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
"Life is like a game of soccer. You need goals. If there are no goals in your life then you can't win.
~ Unknown
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A Focus on Improving Access to Care
Earlier this month, the Commonwealth Fund issued Health Care Coverage Under the Affordable Care Act--A Progress Report that estimates 20 million people have gained health coverage as of May 1, 2014. Many are wondering how providers will meet the increased demand for health services now that people are no longer delaying or forgoing care due to lack of insurance. This issue of Catalyst Center Coverage includes five articles that feature ideas for increasing access to providers (see below). Two of the articles focus specifically on improving access for children and youth with special health care needs (CYSHCN).
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Featured Article
Telemedicine provides a way for health care providers and patients in two difference locations to communicate in real time, increases access to care for patients in remote and underserved areas, and provides access to specialty providers for individuals with complex health needs. And, as more people have gained health insurance under the Affordable Care Act (ACA) and are first seeking health care, telemedicine can be a way for doctors to see increased numbers of patients and help alleviate a provider shortage. But, in order to consult with patients in different states, physicians have to be licensed in the state where the patient is. The Federation of State Medicaid Boards has drafted an interstate compact that would make it easier and faster for doctors to obtain licenses to practice in multiple states. In order to be eligible for this process, doctors must be certified in a medical specialty, cannot be under investigation, and must not have a disciplinary history. States, many of whom have expressed support for the compact, retain the right to regulate medicine in accordance with state laws and regulations. The Obama administration, in an effort to promote the use of telemedicine, has provided grants to the Federation to build support for the compact among states.
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 IN THIS ISSUE
News Items
Resources
Events and Announcements
In Case You Missed It...
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News Items
 Providers Addressing Lack of Child Psychiatrists 
By Paul Swiech
Pantagraph.com
June 23, 2014
There is a shortage of child psychiatrists in Illinois and, unfortunately, there is also a "growing number of children with mental illness." In order to bridge the provider gap, support primary care providers, and ensure children receive needed mental health services, Illinois is using teleconferencing. Primary care providers consult with child psychiatrists via teleconference for assistance in diagnosing and treating children. Families can also access care coordinators, in person or by phone. This helps facilitate communication among providers and provides an opportunity for families to discuss their needs for and receive referrals to additional support services, such as parent support groups.
 HHS Awards $83.4 Million to Train New Primary Care Providers
U.S. Department of Health and Human Services (HHS) Press Office
July 7, 2014
The Affordable Care Act included funding to create the Teaching Health Center Graduate Medical Education (THCGME) Program to increase residency training programs in pediatrics, family medicine, psychiatry, general dentistry, and other fields. This latest round of funding expands the number of teaching health centers to three additional states. It also provides support for more than 550 residents, which is 200 more residents than the 2013-2014 academic year. See the list of existing and new Teaching Health Center GME 2014 Grant Awards.
U.S. Department of Health and Human Services (HHS) Press Office
July 8, 2014
Over the last three years, the Affordable Care Act (ACA) has funded more than 550 new community health center sites. Community health centers provide primary health care services to medically underserved and/or high need communities. On July 8, Sylvia Matthews Burwell, the Secretary of the U.S. Department of Health and Human Services (HHS), announced the availability of $100 million in Affordable Care Act (ACA) funding to support an additional 150 new community health centers throughout the country. This will not only increase access to primary care, but will also help raise awareness of the coverage opportunities available through the ACA, because community health centers help enroll people in coverage.
PRNewswire
June 25, 2014
This article reports that 2 million of the 3 million children with medical complexities enrolled in Medicaid account for almost 40% of total Medicaid spending for children. The Advancing Care for Exceptional (ACE) Kids Act of 2014 (H.R. 4930), introduced by Representatives Joe Barton and Kathy Castor, would create "nationally designated networks that cross state lines under Medicaid." These networks would facilitate treatment across state lines and ensure children have access to highly trained pediatric specialists. This Act would also help coordinate and reduce costs of care.
