Author Suggests Solution to Doctor Shortage - A Solution Long Employed in Rural Healthcare

An editorial published in The New York Times on December 16th says the expansion of healthcare coverage to millions of uninsured Americans under the Affordable Care Act will make the doctor shortage even worse. The author suggests the sensible solution to this crisis — particularly to address the short supply of primary care doctors — is to rely much more on nurse practitioners, physician assistants, pharmacists, community members and even the patients themselves to do many of the routine tasks traditionally reserved for doctors. What the author may not know is that this solution has long been employed in the world of rural health. Read the full opinion here. 

    

Don’t Miss This Important Meeting Hosted by HCPF to Discuss Distribution of Savings to RHCs, FQHCs, BHOs and RCCOs

The Department of Health Care Policy and Financing is beginning a series of ongoing discussions bringing together the Regional Care Collaborative Organizations (RCCOs), the Primary Care Medical Providers (including FQHCs and RHCs), and the Behavioral Health Organizations (BHOs), with HCPF acting as a mediator, to discuss an equitable distribution of savings for these parties. The first of these discussions will be held at the next Accountable Care Collaborative (ACC) Payment Reform Subcommittee meeting tomorrow, December 14th from 2:30 PM to 4:30 PM in the 1st floor conference room at 225 E. 16th Avenue. The agenda can be found here, and the call in information can be found below.

Call-in information:
Toll: 1-720-279-0026
Toll free: 1-877-820-7831
Passcode: 610450#
Mute/unmute: *6

HHS Says No Enhanced Match for Partial Medicaid Expansion

The Obama administration filled in a key detail of what states must do to receive full federal funding for an expansion of Medicaid under the 2010 health law. Health and Human Services Secretary Kathleen Sebelius said in a letter sent Monday to governors that states cannot partially expand their Medicaid programs and get full federal funding. In a blog post, Sebelius also outlined other points of the guidance being provided to states, and gave a conditional nod to exchange plans submitted by Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington. Click on the embedded links to read more.

New Issue Brief Says Coloradans Facing More Barriers to Accessing Oral Healthcare

According to a new Colorado Health Access Survey (CHAS) report, the number of Coloradans without dental insurance grew to 2.1 million in 2011 from 1.8 million in 2009 – a 17 percent increase from the 2008-2009 baseline survey. Over 2.5 times as many Coloradans were without dental insurance than were without health insurance in 2011 (829,000 uninsured Coloradans). The problem is even more pronounced among Hispanic Coloradans, the majority of whom (52.8%) reported that they lack dental insurance, an increase from 47.6% in 2008-2009.

The brief, A Growing Problem: Oral Health Coverage, Access and Usage in Colorado, is based on CHAS data from the 2011 CHAS. It shows that all Coloradans are facing more barriers to accessing oral health care, compared to 2008-2009 when the survey was last done. The brief also shows:

• Having dental insurance makes a significant difference in whether Coloradans seek dental care. Of Coloradans who had dental insurance, 76.9% visited a dental professional. Of those with no dental insurance, 44.5% visited a dental professional. 
• Hispanic Coloradans lack dental insurance at a higher rate (52.8%) than white (39.1%) and black (29.9%) Coloradans.
• Lower-income Coloradans lack dental insurance at a higher rate than those with higher incomes. In addition, uninsured Coloradans with low incomes did not seek dental care as often as uninsured Coloradans with higher incomes.
• Cost is the reason nearly one in four Coloradans (22.9%) did not get the dental care they needed, according to the 2011 CHAS. Even those with dental insurance do not always seek care because of cost. More than a third (36.6%) of Coloradans who did not get needed dental due to cost had dental insurance.

 

Raising the Medicare Age Could Leave Thousands Uninsured

It's predicted that lawmakers will reach a fiscal cliff deal that includes a hike in the Medicare eligibility age — a concession to those on the right who seem determined to see very deep entitlement cuts, even if they take benefits away from vulnerable seniors. One argument for raising the eligibility age is that seniors who lose benefits can get insurance through Medicaid or the Obamacare exchanges.
But a new report to be released this week undercuts that argument — and finds that up to half a million seniors could lose insurance if the eligibility age is raised. Read the article here.

CIVHC Answers Frequently Asked Questions About the APCD

Colorado’s All Payer Claims Database (APCD) went live on November 1st at www.cohealthdata.org. The APCD is a secure database that includes claims data from commercial health plans, Medicare and Medicaid. The APCD was created by legislation in 2010 and administered by the Center for Improving Value in Health Care (CIVHC). Since the launch, CIVHC received some common questions which they've answered below. For the complete list of APCD Frequently Asked Questions, click here.

Question: When will it be possible to see more detailed data and reports like cost and quality reporting at the medical group, clinic or physician level?

Answer: We expect to begin reporting comparative cost and utilization information at the level of named facilities, payers and provider groups beginning in late 2013. We are currently developing processes and procedures to share and vet information with affected groups.

Question: Will data or reports eventually be available for individual diagnoses?
Answer: We expect to begin reporting on the incidence/prevalence and costs to treat common chronic diseases beginning in mid-2013. Entities with an interest in a specific diagnosis or set of diagnoses can request a specialized report through the Data Release Process.
Question: Will you eventually capture and report on quality metrics?

Answer: Yes, we are currently working with stakeholder groups both locally and nationally as well as APCDs in other states to identify appropriate and meaningful quality metrics to include in APCD cost and utilization reporting. We anticipate adding quality metrics by the end of 2013.

Question: Will www.cohealthdata.org eventually provide information that allows consumers to make more informed choices regarding their health care?

Answer: Yes, by the end of 2013 we anticipate releasing a consumer focused section www.cohealthdata.org that will provide comparative cost, quality and value information. One of APCD’s core goals is to provide information that allows consumers to better manage resources and make value based decisions regarding their health care. Information based on the APCD will allow consumers, for the first time, to meaningfully shop for health services and better manage their own care.

Question: Are there plans to link the Colorado APCD to other data such as clinical information maintained by the Colorado Regional Health Information Organization (CORHIO) or Quality Health Network (QHN)?

Answer: Finding ways to link together cost and utilization information from the APCD with clinical information systems will eventually provide for a fuller picture of cost, quality and value. However, combining data sources from Health Information Exchanges and the APCD present numerous technical, privacy and resource challenges. No timetable has been established for this work.

Question: Will the Colorado APCD provide data and reports by payer type?

Answer: Yes, once data from additional payers is added, users will be able to view data and reports by payer type, e.g., Medicare, Medicaid, commercial plans, etc. Click here for payers currently included in the APCD and the timeline for adding additional payers.
Question: Will risk adjustment be based on the same methodology used by Medicare?

Answer: The Colorado APCD will begin generating reports based on risk-adjusted data mid-2013. Initially, risk adjustment of Colorado APCD data will be performed using tools developed by 3M. The Colorado APCD has the ability to use other tools for risk adjustment as well, including the Hierarchical Condition Categories (HCCs) currently used by the Centers for Medicare & Medicaid Services (CMS).

Question: Currently, I cannot see who the providers, facilities or counties are in the snapshot reports on imaging services, routine deliveries or knee arthroscopy. Will I be able to see data on a named facility or provider basis in future releases?

