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Quote of the Week
"It's so beautifully arranged on the plate - you know someone's fingers have been all over it."
-Julia Child |
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Featured Article
Child-Only Coverage and the Affordable Care Act: Lessons for Policymakers By Katie Keith, J.D., M.P.H., Kevin W. Lucia, J.D., M.H.P., Sabrina Corlette, J.D.The Commonwealth FundOctober 9, 2012As of September 23, 2010, the Affordable Care Act (ACA) has prohibited new health plans in the individual insurance market from limiting or denying coverage to children under age 19 with pre-existing conditions. Since then, insurers have walked a fine line between complying with the law and ensuring their own financial stability due to adverse selection. Citing the lack of a mandate for all children to have health insurance and for all health insurers to offer child-only policies, many insurers that did offer this type of policy stopped doing so. In reaction to this trend, 22 states and Washington D.C. either passed new laws, issued new regulations, or issued new subregulatory guidance to ensure child-only coverage options. This issue brief from the Commonwealth Fund provides an overview of the strategies that states used, which include:
- A requirement for insurers to offer child-only coverage if they wanted to participate in a state's other insurance markets;
- The option to limit enrollment periods to reduce the chance that parents will only purchase insurance after a child gets sick, with exceptions for qualifying events;
- The authority to screen children for other coverage options, including employer-sponsored insurance, the Children's Health Insurance Program (CHIP), and a state's high-risk pool;
- The establishment of reinsurance pools, a requirement for all insurers to participate in a "pool" to share the risk taken by the insurers that do offer child-only coverage.
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 IN THIS ISSUE
News Items
News from Our Partners
Events and Announcements
In Case You Missed It...
So, what do you think about
Catalyst Center Coverage?
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News Items
By JoAnn VolkCHIR BlogThe Center on Health Insurance ReformsGeorgetown University Health Policy InstituteOctober 1, 2012Prior to the passage of the Affordable Care Act (ACA) President Obama stated, " If you have insurance that you like, then you will be able to keep that insurance." But what if you don't like your current health plan? Your family, like the Ferstl family profiled in this blog from the Center on Health Insurance Reforms, may also be waiting for 2014, when the ACA will be fully implemented. Aaron and Beth Ferstl's son Henry developed cerebral palsy as a result of an in-utero stroke and seizures after he was born. Aaron was laid off from his job just weeks before Henry's birth, but was able to maintain comprehensive health coverage for his family through his employer's large-group plan by utilizing COBRA ( Consolidated Omnibus Budget Reconciliation Act of 1985). Even though it was expensive to pay the full premium cost, Henry's hospital care was covered and he was able to receive needed health services until the family could enroll in the health plan offered by Beth's employer. Unfortunately, this small-group plan limits some services and does not cover others that Henry needs. In particular, the health plan does not pay for Henry's physical and occupational therapies, because they are habilitative (helping him to develop skills he does not already have), rather than rehabilitative (helping him recover a skill he had but lost due to injury, illness, or an accident). When the Affordable Insurance Exchanges open in 2014, Beth is hoping her small-group employer will choose a new health plan through the Exchange, as habilitative services are one of the 10 Essential Health Benefits that every health plan offered in the Exchanges, as well as new individual and small-group plans offered outside of the Exchanges, must provide. By Christine VestalSTATELINE: The Daily News Service of The Pew Center on the StatesOctober 11, 2012The fee-for-service model of payment for health services perpetuates a high-cost system of care. Health care providers are paid for each appointment, test, and treatment, with little or no incentive to coordinate with their patients' other physicians to avoid duplication and to work together to develop treatment plans. The Affordable Care Act (ACA) includes proposals to improve the quality of health care and control the costs of care. Accountable Care Organizations (ACOs) are one of the strategies that have the potential to accomplish both of these goals. ACOs are voluntary partnerships between primary care physicians, specialists, hospitals, and other providers. They develop a budget for treating a specific patient population and work together to coordinate a patient's care, focus on prevention, and manage any underlying conditions. Their success will be determined by quality measures; they will share any savings in unspent funds. While the ACA authorizes demonstration projects for pediatric ACOs within Medicaid and the Children's Health Insurance Programs (CHIP), they are not currently funded. Some states, realizing the potential savings within Medicaid and CHIP along with the opportunity to reduce fragmentation of care, are working to implement ACOs. The National Academy for State Health Policy (NASHP) is tracking ACO activity in each state.
