 Health Care Reform
Fact sheets focus on health reform implementation
Association of Maternal and Child Health Programs (AMCHP)
October 2010
AMCHP releases several fact sheets that focus on health reform in the context of state MCH programs.
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Key national health care groups file motion in federal suit brought by states against National Health Reform law
By: Families USA
Press Release
November 10, 2010
Groups seek to oppose legal challenge against the Medicaid expansion for low-income people.
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New resources for communities of color
Families USA
The Affordable Care Act has taken many steps to address health disparities in communities of color. There are several resources available to guide organizations and individuals in understanding and taking advantage of new provisions and promising practices.
**On a related note, the National Center for Cultural Competence has a newly redesigned website that will make it easier to connect to the array of resources they provide from self-assessment processes and instruments, to promising practices, policy briefs and distance learning features. Check out their new A to Z list of all the products and content on the site. To visit the site go to http://ncc.georgetown.edu.
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Teleconference Recording: Health Care Reform Provisions
Hosted By: Statewide Parent Advocacy Network (SPAN) of New Jersey
MP3 and other materials available from this teleconference that was held on September 23.
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Medicaid
Guidance letter on hospice care for children in Medicaid and CHIP
Centers for Medicare and Medicaid Services (CMS)
September 9, 2010
Letter from CMS now requires state health officials to provide both hospice services and curative services for children with terminal health conditions.
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Annual report on the quality of care for children in Medicaid and CHIP
Centers for Medicare and Medicaid Services (CMS)
September 2010
CMS has released its annual report providing information on current state reported quality measures for children enrolled in Medicaid and CHIP.
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Medicaid Payment Reform
Center for Health Care Strategies
The Center for Health Care Strategies has released two new resources to help policymakers understand new Medicaid payment policies.
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Medicaid managed care programs grow; so do issues
By: Phil Galewitz
USA Today
November 13, 2010
As the number of people enrolled in Medicaid continue to grow due to the roll out of health reform, Medicaid managed care plans are pressed to provide comprehensive and low cost care.
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Social security disability rules to change - for better or worse
The Bazelon Center's Mental Health Policy Reporter
The Bazelon Center is one of several consumer advocacy groups that are stepping up to take advantage of an important opportunity to comment on a current proposal to revise the mental impairment standard used by the Social Security Administration (SSA) for determining eligibility for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). This report contains their analysis of the potential impact of the proposed revisions on children and adults with mental health concerns. Individuals who receive SSI are eligible for Medicaid coverage in most states so a change in eligibility determination is important to CSHCN. To comment go to http://www.regulations.gov and search for docket number SSA-2007-0101 and follow directions. All concerned parties are encouraged to submit comments by the deadline on Wednesday, Nov 17, 2010.
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Budget cuts shift mental health responsibility to schools (California)
By: Margie M. Palmer
Santee Patch
November 12, 2010
Gov. Schwarzenegger's veto of funding for mental health services for special education and emotionally disturbed students is continuing to draw backlash from parents and school districts throughout the state.
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Brief Report: Preliminary findings from a pilot health care transition education intervention for adolescents and young adults with special health care needs
By: Janet Hess and Diane Straub
Journal of Pediatric Psychology
October 2010
New report assesses a transition intervention model that shows promising outcomes for young adults with special health care needs.
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Kid's health focus of plan (Oklahoma)
Oklahoma State Health Department
Press Release
November 5, 2010
Oklahoma's Children's Health Plan is seeking public comments until November 26, 2010.
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Events
Webinar: Children with special health care needs in rural communities
Hosted By: HRSA, MCHB and the Office of Rural Health Policy
Date and Time: Nov 17th, 2010, 1 - 2pm EST
Webinar will consists of an expert panel discussing issues of CSHCN in rural communities.
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Webinar: The Affordable Care Act, Medical Homes and Childhood Asthma
Hosted by: RCHN Community Health Foundation and Merck Childhood Asthma Network
Date and Time: December 2nd, 2010, 3 - 4 pm EST
The webinar will cover a recent report on the advanced in the medical home concept and the potential role of community health centers.
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Key national health care groups file motion in federal suit brought by states against National Health Reform law
By: Families USA
Press Release
November 10, 2010
Families USA and other major national health care groups are asking a federal judge in Florida to dismiss a lawsuit that would block an expansion of Medicaid that is scheduled under the new health reform law. A key step in that process comes this week as the groups ask the judge for permission to file what is termed an amicus brief in support of the Affordable Care Act on behalf of Medicaid recipients.