Answer: Yes. As we add additional payers and the APCD becomes more representative of Colorado’s insured population, we plan to provide results at finer levels of detail. We anticipate providing cost and utilization data at the level of named facilities, payers and provider groups beginning in late 2013.

Question: I can’t see the interactive maps on my iPad or iPhone, will this be possible in future releases?                

Answer: We hope to address this issue in future releases but in the meantime, those without Flash capability can access the underlying data in the maps by clicking on the Data Sheet within the Maps Tab, or on the Reports Tab

NRHA's Rural Health Policy Institute

With health reform, the fiscal cliff and a new Congress set to decide the future of healthcare, change is coming to rural America. NRHA's Rural Health Policy Institute is a great opportunity for you to educate your elected officials, advocate for your facilities and continue the fight to protect rural healthcare. The Colorado Rural Health Center is the state contact for NRHA's 24th Rural Health Policy Institute, so come with CRHC staff as we learn more about rural health policy and visit our elected officials on the hill!

6 Questions About How the Fiscal Cliff Affects Healthcare

The impending "fiscal cliff" is a package of automatic spending cuts and tax hikes set to kick in next month unless President Barack Obama and Capitol Hill agree on a way to stop them.

Kaiser Health News poses a few questions and answers about what could happen in the weeks before the end-of-year deadline. Read the article here. 

Policy Update from NOSORH

"Fasten your seatbelts, it's going to be a bumpy year!" Bill Finerfrock said during his "Exploring Rural Health Policy Issues" webinar on Nov. 13th. The NOSORH-sponsored webinar was one of the daily webinars offered during the week-long celebration of National Rural Health Day 2012.

At the center of the presentation was a "Washington Update," where Finerfrock gave a run-down on coming changes in House Committee memberships including Ways and Means, and Appropriations, and possible changes in Cabinet-level posts including Defense, State, Justice and Treasury. Finerfrock said that issues that were left unresolved prior to Congressional Adjournment include Bush Tax Cuts, Payroll Tax Cuts, the SGR "fix" (sustainable growth rate fix for Medicare), and Sequestration, which, combined, form what the press is calling the "fiscal cliff." Finerfrock said he thinks Congress will do something to avoid the fiscal cliff. However, if they don’t, the consequences would include a 26.5 percent cut in physician fee schedules, which would have an adverse effect on rural health clinics. Sequestration would also cause a 7- 8 percent annual cut in affected non-defense programs. At this point, he said, there is nothing to do but wait and see. The NOSORH-sponsored webinar was one of the daily webinars offered during the week-long celebration of National Rural Health Day 2012.

For a viewable recording of Finerfrock’s full webinar, click here; for a copy of Finerfrock’s presentation during the webinar, click here.

Source: The Branch: An Update for State Offices of Rural Health and our Partners. December 2012. NOSORH.

Medicaid expansion could cost Colorado $858 million over 10 years

The state's share of costs for expanding Medicaid rolls under federal health-care reform could be $858 million over 10 years, according to new estimates from the Kaiser Family Foundation. The analysts still consider the price a bargain for Colorado and other states that want to bring health insurance to hundreds of thousands of low-income residents. The federal government will pay 100 percent of the added price in the first few years, and bringing people under Medicaid will slow cost-shifting to private insurance and public clinics, they said.

Read the full article by Michael Booth, The Denver Post.

There’s a lot going on in the new essential health benefit rules

This blog entry was originally posted on CHIRblog, a blog from the Center for Health Insurance Reforms, Georgetown University Health Policy Institute.

Last week, right before the Thanksgiving holiday, the Obama Administration released its proposed rule establishing the new, minimum standards for health insurance benefits. For the roughly 29 million Americans who face financial hardship because their health insurance doesn’t cover their needs, this is welcome news. It’s also undoubtedly welcome news to employers and insurance company executives, who need to know the rules of the road before they can design and develop plans that comply with the sweeping insurance reforms set to go into effect in 2014.

Establishing the essential health benefits (EHB) package is just part of a series of proposed rules. The Administration also released new standards for the 2014 market rules (i.e., guaranteed issue, modified community rating, and the prohibition on pre-existing condition exclusions), wellness programs, and rate review. And we’ll likely see more rules coming soon on multi-state plans andexchanges, as well as information about how the federally facilitated exchanges will operate.

While my family debated football and the merits of white meat over dark, I spent some time reading over the new guidance on EHBs. The Administration essentially formalized its bulletinfrom December 2011, allowing states to choose a benefit package benchmark that reflects local needs and meets the statutory requirement of being equal in scope to a “typical” employer plan. A few policy decisions and questions stood out:

State Benefit Mandates

One of the more controversial provisions of the Affordable Care Act is the requirement that states pick up any additional premium costs associated with benefit mandates that are not included in the EHB. HHS provided some good news for benefit mandate proponents, who have worried that consumers might lose access to important benefit protections in states where a benchmark with less coverage is chosen:

· • State benefit mandates enacted on or before December 31, 2011 may be considered EHB, so the state would not be required to pay for any additional costs associated with them. However, those mandates would apply only to the markets originally determined under the state law. In other words, if a pre-2012 state law applies a mandate only to the individual market, it would not become a requirement in the small group market simply because it will now be considered part of the EHB.

· • HHS interprets the Affordable Care Act to affect only those benefit mandates specific to the care, treatment and services that an insurer must offer to its enrollees. If a state has rules regarding provider types, cost-sharing, or reimbursement methods, HHS would not consider those benefit mandates, and states would not be required to defray any additional costs associated with them.

HHS also laid out the enforcement scheme for states to pay any additional premium costs. Exchanges will be required to identify which additional state-required benefits are in excess of the EHB. HHS also proposes that insurers should be responsible for determining the cost, if any, of additional benefits. HHS is asking for comment on whether states should make payments based on the statewide average costs of a benefit, or on each insurer’s actual cost.

State Benchmark Selections

HHS lists states benchmark selections in an appendix to the rule. For states that did not select a benchmark, HHS provides the default selection. However, states can make a selection or change their current selection up to December 26, 2012, the end of the comment period for the EHB rule. As outlined in the December bulletin, the state’s benchmark would be in effect for 2014 and 2015, after which time HHS will revisit its policy on EHBs. HHS has addressed a number of outstanding policy questions, and raised some of its own:

· • Treatment of Multi-State Plans. HHS is proposing that multi-state plans will NOT be subject to a state’s benchmark plan, but instead must meet a standard set by the U.S. Office of Personnel Management (OPM). This could raise concerns about a level playing field among plans within a state, but we don’t yet know what rules OPM will have them follow.

· • Defining habilitative care. Coverage of habilitated services is required under the Affordable Care Act. However, this benefit is frequently not covered in employer sponsored plans and insurers may define it differently. As a result, HHS is proposing that states may define habilitative services, if the benefit is not included in their benchmark plan. If the state does not define habilitative services, then the insurers may define it.

· • Discriminatory benefit design. The Affordable Care Act prohibits insurers from using benefit design to discriminate against high-need enrollees. However, there are no set metrics for determining whether a benefit plan is discriminatory. HHS proposes that states review plans for outlier provisions, such as unusual cost-sharing or limits on benefits, that would suggest possible discrimination.