By Michelle DiamentDisability ScoopOctober 16, 2012The Social Security Administration has announced a 1.7% Cost of Living Adjustment (COLA) for beneficiaries. In 2013, individuals with disabilities who receive benefits through the Supplemental Security Income program (SSI) will receive $710 per month, a $12 increase over the previous year. Couples will receive a $22 increase, making their maximum benefit $1,066 per month. The benefit can vary by state, as some states supplement the federal amount. See a list of states that provide supplements. Summary of Benefits and Coverage (SBC) and Uniform GlossaryHealthCare.govSeptember 23, 2012Understanding the benefits and coverage provided by your health plan just got easier. The patient protections in the Affordable Care Act (ACA) include a provision for all health insurers to use a standard Summary of Benefits and Coverage (SBC) template to explain its benefits and covered services using plain language from the uniform Glossary of Health Coverage and Medical Terms. Each plan will also include examples of covered services, costs, and the consumer's out-of-pocket expenses for deductibles, co-pays, co-insurance, and service limits. Because this is standard for every health plan, it will be easier for consumers to compare covered services and costs between plans. Medicaid Expansion: A Closer Look at Vulnerable Populations and State Coverage OpportunitiesBy Shannon McMahon Health Affairs BlogSeptember 10, 2012States that implement the optional Medicaid expansion provision of the Affordable Care Act (ACA) will increase access to coverage for low-income adults, and help ensure the financial stability of their disproportionate share hospitals. These are safety-net hospitals that serve a high percentage of uninsured patients. To help offset the cost of uncompensated care, these hospitals receive disproportionate share hospital (DSH) payments from the federal government. Starting in 2014, the ACA will reduce federal Medicaid DSH payments. This blog provides an overview of some of the vulnerable populations that will benefit from the Medicaid expansion, including homeless, veterans, and adults transitioning out of the criminal justice system. The expansion will also help increase access to care and reduce health disparities for low-income adults with chronic illnesses who do not receive care because they have no insurance. Learn where each state stands on implementing the Medicaid expansion. Learn how the Medicaid expansion will affect youth and young adults with special health care needs. |
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New Web Page on the National Evaluation of the CHIPRA Quality Demonstration Grant Program
In February 2010, the Centers for Medicare & Medicaid Services (CMS) awarded 10 grants, which funded 18 states to improve health care quality and delivery systems for children enrolled in Medicaid and the Children's Health Insurance Program (CHIP). Funded by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), the Quality Demonstration Grant Program aims to identify effective, replicable strategies for enhancing quality of care for children. The Agency for Healthcare Research and Quality (AHRQ) is overseeing the program's national evaluation, which is being conducted by Mathematica Policy Research, the Urban Institute, and AcademyHealth.
A new national evaluation web page on AHRQ's website provides information about the national evaluation, as well as descriptions of the 51 projects being implemented in the 18 demonstration states. These projects fall into five broad categories of activity:
- Using quality measures to improve child health care
- Applying health information technology for quality improvement
- Implementing provider-based delivery models
- Investigating a model format for pediatric electronic health records (EHRs)
- Assessing the utility of other innovative approaches to enhance quality
Use the various tabs and information boxes on the web page to learn more about the following topics:
You can also sign up for ongoing email updates to learn more as the projects progress.
Medicaid Spending and Enrollment: Who is Covered and What Does the Program Spend on Their Care?
The Kaiser Commission on Medicaid and the UninsuredOctober 10, 2012Of the 63 million Medicaid enrollees, three-quarters are families who account for one-third of the total costs of the program. The remaining two-thirds of Medicaid spending covers the cost of care for the elderly and individuals with disabilities. Using data from 2009, coupled with engaging pictures, graphs, and short, easy-to-understand explanations, this infographic provides an at-a-glance overview of some of the groups of people that Medicaid covers and a breakdown of costs by coverage group and per person. Individuals with disabilities have the highest per person costs. (Note: children with disabilities are included in the individuals with disabilities category; the costs of their coverage are not shown separately.) By April Taylor, Michele Lizzi, Alison Marx, Maryann Chilkatowsky, Symme W. Trachtenberg, and Sue OgleJournal for Healthcare Quality August 22, 2012Care coordination is one of the six core components of a medical home and is linked to improved patient safety and quality of health care. Despite the benefits of care coordination, it's a challenge to fund it. Even when there is funding to support a care coordinator position, it's difficult to create a sustainable model for this element of care that is especially important for children and youth with special health care needs (CYSHCN), their families, and their providers. Staff representing various disciplines at Children's Hospital of Philadelphia (CHOP) designed a way to not only "feed" the care coordination needs of both providers and families, but also "taught them to fish." Researchers hosted focus groups with families to identify the challenges they face and gather suggestions for improving communication and care coordination. Using this information, they created care coordination tools, which included a binder and a database of community resources. They also developed a program to help families learn how to coordinate care and a Care Coordination Network, a multidisciplinary group to help providers learn about