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Quote of the Week:
"Laughter is a tranquilizer with no side effects."
- Arnold Glasow
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In This Issue
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News Items
By Cindy Mann, Director, Center for Medicare and Medicaid Services
Department of Health and Human Services
February 17, 2012
On December 16, 2011, the U.S. Department of Health and Human Services (HHS) issued an Essential Health Benefits Bulletin that gave each state the responsibility for determining its essential health benefits package. As follow up, HHS has responded to 22 frequently asked questions (FAQ) and provided additional guidance about the development of the essential health benefits package. Key points include:
- States have to choose a single benchmark plan to determine the essential health benefits for both the individual and small group markets, both in and out of the state exchange;
- State mandated benefits passed after December 31, 2011, cannot be added to the benchmark plan. Clarification regarding the cost to states for mandated benefits they may want to provide that are not currently included in the benchmark plan is provided in the FAQ document;
- With the exception of individual grandfathered plans, plans cannot impose annual or lifetime dollar limits on services. Some state-mandated services have dollar limits. If these services are included in the benchmark plan, the essential health benefits must include these services without a monetary limit. However, if the benchmark plan provides equivalent services within the 10 required categories of health services, they may substitute those services, again, without a dollar limit. Plans may impose limits on the scope and duration of services.
With regard to services for children, HHS research confirmed that many health plans do not cover habilitative or pediatric oral health and vision services, which are required as part of the essential health benefits under the Affordable Care Act (ACA). The FAQ document outlines two options that HHS is considering for bridging the gap for habilitative therapies:
- Habilitative services must match what the plan offers for rehabilitative services (also known as parity), or
- Plans can design a habilitative service package, which HHS will then evaluate.
For oral health services, states can use the Federal Employees' Dental and Vision Insurance Program (FEDVIP) with the largest enrollment nationally or use the benefit package provided by its separate Children's Health Insurance Program (CHIP). For vision care, states can use the benefits provided by the largest FEDVIP plan.
The Kaiser Family Foundation
February 3, 2012
Kaiser Health News
February 15, 2012
On March 26, 2012, two years and three days after the passage of the national health reform law known as the Affordable Care Act (ACA), the U.S. Supreme Court will hear oral arguments about the constitutionality of two provisions of the health reform law: 1) the mandate that everyone must have health insurance and 2) the Medicaid expansion that raises the income limit so more people will qualify for this public health program. Kaiser Health News's Jackie Judd and attorney Stuart Taylor discuss the significance of the number of hours (6) and days (3) that the Court has allotted to hear oral arguments. The lawsuits, filed by 26 states, are about more than just these two elements of the ACA. Taylor states this is also an issue of individual rights and state sovereignty and whether or not the federal government can make individuals buy a particular commercial product and insist that states increase eligibility for Medicaid. Watch the interview or read the transcript.
Obama Administration Defends Healthcare Medicaid Law
By James Vicini
Reuters
February 10, 2012
Twenty-six states say the Medicaid expansion, the provision of the Affordable Care Act (ACA) that expands Medicaid eligibility for individuals with income up to 133% of the federal poverty level ($30,657 for a family of four) is unconstitutional because it creates a financial burden and coerces them into expanding their Medicaid programs or else risk losing federal funds. Attorneys for the Obama administration disagree. On February 10, 2012, they filed a brief with the U.S. Supreme Court that supports the right of Congress to make rules for dispersing federal dollars. They also state that the federal government will bear the majority of the cost of the expansion by reimbursing states 100% for newly eligible individuals from 2014 through 2016, although the federal match will decrease until 2020, after which the federal reimbursement will be 90%.