· • Parity. HHS confirms its previous guidance that plans, in order to meet the EHB requirements, must provide mental health and substance abuse services in a manner that complies with federal mental health parity law.

· • Substitution. HHS is proposing that insurers be able to substitute benefits within benefit categories, but not between benefit categories. The proposed substitution policy does not apply to prescription drugs. Insurers must supply an actuarial certification, attesting that any substituted benefit is actuarially equivalent to the original benefit in the EHB benchmark plan. HHS also clarifies that states have the authority to restrict substitution or prohibit it entirely.

· • Prescription drugs. HHS has broadened its approach to prescription drugs, originally outlined in the December 2011 bulletin. Instead of requiring insurers to cover at least one drug in each category and class, HHS is now proposing that plans must cover at least the greater of: one drug in every category and class or the same number of drugs in each category and class of the EHB-benchmark plan. Thus, if the EHB benchmark plan covers more than one drug in a category or class, then all plans must offer at least that number.

Cost-sharing

The proposed rule also provides details on the Affordable Care Acts cost-sharing limits. The proposed rule ties the annual limit on cost-sharing to the out-of-pocket limit for high-deductible health plans provided under tax law. For the year 2013, the limits would be $6,250 for self-only coverage and $12,500 for family coverage. However, HHS is offering insurers a waiver from the limits on deductibles, if it can’t reasonably meet a Bronze level of coverage without raising the deductible.

Actuarial value

The law requires non-grandfathered individual and small group insurers to meet set levels of coverage, often called the “precious metal” tiers of Bronze, Silver, Gold, and Platinum. HHS has provided an actuarial value calculator for insurers to determine a plan’s precious metal level. HHS is proposing a fair amount of flexibility for insurers in this part of the proposed rule. In addition to allowing insurers to have a “de minimis” deviation from the prescribed levels of +/- 2%, HHS will also allow insurers with innovative benefit designs, such as tiered networks, to use actuarial certifications to attest to their compliance.

For another great summary of the EHB rule, check out Professor Tim Jost’s blog on Health Affairs’website. There will be lots more to come from the federal government and the states as we gear up for 2014.

Sabrina Corlette, Research Professor and Project Director
The Center on Health Insurance Reforms, Georgetown Health Policy Institute

ONC Goal: 1,000 Rural Hospital Meaningful Users by End of 2014

The Office of the National Coordinator for Health IT has set an ambitious goal of 1,000 rural hospitals becoming meaningful users of health IT by the end of 2014.  Despite the budgetary and work force challenges rural hospitals face, they are making steady progress on health information technology adoption. Between 2009 and 2011 the rural provider EHR adoption rate more than doubled. To speed adoption and share best practices, ONC created the Rural Community of Practice (CoP) and has recruited and convened leaders with expertise to roll out pilot projects. Its 10 subcommittees track the key challenges rural hospitals face.  Read the full article by David Raths, Healthcare Informatics.

Study: US faces shortage of 52,000 doctors by 2025

Researchers predicted that the U.S. population will increase 15.2 percent by 2025, necessitating about 33,000 more physicians. Aging adults will create the need for an additional 10,000 physicians in that period, while the Affordable Care Act will require about 8,000 more. These figures will grow the current workforce by about 3 percent, the study said. Fears about the looming doctor shortage are well-established. Read the full article here, by By Elise Viebeck, Healthwatch The Hill's Healthcare Blog.

Rough Start for Fiscal Cliff Talks

The opening round of negotiations this week between White House and senior GOP congressional staffers left both sides pessimistic about their ability to reach a quick deal on averting the fiscal cliff, according to sources familiar with the talks. Hill Democrats say Republicans aren't serious about crafting a deal that President Barack Obama can accept. For their part, Republicans remain unconvinced that Obama and Senate Majority Leader Harry Reid (D-Nev.) will make the kind of significant concessions on entitlement programs like Medicare and Medicaid that would make them agree to tax rate hikes (Sherman, Bresnahan and Budoff Brown, 11/20). Read more about the negotiations here.

Administration Defines Benefits That Must Be Offered Under the Health Law

Insurance companies are rushing to devise health benefit plans that comply with federal standards. This is in response to the "essential health benefits" which were defined on Tuesday by the Obama administration. Starting in October, people can enroll in the new plans, for coverage that begins on Jan. 1, 2014. The rules translate the broad promises of the 2010 law into detailed standards that can be enforced by state and federal officials.

The rules lay out 10 broad categories of essential health benefits, but allow each state to specify the benefits within those categories, at least for 2014 and 2015. The rules also give employers new freedom to reward employees who participate in workplace wellness programs intended to help them lower blood pressure, lose weight or reduce cholesterol levels. Click here to read the full article by Robert Pear, New York Times.

NOSORH Policy Webinars

NOSORH hosted a series of FREE webinars designed to raise awareness of the most pertinent rural health issues and highlight the good work being done by so many to address those issues.  NOSORH has provided links to the viewable recordings and PowerPoints of each webinar that was presented. Check out the following policy related webinars.

• Exploring Rural Health Policy Issues  (Viewable Recording) (Presentation Slides)
  Bill Finerfrock, NOSORH Legislative Liaison 
• Celebrating 25 Years for HRSA’s Office of Rural Health Policy and 10 Years for the Rural Assistance Center  (Viewable Recording | Presentation Slides)
  Tom Morris, HRSA Associate Administrator and Kristine Sande, RAC Program Director

Recommendations from TBD Released

Leaders of a large-scale effort to ask Coloradans how to address the state's long-term problems released on Wednesday a set of recommendations that calls for constitutional reforms and hints at tax increases but is light on specifics.
The recommendations from the eight-member board of directors of TBD Colorado, or "To Be Determined," came after months of community engagement with more than 1,200 Coloradans during 70 public meetings across the state. The recommendations were presented to Gov. John Hickenlooper, a Democrat who initiated the TBD effort, at the Denver Botanic Gardens.


Read more: TBD Colorado: Consider tax increases, constitutional reforms - The Denver Post http://www.denverpost.com/breakingnews/ci_21993932/tbd-colorado-consider-tax-increases-constitutional-reforms?source=rss#ixzz2COSDJAQe
Read The Denver Post's Terms of Use of its content: http://www.denverpost.com/termsofuse

Leaders of a large-scale effort to ask Coloradans how to address the state's long-term problems released on Wednesday a set of recommendations that calls for constitutional reforms and hints at tax increases but is light on specifics.
The recommendations from the eight-member board of directors of TBD Colorado, or "To Be Determined," came after months of community engagement with more than 1,200 Coloradans during 70 public meetings across the state. The recommendations were presented to Gov. John Hickenlooper, a Democrat who initiated the TBD effort, at the Denver Botanic Gardens.


