Sunday, August 30, 2009

Understanding HR 3200

A couple of weeks ago I wrote:

(a) IN GENERAL.—Section 1905 of the Social Secu7rity Act (42 U.S.C. 1396d), as amended by sections8 1701(a)(2) and 1711(a), is amended—9 (1) in subsection (a)—10 (A) in paragraph (27), by striking ‘‘and’’11 at the end;12 (B) by redesignating paragraph (28) as13 paragraph (29); and14 (C) by inserting after paragraph (27) the15 following new paragraph:16 ‘‘(28) nurse home visitation services (as defined17 in subsection (aa)); and’’; and.18 (2) by adding at the end the following new sub19section:20 ‘‘(aa) The term ‘nurse home visitation services’21 means home visits by trained nurses to families with a22 first-time pregnant woman, or a child (under 2 years of23 age), who is eligible for medical assistance under this title,24 but only, to the extent determined by the Secretary based7691 upon evidence, that such services are effective in one or2 more of the following:3 ‘‘(1) Improving maternal or child health and4 pregnancy outcomes or increasing birth intervals between pregnancies.

And concluded, "What the Hell does that say?"

William Jacobson has decided to undertake a unique tack at reading HR 3200:

I will look at my Sitemeter page count in the morning for seven straight days, and whatever the last three digits are on the page count, I will turn to that page in the House Bill. I will use whichever section of the House Bill appears at the top of the page, even if the section starts on prior pages.

Well, when you are talking about 1000+ pages, one method of breaking it down makes just has much sense as any other. I've tried to read the bill but honestly, I couldn't make heads or tails from it. It goes without saying that a Cornell law professor like Jacobson has better shot at dissecting the bill than someone like such as myself so I am grateful for his take:

This section also adds provisions relating to Medicaid Managed Care Programs as part of this new section "(C)":

Section 1923(f) of such Act (42 U.S.C. 1396u–2(f)) is amended—(A) in the
heading, by adding at the end the following: ‘‘; ADEQUACY OF PAYMENT FOR17
PRIMARY CARE SERVICES’’; and (B) by inserting before the period at the end the
following: ‘‘and, in the case of primary care services described in section
1902(a)(13)(C), consistent with the minimum payment rates specified in such
section (regardless of the manner in which such payments are made, including in
the form of capitation or partial capitation)’’.

In case you were wondering, I already regret this undertaking. I don't know if I can keep this up for seven straight days. This section, what it means, and what it does, is all but incomprehensible. And to think, I could be weeding the garden.

If it is incomprehensible to Prof. Jacobson, what chance do the rest of us have? No offense, but the average congressman doesn't strike me as the sharpest knife in the drawer, so I can see why they wouldn't read a bill that they have no shot of understanding. On the face of it, it does beg the question, who wrote this mess?

Prof. Jacobson continues:

(3)(A) The portion of the amounts expended for medical assistance for
services described in section 1902(a)(13)(C) furnished on or after January 1,
2010, that is attributable to the amount by which the minimum payment rate
required under such section (or, by application, section 1932(f)) exceeds the
payment rate applicable to such services under the State plan as of June 16,
2009.(B) Subparagraphs (A) shall not be construed as preventing the payment of
Federal financial participation based on the Federal medical assistance
percentage for amounts in excess of those specified under such

VERDICT: Close to incomprehensible. I think this means that there will be an increase in reimbursements to states for payments to primary care physicians under Medicaid. I could be wrong. There are so many cross-references, that it would take hours to figure out the full implications and all the conditions to which such payments are made, much less the source of revenue for the payments.

What this section does show is the density of the House Bill. Understanding just this single provision is a daunting task. Call it the banality of bureaucracy. Someone, be it a lobbyist or staffer or both, spent an enormous amount of time writing this dense text to accomplish something which is not explained in a form almost anyone could understand or comprehend.

I'll be checking back to see if Prof. Jacobson has the stamina to make through the entire seven days, and I thank him for his effort. I have neither the training nor the patience. Maybe after reading the bill, Jacobson can explain why the country should support a bill that is so vague, so confusing and so open to interpretation. For my part, I can't support something I can't understand.

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