President's Budget Meets with Predictable Response in Unpredictable Year
By Jocelyn Guyer
A Children's Health Policy Blog: Say Ahhh! Georgetown University Center for Children and Families
February 16, 2012
In response to the release of President Obama's Fiscal Year 2013 budget proposal on February 13, 2012, Jocelyn Guyer at the Georgetown University Center for Children and Families has written a blog about how specific proposals will affect health coverage for children and families. In a d�j� vu moment from previous budgets, the President revisits several strategies to generate $56 billion in Medicaid savings over a 10-year period, including a proposal to blend the federal match rate for CHIP (Children's Health Insurance Program), Medicaid, and the Affordable Care Act (ACA) Medicaid expansion. Positive proposals include extending Transitional Medical Assistance, the program that allows low-income families to remain on Medicaid for 6 to 12 months as they transition from welfare to the workforce, and not adjusting the Federal Poverty Guidelines in years when there is negative inflation so that families would not lose their Medicaid eligibility. Read the President's budget priorities, overviews for each department, and more.
Success of Health Reform Hinges on Hiring 30,000 Primary Care Doctors by 2015
By Sarah Kliff
The Washington Post with Bloomberg Business
February 11, 2012
Regardless of the U.S. Supreme Court's decisions about the constitutionality of some of the provisions of the Affordable Care Act (ACA), ultimately its success or failure may hinge upon the number and availability of primary care physicians. In a good news, bad news scenario, more people have health insurance due to the ACA and are more likely to go to a primary care provider for preventive and sick visits rather than seek expensive and often uncompensated emergency room care. The bad news is there is a shortage of primary care providers. The good news is that the Association of American Medical Colleges reports that between 2009 and 2011, there was a 20% increase in the number of medical students opting for primary care residencies. Unfortunately, despite some funding through Medicare, the Prevention and Public Health Fund created as part of the ACA, and a Primary Care Residency Expansion program, many medical students still plan to become specialty doctors, as this assures higher earnings that will help offset the hundreds of thousands of dollars of debt they incur for their medical education and training.
Latest Drug Shortage Threatens Children with Leukemia
By Richard Knox
SHOTS: NPR's Health Blog
February 16, 2012
Many U.S. plants that manufacture drugs are, themselves, in need of some rest and rehabilitation. When plants fail FDA (Food and Drug Administration) inspections due to poor condition of the physical plant and machinery, they must be shut down. This has caused critical shortages of some generic drugs, in particular, methotrexate, an injectable drug used to treat children with certain types of leukemia and bone cancer. In this National Public Radio (NPR) blog post, Richard Knox reports the FDA, aware of the looming methotrexate shortage, has asked other manufacturers to increase production so patients will continue to receive needed treatment. While this is welcome news for doctors, patients, and their families, Knox acknowledges this will not solve the underlying problem of aging U.S. drug plants, and that this won't be the last time parents and providers, "worry about other shortages."
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Resources
Statehealthfacts.org
The Henry J. Kaiser Family Foundation
February 7, 2012
Kaiser State Health Facts has updated information on each state's progress towards creating a Health Insurance Exchange. Use the interactive map to see the status of each state's Exchange; if the exchange was created, or is being created, by executive order, or by executive or legislative action; if the exchange is, or will be, operated by an existing state agency, a non-profit, or an independent public agency; and if the exchange will be a clearinghouse or an active purchaser that contracts with select plans and negotiates the premiums. This resource allows users to compare a state to the nation or to another state.
By Carey Goldberg
CommonHealth Reform and Reality Wbur.org Boston's NPR News Source
February 10, 2012
Two sections of the Affordable Care Act (ACA) address Accountable Care Organizations or ACOs. In particular, section 2706 specifies requirements for a Pediatric ACO Demonstration Project that is short on details about exactly what an ACO is. To answer this question, CommonHealth Reform and Reality has created a short (just over 5 minutes), laugh-out-loud video that explains ACOs. Watch the video or read the transcript.
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Events and Announcements
Date: March 14, 2012 Time: 2:00 PM - 3:00 pm EDT
National Academy for State Health Policy (NASHP)
January 31, 2012
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News You Can Use from Our Partners
Promote Child and Adolescent Health Across the Life Span with New Data and Features on the DRC Website February 8, 2012 The Child and Adolescent Health Measurement Initiative (CAHMI) has added new data and features to the Data Resource Center for Child and Adolescent Health (DRC) website. Users can now access data from the 2009/10 National Survey of Children with Special Health Care Needs (CSHCN) on the six Maternal and Child Health core outcomes and subcomponents for CSHCN, compare data trends from the 2001, 2005/06, and 2009/10 National Surveys for CSHCN, obtain Title V Needs Assessment data for your state, region, or the nation, and more. Read new data briefs about functional difficulties for CSHCN with specific conditions, the system of care, and other topics. Users can also "Put Data into Action" by tailoring data that, for example, will "illustrate" the need for a particular health service, a problem with access to care, or health care disparities.