The scheduled Medicaid expansion will provide health coverage to an additional 16 million low-income adults for whom quality coverage is unaffordable and who were ineligible for Medicaid in the past.
"The lawsuit to block the Medicaid expansion in the Affordable Care Act is not only purely political, but it is also astoundingly insensitive to the needs of families without health coverage," Ron Pollack, Executive Director of Families USA, said of the lawsuit by an assortment of states' attorneys general.
"For millions of uninsured people who cannot afford health coverage, the Medicaid eligibility standards have been miserly. The Affordable Care Act creates a new eligibility standard that will cover people who are unquestionably needy, and it would be cruel to lock these people out of the health coverage they need."
Nineteen groups joined in the filing of the motion to dismiss the states' suit. In addition to Families USA, these include the American Academy of Pediatrics, AARP, American Public Health Association, Children's Dental Health Project, National Alliance on Mental Illness, National Association of Community Health Centers, National Committee to Preserve Social Security and Medicare, National Disability Rights Network, National Health Law Program, National Partnership for Women and Families, SEIU Florida, and Voices for America's Children.
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New resources for communities of color
Families USA
Families USA
In the wake of the mid-term elections, opponents of the Affordable Care Act wasted no time in declaring their desire to repeal the new law. But polling shows that the American public is not in favor of repealing the Affordable Care Act, and that many still feel the law did not go far enough. With this new wave of opposition, it is now even more imperative to ramp up our public education efforts. We need to ensure that the public is aware of what they stand to gain from the Affordable Care Act and what is at stake if opponents of the law have their way.
The Affordable Care Act takes many steps to advance health equity for racially and ethnically diverse populations. To help educate communities about how the new law is designed to address health disparities, the Minority Health Department of Families USA recently developed several new resources: Please use these new resources to reach out to your communities and demonstrate how people stand to gain from the Affordable Care Act. The benefits and protections in the new law lay a critical foundation for eliminating racial and ethnic health disparities and promoting health equity.
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Fact sheets focus on health reform implementation
Association of Maternal and Child Health Programs (AMCHP)
October 2010
The Association of Maternal & Child Health Programs (AMCHP) has released three new fact sheets to help state maternal and child health (MCH) programs understand and implement key provisions of the Patient Protection and Affordable Care Act (ACA). The resources focus on provisions related to promoting medical homes, adolescent health, and children and adolescents with special health care needs. Each document provides an overview of the legislation, opportunities and issues for state programs, and links to additional resources. The fact sheets are available as follows:
The fact sheets are part of a series of AMCHP tools, documents, and resources on ACA implementation and its impact on MCH populations. More information is available from AMCHP's National Center for Health Reform Implementation at http://www.amchp.org/Advocacy/health-reform/Pages/default.aspx.
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Medicaid Payment Reform
Center for Health Care Strategies
Medicaid payment policies influence whether beneficiaries have access to care and the amount, type, and quality of care they receive. As Medicaid transitions from a welfare program to the nation's largest health insurer, it is critical that payment policies support high-quality, cost-effective care. Two new resources from the Center for Health Care Strategies (CHCS) are designed to help Medicaid stakeholders take fuller advantage of the program's increasing purchasing leverage:
Medicaid Payment Reform: What Policymakers Need to Know About Federal Law This policy brief, authored by Deborah Bachrach, senior program consultant to CHCS and former New York Medicaid director, examines federal law, regulations, and court decisions that govern Medicaid payment practices in both fee-for-service and managed care. The brief provides federal and state government officials and other Medicaid stakeholders with an accessible legal context for understanding Medicaid payment.
Sound Practices in Medicaid Payment for Hospital Care This resource paper examines current state practices in hospital inpatient and outpatient payment and suggests approaches for incentivizing improvements in quality and reductions in unnecessary expenditures. In the paper, authors Kevin Quinn and Connie Courts of ACS outline eight sound practices to guide Medicaid purchasing of hospital services and discuss how different payment methods can be used to address value-based purchasing principles.
