By Mark Miller
Reuters
April 16, 2012
While the country awaits the U.S. Supreme Court's decision about two key provisions of the Affordable Care Act (ACA) -- the individual mandate and the Medicaid expansion -- Rhode Island, Maryland, and Oregon are not taking a wait-and-see attitude. Columnist Mark Miller reports that prior to the passage of the ACA these three states were working to reform health care and they are committed to moving forward with these efforts, regardless of the Court's decision expected in June. They are joined by 16 other states and the District of Columbia that have enacted legislation, or their governors have issued an executive order, to create a state health insurance Exchange. Of the remaining states, only 15 have taken few or no steps towards creating an Exchange, a marketplace where residents with incomes less than 400% of the federal poverty level (less than $92,200 a year for a family of four) and no access to an affordable employer-sponsored health plan, will be able to compare and shop for health insurance. If the Court upholds the ACA, these states will have to play catch up and work quickly to establish their Exchanges so they can be operational by January 2014. See a map of each state's progress towards developing an Exchange. If the Court decides the individual mandate is unconstitutional, but does not strike down the entire ACA, Congress may have to enact additional legislation to ensure enough healthy, uninsured individuals purchase health insurance. Without robust participation in the Exchanges, insurance companies will not be able to control premium costs or provide coverage to individuals with pre-existing conditions. In February 2011, the U.S. Government Accountability Office (GAO) interviewed experts about ways to encourage voluntary enrollment in private health plans. Recommendations include limiting open enrollment periods, creating public outreach and education campaigns, providing personalized assistance with enrollment, and including insurance status as part of personal credit ratings.

By Sam Baker
Healthwatch: THE HILL'S Healthcare Blog
April 9, 2012
If there were an ICD-9 code for "needs more time," a majority of physicians would be self-diagnosing and using the code to explain why they can't begin using the new ICD-10 system as scheduled in October 2013. ICDs, which stand for "International Classification of Diseases," are the universal codes used to describe symptoms, diagnoses, and causes of death. Doctors, hospitals, and other providers use ICD codes to bill health insurers for services. The U.S. Department of Health and Human Services (HHS) proposed the new ICD-10 coding system, which has five times as many codes as ICD-9 because it includes new procedures, diagnoses, preventive services, and codes to describe the degree of difficulty for a specific procedure. HHS is now granting a one-year delay in implementation, because, as reported in this article, doctors state the new rules are "overly complicated." However, once the new coding system is put into practice, it will save an estimated $4.6 billion, as it will streamline reimbursement and decrease fraud.

By Karen VanLandeghem and Edward L. Schor
The Commonwealth Fund
February 8, 2012
State Medicaid and Title V programs are required to coordinate with each other to ensure children with special health care needs (CSHCN) receive a comprehensive array of services. In addition, each state must specify how its Children's Health Insurance Program (CHIP) will coordinate with other public and private health programs, including Title V. (Learn more about Title V, Medicaid, and CHIP partnerships in this section of the Catalyst Center Medicaid/CHIP tutorial.) To foster and expand existing public partnerships to include private health care services, the Affordable Care Act (ACA) offers states various tools and funding opportunities. This issue brief provides an overview of provisions of the ACA that will help states develop public-private partnerships. These include:

The authors highlight how four states have used these tools to create public-private partnerships that increase coverage, improve quality of care, and reduce health care costs for women and children. Colorado is engaging key stakeholders in its Colorado Medical Home Initiative, which is a partnership between the state's Medicaid agency, Family Voices Colorado, the Colorado chapter of the American Academy of Pediatrics, and the Division of Family Health Services in the Department of Public Health. Its purpose is to establish medical homes in order to promote high-quality health care for children that qualify for Medicaid and CHIP, including children with special health care needs (CSHCN). The Florida Children's Medical Services (CMS) Network is building systems to serve children with special needs and provide care coordination. CMS is a managed care plan option for CSHCN enrolled in Medicaid or CHIP. With the help of a CHIPRA (Children's Health Insurance Program Reauthorization Act) demonstration grant, it also pays for pediatric primary care in certain areas of Florida. Ohio and Vermont are both developing standards and promoting quality with Best Evidence for Advancing Child Health in Ohio Now (BEACON) and the Vermont Blueprint for Health. BEACON is a collaborative that promotes cost-effectiveness in care and expands developmental screening for Medicaid-enrolled children. The Vermont Blueprint for Health is a health care reform initiative that requires major insurers to support Community Health Teams and recognize Advanced Primary Care Practices as patient-centered medical homes.

Kaiser Commission on Medicaid and the Uninsured
The Henry J. Kaiser Foundation
March 2012
This issue paper from the Kaiser Commission on Medicaid and the Uninsured, provides an overview of the governors' budget proposals for Medicaid for fiscal year 2013. In general, Medicaid enrollment and spending has slowed as the economy has improved. The majority of states are proposing Medicaid expansions or enhancements for eligibility and enrollment, benefits, long-term care, care management, health information technology (HIT), and program integrity. Some states budgeted for an increase in provider rates, as they will receive additional federal funds from the Affordable Care Act (ACA) for primary care physician fees in 2013. Despite the Maintenance of Effort (MOE) requirement of the ACA, six states have proposed cuts for eligibility and enrollment; however, these reductions are subject to approval from the Centers for Medicare and Medicaid (CMS) Services before they can go into effect. States are also implementing provisions of the ACA, such as the health home option and use of HIT; the 90% federal match rate for these improvements is incentive for updating and coordinating systems of care. In addition, many states are working to reduce costs with proposals for Medicaid managed care initiatives.

From the American Academy of Pediatrics Committee on Child Health Financing
By Lead Authors Mark E. Helm and Patience Haydock White
Pediatrics
January 1, 2012
In 2008, the American Academy of Pediatrics (AAP) published the third edition of Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, a comprehensive set of recommendations for health supervision, developmental surveillance, and anticipatory guidance for infancy, early and middle childhood, and adolescence through age 21. The Affordable Care Act (ACA) references Bright Futures as the standard of care for children and young adults. This policy statement from the AAP recommends:

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If you have suggestions for news items related to coverage and financing of care for CYSHCN please email Beth Dworetzky Catalyst Center Coverage editor and Catalyst Center Assistant Director by 12 noon on Friday.