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
"You can never climb the ladder of success with your hands in your pocket."
~ African Proverb
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Featured Article
In an effort to keep the cost of health insurance premiums low, many insurers who sell health plans through the marketplaces have narrow networks of providers. Families who purchased marketplace plans are discovering their providers of choice are not in network. Faced with paying the full cost of services for an out-of-network provider, they must decide if they can afford continuity of care. And, as reported in this article, it is not always easy to find an in-network provider, as some are limiting the number of patients they accept with marketplace coverage. Washington State and New York have already enacted new standards to ensure network adequacy and protect consumers from out-of-pockets costs for seeking care outside of a health plan's network. The National Association of Insurance Commissioners is adding new consumer protections to its model law. In addition, the Obama administration and state insurance regulators are looking to create new network standards for marketplace plans based on Medicare network adequacy rules.
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 IN THIS ISSUE
News Items
Resources
Events and Announcements
In Case You Missed It...
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News Items
Annual Medicaid Costs for Pediatric Asthma-related ED Visits Topped $270 Million 
Healio
July 15, 2014
Asthma is one of the five most costly conditions for children. Depending on severity, childhood asthma can be a disabling condition and is included in the Social Security Administration's Childhood Listing of Impairments. This article, based on the research presented in State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits, reports that emergency department (ED) visits for the treatment of asthma in children cost state Medicaid and Children's Health Insurance Programs (CHIP) $272 million in 2010. On January 1 of this year, the Centers for Medicare and Medicaid Services (CMS) expanded payment rules. State Medicaid and CHIP programs can now reimburse community health workers and certified asthma educators for providing preventive asthma care. Previously, CMS had allowed states to define the types of settings in which care could be provided. These two changes have the potential to reduce the severity of asthma in children enrolled in Medicaid and CHIP, improve child health, and reduce costs related to the treatment of asthma.
Autism Program Impresses Iowa Legislators
By Tom Leys
The Des Moines Register
July 20, 2014
The Medicaid program in Iowa covers Applied Behavioral Analysis (ABA) therapy for children with "severe intellectual disabilities." By state mandate, state employee health plans are required to "provide coverage benefits to covered individuals under twenty-one years of age for the diagnostic assessment of autism spectrum disorders and for the treatment of autism spectrum disorders." These protections help children diagnosed with autism spectrum disorders enrolled in Medicaid or a state employee's health plan. State legislators recognized and decided to bridge the gap in autism services for children with other employer-sponsored insurance. In 2013, the Iowa legislature allocated $5 million to pay for ABA. This article includes the story of one young child who is benefiting from this decision.
U.S. Department of Health and Human Services (HHS) Press Office
July 9, 2014
The Affordable Care Act (ACA) includes a section that authorizes the Centers for Medicare and Medicaid Services (CMS) to test service delivery and payment models that have the potential to improve quality of care and lower costs for individuals enrolled in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). Public and private organizations can apply for Health Care Innovation Awards. With CMS approval of its proposal, the organization receives funding to test its innovative strategy for improving care and lowering costs. On July 9, 2014, HHS Secretary Sylvia Mathews Burwell announced the second round of Health Care Innovation awardees. The award amount is not final, but three of the ten awardees who will focus on improving care for children will specifically work to improve care for children with medical complexities. Read the Health Care Innovation Awards Round Two Project Profiles.
Connecticut Health Foundation
July 8, 2014
In the spirit of "nothing about us without us," the Connecticut Health Foundation is sponsoring a Diverse Advocacy and Consumer Engagement in Health Reform project. The goal of this one-year initiative is to promote health equity by ensuring diverse consumers have the knowledge and skills they need to provide input about health reform implementation. As part of a competitive application process, the African Caribbean American Parents of Children with Disabilities, Inc., the Hispanic Alliance of Southeastern Connecticut, the Greater New England Minority Supplier Development Council, and the Hispanic Federation will share the $350,000 of funding provided by the Foundation. These organizations will focus on a variety of projects that include promoting health literacy, eliminating barriers to health insurance enrollment, increasing understanding of the Affordable Care Act (ACA), and monitoring the implementation of enrollment systems.
By Michelle Andrews
Kaiser Health News
July 18, 2014
In this installment of A Reader Asks, Michelle Andrews clarifies that anyone can purchase health insurance through a marketplace as long as he or she is a U.S. citizen or lawful resident in the country and is not in jail. However, not everyone is eligible for subsidized plans. In order to receive federal subsidies to help defray the cost of marketplace insurance, household income must be less than 400% of the federal poverty level and the individual or family must not have access to affordable, adequate health insurance through an employer. Employer-sponsored insurance is affordable if the premiums for an individual policy are less than 9.5% of household income. Employer plans are adequate if they pay for 60% of the cost of covered services.
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Resources
Prepared by David Murphey, Brandon Stratford, Rachel Gooze, Elizabeth Bringewatt,
P. Mae Cooper, Rachel Carney, and Angela Rojas
Child Trends
July 2014
This policy brief provides and overview of the current state of mental health services for children and provides recommendations for improving overall wellness. This includes integrating physical and mental health, overcoming stigma, and revamping current payment models that create barriers to both access to care and to the provision of preventive services. The authors also provide a framework for improving policies and practices around promoting family wellness at home and in the community, identifying children at risk, and improving support services.
By Tricia McGinnis, Maia Crawford, and Stephen A. Somers
The Commonwealth Fund
July 2014
The Affordable Care Act (ACA) includes provisions to expand Medicaid and funds innovative strategies to improve the delivery of health services at reduced costs (read more above in Health Care Innovation Awards to Provide Better Health Care and Lower Costs). At the same time, providers are focusing on patient- and family-centered care and looking to connect them to community-based supports for unmet social needs. This issue brief from The Commonwealth Fund provides a policy framework to help states achieve the Triple Aim (improve care, improve population health, and decrease costs) by developing a system for coordinating and managing cross system collaborations, sharing data to measure quality and outcomes, and developing a payment and financing model that rewards system integration. The authors provide steps for integrating health and social services and state- and community-based examples of integration efforts.
Center for Health Care Strategies
June 2014
This fact sheet from the Centers for Health Care Strategies, Inc. (CHCS) highlights the differences in use of Medicaid behavioral health services among children in foster care and other children enrolled in Medicaid. Children in foster care are more likely to use behavioral health services and are more likely to be prescribed one or more psychotropic medications. They also have higher costs than the general child Medicaid population. Cross-system collaboration, improving medication monitoring, and expanding access to more appropriate behavioral health services, such as intensive care coordination, in home supports, and providing peer supports have the potential to improve quality of care and reduce costs for children in the foster care system. CHCS has an excellent infographic that illustrates A Striking Contrast: Behavioral Health Care for Children in Foster Care vs. the General Medicaid Child Population.
News From Our Partners
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Events & Announcements
Date: July 24, 2014
Time: 2:00 to 3:00 pm ET
Date: July 29, 2014
Time: 1:00 to 2:15 pm ET
Date: July 31, 2014
Time: 1:00 to 2:00 pm ET
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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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