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Guidance letter on hospice care for children in Medicaid and CHIP
Centers for Medicare and Medicaid Services (CMS)
September 9, 2010 On September 9, CMS issued a "Dear State Health Official/State Medicaid Director" (SHO) letter to provide further guidance on implementing the PPACA provision impacting curative and palliative services for children. Although hospice services are an optional benefit under Medicaid and CHIP, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program requires Medicaid and Medicaid-expansion CHIP programs to provide all medically necessary services, including hospice care, to individuals under age 21.
Specifically, the SHO letter explained that curative treatment for a terminal illness no longer ends when the hospice benefit becomes effective for eligible children. States will now be required to provide hospice services along with other curative services that the child may require for treatment of the terminal health condition. This may include services for pain, symptom management, and family counseling. States with stand-alone CHIP programs that offer the optional hospice benefit must now also concurrently provide medically necessary curative services.
For the complete SHO letter, click here....Back
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Annual report on the quality of care for children in Medicaid and CHIP
Centers for Medicare and Medicaid Services (CMS)
September 2010
The Centers for Medicare & Medicaid Services (CMS) recently released its Annual Report on the Quality of Care for Children in Medicaid and CHIP. Based on a review of previously published reports, CMS made several important conclusions about the quality of care that children with public insurance receive:
Children enrolled in CHIP experience improved access to preventive services. Every study reviewed with the exception of one provided evidence of better access after CHIP enrollment.
Access to specialty services, including dental and mental health, is still a key unmet need. Surveys measuring patient experiences show that about one fourth of parents with children enrolled in Medicaid/CHIP have difficulty in obtaining specialty care.
Racial and ethnic disparities continue to exist among children covered by Medicaid and CHIP. For example, among enrolled children in Medicaid, African American and Hispanic children were less likely to have a usual source of care compared to their white peers.
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Medicaid managed care programs grow; so do issues
By: Phil Galewitz
USA Today
November 13, 2010After Tonya Bauserman slipped in a grocery store and hurt her right knee last July, an emergency room doctor prescribed painkillers and told her to see an orthopedic surgeon. But Bauserman, 27, who's insured by a Medicaid managed health care plan called HealthCare USA, says she had trouble finding an orthopedist in her plan who would see her. Finally, she drove 2½ hours to Columbia from her home in a northwestern suburb here to see a physician, who fitted her for a brace and recommended physical therapy. HealthCare USA later said it wouldn't pay for the brace.
Furious, Bauserman says her experience was "crazy." But it's not uncommon. Primary care physicians in the area say a shortage of specialists in Medicaid managed-care networks makes it difficult sometimes to refer patients. Matthew Eyles, a spokesman for Coventry Health Care (CVH), which owns HealthCare USA, wouldn't comment on Bauserman's case but says that the plan has "a solid network" of all types of health providers.
HealthCare USA is one of dozens of private managed health care plans providing care to nearly half the nearly 50 million Americans on Medicaid, a state-federal program for the poor and disabled. That number is increasing. Beginning in 2014, an additional 16 million people will become eligible for Medicaid under the health care law. People with incomes below 133% of the federal poverty level ($14,403 for an individual or $29,326 for a family of four in 2010) will qualify. Currently, eligibility varies greatly by state. In many cases, Medicaid recipients will be required by their states to enroll in managed-care plans.
That represents a potential bonanza for companies such as Coventry, which covers 462,000 Medicaid enrollees in eight states - including 196,000 in Missouri - and wants to grow. Also likely to capitalize: big insurance carriers including UnitedHealthcare (UNH) (which runs the biggest Medicaid managed-care plan, with 3 million enrollees) and Aetna (AET), and companies that specialize in Medicaid, such as Molina Healthcare (MOH), Centene (CNC) and Amerigroup (AGP).
"Medicaid health plans without exception are seeing reform as a tremendous business opportunity, and they are preparing for the expansion as a chance to grow and expand," says Vernon Smith, a principal at consulting firm Health Management Associates. But the coming boom is sparking debate about whether Medicaid managed care is best for patients. In traditional fee-for-service Medicaid, enrollees can go to any doctor willing to participate, although finding a specialist can be a challenge in some areas. In managed care, enrollees must see providers in their plans' networks.
