Catalyst Center Coverage
Roundup of news related to financing of care for children and youth with special health care needs |
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Quote of the Week
"Time flies. It's up to you to be the navigator."
~ Robert Orben
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Featured Article
By Michelle Andrews
Shots: A health news blog from National Public Radio
March 11, 2014
If you are uninsured, you have until March 31 - the end of the Affordable Care Act's first open enrollment period - to purchase health insurance. If you tried to enroll in a health plan through a federally facilitated marketplace before the "glitches" were resolved, your coverage and any federal subsidies for which you may be eligible, should be retroactive to the date you first applied. Many state-run marketplaces also had technology problems that frustrated shoppers who then purchased health insurance in the individual and small group markets. Each state can decide if they will allow these consumers to switch to marketplace plans and provide retroactive coverage and subsidies. Further complications arose in some cases when health plan benefits and deductibles were listed incorrectly in the marketplaces. Insurers are encouraged to provide any "benefit display errors." However, if they choose not to, and the misinformation affected a consumer's enrollment decision, that person has 60 days to switch plans. If consumers want to switch plans because the provider network was incorrectly reported, they must do so before March 31. The next open enrollment period begins on November 15, 2014 and will extend through February 15, 2015. If you are uninsured for more than three months this year, are not exempt from payment, do not experience a qualifying life event for purchasing insurance outside of the open enrollment periods, and do not purchase insurance before March 31, you will be responsible for an individual shared responsibility payment (tax penalty). Individuals who are eligible for public health insurance through Medicaid and the Children's Health Insurance Program (CHIP) can enroll at any time.
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 IN THIS ISSUE
News Items
Resources
Events and Announcements
So, what do you think about
Catalyst Center Coverage?
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News Items
By Robert Pear
The New York Times
March 14, 2014
In response to consumers' concerns about health plans sold through the marketplaces, which included complaints about limited provider networks, the federal government created new standards for marketplace plans for 2015. The preamble to the proposed rules acknowledges that individuals with complex health needs may have experienced delays in receiving needed health services. Moving forward, at least 30% of each insurance plan's network must include children's hospitals and other community providers in each plan's service area.
By Jay Hancock and Julie Appleby
Capsules, the Kaiser Health News Blog
March 13, 2014
Many people who purchased marketplace insurance plans received cost breaks in the form of federal tax credits and cost-sharing subsidies. Now the federal government may extend a cost break, of sorts, to insurers who sold individual and small group plans. These insurers are subject to the medical loss ratio (MLR) provision of the Affordable Care Act (ACA). The MLR provision requires individual and small-group health plans to limit spending on advertising, salaries, and other administrative costs to 20% of the total premiums they collect. If they exceed this percentage, they must provide rebates to consumers. The U.S. Department of Health and Human Services (HHS), in acknowledgment of the extra administrative costs insurers have incurred for mailings, broker fees, and data entry due to the technology problems in the marketplaces, may reduce the MLR requirement. As a result, consumers may receive smaller rebates from insurers who exceeded the 20% requirement. However, the potential reduction in rebates is offset by insurers' efforts to compensate for wonky marketplace functionality and ease the enrollment process for consumers.
By Shaun Heasley
Disability Scoop
March 11, 2014
Supplemental Security Income (SSI) is a federal program that provides a monthly cash benefit to individuals with disabilities who meet certain income, asset, and disability guidelines. Since 1989, the asset limit for an individual has been $2,000. The U.S. Senate is proposing to raise the asset limit to $10,000 and allow family and others to help provide financial supports for food, housing, and other living expenses without losing benefits, which in most states include Medicaid.
March 18, 2014Health and Human Services (HHS) Press OfficeIn an effort to " ensure access to quality, culturally competent care, including long-term services and supports, for vulnerable populations" several provisions of the Affordable Care Act (ACA) are aimed at reducing health disparities. The U.S. Department of Health and Human Services estimates that 1.9 million Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) are currently uninsured. Due to the new ways, created by the ACA, to get health insurance, 80% of uninsured AANHPIs will be eligible for Medicaid, the Children's Health Insurance Plan (CHIP) or for subsidized health plans through the marketplaces. If every state implements the adult Medicaid expansion, 89% of uninsured AANHPIs would gain health insurance coverage. Learn more about the provisions of the ACA that help reduce health insurance inequities among low-income children with special health care needs and immigrant children with special health care needs.
Joe Touschner Say Ahhh! A Children's Health Policy BlogMarch 14, 2014 In this blog, Joe Touschner, a senior health policy analyst at Georgetown University's Center for Children and Families, provides an overview of the differences between stand-alone dental plans and health plans that include pediatric dental coverage. He also shares a resource, developed by the Children's Dental Health Project (CDHP) and Families USA (reviewed below), as well as a report by the CDHP that analyzed the number of federal and state partnership marketplaces that embed pediatric dental coverage in their health plans. He concludes with an overview of the changes that the U.S. Department of Health and Human Services will make to reduce cost sharing for stand-alone dental plans in 2015.
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Resources
Children's Dental Health Project and Families USA
2014This guide, developed by the Children's Dental Health Project (CDHP) and Families USA, provides easy-to-understand information about pediatric dental benefits for children, up to age 19, enrolled in marketplace plans. Depending on the state, dental benefits may be provided as part of medical health plans and/or may be available as a separate stand-alone dental policy. The guide includes a comparison of costs associated with embedded and stand-alone plans. A chart shows the differences between the consumer protections that health plans and dental plans must provide. Dental plans are exempt from many of the consumer protections mandated by the Affordable Care Act. For example, dental plans can refuse to cover individuals with pre-existing conditions and can charge higher premiums based on an individual's health status. National Academy for State Health Policy (NASHP) NASHP has created an interactive map that provides information about the strategies each state uses to ensure children and youth enrolled in Medicaid receive the federally mandated Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit. Learn how each state defines medical necessity, and how they may pay for behavioral health and care coordination services.
As part of Healthy People 2000, the Maternal and Child Health Bureau (MCHB) within the Health Resources and Services Administration (HRSA) developed six key performance measures to ensure children and youth with special health care needs receive care within a comprehensive, coordinated, community-based service system. Many organizations have developed standards for these performance measures, but this is the first work to develop a "nationally endorsed set of standards...to improve health care quality and health outcomes for this population of children." This white paper describes the need for pediatric system standards, especially in this era of national health reform. Once the background information was collected, the national work group met to discuss the findings and come to an agreement about developing the content areas for the standards. Meg Comeau, the co-principal investigator for the Catalyst Center, was a member of this workgroup. The Standards for Systems of Care for Children and Youth with Special Health Care Needs lists each performance measure, system domains, system standards, existing national principles and frameworks, federal requirements, and relevant quality measures.
News From Our Partners
"Meet" Laura Kavanagh, the Director of DMCHWD, and watch her "welcome video" to hear an overview of the training programs. The redesigned site has information about funded projects, news and events, and much more. You can also learn about the Division's goals for the 21st century, which include MCH Workforce Development, Diversity and Health Equity, Interdisciplinary/Interprofessional Training and Practice, and Science, Innovation and Quality Improvement.
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Events & Announcements
Date: March 26, 2014
Time: 7:00 pm ET
To Join By Phone Only, Dial 646-307-1705, Access Code: 603-316-464
Date: March 31, 2014
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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 Project 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, Co-Principal Investigator, 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. Kathleen Watters, MA, 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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