Read more: TBD Colorado: Consider tax increases, constitutional reforms - The Denver Post http://www.denverpost.com/breakingnews/ci_21993932/tbd-colorado-consider-tax-increases-constitutional-reforms?source=rss#ixzz2COSDJAQe
Read The Denver Post's Terms of Use of its content: http://www.denverpost.com/termsofuse

Leaders of a large-scale effort to ask Coloradans how to address the state's long-term problems released on Wednesday a set of recommendations that calls for constitutional reforms and hints at tax increases but is light on specifics.
The recommendations from the eight-member board of directors of TBD Colorado, or "To Be Determined," came after months of community engagement with more than 1,200 Coloradans during 70 public meetings across the state. The recommendations were presented to Gov. John Hickenlooper, a Democrat who initiated the TBD effort, at the Denver Botanic Gardens.
The TBD effort, paid for with about $1.2 million in donated funds, focused on five issues: education, health, transportation, the state budget

The Spot Blog

• Read the inside scoop on Colorado politics and policies at blogs.denverpost.com/thespot/.
• Full political news coverage at denverpost.com/politics.

and the state workforce. Critics have savaged the effort as the inevitable precursor to a tax-increase initiative, although Hickenlooper and TBD organizers have denied there was any predetermined agenda.

Read more: TBD Colorado: Consider tax increases, constitutional reforms - The Denver Post http://www.denverpost.com/breakingnews/ci_21993932/tbd-colorado-consider-tax-increases-constitutional-reforms?source=rss#ixzz2COSTbIMw
Read The Denver Post's Terms of Use of its content: http://www.denverpost.com/termsofuse

Leaders of a large-scale effort to ask Coloradans how to address the state's long-term problems released on Wednesday a set of recommendations that calls for constitutional reforms and hints at tax increases but is light on specifics.
The recommendations from the eight-member board of directors of TBD Colorado, or "To Be Determined," came after months of community engagement with more than 1,200 Coloradans during 70 public meetings across the state. The recommendations were presented to Gov. John Hickenlooper, a Democrat who initiated the TBD effort, at the Denver Botanic Gardens.
The TBD effort, paid for with about $1.2 million in donated funds, focused on five issues: education, health, transportation, the state budget

The Spot Blog

• Read the inside scoop on Colorado politics and policies at blogs.denverpost.com/thespot/.
• Full political news coverage at denverpost.com/politics.

and the state workforce. Critics have savaged the effort as the inevitable precursor to a tax-increase initiative, although Hickenlooper and TBD organizers have denied there was any predetermined agenda.

Read more: TBD Colorado: Consider tax increases, constitutional reforms - The Denver Post http://www.denverpost.com/breakingnews/ci_21993932/tbd-colorado-consider-tax-increases-constitutional-reforms?source=rss#ixzz2COSTbIMw
Read The Denver Post's Terms of Use of its content: http://www.denverpost.com/termsofuse

Leaders of a large-scale effort to ask Coloradans how to address the state's long-term problems released on Wednesday a set of recommendations that calls for constitutional reforms and hints at tax increases but is light on specifics.
The recommendations from the eight-member board of directors of TBD Colorado, or "To Be Determined," came after months of community engagement with more than 1,200 Coloradans during 70 public meetings across the state. The recommendations were presented to Gov. John Hickenlooper, a Democrat who initiated the TBD effort, at the Denver Botanic Gardens.


Read more: TBD Colorado: Consider tax increases, constitutional reforms - The Denver Post http://www.denverpost.com/breakingnews/ci_21993932/tbd-colorado-consider-tax-increases-constitutional-reforms?source=rss#ixzz2COSTbIMw
Read The Denver Post's Terms of Use of its content: http://www.denverpost.com/termsofuse

Leaders of a large-scale effort to ask Coloradans how to address the state's long-term problems released on Wednesday a set of recommendations that calls for constitutional reforms and hints at tax increases but is light on specifics.
The recommendations from the eight-member board of directors of TBD Colorado, or "To Be Determined," came after months of community engagement with more than 1,200 Coloradans during 70 public meetings across the state. The recommendations were presented to Gov. John Hickenlooper, a Democrat who initiated the TBD effort, at the Denver Botanic Gardens.


Read more: TBD Colorado: Consider tax increases, constitutional reforms - The Denver Post http://www.denverpost.com/breakingnews/ci_21993932/tbd-colorado-consider-tax-increases-constitutional-reforms?source=rss#ixzz2COSTbIMw
Read The Denver Post's Terms of Use of its content: http://www.denverpost.com/termsofuse

Leaders of a large-scale effort to ask Coloradans how to address the state's long-term problems released on Wednesday a set of recommendations that calls for constitutional reforms and hints at tax increases but is light on specifics.

Read more: TBD Colorado: Consider tax increases, constitutional reforms - The Denver Post http://www.denverpost.com/breakingnews/ci_21993932/tbd-colorado-consider-tax-increases-constitutional-reforms?source=rss#ixzz2COShIqb4
Read The Denver Post's Terms of Use of its content: http://www.denverpost.com/termsofuse

Leaders of TBD, a large-scale effort to ask Coloradans how to address the state's long-term problems, released on Wednesday a set of recommendations that calls for constitutional reforms and hints at tax increases.

The recommendations from the eight-member board of directors of TBD Colorado, or "To Be Determined," came after months of community engagement with more than 1,200 Coloradans during 70 public meetings across the state. The recommendations were presented to Gov. John Hickenlooper, who initiated the TBD effort.

The TBD effort focused on five issues: education, health, transportation, the state budget and the state workforce. The full report is due to be released December 3rd. Read more here.

Provider Groups Lobby Against Fiscal Cliff

As lawmakers and President Barack Obama discuss possible changes to federal entitlement programs as part of a larger deal to avoid the fiscal cliff, provider groups are making their case loud and clear - cuts are not welcome. The fiscal cliff is the mix of expiring tax breaks and automatic spending reductions set to begin in January.

In a document provided to lawmakers, the American Hospital Association said, "providers already face billions of dollars in Medicare and Medicaid payment cuts, and additional reductions could jeopardize beneficiaries’ access to care. True entitlement reform and approaches to change the health care delivery system are needed – not provider cuts.” Read the full article here.

State Budet Update

The Governor released his budget request on November 1st. This is the beginning of a long process to set the budget for Fiscal Year 2013-14. Beginning this week, the Joint Budget Committee (JBC) began hearing briefings from the various state departments. Some health related highlights from Governor Hickenlooper's budget request are listed below.

 

• Purchase a Medicaid Management Information System (MMIS or claims payment).
• Add a dental benefit for adults, including pregnant women, covered by Medicaid. This is to be capped at $1,000 per patient.
• Change the current Medicaid dental program for kids to an Administrative Services Organization, similar to that of CHP+.
• Expand the current Substance Use Disorder Medicaid benefit and include substance use disorder treatment under the Behavioral Health Organization (BHO) contract.
• Increase provider rate by 1.5%. The increase would not apply to RHCs, FQHCs, nursing homes or pharmaceutical reimbursements.
• Create a behavioral health crisis system (mental health triage).
• Increase funds for Local Public Health Agencies to support legislatively required core public health services in some communities. 
• Increase the average cost per K-12 student from $6,474 to $6,659.

 

We're still waiting to hear the Governor's plans for the Medicaid expansion (states can expand their eligibility for Medicaid up to 133% FPL as part of the Affordable Care Act).The federal guidance is expected to be released in the next week, so we can expect to hear something publicly soon after that.

Sign Up for NOSORH'S Series of Free Webinars to Celebrate National Rural Health Week

November 12th through the 16th is National Rural Health Week, and at CRHC, we will be celebrating the power of rural all week. We recognize that while facing unique healthcare needs, rural areas are full of innovation and are wonderful places to live and work. We also know that these communities are fueled by the creative energy of ordinary citizens who are always willing to step forward and take risks in order to provide a wealth of products and resources for the rest of the country. We thank you for all you do to serve your communities.