Patient advocates and doctors complain that some managed-care plans aren't keeping promises to improve care while holding down costs. "We see the health plans managing costs, not managing the care," says Dan Purdom, a family doctor and medical director at the Samuel U. Rodgers Health Center, a community health center in Kansas City. He says he frequently has had to send patients to Columbia, about a two-hour drive away, to find specialists such as cardiologists.
"We get a lot of calls from parents whose child needs a specialist but none will see their children," says JoAnne Morrow, director of Advocates for Family Health at Legal Services of Eastern Missouri, a non-profit group that helps patients in Medicaid managed-care plans. Morrow and other advocates also say they deal with patients who have difficulty getting their health plans to approve expensive services, such as CT scans and some surgeries.
Missouri Medicaid Director Ian McCaslin acknowledged at a Jefferson City forum in July that managed care is "not a perfect system" and that managed-care plans - which often pay doctors the same low rates the state pays under traditional Medicaid - have trouble getting doctors to contract with them. But he said the state is trying to do a better job of ensuring access.
Wide variations in plans
Some experts, such as James Verdier, senior fellow at non-partisan think tank Mathematica Policy Research, say managed-care plans are generally better than traditional Medicaid in "saving money and improving quality" and ensuring access to doctors. But he says it's difficult to generalize, as there is "tremendous variation" among plans. "When managed care performs well, it substantially outperforms fee-for-service," says Aetna Medicaid head Tom Kelly, noting that the plans often encourage members to seek preventive care. "But it doesn't always perform well."
Even before the 2014 expansion of Medicaid enrollment, cash-strapped states, hoping to control costs, are increasingly requiring Medicaid recipients to leave the traditional program and enroll in managed-care plans. Louisiana and Mississippi, which have never used Medicaid managed-care plans, are planning to introduce them statewide beginning next year.
In Missouri, the Department of Social Services (DSS), which oversees Medicaid, has proposed requiring all Medicaid recipients in the state - except the disabled and the elderly - to enroll in managed-care plans. Currently, about 425,000 people are in Medicaid managed care, about half the total number on Medicaid. In West Virginia, beginning in January, 55,000 recipients with disabilities and mental health problems will be required to enroll in Medicaid managed care. Criticism from advocates temporarily delayed the move. About half of West Virginia's 325,000 Medicaid enrollees are already in managed-care plans, according to Centers for Medicare & Medicaid Services 2009 data.
In January 2011, Aetna and Centene will start covering up to 40,000 elderly and disabled Medicaid enrollees in parts of Illinois. At the same time, Molina and Amerigroup will begin enrolling about 75,000 Medicaid aged, blind and disabled enrollees in the Dallas area. Aged, blind and disabled Medicaid recipients make up 27% of states' total Medicaid populations, yet consume about 70% of the spending, according to federal data. Some states that have used managed care mostly in urban areas, such as Texas and Nebraska, are extending Medicaid managed care into rural areas.
Predictability sought
Typically, states pay managed-care plans a lump sum for each enrollee to provide all the health services needed. Such predictability is invaluable, says Darin Gordon, director of Medicaid in Tennessee, which has required all recipients to be enrolled in managed care since 1994. By contracting with managed-care plans, states know at the beginning of each year how much they'll spend on Medicaid, because the health plans assume the financial risk if costs exceed projections.
Faced with a huge opportunity, managed-care plans are scrambling to develop expansion strategies. "We are looking at every place we don't have a presence and are trying to prioritize states in terms of how we think they are committed to managed care," says Russell Petrella, president of UnitedHealthcare's Medicaid managed-care operation, UnitedHealthcare Community & State, formerly known as AmeriChoice.
Citigroup analyst Carl McDonald says that UnitedHealthcare could end up with nearly 1 million new customers as a result of the law's Medicaid expansion. The new opportunities for managed care come with risks. Given the states' budget problems, it's far from clear the plans will be adequately paid or whether they'll be able to recruit enough doctors.
The concern is not that states will default on payments, but that they might cut reimbursement to the plans. That could result in plans pulling out of markets or cutting optional benefits such as dental care or paying providers less, which can make it harder to attract doctors. Aetna's Kelly says the company will focus its expansion plan on states committed to maintaining funding to health plans so rates keep up with rising health costs. Aetna this year began offering Medicaid managed-care plans in central and eastern Pennsylvania.
