March 6, 2012

Senate budget subcommittees make first cuts: higher ed and Medicaid

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By Justin Snow and Daniel Menefee
Justin@MarylandReporter.com
Dan@MarylandReporter.com

Senate budget subcommittees Monday began their decisions to approve or reject recommendations from the Department of Legislative Services.

Scissors on a budgetThe Senate Subcommittee on Education, Business, and Administration considered a budget amendment proposed by Sen. Richard Colburn, R-Dorchester, that would siphon $500,000 the University of Maryland Baltimore uses to pay lobbyists to establish a new agricultural law clinic dedicated to assisting and preserving Maryland farms instead.

Colburn’s amendment comes as a blow to the embattled environmental law clinic run by the law school, which spurred controversy last year after opting to represent an environmental group that is suing a Worcester County chicken farm for polluting local waterways. The clinic’s actions brought criticism last spring from Eastern Shore Republicans as well as Gov. Martin O’Malley due to the financial burden it placed upon the family that owns the farm.

“It certainly is a direct rebuke to the school for the way they handled this whole thing,” said Sen. David Brinkley, R-Frederick.

Briefly, it seemed Colburn’s amendment would not be adopted until Committee Chair Richard Madaleno, D-Montgomery stepped in to second the motion so the issue could go to the full Senate Budget and Taxation Committee for consideration.

University system, classroom breakfasts

The subcommittee also approved a $4 million cut to the University System of Maryland Office’s budget despite objections raised by members of the System Office last month.

The subcommittee rejected a recommendation to cut in half O’Malley’s proposed $560,000 increase to the Maryland Meals for Achievement program, which provides thousands of students with free classroom breakfast. The proposed cut faced fierce opposition from activists and parents last month. The program remains part of O’Malley’s broader goal to eliminate childhood hunger by 2015.

Medicaid cuts, physicians get increase

The Subcommittee on Health and Human Services approved $63 million in proposed General Fund reductions for Medicaid in fiscal 2013 — but rejected a recommendation to scrap the administration’s proposed $16 million increase in physician reimbursements for medical coding and management.

The 2013 budget increases reimbursement rates to Medicare levels that become effective Jan. 1, 2013 for primary care physicians – and are 100% federally funded under the Patient Protection and Affordable Care Act.

But reimbursements to specialists  are only partially funded at the “traditional federal matching rate,” according to Department of Legislative Services, which recommended the $16 million reduction.

Sen. James Robey, D-Howard, said the increases were needed for doctors to set up and maintain coding systems under the new Patient Protection and Affordable Care Act.

“The system isn’t set up to handle [the complexities] of medical coding,” Robey said. “There were concerns from doctors that the [current coding system] is confusing.”

Robey said the confusing nature of medical coding often results in slow or rejected payments, and often requires the physician to submit a second request for reimbursement.

The subcommittee was concerned that reducing the increases would deter specialists from taking on the additional 120,000 patients who will enter the system in Maryland when the Patient Protection and Affordable Care Act is phased in.

Robey also said the system that determines who is a specialist or a primary care doctor needs clarity.

“The system that is set up to determine primary care doctor versus a specialist is not that clearly defined,” Robey said. He said a doctor who is a specialist and also a primary care physician can have great difficulty in determining how to code his billing.

Analyst Simon Powell said the federal matching for the specialists sunsets in fiscal 2013 and that the burden to the general fund could grow to $75 million annually by 2016.

The subcommittee’s recommendations now move to the full Senate Budget and Taxation Committee for approval.

  • LIE!!  James Robey, D-Howard is quoted as saying “The system that is set up to determine primary care doctor versus a specialist is not that clearly defined,” He said a doctor who is a specialist and also a primary care physician can have great difficulty in determining how to code his billing. THIS IS A BIG FAT UNMITIGATED LIE.  I AM A CODER AND THIS IS SIMPLY NOT TRUE 1. 1) PCPs who are also specialist” are not very common.  HINT – there are reasons why they put all that extra time and schooling to into speciality medicine. One of them is that they don’t want to do day to day primary care.  2) There are two separate codes for a PCP and a specialist – each speciality is assigned a 2 digit code.  NONE of this is new.  It would be interesting to see which physicians contribute politically to Robey.  He’s being lied to.  There is no increased cost whatsoever.  It’s the same coding that has been around since the 1970’s which have evolved and change every year that are not difficult at all to implement – all you need is a qualified coder.  Coding does not required a degree in rocket science.  Ok?