As part of the week long celebration, the National Organization of State Office of Rural Health (NOSORH) is hosting a series of free webinars highlighting the good work being done to address rural health concerns.

All webinars will be recorded and made available to the public at www.celebratepowerofrural.org.

Schedule/Participating Partners:

Monday, November 12, 3:00 - 4:00 p.m. EST
The Basics of Rural Health

Kristine Sande, Program Director, Rural Assistance Center
Rebecca Davis, Executive Director, National Cooperative of Health Networks
Mike Shimmens, Executive Director, Rural Recruitment and Retention Network (3RNet)
Teryl Eisinger, Director, National Organization of State Offices of Rural Health

Tuesday, November 13, 1:00 - 2:00 p.m. EST

Cultural Awareness While Serving Rural Veterans

Jay H. Shore, MD, MPH, Associate Professor, University of Colorado Denver

Tuesday, November 13, 3:00 - 4:00 p.m. EST

Exploring Rural Health Policy Issues
Bill Finerfrock, Legislative Liaison, NOSORH

Wednesday, November 14, 2:30 - 3:15 p.m. EST

HRSA Rural Health Update
Mary Wakefield, HRSA Administrator

Thursday, November 15, 3:00 - 4:00 p.m. EST
HRSA’s Office of Rural Health Policy - Celebrating 25 Years and the Rural Assistance Center - Celebrating 10 Years

Tom Morris, HRSA Associate Administrator for Rural Health Policy
Kristine Sande, Program Director, Rural Assistance Center

Friday, November 16, 2:00 - 3:00 p.m. EST

Looking Towards the Future of Rural Health Care

Randall Longenecker MD, Project Director, Rural Training Track Technical Assistance Program
Jim DeTienne, Supervisor, Montana EMS and Trauma Systems; President, NASEMSO

For additional information, contact: Stephanie Hansen 208.375.0407 or steph@nosorh.org.
Click on the following link to register for a webinar - https://www.surveymonkey.com/s/NRHD2012

Survey Ends Today!

Click here to complete the survey.

Colorado Rural Health Center’s Policy & Advocacy Program tracks and assesses healthcare policies and regulations at both the state and Federal level.

In order to assess the general landscape of rural health issues throughout the state, CRHC relies upon you, the rural healthcare provider and consumer, to help shape the CRHC policy and advocacy agenda. Each year, CRHC establishes a set of legislative priorities that the organization will support for the upcoming year.

As a professional in the field, your input is crucial!

 

Half of the States Are Implementing Patient Centered Medical Homes for Their Medicaid Populations

Medicaid agencies in 25 states have pursued initiatives to incentivize and support physician practices to become patient-centered medical homes, where clinicians and other health professionals team up to provide comprehensive, coordinated, accessible services to their low-income patient populations. Mary Takach, program director at the National Academy for State Health Policy, reviews the variety of reforms taking shape in the latest issue of Health Affairs. Read what initiatives other states are pursuing here. Read more here about what Colorado is doing to incentivize patient centered medical homes for Medicaid b.

Let your "Rural Voice" be heard!

Colorado Rural Health Center’s Policy & Advocacy Program tracks and assesses healthcare policies and regulations at both the state and Federal level.

In order to assess the general landscape of rural health issues throughout the state, CRHC relies upon you, the rural healthcare provider and consumer, to help shape the CRHC policy and advocacy agenda. Each year, CRHC establishes a set of legislative priorities that the organization will support for the upcoming year.

As a professional in the field, your input is crucial!

Click here to complete the survey.

Please find the latest updates from the Health Benefit Exchange below.

Patty Fontneau blogs about metal tier labels for health plans, which will be discussed at next week’s Outreach and Communications Advisory Group meeting (more info below).

Answers to vendor questions regarding the Provider Directory Services RFI are available here.

SHOP Exchange Manager Jim Sugden blogs about how the Exchange will assist small businesses on the Colorado Health Foundation’s blog Health Relay.

The next Board meeting is scheduled for November 12, 8:30 am. More information is available here.

The Exchange is seeking applicants for several positions; job announcements are posted on our website:

      - The SHOP Exchange Coordinator will provide research and administrative support for implementation and operation of the SHOP.

     - The Documents & Meetings Coordinator will perform administrative functions to support staff, Board and Advisory Group meetings.

      - Outreach Coordinator(s) will engage a variety of communities across Colorado to ensure there is accurate knowledge about the Exchange and effective communication with our partner organizations.

2013 Legislative and Policy Priorities Survey

Colorado Rural Health Center’s Policy & Advocacy Program tracks and assesses healthcare policies and regulations at both the state and Federal level and advocates on behalf of the health needs of rural Colorado. In order to assess the general landscape of rural health issues throughout the state, CRHC relies upon you, the rural healthcare provider and consumer, to help shape the CRHC policy and advocacy agenda.

Each year, CRHC establishes a set of legislative priorities that the organization will support for the upcoming year. As a professional in the field, your input is crucial, so please share your thoughts on legislative and regulatory issues to help CRHC determine priorities for 2013. Responses will be reported in December and used to improve our Policy and Advocacy Program.

Please take a few moments to fill out this short survey by clicking here. It should take no more than 3 – 5 minutes to complete. The survey closes Friday, November 9th.

To learn more about CRHC’s Policy and Advocacy Program and to see CRHC’s 2012 policy priorities, please visit our website.
Click here to take the survey before November 9th!

Please see the latest updates from the Colorado Health Benefit Exchange Below.

§  Executive Director Patty Fontneau blogs about defined contributions and assisting small businesses.

§  The SHOP Advisory Group will meet Thursday, Oct. 25, 10 am. More information is available here.

§  The Exchange is seeking applicants for the position of Documents and Meetings Coordinator. More information is available here.

§  The Exchange is seeking applicants for the position(s) of Outreach Coordinator. More information is available here.

§  The COHBE Board will meet on Nov. 12, 8:30 am. More information is available here.

Small Number of Colorado Businesses Use Health Insurance Tax Credit

Just 5 percent of Colorado small businesses are using a tax credit created as part of the Affordable Care Act, meant to encourage small businesses and nonprofits with low average wages to provide health insurance to their employees. To obtain the credit, a small business must have fewer than 25 full-time employees, pay average annual wages below $50,000 per full-time employee, and contribute at least 50% to each employee’s premium. The law provides a tax credit for up to 35% of the insurance premiums now, growing to 50% in 2014.”

According to Rhett Buttle, a spokesman for the Small Business Majority, small businesses don’t know about it. With all the political rhetoric going around about the ACA, folks weren’t focused on learning about it,” The Small Business Authority offers an online calculator for estimating whether an employer will qualify for the tax credit. Read more about the credit from Colorado Public News.

Medscape’s Political Guide for Clinicians

The first in a series of debates between the presidential candidates kicks off tonight in Denver with a focus on domestic policy.  With all the mudslinging of late, it’s tough to know what to pay attention to, especially when it comes to health policies.  To help, Medscape created a primer on the political issues that matter most to clinicians and healthcare professionals.  You can read the primer here, or click here to get more information on the debates.