and support care coordination among multiple providers and specialties. In a yearlong intervention, families received the care coordination tools and mentoring from a Care Coordination Counselor who facilitated team meetings and modeled communication and shared decision-making for patients, families, and providers. The researchers compared the intervention group's perceptions about care coordination to the experiences of families who received just the care coordination tools. Families in both groups reported improved care coordination for their CYSHCN, but families who received assistance from the Care Coordination Counselor reported they developed the skills and the confidence to partner with providers and identify and use community resources. In the end, they (75% of the intervention group) were able to navigate the health care system independently so that new patients, families, and providers could enroll in the program and begin to develop and improve their care coordination expertise. Family Caregivers: The Primary Providers of Assistance to People with Functional Limitations and Chronic ImpairmentsBy Carol V. O'Shaughnessy The National Health Policy ForumThe George Washington UniversityJuly 20, 2012"Informal care" is the term used to describe the assistance that family members, friends, and others provide - unpaid - to individuals with functional limitations and ongoing health needs that make it difficult for them to care for themselves. This background paper provides an overview of:
- Survey data from the National Long-Term Care Survey, the National Health and Aging Trends Study, and the National Survey on Caregiving;
- Types of assistance that family caregivers provide;
- Estimated costs of uncompensated care;
- Federal programs that assist caregivers; and
- Future practices and policies to integrate family caregivers into the healthcare team and improve person-centered and family-centered care.
The author focuses on the care needs of individuals, age 18 and older, with functional limitations and chronic health needs. However, the types of assistance these "informal" caregivers provide, the time they spend, and the stresses they experience are similar to the issues faced by parents who care for children and youth with complex health needs, as noted in this publication from the Lucille Packard Foundation for Children's Health. In addition to helping with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), family caregivers coordinate care, help ensure smooth transitions between hospital and home or other settings, provide medical care, and oversee care provided in other facilities. These responsibilities, while provided as a labor of love, often take a toll on the caregiver's physical, emotional, and financial health. These combined stresses can also put the recipient at risk of residential placement. |
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News You Can Use from Our Partners
The National Center for Medicaid Home Implementation Launches a FAQ PageThe National Center for Medicaid Home Implementation (NCMHI) has added a Frequently Asked Questions (FAQ) page to its website. The six topic areas are general information; payment and finance; practice transformation; state medical home activities; information for patients and families; and medical home promotion resources. Read through each section to find answers to questions you may have about these topics, for lists of pertinent articles, and other resources.
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Events & Announcements
The Catalyst Center extends happy birthday felicitations to the National Academy for State Health Policy (NASHP) as it celebrates its 25th year. Meg Comeau, director of the Catalyst Center, personally delivered our best wishes and thanks for their research and policy work on multiple topics, which include the Affordable Care Act (ACA), Medicaid, Children's Health Insurance Programs (CHIP), and patient safety. As part of a panel presentation about Transitions in Care for Children with Complex Health Care Needs: Effective State Approaches, Meg shared her expertise on Medicaid, the ACA, and implications for youth with special health care needs at NASHP's 25th annual State Health Policy conference on October 15 - 17, 2012, in Baltimore, Maryland. Got Transition Radio: Episode 13: Health Care Transition in a New State Part IIDate: October 27, 2012
Time: 11:00 - 11:30 am EDT
Youth leader Owen Erquiaga recently moved from Nevada to Massachusetts. In this edition of Got Transition Radio, he will share what he learned about finding health care, employment, and transition during his 2,000 mile journey. Register for this event. Listen to previous broadcasts by the National Health Care Transition Center.
Annual AMCHP ConferenceMark your calendar now for the Association of Maternal and Child Health Program's (AMCHP) annual conference. This year's event, " Advancing the Maternal & Child Health Vision" will take place on February 9 -12, 2013, in Washington, D.C. Review the preliminary schedule and register for this exciting opportunity to help advance leadership, quality, and action to improve the health of women, children, youth, and families, including those with special health care needs. |
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Want more news?
To view more articles from past issues of Catalyst Center Coverage, visit the Catalyst Center website. For state-specific news, visit the Catalyst Center Facebook page.
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News to share?
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.
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The Catalyst Center is a national center dedicated to working with states and stakeholder groups on 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 is funded under cooperative agreement #U41MC13618 from the Division of Services for Children with Special Health Needs, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. Lynda Honberg, MHSA, MCHB/HRSA Project Officer. The contents of Catalyst Center Coverage are solely the responsibility of the authors and do not necessarily represent the views of the funding agencies or the U.S. government.
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