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
"Why not go out on a limb? Isn't that where the fruit is?"
~ Frank Scully
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Featured Article
On July 7, 2014, the Centers for Medicare and Medicaid Services (CMS) issued an information bulletin about Clarification of Medicaid Coverage of Services to Children with Autism. The bulletin does not specifically say that Medicaid programs must cover applied behavioral analysis (ABA) for children diagnosed with autism spectrum disorders. Rather, it provides information about how states can cover autism services under section 1905 benefit categories including the federally mandated Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit. Coverage of autism services, specifically ABA, by private insurance and Medicaid has received a lot of focus. To date, 37 states and the District of Columbia have enacted autism insurance reform laws which require some private health insurers to cover autism services. Federal circuit courts in Florida and Ohio have ruled that Medicaid must cover ABA under EPSDT. As states work to implement the policies described in the CMS informational bulletin, the child's age and family income, dollar amount of services, or the disability criteria that some states use to determine a child's eligibility for ABA through Medicaid will no longer apply. Advocates are hoping that families like the Maldonado family profiled in this article will no longer have to pay out of pocket for ABA or purchase expensive individual policies to ensure their children with autism spectrum disorders receive needed medical and behavioral health services. |
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 IN THIS ISSUE
News Items
Resources
Events and Announcements
In Case You Missed It...
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News Items
From New Jersey: Strategies to Support Youth with Serious Behavioral Health Needs 
By Taylor Hendricks
Center for Health Care Strategies (CHCS) Blog
September 3, 2014
This blog provides information about New Jersey's care management entity (CME) approach to meeting the needs of children and youth with behavioral health issues. CMEs provide a range of services designed to "help youth and families address behavioral health issues and create long-term plans to keep youth in their homes and communities." Core CME services include intensive care coordination, crisis response and intervention, and links to peer supports and home- and community-based services. Medicaid pays the majority of costs for CMS services; state contracts provide additional funding. Children whose family income is too high for Medicaid can access these services through a Medicaid "look-alike" plan. As part of quality improvement, CMEs collect data and report on service utilization, management, and quality outcomes. The blog guides readers through the CME process from referral to transition. The Centers for Medicare and Medicaid Services (CMS) is providing funding for a quality improvement collaborative. The Center for Health Care Strategies (CHCS) is working with Georgia, Maryland, and Wyoming to expand or implement the CME approach to behavioral health services.
Study: Follow-Up Critical After Developmental Screenings
By Shaun Heasley
Disability Scoop
September 2, 2014
Part C of the Individuals with Disabilities Education Act (IDEA) describes early intervention services for infants and toddlers through age three. The Part C Findings and Policy section notes that early intervention services were created to enhance the development of young children with disabilities, to maximize their potential for independent living, to reduce educational costs, and to help families meet the needs of their children with special needs. Therefore, timely identification of developmental delays and referral to early intervention services is important. This article reports the findings of the Improving Developmental Screening Documentation and Referral Completion study at a children's hospital in Colorado. Researchers found that use of a developmental screening template increased the referral rate to early intervention and other community resources. However, when the pediatric primary care office phoned the family to further explain early intervention services, follow-up on referrals improved from 20% to 50%. Follow-up phone calls are just one step in the process to improve quality of care for children with disabilities.
By Drew Altman
The Wall Street Journal
September 4, 2014
The Affordable Care Act (ACA) has transformed the health insurance and health care delivery system in the U.S. It can be difficult to navigate health insurance even when you've always been insured. For individuals and families who are newly insured, it's a brave new world. In this article, Drew Altman provides statistics about what people don't know about their marketplace coverage and about using health insurance. If you know someone who needs help using their health insurance, please share information about the upcoming Got Coverage? Next Steps in Using Your Health Insurance webinar detailed below. If you are in contact with families who have questions about health coverage for their children with special health care needs, be sure to connect them with the Family-to-Family Health Information Center (F2F) in their state. Find the F2F in your state on the Family Voices National Center for Family/Professional Partnerships website. Find additional Family Resources in English and in Spanish on the Catalyst Center website.
CMS Media Relations
September 3, 2014
The Centers for Medicare and Medicaid Services (CMS) reports a good news/good news scenario for health care spending in 2013. Due to the Affordable Care Act (ACA), the number of people without health insurance has decreased. This means more people are using health services, which is why health care spending in 2013 increased - but at a much slower rate than expected. In fact, for the previous five years, the growth rate for health care spending was less than 4%. By the end of this year, it is estimated that 9 million people will have gained health insurance and that the health care spending growth rate will increase to 5.6%. There is a projected 0.2% decrease in out-of-pocket spending.
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Resources
By Jay G. Berry, Kevin Blaine, Jayne Rogers, Sarah McBride, Jackie Birmingham, Mark A. Schuster, and Chris Feudtner
JAMA Pediatrics
August 25, 2014
A successful pediatric discharge from the hospital to home or other setting should begin when the child is first admitted to the hospital. In this article, the authors present a framework for discharging pediatric patients and use a case study to illustrate each step of the process. The discharge framework includes involving the family, setting discharge goals, identifying and assessing needs (such as family leave from work, special diets, or health literacy), monitoring the discharge plan and progress, and following up after discharge. These steps help ensure patient safety and satisfaction, reduce the potential for readmission, and decrease costs. Discharge planning also provides an opportunity for health professionals to understand the elements of the discharge-planning process and learn what works and what does not work.
The Henry J. Kaiser Family Foundation
August 28, 2014
As of August 28, 2014, 27 states and the District of Columbia have expanded Medicaid to non-disabled, non-pregnant, childless adults ages 19 to 65, whose household income is less than 138% of the federal poverty level. While the majority of these states have expanded Medicaid by implementing the optional adult Medicaid expansion provision of the Affordable Care Act (ACA), several have used Medicaid Section 1115 demonstration waivers. Utah and Indiana are currently debating whether or not to move forward with the Medicaid expansion, although Indiana has a pending waiver. Twenty-one states are not moving forward with the Medicaid expansion at this time.
By Claire McAndrew and Sinsi Hern�ndez-Cancio
Families USA
August 2014
Now that more people have health insurance due to the Affordable Care Act (ACA), Families USA, is focusing on ways to overcome the barriers that communities of color face when trying to access health providers. This issue brief includes examples of policies that states have implemented to ensure that insurance networks include sufficient numbers, types, and distribution of providers; provide timely access to services; and that services are language-accessible and culturally competent.
News From Our Partners
AMCHP Awards
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Events & Announcements
Date: September 9, 2014
Time: 2:00-3:00 pm ET
Date: September 9, 2014
Time: 3:00 - 4:00 pm ET
Date: September 10, 2014
Time: 1 pm ET
This webinar and conference call is an opportunity to learn how to use your health insurance, find a doctor, make appointments, and handle a health emergency. Participants will also learn about recommended health screenings and key health insurance terms. Send questions in advance to ACA101@hhs.gov before 10 am on September 10. Register for the Got Coverage? Next Steps in Using Your Health Insurance webinar. To join by phone only, dial 702-489-0001 and enter access code 163-133-543. The pin number is the # (pound) key.
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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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