1/28/14 The U.S. Preventive Services Task Force (Task Force) issued a draft recommendation statement on screening adults for abdominal aortic aneurysm (AAA). The USPSTF issued four findings with respect to whether screening for AAA with ultrasonography can reduce the risk of dying from the condition. An AAA is a weakening in the wall of the abdominal section of the aorta. Once a section of the aortic wall is weakened, pressure from the blood flowing through the vessel causes the aorta to bulge or balloon, resulting in the formation of an aneurysm. According to the USPSTF, a large proportion of AAAs are asymptomatic until rupture. If untreated, AAA rupture can be life-threatening or cause death. The draft recommendations apply to asymptomatic adults age 50 years and older.

According to the USPSTF's research, AAA is estimated to affect between 3.9% and 7.2% of men and 1.0% and 1.3% of women age 50 years and older. An estimated 59% to 83% of patients with a rupture die before hospitalization; operative mortality is approximately 40%. Consequently, 10% to 25% of individuals with a ruptured AAA survive to hospital discharge. Almost all deaths from ruptured AAA occur after age 65 years; and in women, the majority of deaths occur after age 80 years.

The USPSTF recommends one-time screening for AAA by ultrasonography in men ages 65 to 75 years who have ever smoked. Because the Task Force concluded that there is a high certainty that screening in older male smokers can reduce AAA-related mortality, the USPSTF assigned a "B" rating to the recommendation.

Secondly, the USPSTFdetermined with moderate certainty that AAA-screening in men ages 65 to 75 years who have never smoked has a small net benefit. As a result, the Task Force assigned a "C" rating to the recommendation that clinicians selectively (rather than routinely) offer AAA screening in men of this age group. In determining the appropriateness of screening, patients and clinicians should consider factors such as medical history, family history and other risk factors.

The USPSTF also concluded that the evidence is insufficient to make a recommendation about the effectiveness of AAA screening in women ages 65 to 75 years who have ever smoked. As a result, the Task Force issued an "I" statement for this recommendation.

Lastly, the Task Force decided against routine screening for AAA in women who have never smoked. Because the USPSTF believes with moderate certainty that the harms of screening outweigh any potential benefits, the Task Force assigned a "D" rating to the recommendation.

The USPSTF is an independent panel of non-federal government experts that conduct reviews of scientific evidence of preventive health care services. The USPSTF then develops and publishes recommendations for primary care clinicians and health systems in the form of recommendation statements. As part of their recommendations process, the USPSTF will assign definitions to the services they review based on the certainty that a patient will receive a substantial benefit from receiving the benefit. Services that are graded "A" and "B" are highly recommended and the USPSTF believes there is a high certainty that patient will receive a substantial or moderate benefit. 

Under ACA §1001, all of the recommended services receiving grades of "A" or "B" must be provided without cost-sharing when delivered by an in-network health insurance provider in the plan years (or, in the individual market, policy years) that begin on or after September 23, 2010. If the draft recommendations are finalized, then only the recommendation that was assigned a "B" rating (one-time screening for AAAwith ultrasonography for men ages 65 to 75 who have ever smoked) will be required to be covered without cost-sharing under the ACA.

Comments on the draft are due February 24, 2014 and can be submitted at: http://www.uspreventiveservicestaskforcecomments.org/?dno=MzlVT3V0T0FnVlklM2Q$

Read the draft recommendation statement at:

http://www.uspreventiveservicestaskforce.org/draftrec.htm

Learn more about preventive services covered under the ACA at: HHS.Gov 

Learn more about the USPSTF at: http://www.uspreventiveservicestaskforce.org/ 

Commonwealth of MA News

State Plan Amendments for Massachusetts Alternative Benefit Plans: Public Comment Period

The Executive Office of Health and Human Services (EOHHS) plans to submit to the Centers for Medicare and Medicaid Services (CMS) by March 31, 2014 two State Plan Amendments (SPAs) authorizing MassHealth's two Alternative Benefit Plans (ABPs) under the Affordable Care Act. EOHHS will accept comments on the proposal contained in the summary linked below through 5:00 pm on February 21, 2014.

A summary of the proposed SPAs and information about how to submit comments are available at: http://www.mass.gov/eohhs/docs/eohhs/healthcare-reform/alternate-benefit-plans-public-notice.pdf

On January 22, 2014, Massachusetts submitted comments to HHS/CMS on the proposed "Basic Health Program: Proposed Federal Funding Methodology for Program Year 2015" which provides the proposed funding methodology and data sources necessary to determine federal payments for states electing to implement a Basic Health Program (BHP) in 2015.

The proposed payment notice lists the factors that will be used to determine the federal payment amount to states, which must equal 95 percent of the premium tax credits (PTCs) and cost sharing reductions (CSRs) that BHP enrollees would have been provided had they enrolled in a qualified health plan (QHP) through the Exchange (Marketplace). The proposed methodology takes into consideration the age, income, coverage type (individual or family), geographic variation, enrollee health status, and any reconciliation of the PTCs and CSRs that would occur. BHP monthly premiums and cost sharing cannot exceed what an eligible individual would have paid if the eligible individual were to receive coverage from a QHP through the Exchange.

The payment notice follows the proposed rule published on September 25, 2013 regarding the programmatic elements and implementation of the BHP. The program provides states the option to establish a health benefits coverage program for low-income individuals who would otherwise be eligible to purchase coverage through the Health Insurance Exchange.

The comment period has closed but a link to the December 23, 2013 Federal Register notice containing the notice can be read at: http://www.gpo.gov/fdsys/pkg/FR-2013-12-23/pdf/2013-30435.pdf

The Massachusetts comment letter can be read online at the Massachusetts national health reform website under the State and Federal Communications section at: http://www.mass.gov/eohhs/docs/eohhs/healthcare-reform/state-fed-comm/140122-comment-letter-basic-health-program.pdf

Upcoming Events

Integrating Medicare and Medicaid for Dual Eligible Individuals (also known as One Care) Open Meetings

Friday, February 21, 2014, 1:00-3:00 PM

State Transportation Building, Conference Room 1-3

10 Park Plaza

Boston, MA

We welcome attendance from all stakeholders and members of the public with an interest in One Care. Reasonable accommodations will be made for participants who need assistance. Please send your request for accommodations to Donna Kymalainen at Donna.Kymalainen@state.ma.us.

Integrating Medicare and Medicaid for Dual Eligible Individuals (also known as One Care) Implementation Council Meetings

Friday, February 28, 2014

11:00 AM-1:00PM

1 Ashburton Place, 21st Floor

Boston, MA

MBTA and driving directions to 1 Ashburton Place are located here: www.mass.gov/anf

A meeting agenda and any meeting material will be distributed prior to the meeting.

Meetings of the Implementation Council are open to stakeholders and members of the public with an interest in One Care. Reasonable accommodations are available upon request. Please contact Donna Kymalainen at Donna.Kymalainen@umassmed.edu to request accommodations.