Census Report Says Uninsured Are Visiting the Doctor Less

The Census Bureau recently released its annual report on how Americans use the healthcare system this month.  The report, which can be viewed here, says the uninsured are visiting the doctor less than they were a decade ago.  Medical utilization services vary by demographic and economic indicators, and not surprisingly, respondents were much less likely to visit a dentist than a medical provider.  Read more comments on the findings written by Sarah Kliff, a blogger for the Washington Post.

States Ask About Partial Medicaid Expansion Options

Several states are querying the federal government on how flexible they can be with their Medicaid eligibility levels starting in 2014, given that the full expansion under the Affordable Care Act (ACA) authorizes states to cover individuals up to 133% of the federal poverty line is now optional under the Supreme Court’s ruling on the law. For states that decide not to participate in the expansion, those above 100% of poverty potentially still could qualify for federal subsidies to buy private coverage through the law’s health insurance exchanges. Read here about what kind of flexibility, if any, states will have in expanding Medicaid up to 100% FPL.

Dial-a-Doctor Telemedicine Program Seen as Solution for Provider Shortage in Rural Georgia

Until recently, when children in Ware County, Georgia, needed to see a pediatrician or a specialist, getting to the nearest doctor could entail a four hour drive up Interstate 75 to Atlanta. Now, there’s another option. As part of a state-wide initiative, the rural county has installed videoconferencing equipment at all 10 of its schools to give its 5,782 students one-on-one access to physicians. Read about the program here.

Draft of Essential Health Benefits Benchmark Plan Released

The Governor’s Office, Division of Insurance and the Exchange are requesting stakeholder feedback about a draft recommendation for Colorado’s essential health benefits (EHB) benchmark plan. Beginning in 2014, most health insurance plans sold to small employers and individuals must include a minimum set of health care services and products. This set of services and benefits is called Essential Health Benefits. A draft of Colorado’s EHB Benchmark plan can be found here. Comments on this draft should be sent to the EHB email, ehb@dora.state.co.us. After consideration of the comments from stakeholders, the Division of Insurance will release a final recommendation. The deadline for submitting public comment is September 10, and Colorado’s benchmark plan will be chosen by October.

An introduction to the EHB decision making process, a comparison of EHB plans and an FAQ document can be found on the Colorado Health Benefit Exchange website (click here).

ACC Payment Reform Initiative Update

The Accountable Care Collaborative (ACC) payment reform initiative bill passed during the 2012 legislative session allows the Department of Health Care Policy and Financing (HCPF) to accept proposals for innovative payment reforms that will demonstrate new ways of paying for improved client health outcomes for Medicaid clients while reducing costs.

The Department is developing a formal process for requesting, receiving, evaluating and selecting proposals. The first step will be an invitation for abstracts. All abstracts must be submitted through the Accountable Care Collaborative's Regional Care Collaborative Organizations (RCCOs) and their partners. Abstracts will assist the Department in developing the proposal evaluation criteria. Please click here to find a fact sheet, FAQ document and the invitation for abstracts link. There will be an opportunity for stakeholder input during the proposal criteria development phase of the process.

Click here to read more about the process, to find the invitation for abstracts, a fact sheet and FAQs.

Boomers Retiring to Rural Areas Face Trouble Finding Providers

As record numbers of baby boomers go into retirement, many are thinking about moving from the places they needed to live to make a living, and going someplace warmer, quieter or prettier. And if they choose rural towns they may have a hard time finding a family doctor willing to take Medicare, even supplemental plans, rather than private insurance.

Click here to read the Associated Press article.

Funding for the Old Age Pension Program Renewed

A bill passed during the 2012 legislative session which restored funding for the Old Age Pension (OAP) program. Treatment for the Oral Health Program of OAP is anticipated to begin January of 2013.

The OAP program was established by legislation in 1977 to provide dental care (dentures and related services) to senior citizens who receive Old Age Pension public assistance. To qualify for the OAP Dental Program, an individual must be 60 years or older, live in Colorado, and receive OAP public assistance from the state of Colorado. Interested seniors should contact their individual county department of social services for eligibility information.

The Oral Health Program manages the dental component of the OAP providing grants to eligible grantees for the provision of dental services to seniors eligible for OAP.

Approved procedures and maximum allowable fees are set in the Code of Colorado Regulations (6 CCR 1015-8). Clients may be asked to pay a co-payment not to exceed 20% of the maximum allowable fee.

Click here to read more (scroll down to Old Age Pension Program).

GAO Reports on Medicaid Expansion

The United States GAO released "Medicaid Expansion: States' Implementation of the Patient Protection and Affordable Care Act." The report addresses the actions states are taking to implement the Medicaid expansion, what actions selected states have taken to prepare for the Medicaid expansion provisions of the Affordable Care Act, what challenges they have encountered, and states’ views on the fiscal implications of the Medicaid expansion on state budget planning.

SHADAC Report Finds Safety Net Programs Working for Kids

The State Health Access Data Assistance Center (SHADAC) released a report which analyzes recent trends in health insurance coverage for children at the state level between 2008 and 2010. The report found the percentage of children with public coverage through Medicaid or the Children’s Health Insurance Program (CHIP) increased substantially, while rates of private coverage and uninsurance declined. Read more here.

Rules Released for ICD-10 and Meaningful Use

Health and Human Services (HHS) Secretary Kathleen Sebelius announced the release of a rule that makes final a one-year proposed delay in the compliance date for the industry’s use of ICD-10 codes. The ICD-10 codes classify diseases and health problems. The new deadline for the transition is October 1st of 2014. Read the final rule here.

Also released, were the final rules for Stage 2 of meaningful use. The rules are part of a federal incentive program for Medicare and Medicaid physicians to adopt electronic health records and are set to become effective for participants in the program no earlier than 2014. The final rules can be viewed here.

The Hospitality of Rural Hospitals

The Durango Herald writes about the hospitality of a rural hospital. Read the article here.

Happy Safety Net Clinic Week!

Safety Net Clinic Week (SNCW) is almost over, but the success continues. This week 13 clinics across the state provided tours or hosted an open house to celebrate SNCW. All total, over 200 people visited a Rural Health Clinic (RHC) or a Community-Funded Safety Net Clinic (CSNC). CRHC and ClinicNET would like to thank clinic and hospital staff for taking time out of your busy days to provide tours and host guests.

While we’ve dedicated this week to celebrating these important facilities in the safety net, it’s important to remember they should be celebrated all year long, because despite limited resources, workforce challenges, and low reimbursements, these clinics remain committed to providing high quality, patient-centered, affordable healthcare for their patients and their communities. Thank you for all you do!

Colorado’s Health Care Safety Net: 2012 Primer Released by CHI

This week the Colorado Health Institute (CHI) published, “Colorado’s Health Care Safety Net: 2012 Primer.” The primer provides information about the providers in the safety net, who uses it, and where safety net funding comes from, as well as a list of additional resources and more information regarding the safety net. Click here to read the report.

Webinar: Potential Roles for Safety Net Providers in Supporting Continuity Across Medicaid and Health Insurance Exchanges

Next week the National Academy for State Health Policy (NASHP) is hosting a webinar about the challenge states face supporting continuity of care for individuals and families who may churn between Medicaid and commercial coverage purchased through health insurance exchanges.

