CMS Media Relations
April 9, 2013
Marilyn Tavenner, the Acting Administrator for the Centers for Medicare and Medicaid Services (CMS) is quoted as saying, "Navigators will be an important resource for the millions of Americans who are eligible to enroll in new coverage opportunities through the Marketplace starting in October of 2013." Now that the proposed rule for Navigator and Non-Navigator Personnel has been published, CMS is accepting grant applications from "self-employed individuals and private and public entities" to act as Navigators for federally facilitated and state-partnership Exchanges. (See each state's decision for creating its health insurance Exchange, as of April 1, 2013.) Search for CFDA # 93.750 at Grants.gov to read the funding opportunity announcement. Applications are due on June 7, 2013.

By Wells Wilkinson
Health Policy Hub
March 25, 2013
"Pay for delay" is a term that describes a practice where brand name drug company producers use a portion of their profits from the sale of brand name drugs to incentivize generic drug manufacturers to not manufacture low-cost forms of high-cost medications. This blog, by Wells Wilkinson, the director of the Prescription Access Litigation project at Community Catalyst, discusses the lawsuit being deliberated by the U.S. Supreme Court and the consequences of this tactic that is win-win for both brand name and generic drug manufacturers and lose-lose for consumers and health insurers. Generic manufacturers and brand name pharmaceutical companies both profit from the sale of brand name drugs. Consumers and their health plans pay higher costs. Wilkinson cites a Federal Trade Commission report from 2010 that estimates pay for delay for just one drug "can cost each consumer, and his or her health insurer, an extra $4,500 over a year and a half."  In a follow-up blog Paying for Delay - Putting Consumers in the Crosshairs on April 2, 2013, Khadijah Britton, a Program and Policy Associate, illustrates the financial impact of pay for delay with two patients' stories.

By Jeffrey Cohen
Shots: Health News from NPR
April 2, 2013
While the Affordable Care Act (ACA) works toward one of its goals - to reduce the number of people without health insurance - medical schools are working toward a goal of their own. They are striving to ensure there are enough primary care physicians to meet the health care needs of the additional 30 to 33 million individuals who will have insurance by 2016. Since the 1970s, the Southern Illinois University School of Medicine has let potential candidates know they are expected to practice in underserved areas of the state after they graduate. When applicants are interviewed at the new Frank H. Netter School of Medicine at Quinnipiac University in Connecticut, Michael Ellison, the associate dean of admissions, and Bruce Koeppen, the dean, are clear about their goal. They expect at least fifty percent of graduates to become primary care doctors. (Nationally, about thirty percent of medical school graduates choose primary care.) Koeppen notes that women, individuals looking for a second career, those who are the first in their family to attend college, and students from medically underserved areas are more likely to choose primary care. In order to provide hands-on experience, the Quinnipiac curriculum includes days where students will spend time with primary care physicians.

By Randall O'Donnell
Pediatrics
April 1, 2013
In anticipation of proposals to reform or cut Medicaid funding, this article, by Randall O'Donnell of Children's Mercy Hospital and Clinics, discusses ideas put forth by representatives from children's hospitals to improve care and reduce Medicaid costs for children with complex health conditions. They know that children with complex health needs do not receive coordinated care, even though care coordination leads to better health outcomes and reduced costs. The group attributes fragmented care to the differences in each state's Medicaid program, difficulties in communication between multiple providers, reimbursement systems that do not support integration of care, and many states' failures to authorize or pay for specialty care at hospitals across state lines. To coordinate care and reduce costs for children with complex needs, they propose the creation of Nationally Designated Children's Hospital Networks in Medicaid and the Children's Health Insurance Program (CHIP). These "Centers of Excellence" would establish regional networks to provide medical homes for children with chronic and complex health needs enrolled in Medicaid and CHIP. Within Medicaid and CHIP, these Centers will 1) create a coordinated system of care; 2) improve the delivery of pediatric care by developing guidelines for care coordination, quality metrics and standards for provider networks; and 3) create a bundled payment or shared savings reimbursement system that supports care coordination and reduces costs. The networks would work with the health providers from whom the children currently receive care to enhance their care. States that choose to participate in the Centers of Excellence and regional network model will pay for services for children with complex health needs, regardless of the state in which the care is provided.

A publication of the Asian & Pacific Islander American Health Forum
March 2013
The Asian & Pacific Islander American Health Forum (APIAHF) estimates that 1 in 10 Asian Americans and 1 in 8 Native Hawaiians and Pacific Islanders will be eligible for health insurance through the Exchanges, the online marketplaces where eligible individuals and families will be able to compare and shop for health insurance. As part of its celebration of the third anniversary of the Affordable Care Act (ACA), APIAHF created The Affordable Care Act Turns 3: A Planning and Educational Toolkit for Asian American, Native Hawaiian, and Pacific Islander Communities. They are encouraging community groups to use the toolkit to help Asian American, Native Hawaiian, and Pacific Islander communities learn about and understand the new options for obtaining health insurance when the Exchanges open in October of this year. The toolkit, which has ideas that are helpful for anyone who is trying to reach individuals with limited English proficiency, includes worksheets for planning community events, campaigns to ensure Exchange materials are easy to understand and available in multiple languages, checklists to help families learn about insurance options, and examples of ways to use social media to educate communities about the ACA.

Date: April 16, 2013
Time: 3 - 4 pm EDT
Learn about the key findings from the latest National Survey of Children's Health (NSCH), uses for the data, and other resources on the Data Resource Center for Child and Adolescent Health website. Register for this event.

Date: April 16, 2013
Time: 1 pm EDT
About 25% of children in foster care have unmet health needs, even though almost 60% have chronic health issues and nearly 70% have mental health needs. This webinar will focus on public and private sector initiatives to improve the health of both children in foster care and youth who are aging out of this child welfare system. Learn more about this event hosted by NIHCM and the ABA Center on Children and the Law and register for this event.

National Center for Medical Home Implementation Medical Home webinar: How to Use Data to Improve Care Delivery
Date: April 25, 2013
Time: 12 noon - 1 pm CDT
Join the National Center for Medical Home Implementation (NCMHI) and the Child and Adolescent Health Measurement Initiative (CAHMI) to learn how to use data to educate stakeholders, inform decision makers, and track improvements in children's health care. This is the third in a free, four-part Medical Home in Pediatrics How To webinar series hosted by the American Academy of Pediatrics (AAP) and NCMHI. These learning sessions are for pediatric providers, patient and family advocates, health policy administrators, and others interested in advancing the medical home model for children. Register for this webinar. Review the 2013 webinar series schedule and the materials from the two previous webinars.

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.