In Pa.

[Guest guest]

If you are in Pa. Please take a moment to read the below.

Understand that this would eliminate TSS and Behavior

Specialist from your children if you qualify. If they pass

this, they should passa parellel parity bill demanding that

private insurences pick up the case/services/treatment.

Joe

RENDELL BUDGET PRESERVES PROTECTION FOR VULNERABLE CITIZENS

BY INCREASING FUNDS AND MODERNIZING PROGRAMS

February 9, 2005

FOR IMMEDIATE RELEASE

HARRISBURG: Under Governor G. Rendell's

proposed 2005-06 budget, health care benefits for

Pennsylvania's most vulnerable citizens-- including children,

people with disabilities, the low-income and the elderly --

will be preserved, while achieving necessary cost savings,

Public Welfare Secretary Estelle B. Richman announced today.

" This is a prudent budget that allows us to preserve

a full scope of essential health care services for those who

need them most, " Richman said. " The administration worked to

preserve and maintain children's services, to protect the

eligibility of all those now receiving services and to meet

anticipated future demand. Despite the many challenges we

face this year, we successfully followed those guiding

principles. "

ABOARD NOTE: From text on page 59 of the budget, “Budget

Implements Cost Sharing for Disabled Children from Higher

Income Familiesâ€

· More than 38,000 are considered “loophole†children

in PA.

· Loophole children are part of families with incomes

ranging from $40,000 to over $1 million.

· Pennsylvania now spends nearly $375 million to

finance services for loophole children.

· Right now 3,000 of these families have incomes over

$200,000.

· This is a program unique to PA.

· Proposal would implement a sliding scale premium

based on income level, family size, and how many children in

the family have disabilities.

· All children would continue to received the same

services they currently receive; no elgibiity changes will be

make.

The proposed spending plan increases the Department

of Public Welfare's $7.9 billion General Fund budget by $612

million in state funds, which will allow the agency to serve

nearly 100,000 additional people across all programs during

the next fiscal year. The new spending plan calls for

additional investments in some of Governor Rendell's key

programs by:

* Continuing the Rendell Administration's effort to

reduce the waiting list for mental retardation services by

providing sufficient funds to provide services for 910

individuals, almost double the number of people added to the

waiting list last year;

* Subsidizing child-care to benefit 1,540 low-income

children and help their parents achieve economic self-

sufficiency. This is the second major expansion of child

care under Governor Rendell's leadership. Funds are allocated

to create more slots to help ensure that low-income families

do not face lengthy waiting periods to receive subsidized

child care and to help stabilize the payment levels per child

for programs serving vulnerable infants, toddlers and

preschoolers;

* Making a major investment in the effort to

rebalance long term care by providing services to an

additional 4,353 people through waiver services in the

community; dramatically reducing the time it takes to apply

and receive services; and expanding the number of counties in

the popular Community Choice program;

* Providing funds to support cost of living increases

for direct care workers who provide behavioral health, mental

retardation and disability services in the community. These

funds will allow providers to increase the salary of direct

care workers, which may help them reduce turnover rates.

Providers must compete with other businesses for employees

and retaining these direct care workers is a key component of

providing quality care to vulnerable clients;

* Enhancing early learning by an additional

investment of $15 million targeted to match the federally

funded Head Start program. Existing Head Start providers

will use these resources to serve an additional estimated

2,500 children. These funds will also encourage Head Start

programs to establish partnerships with school districts and

other child care providers in order to provide the most

effective and comprehensive services for Pennsylvania

children.

Without changes to modernize and improve the purchase

and delivery of services, more than 300,000 people would have

been forced out of the Medical Assistance program.

As in other states, soaring health care costs,

declining federal funds and the growing number of people in

need have created large budget gaps in Pennsylvania's Medical

Assistance (Medicaid) program. The Governor has consistently

pledged to do everything possible to maintain eligibility for

the 1.7 million people already being served.

" This budget does require shared sacrifice, " said

Secretary Richman. " In order to make sure that our most

vulnerable residents continue to receive essential health

care services, we restructured and modernized many of our

programs to achieve necessary savings and to reflect some of

the policies already implemented in other states. "

Under the proposed restructuring plan, which includes

a 6.8 percent increase in Medicaid spending, DPW will:

* Fully implement ACCESS Plus, a program designed to

improve disease and primary care case management;

* Further strengthen initiatives to reduce fraud and

abuse and increase recoveries from third party payers.

Included among the initiatives are: increased efforts to flag

suspicious claims; audits to identify duplicate payments and

catch claims that should have been submitted separately

rather than bundled into one claim; and increased data

exchange with health insurers, pharmacies and benefit

managers;

* Place limits on certain health care services and

expand the use of co-payments for adult Medicaid clients and

those on General Assistance (pregnant women and children will

be exempt from outpatient limits). Within these outpatient

limits, consumers will have the flexibility to choose

services to meet their individual needs;

* Implement a plan of cost sharing under which higher

income families with disabled children eligible for Medical

Assistance would be required to pay a monthly premium, based

on a sliding scale;

* Implement a series of initiatives to reduce the

growth of MA drug costs including: development of a preferred

drug list, updating payments to pharmacies for generic drugs

and a revised payment methodology for brand name drugs;

* Provide a modest rate increase for providers.

" States across the country are making very difficult

choices this year, " Richman said. " Here in Pennsylvania, we

promised we would not, and in this budget proposal did not,

leave vulnerable families unprotected. This budget will meet

anticipated demand, while making significant investments in

Governor Rendell's priorities. "

An overview of the DPW budget is available online at

www.dpw.state.pa.us (keyword: budget) or by calling (717) 787-

4592.