As the Colorado Health Benefit Exchange Board works to develop a health insurance exchange where Coloradans can successfully go to compare cost and quality across health plans, determine if they are eligible for Medicaid or for premium tax credits, and purchase coverage, one significant concern remains unsolved. What happens when individuals and families experience changes in income that will cause them to churn (shift eligibility for Medicaid and other subsidized coverage)? Disruptions in coverage have the potential to lead to expensive disruptions in care. Learn more about this challenge and what providers may need to undertake to adapt to the new coverage environment by participating in NASHP’s webinar on Tuesday, August 28th. Click here to register.

73 Colorado Primary Care Practices to Participate in Initiative

The CMS Innovation Center selected 73 Colorado primary care practices to participate in the Comprehensive Primary Care Initiative. The practices represent 335 primary care practitioners serving approximately 41,000 Medicare beneficiaries across urban and rural Colorado.

The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private healthcare payers to strengthen primary care. Medicare will work with commercial and state health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients.

Click on the hyperlinks above to see a list of the practices selected in Colorado or to read more about the Comprehensive Primary Care Initiative.

The Accountable Care Organization (ACO) Work Continues

An article in the MedPage Today this week reported the vast majority of hospitals aren’t ready to participate in ACOs (read here). According to the Centers for Medicare and Medicaid Services (CMS), an ACO is, "an organization of healthcare providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it.”

While most hospitals may not be ready to embrace an ACO, there are opportunities to learn more about them and provide feedback on how educational opportunities can be designed. A report published by the Commonwealth Fund published this week examines six shared-savings pilot initiatives and explores the differences in shared-savings approaches, the outcomes they achieve, how to improve them, and whether and how to diffuse them. Read the report here.

On Monday, August 27th from 11:00am – 1:00pm MT, the Center for Medicare and Medicaid Innovation will host an open door forum to solicit input on how educational opportunities for providers interested in participating in ACOs or other coordinated care initiatives could be designed. No prior registration is necessary. Call the number below 5 – 10 minutes before beginning the forum.
Phone Number: (866) 501-5502
Conference ID: 1602701

HCPF is Committed to Colorado's Medicaid Accountable Care Organization

The Department of Health Care Policy and Financing released a position statement last month related to the Accountable Care Collaborative (Colorado's version of an Accountable Care Organization for Medicaid clients, rather than Medicare). You can read the statement here, but to summarize, the Department states they remain committed to the ACC as the predominant program that will lead Colorado Medicaid into the future of better health care. The primary goals of the ACC Program are to improve the health of Medicaid clients and reduce costs.

Tricia McGinnis of the Commonwealth Fund wrote a blog post about the emergence of Medicaid Accountable Care Organizations in states and the opportunity these programs have to better serve the most vulnerable low-income populations. Read the blog post here.

Learn More About the CO-OP Intended to Improve Coverage in Rural Areas

The Colorado Health Insurance Cooperative, Inc. (CO-OP) was notified last month by the U.S. Department of Health and Human Services that its loan application for $69 million to start and operate a statewide nonprofit health insurance CO-OP was approved. The CO-OP is a Consumer Operated and Oriented Plan, a new kind of nonprofit health insurance company intended to overcome some of the access issues commonly experienced in rural areas by offering affordable, high quality health plans to both rural and urban Coloradans.

The Colorado Health Insurance Cooperative (CO-OP) is sponsored by the Rocky Mountain Farmers Union Educational and Charitable Foundation. Many consumer groups, healthcare provider organizations, another nonprofit health plan, the Colorado Medical Society and the National Federation of Independent Business supported the CO-OP’s loan application process.

Colorado Public Radio reporter Ryan Warner discusses health insurance cooperatives and the efforts to build a member owned CO-OP in Colorado. You can listen to Ryan's interview here to learn more about what this means for Coloradans.

Aging Baby Boomers Face Home Healthcare Challenge

Home health aides can help keep people in their homes who might otherwise need to live in a long term care facility. The U.S. Labor Department projects that home health and personal care aides will be among the fastest-growing jobs over the next decade, adding 1.3 million positions and increasing at a rate higher than any other occupation. However, filling those new home care positions over the next decade will be a challenge to say the least. Read more from Minnesota Public Radio.

Will Anyone See the New Medicaid Patients?

About 69 percent of doctors nationally accept new Medicaid patients, but the rate varies widely across the country. A new study in Health Affairs, detailed in Kaiser Health News, says that in Colorado, slightly less than the national average of doctors agree to take on new patients who are on low-paying Medicaid. The Colorado rate is about 66 percent, just under the national average of 69 percent.

Comments from a Rural Healthcare Leader

Watch a video interview with Todd Linden, President and CEO of Grinnell Regional Medical Center, a 49- bed, private non-profit hospital in Grinnell, Iowa. In the interview. Mr. Linden discusses the differences between running a rural versus an urban medical facility, how technology is affecting rural healthcare, and his hopes for the future of the field.

Should You Celebrate Safety Net Clinic Week? The Answer is Probably Yes!

Is My Clinic A Safety Net Clinic? The answer may not be obvious. If you have ever wondered if your clinic is a safety net clinic, the following survey may help you answer that question.

 

First, does your clinic provide preventive and primary health care services or chronic disease management?

Yes / No

 

If you answered yes to the question above, please read each statement below and determine if the statement is true.  

• My clinic is a federally certified Rural Health Clinic (RHC).
• My clinic is located in a health professional shortage or medically underserved area.
• My clinic offers free or discounted services on a sliding fee scale or as a flat fee.
• My clinic sees uninsured patients regardless of their ability to pay.
• My clinic accepts Medicaid, Child Health Plan (CHP), and/or Tri-Care.
• My clinic participates in the Colorado Indigent Care Program (CICP).
• My clinic does not accept reimbursements from third-party payers.
• My clinic utilizes volunteer clinicians.
• My clinic is eligible for FTCA medical malpractice liability protection.
• My clinic receives Primary Care Fund dollars.
• My clinic receives grants, contributions and/or donations.
• My clinic is part of a Family or Internal Medicine Residency Program.
• My clinic provides translation services for non-English speaking patients.
• My clinic receives Section 330 funding (under the Public Health Services Act).
• My clinic provides Indian Health Services.
• My clinic receives funding under Title X.

If your clinic provides health care services and the answer to one or more of the options above is yes, then congratulations, your clinic is a safety net clinic! Therefore, the Colorado Rural Health Center and ClinicNET encourage you to consider celebrating Safety Net Clinic Week August 20th through 24th, 2012. SNCW is a week dedicated to raising awareness of all the various types of clinics with a commitment to serving patients who might otherwise have difficulty getting medical care.

 

Why is it important to celebrate Safety Net Clinic Week? Because while safety net clinics have some similarities, they also look very different from one another and it is important to know where, why and how health care is currently being delivered. When it comes time for the federal, state, or even local government to make decisions regarding provider reimbursements, tobacco tax funds, Medicare or Medicaid payments, public coverage program eligibility, electronic health records (EHR) incentives, or other important policy choices, the people making those decisions need to understand how they affect safety net clinics like yours.