As managed-care plans expand, they face scrutiny from some health care providers, as well as advocates. At the Jefferson City forum last summer, hospital officials, dentists and patient advocates complained of "phantom doctor networks," low reimbursement and long waits for patients seeking specialty services. Julie Wood, a family doctor in Kansas City, says her Medicaid managed-care patients routinely wait six to nine months for appointments with neurologists, orthopedic surgeons and other specialists. "It's frustrating," she says. Wood says her medical practice has stopped taking Healthcare USA due to a contract dispute. Carol Clay, whose grandson Kaleb Wooten lives with her in Sedalia, Mo., had trouble finding a doctor in Molina's network when the 7-year-old's tonsils needed to be removed. Eventually, the company got him an appointment, but with a doctor nearly two hours away. "I initially thought, 'You've got to be kidding,' " Clay says. But she made the drive, and the plan reimbursed her for her gas costs.
Missouri, as do most other states, requires health plans to ensure that patients don't have to go too far to find a doctor - typically, within a 30-minute drive. Missouri Medicaid officials acknowledge they don't have the funding to call the health plan's doctors to make sure they're taking Medicaid patients. But the state does survey recipients each year to make sure they have timely access to doctors, says Scott Rowson, spokesman for DSS. The state also requires managed-care plans to assess their availability of doctors to ensure compliance with the state contract. Medicaid Director McCaslin declined to be interviewed.
In an evaluation report done last year of plans operating in the Kansas City area, 76% of Medicaid managed-care enrollees say getting care is "not a problem," and 90% say they always or usually "get care quickly." A report completed last December for the state found no significant difference in access to doctors or quality of care between the fee-for-service Medicaid program and managed care. Missouri officials say managed care saved the state about $38 million in 2009.
Some patients praise their health plans. When Jessica Landfair of Wentzville, Mo., was pregnant with her sixth child, she started having contractions at 25 weeks. Her plan, Molina, ordered a home health nurse to help and made sure she got weekly shots of a drug to delay early delivery. It also had a nurse call each week to check on her and provided her transportation to get to doctor's appointments. She delivered a healthy baby at 39 weeks. "I never knew they had this much to offer," she said of the health plan. "They were really supportive." ...Back
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Teleconference Recording: Health Care Reform Provisions
Hosted By: Statewide Parent Advocacy Network (SPAN) of New Jersey
SPAN's Family to Family Health Information Center can help you understand the new health care reform law and how it impacts children. On September 22, SPAN presented a teleconference on the new provisions that kick in on September 23. Listen to the recorded teleconference (MP3), get access to the presentation materials, find an implementation timeline and fact sheets from Families USA and other health advocacy organizations at: http://spannj.org/healthcarematerials.htm.
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Budget cuts shift mental health responsibility to schools (California)
By: Margie M. Palmer
Santee Patch
November 12, 2010A specific veto item to the state's fiscal year 2011 budget remains a topic of concern for parents of special needs children and the school districts that educate them. Funding for Assembly Bill 3632, which mandates the state fund county mental health departments in order to provide mental health services for special needs and severely emotionally disturbed students was blue-penciled by the governor on Oct. 8.
$133 million previously allocated for AB 3632 programs, which are required under law pursuant to the federal Individuals with Disabilities Education Act, has since been shifted back to the state to increase the Special Fund for Economic Uncertainties. The responsibility to fund them now sits on the backs of local school districts, the state said - including Santee School District (SSD). Despite the governor's veto, however, State Superintendent of Public Instruction Jack O'Connell has committed to releasing $76 million in federal funding to maintain services.
Although O'Connell's office was concerned that they would not be able to allocate federal funding due to cuts made by the state, they are "proceeding with business as usual," said California Department of Education (CDE) Director of Communications Hilary McLean. "Every California student deserves an education that gives them the opportunity to meet their full potential," O'Connell said. " Gov. Schwarzenegger's action to eliminate funding for severely disabled students' mental health services is cruel to vulnerable children and is yet another slap in the face to public schools that have been underfunded by $21 billion over the last three budget years."
O'Connell said he refuses to let Schwarzenegger's action prevent severely disabled students from getting the health care they need from qualified providers. "I have directed the CDE to disburse federal funds allocated for this purpose in the same manner as it has for the last six years so that districts can continue to contract with the most appropriate providers and ensure continuity to help these vulnerable students," he said. The $76 million will help ensure mental health services that are included within a students' individualized education program (IEP), are appropriately provided during the current fiscal year by county mental health agencies consistent with current statute. In keeping with how funds have been dispersed in the past, the CDE will allocate federal funds to each county office of education to contract with the appropriate mental health agency to provide specified mental health services.