By Kristy Kennedy
AAP News
July 1, 2014
This article provides examples of state Title V and American Academy of Pediatrics (AAP) Chapter collaborations to improve services for children with special health care needs (CSHCN). In Ohio, the AAP chapter and the State Title V program wanted to improve screening and diagnosis of children with developmental disabilities so the children could be referred to early intervention programs as soon as possible. Title V and the AAP worked together to train doctors to provide screenings. And, in order to benefit both the children and the providers, doctors received credit towards their Maintenance of Certification requirements. In Wisconsin, among other efforts, Title V and the AAP established a telephone consultation line to link primary care providers with pediatric psychiatrists to support them in caring for children and youth with mental health needs. Washington AAP members share concerns they identify in their clinics with Title V to inform policies, such as managed care for CSHCN. Want to know more about Title V? This article includes "the top 10 things pediatricians should know about Title V," which is of interest to other stakeholders as well.
By Michelle Andrews
Kaiser Health News
June 24, 2014
Connecticut mandates coverage for autism services and includes them in the state's essential health benefits. However, a decision by the Connecticut Insurance Department to classify behavioral therapy as habilitative is causing concern. Habilitative services are medical, rather than mental health services. This decision exempts insurers from having to provide behavioral therapy in parity with medical services. In addition, depending on the age of the child, Connecticut provides different dollar amounts of autism-related services. While the Affordable Care Act (ACA) prohibits insurers from setting annual or lifetime dollar caps for essential health benefits, they can still limit the amount, scope, and duration of specific services. Insurers are converting the dollar amounts of autism services into hours of care or number of visits. This may make it difficult for families to compare behavioral therapy options among plans and make the best choice for a child with an autism spectrum disorder.
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Resources
By Dayana Simons, Taylor Hendricks, Jessica Lipper, and Sheila A. Pires
Center for Health Care Strategies
July 2014
This report, the product of a Children's Health Insurance Program Reauthorization Quality Demonstration (CHIPRA QD) grant to Maryland, Georgia, and Wyoming, provides information about the use of intensive care coordination (ICC) to provide wraparound services for children with behavioral health needs. It provides information about established, evolving, and emerging ICC/wraparound programs in 15 states. Details for each state include the general structure, eligibility and screening, requirements for care coordinators, and evaluation and monitoring.
By Sharon Silow-Carroll, Brooke Ehrenpreis, and Stan Rosenstein
Lucile Packard Foundation for Children's Health
June 2014
The California Department of Health Care Services, in partnership with county health departments, provides care coordination services for children and youth with special health care needs (CYSHCN). This issue brief, created by Health Management Associates (HMA) for the Lucile Packard Foundation for Children's Health, was prompted by concerns about funding and inconsistencies in care coordination services across counties. HMA examined care coordination programs in Florida, Maryland, North Carolina, Rhode Island, South Carolina, and Vermont. They collected information about reimbursement, financing, monitoring, and lessons learned that California can use to redesign its care coordination program and promote the Triple Aim ("better care, better health, and lower costs"). Appendices include tables about each state's eligibility, care coordination services and standards, financing and reimbursement, and sample assessments and other tools.
News From Our Partners
The Latest EPSDT Resources
The Maternal and Child Health Library at Georgetown University (MCH Library) is a one-stop source of materials for Title V agencies, health professionals, researchers, families, and others. One of the many new resources available this month is an updated version of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services in Medicaid Knowledge Path. Visitors can learn about EPSDT policy, tools, links to data sources, journal articles, and more. The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services in Medicaid Resources for Families section provides resources for learning more about the EPSDT benefit, tools, and links to other organizations that can help locate care, services, and supports.
Highlighting Diversity and Health Equity
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Events & Announcements
Date: July 17, 2014
Time: 3:00 to 4:30 ET
Date: July 22, 2014
Time: 2:00 to 3:30 pm ET
This webinar, hosted by the National Academy for State Health Policy (NASHP), is an opportunity to learn about states' experiences during the Affordable Care Act's (ACA) first open enrollment period. As states prepare for the next open enrollment period that will begin on November 15, NASHP program directors will share what they learned from interviews with 10 states. Panelists from Kentucky, Montana, and Washington State will provide additional information about innovative strategies for promoting enrollment and retention in marketplace health plans. Register for the Enrollment 1.0: State Reflections on ACA's First Year and What's Next webinar.
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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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