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
"If we don't stand up for children then we don't stand for much."
~ Marian Wright Edelman
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Featured Article
 Healing a Child's Broken Heart
By Marian Wright Edelman
Huff Post: The Blog
May 15, 2015
Medicaid turns 50 this year. Together Medicaid and the Children's Health Insurance Program (CHIP) provide coverage for 57% of America's children. In 2013, more than half of the 5.2 million children without insurance were eligible for Medicaid or CHIP but were unenrolled. The majority of eligible but unenrolled children were children of color, older children (13 to 18 years old), and children living in rural areas. This article tells the story of a young girl with a heart condition who was not receiving needed specialty services because she was uninsured. The school nurse helped connect the family to coverage, and the child got the care and surgery she needed. The article emphasizes the role schools can play as important partners in outreach and enrollment.
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IN THIS ISSUE
Featured Article
News
Resources
News from Our Partners
Events and Announcements
In Case You Missed It...
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News Items
White House Moves to Fix 2 Key Consumer Complaints About Health Care Law 
By Robert Pear
The New York Times
May 8, 2015
Consumers complained and the White House responded. As reported in this article, consumers are distressed to find they are paying unanticipated out-of-pocket health costs that they thought their health plans would reimburse. In addition, consumers and providers are frustrated that provider directories are not up to date. This problem is not unique to the Qualified Health Plans sold in the Marketplaces. Provider directories for Medicaid managed care organizations are also inaccurate. The Obama administration has issued new standards for the federal Marketplace. Insurers must publish up-to-date directories at least once a month or pay a fine. In addition, the directories must not only list the providers, but also include if they are accepting new patients, their specialties, and hospital affiliations. This will facilitate access to care and ensure network adequacy. Consumers will know which doctors are accepting new patients, and primary care providers will know the specialty providers and hospitals, such as children's hospitals, where they can refer patients. The Administration also hopes to include an online tool to help consumers estimate their out-of-pocket costs to raise awareness that the cost of health care is not limited to just the monthly premiums they pay.
CHIP Participants Can Avoid Tax Penalties
By Heather Stauffer
Insurance News Net
May 1, 2015
Pennsylvania families with income in excess of 300% of the federal poverty level can purchase coverage for their children through the state's Children's Health Insurance Program (CHIP) Buy-in program. (Note: the CHIP Buy-in program is separate from the Pennsylvania CHIP program). The Centers for Medicare and Medicaid Services (CMS) has been reviewing CHIP Buy-in programs to make sure they provide Minimum Essential Coverage (MEC). Until recently, families whose children were enrolled in the CHIP Buy-in program thought they would have to purchase new insurance for their children or face a tax penalty because the covered services were not considered MEC. However, CMS has now ruled that the Pennsylvania CHIP Buy-in meets the MEC requirement.
State Rebuffed in Children's Medicaid Fight
By Jim Saunders
CBS Miami
May 4, 2015
The Florida Agency for Health Care Administration contends that a decade-old lawsuit by the Florida chapter of the American Academy of Pediatrics should be dismissed based on a recent decision by the U.S. Supreme Court that said only the U.S. Department of Health and Human Services can enforce Medicaid law. While a Florida judge agreed that the state can't be sued for low Medicaid provider reimbursement rates, the two other charges - that the state does not provide reasonable access to care and that outreach to Medicaid-eligible children is insufficient - still have merit, and the case will move forward. By Kaitlin Sheedy
Statereforum
April 30, 2015
Medicaid reimbursement for Telehealth, the use of telecommunications and electronic information to increase access to care for individuals living in rural areas, varies from state to state. Some states only reimburse for physician services, while others include services provided by physician assistants and nurses. Others reimburse for electronic sharing of digital images, remote monitoring of vital signs, such as blood pressure, and mental health services.
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Resources
Mental Health America
2015
The authors of this report examined national survey data that was available for all 50 states and the District of Columbia to see if the Affordable Care Act (ACA) increased coverage and access to care for individuals with mental health needs. The measures included children with Emotional, Behavioral, or Developmental (EBD) issues and if they were insured consistently, if the insurance was adequate, and if those who needed mental health services received them. The report includes rankings by state.
Medicaid Primary Care Parity
Health Policy Brief
Health Affairs
May 11, 2015
In an effort to entice primary care providers to accept Medicaid and ensure access to care, the Affordable Care Act (ACA) included funding for a "Medicaid primary care fee bump" for 2013 and 2014. Even though the enhanced federal match ended in December 2014, 16 states and the District of Columbia have decided to continue to reimburse primary care providers at the higher rate. This brief examines the policy and reviews the evidence about increased numbers of Medicaid providers versus increased capacity of providers who already serve Medicaid patients.
New Tip Sheet from Got Transition
Got Transition is the national center that works to improve transition from pediatric to adult health care. In partnership with the American Academy of Pediatrics, they have developed a Coding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care that describes payment methodologies and provides a list of CPT (Current Procedural Terminology) codes providers can use to bill for the transition-related services they provide.
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Events & Announcements
Date: May 19, 2015
Time: 3:00 to 4:00 pm ET
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In case you missed it... the most popular news item from our last issue
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Want more news?
To view more articles from past issues of Catalyst Center Coverage, visit the Catalyst Center website. Or follow the Catalyst Center on Facebook or Twitter.
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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, the National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs, is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U41MC13618, $473,000. This information or content and conclusions are those of the Catalyst Center staff and should not be construed as the official position or policy of nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. LT Leticia Manning, MPH, MCHB/HRSA Project Officer.
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