Although San Diego County is slated to receive just over $4 million, it spends approximately $13 million annually to serve students under the AB 3632 program. A total of $8 million has previously been provided by state and federal funding, while $5 million comes from Medi-Cal-the state public health insurance program which provides health care services for low-income families. San Diego County Mental Health Director Alfredo Aguirre, however, said the disbursement of federal funding is "not new news," he said. "We knew the federal funds were coming," Aguirre said. "The Governor's suspension of state funding for AB 3632 programs is a completely separate issue from funding which is provided by the federal government."
SSD is currently working with the East County SELPA to ensure no student is left without the services they need. "Our interest is that everyone come together for students and families in need," said East County SELPA Senior Director Dr. Tim Glover. "There may be uncertainty as to who has fiscal responsibility to provide these services, but until we sort that out we will certainly not allow services to go uninterrupted. It's a money issue right now but these are our neediest students and it's our goal to make sure these services stay in place."
San Diego County Supervisor Dianne Jacob, whose district includes Santee, feels that the shift in responsibility as to who must provide AB 3632 programs is not good news for the children who rely on them. "It is in the best interest of all Californians to ensure that vulnerable children have a chance at a safe and self-sufficient future. Yet, year after year, the Legislature and the governor cobble together a sham budget that doesn't begin to make the reforms necessary to adequately fund this program into the future," Jacob said.
Jacob believes that the people of California must demand Sacramento fundamentally change the way it deals with finances to "ensure that deserving programs like this aren't repeatedly left in the lurch by the state," she said. While O'Connell has said members of the Legislature are pursuing a legal opinion on whether the Governor broke the law by suspending state funding for AB 3632 programs, parents of Los Angeles County students who receive services provided by this funding have already taken legal action.
In late October, a class action lawsuit against the state was filed with the Central District of California Court, with attorneys for the plaintiffs citing violations to the Individuals with Disabilities Education Improvement Act, the Americans with Disabilities Act, and the Rehabilitation Act, alleging the Governor's actions resulted in mass confusion of crisis proportions throughout the state. US District Judge George H. Wu approved a stipulated injunction on Nov. 1, temporarily restoring programs within that county. The California School Boards Association (CSBA) has also taken legal action.
On Nov. 9 the CSBA filed a lawsuit requesting the governor's veto of funding for AB 3632 be declared void and set aside, arguing that only the Legislature has the authority to authorize such a suspension. "The governor's decision to use his veto authority to deny millions of dollars in child mental health services is appalling," said CSBA President Frank Pugh. "Cuts to our schools and students have reached an all-time high. Students already face larger class sizes, fewer counselors and less support staff on campus. It is unthinkable to now eliminate the very services that provide assistance to students struggling with mental health issues." Local attorney Mattheus Stephens said parents within San Diego County could benefit from filing a similar lawsuit.
"Gov. Schwarzenegger discriminated against this segment of our citizens who are specifically protected by the referenced statute and by laws against disability discrimination," Stephens said. "It is regrettable that he picked the most vulnerable of our citizens to victimize in the budget morass." AB 3632 services include, but are not limited to, mental health assessments, participation and recommendation to an IEP Team, out-of-state residential placement, participation in due process hearings related to mental health services, and inter-agency contract related duties. SSD currently has eight students which receive services funded by the program. Aguirre has said the county will continue to provide services to students who are in ongoing care through Dec. 31. ...Back
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Kid's health focus of plan (Oklahoma)
Oklahoma State Health Department
Press Release
November 5, 2010
The Oklahoma Health Improvement Planning Team and Children's Health Panel are seeking comments from the public regarding its draft Oklahoma Children's Health Plan: Keeping Kids Healthy, a document that provides a blueprint for improving the health status of Oklahoma's children. The comment period is open from now until November 26, 2010. Following the comment period, the Oklahoma Health Improvement Planning Team will review the plan, including any additions or revisions resulting from public comment.