New and Noteworthy Releases from the National Center for Cultural Competence National Center for Cultural Competence The National Center for Cultural Competence at the Georgetown University Center for Child and Human Development has released a new self-assessment checklist and a new publication. Promoting Cultural Diversity and Cultural and Linguistic Competency: Self-Assessment Checklist for Personnel Providing Services and Supports to LGBTQ (Lesbian, Gay, Bisexual, Transgender, Questioning) Youth and their Families is the latest in a series of self-assessment checklists. Organizations and their staff can use this tool to gauge how responsive their materials, resources, and environment; communication styles; and values and attitudes are to LGBTQ youth and their families. There are no right or wrong answers. Rather, the checklist can help an organization identify its strengths and weaknesses and then work towards developing a plan to provide services that are more culturally and linguistically appropriate for this population of youth and their families. In fall 2011, the National Center for Cultural Competence published PROMISING PRACTICES: Community Engagement and Partnerships Improve Access to Medical Homes. Citing data from the 2005/06 National Survey for Children with Special Health Care Needs, the authors highlight the disparities in access to coordinated care within a medical home for children with epilepsy, and how the disparities are even greater by race, ethnicity, and language. This paper provides an overview of Project Access, a U.S. Department of Health and Human Services (HHS) initiative supported by the Epilepsy Foundation of America, to improve access to health services for children and youth with epilepsy living in medically underserved communities. As part of those efforts, the Epilepsy Foundation of Florida collected data about barriers to care and created professional development opportunities for providers. They also developed policies and practices to ensure individuals with epilepsy had access to coordinated and culturally and linguistically competent care within a medical home. 2012 AMCHP Annual Conference By Go BeyondMCH's Channel If you were unable to attend Improving Maternal and Child Health Across the Lifespan: Acting Today for Healthy Tomorrows, the Association of Maternal and Child Health Program's (AMCHP) annual conference on February 11 - 14, 2012, or if you did but did not have a chance to talk to some of the attendees, you can catch up with those you missed. Go BeyondMCH has uploaded video from this year's conference. Hear from Mike Fraser, Executive Director of AMCHP, and listen to conversations with Title V partners, such as Cheryl Jones from the Iowa Child Health Specialty Clinics, Christina Bethell, Director of the Child and Adolescent Health Measurement Initiative, and family leaders Laura Warren and Dawn Wardyga, Executive Director of Texas Parent-to-Parent and Director of the Rhode Island Family-to-Family Health Center, respectively. Back to Top
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In case you missed it...here is the most popular news item from our last issue of the Week In Review
The Catalyst Center and the National Academy for State Health Policy (NASHP) have pooled their expertise to create a user-friendly tutorial, specially written for Title V staff, family leaders, public health/maternal and child health students, and interested others. Go through each section sequentially, assessing your knowledge by taking a quiz at the end of each section, or focus on specific areas of interest such as partnerships between Title V and Medicaid staff, pathways to coverage, financing, service delivery models, quality measurement and improvement, or eligibility changes under the Affordable Care Act. You can test your newfound proficiency by playing a game of Medicaid/CHIP Jeopardy or completing the "Alphabet Soup" crossword puzzle. It's all available at Public Insurance Programs and Children with Special Health Care Needs: A Tutorial on the Basics of Medicaid and The Children's Health Insurance Program (CHIP).
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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 [email protected].
The Catalyst Center
Health & Disability Working Group
Boston University School of Public Health
715 Albany Street
Boston, MA 02118-2526
The Catalyst Center is funded under grant #U41MC13618 from the Maternal and Child Health Bureau, Health Resources and Services Administration U.S. Department of Health and Human Services. |
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