Dec. 4, 2013

By Tricia Brooks
Say Ahhh! A Children's Health Policy Blog
November 22, 2013  

By Sandhya Somashekhar and Ariana Eunjung Cha
The Washington Post
November 20, 2013
While many families raising children and youth with special health care needs (CYSHCN) celebrate the consumer protections mandated by the Affordable Care Act (ACA), others are concerned about the consequences of providing affordable health plans through the marketplaces. Health insurers, in an effort to keep the cost of marketplace plans affordable, are limiting the choice of provider networks. As a result, some insurers are excluding children's hospitals from their networks or limiting their participation to the provision of specialty services that in-network providers do not offer. This is problematic for CYSHCN who rely on children's hospitals not only for specialized care, but also for primary and follow-up care. Families who use out-of-network providers for routine care services for a CYSHCN, rather than an in-network provider, will pay higher costs for those services. Hospitals in Washington state and New Hampshire are taking legal action to be included in marketplace plans. Consumer advocates in Missouri successfully advocated to have a children's hospital added to a marketplace insurance plan's network. 

Telemedicine Consults May Reduce Errors at Rural ERs
By Genevra Pittman
Reuters
November 25, 2013
Doctors at the University of California Davis Children's Hospital worked with five rural hospitals to install videoconferencing systems in their emergency departments to assess the value of telemedicine consultations for children treated in the ER (emergency room) for sickness or injury. Over the course of two years, pediatric ER patients received consults with specialty doctors via telemedicine, or phone consultations with specialists, or did not receive any specialty consultations. Providers who specialize in pediatric critical care performed a blind chart review to rate the ER care of more than 300 children. Those who had telemedicine consults received the highest quality of care scores; those who did not receive any consultation had the lowest. Telemedicine may also reduce costs by helping to determine when the local or intermediate-care hospital can manage a child's needs, thus saving the costs associated with helicopter transport and admission to a tertiary care center. Learn about Telemedicine in the Patient Protection and Affordable Care Act (2010).

For Californians Who Can Afford It, Autism Coverage Should Improve Under ACA
By George Lauer
California Healthline
October 28, 2013
The benchmark health plan that California (along with 23 other states and Washington D.C.) has chosen to define the amount, scope, and duration of services provided in each of the ten categories of essential health benefits includes "autism coverage." All new health plans sold in the individual market and through the California health benefits marketplace must cover autism services. Families raising children with autism spectrum disorders who qualify for federal subsidies to purchase marketplace coverage will be relieved of the financial burden of paying for these services out-of-pocket or of having to forgo autism services for their child. But, what about the families who have the option of affordable employer-sponsored insurance that does not include autism services? If a family chooses to purchase a marketplace plan that covers autism services, rather than enroll in the employer-sponsored plan, they will not be eligible for federal subsidies. In addition, children enrolled in California's Medicaid program, which does not provide applied behavioral analysis (ABA), cannot also have marketplace coverage. This article explains the implications of the family "glitch" for households with limited income and advocates efforts to provide funding to include ABA in the state's Medicaid program.  

By Sarah Summers and Kim Lewis
Health Advocate
November 2013
This issue of the e-newsletter of the National Health Law Program (NHeLP) provides information about the Due Process rights of individuals who apply for and/or receive Medicaid benefits. It outlines the changes that will occur in order to align and extend the same protections to individuals and families who apply for marketplace coverage.

By Leslie Foster
Agency for Healthcare Research and Quality
October 2013
In an effort to track the quality of care for children enrolled in Medicaid and CHIP (Children's Health Insurance Program), the Centers for Medicare & Medicaid Services (CMS) released a core set of child quality measures in 2011. [See the updated 2013 Core Set of Children's Health Care Quality Measures for Medicaid and CHIP.] All states are encouraged to report on these measures. This Evaluation Highlight, the fifth from the National Evaluation of the CHIPRA Quality Demonstration Grant Program, discusses how Pennsylvania and South Carolina, 2 of 18 states that received Children's Health Insurance Program Reauthorization Act Quality Demonstration grants (CHIPRA QD), used the Core Measures to direct quality improvement efforts for participating health systems and primary care practices.

The National Center for Family ♥ Professional Partnerships is a project of Family Voices. With funding from the Maternal and Child Health Bureau (MCHB), they work to promote families as partners in the decision making of healthcare for children and youth with special health care needs (CYSHCN) at all levels of care. Download their new brochure to learn about this national center and the activities to support their goals, which include increasing the capacity of families, Title V, and other providers to work together towards full implementation of the Affordable Care Act (ACA).   MLR, ACA, MCO, EOB, FSA, F2F - what do all these acronyms mean? The NCFPP has created an excellent  ALPHABET SOUP - A Glossary of Health Care Terms for Families of Children/Youth with Special Health Care Needs/Disabilities.

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 Project Director by 12 noon on Friday.