The plan provides a comprehensive strategy to improve health outcomes for children ages 1 to 18 years by addressing the following areas of concern: access to primary care, injury prevention, immunization, oral health, adolescent health, mental health and substance abuse, child abuse and neglect, and children with special health care needs. The plan also addresses child health policy, health inequities for children, youth development opportunities, and services for youth and families.
A copy of the draft Oklahoma Children's Health Plan, and instructions for commenting on the plan, may be viewed by visiting the Oklahoma State Department of Health's Web site at www.health.ok.gov .
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Brief Report: Preliminary findings from a pilot health care transition education intervention for adolescents and young adults with special health care needs
By: Janet Hess and Diane Straub
Journal of Pediatric Psychology
October 2010Brief AbstractObjective To assess acceptability and feasibility of a school-based health care transition education intervention designed to equip adolescents and young adults (A/YA) who have special health care needs with important health literacy, self-advocacy, and self-determination skills.
Methods A qualitative research approach was used to assess a 40-hr curriculum implemented with 137 A/YA in 13 high school special education classes. Three focus groups were conducted with 15 students and 7 educators. Participants were questioned about perceived relevance, readability, interest, ease of implementation and completeness of the curriculum.
Results All focus group participants said the curriculum was highly relevant and valuable. Teachers reported little difficulty with ease of implementation, though the reading level appeared high for some students.
Conclusions This intervention model shows promise for empowering A/YA with special health care needs to become more independent in managing their health care, and warrants further development and evaluation. The curriculum is available at http://health.usf.edu/medicine/pediatrics/ad_med/resources.htm. ...Back
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Social security disability rules to change - for better or worse
The Bazelon Center's Mental Health Policy Reporter
The Social Security Administration (SSA) has proposed changes to the way decisions are made for awarding disability benefits based on a mental impairment. These changes will threaten the ability of people with serious mental illnesses to obtain benefits. SSA will not revise these proposed changes unless it hears a large outcry from consumers, providers and experts on mental health and disability. The changes appear in a regulation that would amend the "Medical Listings" -the standards that SSA uses to determine eligibility for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits. While the proposed new Listings include some very good features, these are undermined by a provision that could limit the number of people with mental illnesses who can qualify to only one or two percent of the nation's population. This is far below even the most conservative estimate of the number whose mental health disability makes them unable to work (the criterion for eligibility for federal disability benefits) and who therefore need this monthly income. To qualify under the proposed Listings, individuals must have more than one "marked" impairment in functioning or one "extreme" functional limitation. (A list of functions is provided in the Listings. It includes such things as the ability to get along with co-workers and others, the ability to maintain concentration, persistence and pace, and the ability to understand, remember and apply information). These standards are similar to current rules and pose no problem. The trouble lies in the process disability examiners would use in deciding how an individual meets them.
What's Bad About the Proposed Rule?
The specific problem with the proposed Listings, for both children and adults, is a reference to standardized test results and the scores a person must have on those tests in order to meet the new standard. The definitions of the minimum scores are arbitrary and exclusionary. First, there are no suitable tests that validly measure ability to work, nor is there any research showing a link between the tests of mental functioning that do exist and the ability to work that needs to be measured for the SSA process. Nonetheless, SSA would encourage its disability examiners to use "standardized tests." If a test is used, under the proposed rule an individual's score must be two standard deviations below the mean for the level of functioning to be considered "marked," and it must be three standard deviations below the mean for the level of functioning to be considered "extreme." So in addition to encouraging the use of tests that cannot measure what needs to be measured, SSA has created a stringent- and flawed- standard in terms of the score required to qualify. This change would drastically reduce the number of children and adults with serious mental disorders who qualify for disability benefits.
What's Good in the Proposed Rule? Aspects of the new rule that are positive include the following: - A shift away from reliance on a specific diagnosis, creating instead a functional focus. This would bring the Listings in line with scientific thinking that diagnosis is less a determining factor in a person's ability to work than level of functioning.
- The proposed Listings still include a description of the signs and symptoms of the various categories of mental illness, as guidance to disability examiners. These descriptions are appropriate and helpful.
- There are some modifications to the functioning that is measured and these would align well with a later step in the disability determination process, which measures "Residential Functional Capacity" (RFC).
- The proposed Listings suggest (while not requiring) that disability examiners use a five-point scale in assessing whether someone's impairment results in a "marked" or "extreme" limitation in function. Until now, examiners have had no way to anchor this. The change would be helpful in making assessments more uniform.
