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
"All the world's a stage, and most of us are desperately unrehearsed."
~ Sean O'Casey
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Featured Article
 Medicaid Managed Care: Modernized Federal Regulations Have Finally Been Released 
By Sarah Somers
Health Advocate
June 2015
The June issue of the National Health Law Program's e-newsletter Health Advocate provides an overview and explanation of the recent changes to the Medicaid managed care regulations proposed by the Centers for Medicare and Medicaid Services (CMS) outlined in Medicaid and Children's Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability, 80 Fed. Reg. 31,098-31,297 (proposed June 1, 2015). This is the first major revision to Medicaid managed care since 2002. Notable changes have been made to enrollee rights and protections, network adequacy, and rate setting, among others. Comments on the proposed regulations are due to CMS by July 27, 2015. |
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IN THIS ISSUE
Featured Article
News
Resources
Announcements and Events
In Case You Missed It...
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News Items
States Consider Better Pay for In-Home Caregivers
By Rebecca Beitsch
Disability Scoop
June 10, 2015
With a growing emphasis on persons with disabilities and seniors receiving care at home rather than in institutional settings, in-home caregivers are in high demand. However, they are often poorly compensated and lack employment benefits such as overtime, health insurance, and retirement because federal minimum wage and overtime protections do not currently apply to them. The caregiver workforce is predominantly female, minority and lives at or below the federal poverty level. A U.S. Department of Labor regulation released in 2013 calls for minimum wage and overtime rules to be applied to in-home care workers, but implementation is stalled pending litigation. Several states have increased wages on their own for this vital workforce, but there is widespread concern that increasing benefits and wages may lead to further spending at a time when state Medicaid budgets are under significant pressure to control costs. Learn more about the Department of Labor's Final rule: Application of the Fair Labor Standard Act to Domestic Service.
When Your Doctor Leaves Your Health Plan, You Likely Can't Follow
By Michelle Andrews
Kaiser Health News
June 2, 2015
When a doctor leaves an insurance provider network, enrollees who are his or her patients are generally not entitled to then change insurance plans in order to follow the provider. However, under certain circumstances, insurers will continue to pay for care by the provider "outside" of their network. "Continuity of care" laws in some states allow for pregnant women or people receiving ongoing treatment for a serious medical condition or terminal illness to continue seeing their provider for a specified amount of time, which varies according to the circumstance. Find information on provider networks and some examples of states that have continuity of care laws in the Families USA Issue Brief: Affordable Care Act: Standards for Health Insurance Provider Networks: Examples from the States.
Even As Obamacare Seeks to Expand Women's Coverage, Some Still Face Key Gap
By Michelle Andrews
Kaiser Health News
June 16, 2015
As adult children of child-bearing age may now remain on their parents' insurance up to age 26, many families must pay out-of-pocket for a significant portion of the cost of labor and delivery. Maternity care, including prenatal, delivery, and postpartum care, is covered under the ACA's essential health benefits for individual and small group plans, and large employers are required to cover maternity care for employees and their spouse under the 1978 Pregnancy Discrimination Act. The federal government recently clarified that prenatal care for dependents must be covered without cost-sharing as a preventative service, except in grandfathered plans. But insurers do not have to pay for maternity care (labor and delivery) for dependent children who are enrolled in their parents' plan. Legal advocacy groups have filed sex discrimination complaints against five employers for excluding pregnancy-related services for employee dependents.
In anticipation of the upcoming U.S. Supreme Court decision in King v. Burwell which will determine the fate of federal health insurance subsidies in the 34 states currently operating federal or state-federal partnership Marketplaces, the U.S. Department of Health and Human Services has conditionally approved plans in Pennsylvania, Delaware, and Arkansas to increase state control over the Marketplaces. Roughly 6 million people nationwide are at risk for losing the subsidies that make their health insurance affordable but to date, the other potentially impacted states have not publicly released contingency plans.
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Resources
By Agency for Healthcare Research and Quality (AHRQ)
June 10, 2015
The 13th edition of Evaluation Highlights from the CHIPRA Quality Demonstration Grant Program is now available. This edition outlines successful strategies states have used to improve medical home capacity and/or quality of care in the pediatric practices that participated in learning collaboratives under the CHIPRA quality demonstration.
Implementing Health Reform: Provision of Summary of Benefits and Coverage, and More
By Timothy Jost
Health Affairs Blog
June 14, 2015
This blog post outlines the recently released final rules regarding the Summary of Benefit and Coverage (SBC). Under the ACA, the original rule required insurers to provide information about insurance plans so that applicants could compare plans and enrollees could easily access and understand their benefits once enrolled. The new rule, finalized on June 12, 2015, is based on feedback received since 2012 when the original rule was issued. Read a CMS Center for Consumer Information and Insurance Oversight fact sheet on the final rule.
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Announcements & Events
Date: July 16, 2015Time: 12:00 to 1:00 pm ETThis webinar, hosted by Maine Quality Counts & MECHIP, explains why it's important to collect family history in primary care and include the information in a child's electronic medical record. It is also an opportunity to share strategies for assessing family strengths. Register for the Obtaining and Documenting a Pediatric Family History webinar.
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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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