4/13/2012 HHS announced that, as of February 29, 2012, the Pre-Existing Condition Insurance Plan (PCIP) under ACA §1101 is providing insurance to approximately 56,000 people with high-risk pre-existing conditions nationwide. The new numbers show that there are 11 Massachusetts residents who are enrolled in this program. Massachusetts and Vermont are guarantee-issue states where existing commercial plans already offer guaranteed coverage at premiums comparable to PCIP so the need for such a program may not be as high as in other states. In May 2011 CMS announced a policy change to the PCIP in states with a federally-administered PCIP program, such as Massachusetts. The change stated that United States citizens and nationals who have been without health insurance for at least six months can qualify for coverage if they can provide a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that they have or, at any time in the past, had a medical condition, disability, or illness. Applicants do not need to provide a denial letter from an insurance company. This may have provided an additional opportunity for individuals with pre-existing conditions in the state who might have to wait up to eleven months to enroll in other plans in the state due to eligibility or open enrollment restrictions under Massachusetts law. The last enrollment update, which shows enrollment through December 31, 2011, showed five enrollees in the state.

For more information, visit:

http://www.healthcare.gov/news/factsheets/2012/04/pcip04132012a.ht

4/13/12 The Commonwealth Fund published an issue brief called "Innovative Strategies to Help Affordable Consumer Operated and Oriented Plans (CO-OPs) Compete in New Insurance Marketplaces."The CO-OP Program provides loans to private entities to foster the creation of consumer-governed, private, nonprofit health insurance issuers to offer qualified health plans in the health insurance exchanges. Established under §1322 of the ACA, the goal of CO-OP program is to create a new CO-OP in every state in order to expand the number of exchange health plans with a focus on integrated care and plan accountability. This issue brief outlines several innovative strategies CO-OP organizers are developing to increase their long-term sustainability and economic success. These strategies are aimed at building market share, creating integrated provider networks, and achieving cost savings through payment reform in order to maintain the viability of CO-OPs in the health care marketplace. The report also mentions assets the CO-OPs have, including that they're exempt from federal taxes and can market themselves as a customer-oriented alternative to traditional insurers.

Read the brief at: Commonwealth Fund

4/13/12 The Substance Abuse and Mental Health Services Administration (SAMHSA) launched a new health insurance enrollment resource webpage. The SAMHSA webpage is designed to help users find information about health insurance coverage options and state specific ACA implementation activities. Specifically, the resources on the webpage include: 1) a web link to the insurance finder at the federal website healthcare.gov; 2) information about current health insurance options, such as Medicaid, CHIP and the Pre-Existing Condition Insurance Plan (and web links to the federal program pages); 3) information about health insurance options available starting January 1, 2014, including expanded Medicaid eligibility and coverage through the health insurance exchanges; 4) information about specific populations, such as young adults and individuals who have difficulty sustaining health insurance coverage (both populations with disproportionally high behavioral health needs); 5) Provider specific information, such as webinars, fact sheets, and business operations resources; and 6) state specific information, such as state level behavioral health prevalence data, webinars, and information on state SAMHSA projects that awarded grants to peer-run/recovery community organizations that work to increase public awareness about behavioral health services available through the ACA.

The SAMHSA enrollment webpage can be found at: http://www.samhsa.gov/enrollment/index.aspx

4/12/12 The NASHP State Refor(u)m team hosted a webinar "Building It from the Ground Up: A Conversation with State Health Insurance Exchange Leaders." As authorized under ACA §1311, beginning in January 1, 2014, state health insurance exchanges will operate as a one-stop marketplace for consumers and small businesses to compare and shop for affordable, quality health plans. Susan Dentzer, the Editor-in-Chief at Health Affairs, moderated the discussion with exchange directors from three states: Richard Fiore (Alabama), Patty Fontneau (Colorado), and Peter Lee (California). During the webinar the exchange directors discussed: What they've accomplished so far, the challenges they see ahead, their major policy priorities and how they work with other agencies and partners across program boundaries.

The NASHP State Refor(u)m website is an online network for health reform implementation which connects state health officials looking for information and assistance with their peers and other experts who have relevant resources and experiences to share. The site is an initiative of the National Academy for State Health Policy, funded by the Robert Wood Johnson Foundation.

View the webinar at: http://www.statereforum.org/node/9770

Sign up to receive their weekly newsletter which summarizes site content such as health reform documents, discussions, and blog posts: NASHP State Refor(u)m website

4/11/12 The CMS Innovation Center announced seven geographic markets to implement the Comprehensive Primary Care (CPC) initiative, a funding initiative authorized through the Innovation Center under §3021 of the ACA. The CPC initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Under the new initiative, Medicare will work with commercial and state health insurance plans to offer additional support to primary care doctors who better coordinate care for their patients.

According to CMS, the seven markets were selected based on a pool of applicants, which include private health plans, state Medicaid agencies, and employers, that proposed to pay for and support comprehensive primary care coordination in partnership with Medicare. The selected markets are: 1) Arkansas: Statewide, 2) Colorado: Statewide, 3) New Jersey: Statewide, 4) New York: Capital District-Hudson Valley Region, 4) Ohio: Cincinnati-Dayton Region, 5) Oklahoma: Greater Tulsa Region, and 6) Oregon: Statewide. Once the participating payers enter into agreements with CMS, approximately 75 primary care practices will be selected to participate in the initiative in each designated market and each will receive a new care management fee in addition to traditional fee-for-service payments on behalf of Medicare fee-for-service beneficiaries to support enhanced primary care services for their patients. Enhanced services include: improved care coordination; delivering preventive care; engaging patients and caregivers in managing their own care, and providing individualized care for patients with multiple chronic diseases.

More information on the seven markets and the Comprehensive Primary Care initiative is available at: http://innovations.cms.gov/initiatives/Comprehensive-Primary-Care-Initiative/index.html

4/11/12- 4/12/12 The Advisory Group on Prevention, Health Promotion, and Integrative and Public Health held their fifth meeting at HHS in Washington, DC. Meeting materials, including presentations, briefs and reports, are available at: Healthcare 

View the meeting agenda at: Healthcare