- The proposed Listings recognize that reaction to the stress of work is relevant and that this may differ from one person to another. They also include a focus on how someone's functioning varies over time, a longitudinal approach that is helpful.
However, these positive aspects are outweighed by the detrimental impact of the proposed testing. SSA needs to hear about the problem from advocates, consumers and experts.
What You Can Do
Please ask SSA to revise its proposed mental impairment Listings -and please circulate this alert widely. The deadline for comments is November 17. The message to SSA should be as follows: - The proposed use of standardized tests to measure the functioning of people with serious mental illnesses is a flawed approach, with no scientific basis.
- SSA should drop all reference to standardized tests in the mental illness sections of the proposed mental impairment Listings, especially the requirements for people to score so low on such tests in order to qualify for benefits.
- Under the proposed rule, every year thousands of people who cannot work would be unable to qualify for federal disability benefits.
When you submit your comments, refer to Docket No. SSA-2007-0101 so your comments are connected to this particular regulation.
To send your message, use one of these methods: - Internet-go to http://www.regulations.gov and search for docket number SSA-2007-0101 and follow directions.
- Fax to 410/966-2830
- Mail to Office of Regulations, Social Security Administration, 137 Altmeyer Bldg., 6401 Security Boulevard, Baltimore, MD 21235-6401.
To read SSA's proposed changes, download http://edocket.access.gpo.gov/2010/pdf/2010-20247.pdf.
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Webinar: Children with special health care needs in rural communities
Hosted By: HRSA, MCHB and the Office of Rural Health Policy
Date and Time: Nov 17th, 2010, 1 - 2pm ESTPlease join us for a webinar on Wednesday, November 17th, from 1:00 - 2:00 pm EST This webinar represents a collaborative effort between the Health Resources and Services Administration's Maternal and Child Health Bureau and Office of Rural Health Policy. It will provide information regarding the issues of Children with Special Health Care Needs in rural communities. The webinar will consist of an expert panel discussion about technology, research, and state systems specific to children with special health care needs in rural areas.
The presenters include: Brent A. Askvig, PhD Executive Director North Dakota Persons with Disabilities, Minot State University Amy Carlsen, RN Parent Professional Partnership Leader Center on Human Development and Disability Victoria Freeman, RN, DrPH Deputy Director NC Rural Health Research and Policy Analysis Center Register for the event at http://www.mchcom.com If you have any questions about the above webinar, please contact LCDR Deidre Washington-Jones at 301-443-6844 or dwashington-jones@hrsa.gov or LCDR Julia Bryan at 301-443-6707 or jbryan@hrsa.gov ...Back
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Webinar: The Affordable Care Act, Medical Homes and Childhood Asthma
Hosted by: RCHN Community Health Foundation and Merck Childhood Asthma Network
Date and Time: December 2nd, 2010, 3 - 4 pm EST
This webinar will highlight the recent policy brief by researchers at George Washington University titled The Affordable Care Act, Medical Homes and Childhood Asthma: A Key Opportunity for Progress, supported by the RCHN Community Health Foundation and Merck Childhood Asthma Network (MCAN). The report focuses on how the medical home model facilitates comprehensive, patient-centered care by fostering partnerships among and between patients, their providers (including pediatricians), and other primary care clinicians, specialists, emergency, and other service providers. This report reviews the Patient Protection and Affordable Care Act (PPACA) provisions that advance the medical home concept in public and private health insurance and recommends ways to fully utilize the medical home to advance high quality treatment and effective asthma management. The report also highlights the potential role of community health centers (CHCs), one of the providers PPACA designates as a health home, in treating children with asthma. For more information or to register for this Webinar, click here.
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If you have suggestions for news items related to coverage and financing of care for CSHCN, please email Meg by 12 pm EST on Friday at mcomeau@bu.edu.
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The Catalyst Center is a national center dedicated to improving health care insurance and financing for Children and Youth with Special Health Care Needs (CYSHCN). For more information please visit us at www.catalystctr.org or contact Meg Comeau, Program Director at mcomeau@bu.edu.
The Catalyst Center
Health & Disability Working Group
Boston University School of Public Health
715 Albany Street
Boston, MA 02118-2526
Week in Review is prepared by Sheila Phicil and Emily Winter of the Catalyst Center.
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