleman
  • Sen. Bob Rucho
  • Sen. Dan Soucek
  • Sen. Jerry W. Tillman
  • Sen. Tommy Tucker

SB 744 is still not law. It takes both the House and Senate to pass the bill, and then the Governor has to sign the bill. So we have a ways to go. We need the agreement of the right wing and the left wing.

The two main political parties were not always so polarized.

A couple of our founding fathers, John Adams and Thomas Jefferson, were fierce political adversaries. Imagine the political distance between Barack Obama and Ted Cruz. Despite their political differences, both Adams and Jefferson believed in the importance of funding public education. Rather than defaming the other’s point of view, Adams and Jefferson collaborated and compromised. “The whole people must take upon themselves the education of the whole people and be willing to bear the expenses of it,” wrote Adams. “There should not be a district of one mile square, without a school in it, not founded by a charitable individual, but maintained at the public expense of the people themselves.” Adams and Jefferson were able to balance out the right wing and the left wing in order to fly a straight path.

Back when our founding fathers squabbled and debated key issues, both sides worked together, instead of running mudslinging commercials and scoffing at the other side’s position on the media. During one of the biggest debates in history, the creation of our government, the lawmakers convened together for about 4 months. The Constitutional Convention lasted from May 25 to September 17, 1787 (the first one). The delegates were within close proximity of one another, which led to more conversations and more compromises. Until the Constitution was drafted, the delegates continued to meet together. I imagine they ate lunch together and shared whiskey and cigars in the evenings.

Maybe our lawmakers should schedule a new constitutional convention, both on the state and federal level. At least, both sides need to realize that the right wing and the left wing are necessary. Otherwise we would just fly in circles.

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on June 19, 2014, in Accountable Care Organizations, Aldona Wos, Budget, CMS, DHHS, Division of Medical Assistance, General Assembly, Gov. Pat McCrory, Health Care Providers and Services, Joint Legislative Oversight Committee on Health and Human Services, Legal Analysis, Legislation, McCrory, Medicaid, Medicaid Attorney, Medicaid Budget, Medicaid Costs, Medicaid Funds, Medicaid Providers, Medicaid Reform, Medicaid Services, Medicaid Spending, Medicare Attorney, NC, North Carolina, Olmstead, Senate Bill 744, Shared Saving Plan, State Plan, State Plan Amendments, Tax Dollars, Taxes, Taxpayers, Wos and tagged , , , , , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink. Leave a comment.

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