The COHBE Board will Submit Grant Application, and Other Updates on the Exchange

The Chair and Vice-Chair of the Legislative Implementation Review Committee gave approval Thursday for the Exchange to submit a second Level One Establishment Grant application to the federal government for activities related to the Exchange. Previously approved by the Colorado Health Benefit Exchange (COHBE) Board, this grant application seeks funds to pay for planning activities, acquisition of technology systems and development of customer service operations necessary to implement Senate Bill 11-200 for the period between October 2012 and July 2013. The application will be submitted prior to the August 15 deadline.

 

Read the other updates on the development of Colorado's Health Benefit Exchange, from the Exchange's Director of Outreach and Communications, below.

• Patty Fontneau blogs about the next grant application. 
• The COHBE Board will meet on Monday, August 13, 8:30 am. Information is available here. 
• The Individual Experience Advisory Group will meet on Tuesday, August 14, 2:30 pm. Information is available here. 
• The SHOP Advisory Group will meet on Thursday, August 16, 10 am. Information is available here.

How Will You Celebrate Safety Net Clinic Week?

Safety Net Clinic Week Project Coordinator Charlotte Kaye, is available to help you get the most out of the third annual Safety Net Clinic Week, August 20-24, 2012! Are you interested in hosting public officials, candidates for office or business leaders for a site-visit? How about hosting an open house? Do you already have an event or activity planned that week that could be highlighted by Safety Net Clinic Week? Seize this opportunity to celebrate your clinic and the important role you fill in the healthcare safety net with help from the Colorado Rural Health Center and ClinicNET. Please contact Charlotte Kaye for assistance and ideas! She can be reached at charlotte.kaye@clinicnet.org or at 720-863-7805.

To get a sense of Safety Net Clinic Week, click here for a look at past years’ activities!

The Safety Net Clinic Week “toolkit” can be found here. It includes fact sheets, flyers, logo and templates for press releases, letters to the editor, invitations for site-visits, and governmental proclamations.

CIVHC and CHI Release New Report on Payment Models

The Center for Improving Value in Health Care (CIVHC) and the Colorado Health Institute (CHI) released a new report that examines strategies to reform the health care payment system, how the new models are being used in Colorado and their potential impact on improving quality and controlling costs.

The report, titled "New Approaches to Paying for Health Care: Implications for Quality Improvement and Cost Containment in Colorado," documents the role that the traditional fee-for-service payment model plays in rising health care costs and the potential that different payment approaches hold for changing that dynamic.

The report is designed to help policy makers, industry leaders and other stakeholders make informed decisions as they contemplate alternative health care payment approaches.

Court of Appeals Ruled on Physician Supervision Lawsuit

The Colorado Court of Appeals ruled last week in favor of Gov. John Hickenlooper in a lawsuit filed by the Colorado Medical Society and the Colorado Society of Anesthesiologists. The two groups were trying to overturn a Denver District Court’s dismissal of their lawsuit over delivery of anesthesia to Medicare patients.

At the heart of the lawsuit was whether or not to allow certified registered nurse anesthetists (CRNAs) to administer anesthesia without a physician’s supervision. Read more here.

The New “Doughnut Hole” Describes Coverage Gap Created in States Rejecting the Medicaid Expansion

The Supreme Court’s recent ruling on the Affordable Care Act gave governors new flexibility to reject the law’s Medicaid expansion.

States that reject the Medicaid expansion may create a coverage gap being called the new “doughnut hole." Those that fall into the hole will be people who don’t qualify for their state’s current Medicaid eligibility categories nor are eligible for subsidized private insurance in the marketplaces called exchanges. In Colorado, the majority of those folks would be adults without dependent children between 10 and 133% of the federal poverty level (FPL) and adults with dependent children between 100 and 133% FPL. Read the Washington Post‘s article here.

Could Value-based Purchasing Program Hurt Safety Net Hospitals? iVantage Report Suggests Rural May Be Different

A study published in the Archives of Internal Medicine suggests CMS's Hospital Value-based Purchasing program could mean trouble for safety net hospitals, because safety net hospitals tend to get poorer marks from patients than do other hospitals. These patient satisfaction scores will be used to dole out bonuses and penalties beginning in October.

However, according to the iVantage report, "Rural Relevance Under Healthcare Reform," rural hospital performance on HCAHPS patient experience survey measures is better than urban hospitals. The iVantage report was released in April, and updated last month. You can read the updated report here.

IOM Reports Higher Payments Are Not the Cure for Doctor Shortage

An Institute of Medicine (IOM) report released Tuesday concluded that while there are wide discrepancies in access to and quality of care across geographic areas, the variations were unlikely to be influenced by changes in Medicare reimbursement rates to providers. In light of this, the IOM committee recommended Medicare should not try to address the shortages of doctors and healthcare providers by raising reimbursements to entice practitioners to practice in underserved areas. You can read the report here.

Instead of altering payments, the committee recommended that Medicare pay for services such as telemedicine that improve access to medical care in underserved regions. It also encouraged states to change scope of practice laws so that nurse practitioners can provide more care.
Soon the IOM will release a separate report looking into why Medicare spends more on patients in some areas of the country than others without always giving better care.

CHI Presents on the 5 Biggest Questions for Colorado After the Supreme Court's Ruling on the ACA

Do you want to know more about the implications of the Supreme Court's recent ruling on the Affordable Care Act? The Colorado Health Institute (CHI) analyzed the five biggest questions looming for Colorado in the wake of the Supreme Court's decision that the health reform law is constitutional. Download CHI president and CEO Michele Lueck's June 28th presentation, listen to the recorded webinar, and read the report to learn more.

The Center for Rural Affairs Publishes Latest Healthcare Report

The Center for Rural Affairs recently published their latest healthcare report, The Affordable Care Act: Real Help for Real People, which highlights provisions in the law that are helpful for rural people across the country. You can read the short version here.

New Federal Waiver in Oregon Offers Incentives to Get More Doctors in Rural Areas

A new federal waiver for Oregon includes a provision aimed at luring doctors to small towns. The state won final approval Monday from the Obama administration for plans to move ahead with big changes in healthcare. The new agreement also funds a program to help physicians pay off their student loans if they agree to set up shop in rural or other underserved areas. Read more here.

States Should Check with Hospitals Regarding Medicaid Expansion

Hospitals might experience the largest impacts of any type of provider if states decline the opportunity to expand Medicaid eligibility under the Affordable Care Act, so states are being urged to check with hospitals before making the decision to reject the Medicaid expansion. Read more here.

ACO Executives Would Have Continued Regardless of Decision

Accountable Care Organization (ACO) executives say they would have continued building the ACOs, regardless of the Supreme Court's decision. An ACO is a type of payment and delivery reform model that ties provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. Executives believe the rise of healthcare spending creates a demand for greater efficiency, more collaboration, and new incentives that reward hospitals and doctors that keep people healthy. Click here to read more.

Nominations for Dual Eligibles Advisory Subcommittee

To support greater collaboration between the Demonstration to Integrate Care for Dual Eligible Individuals (the Demonstration) and other healthcare initiatives, the Department of Health Care Policy and Financing (HCPF) will assemble a group of dual eligible individuals (eligible for Medicaid and Medicare), family members, advocates, and other stakeholders with additional expertise to interact with existing advisory bodies.

HCPF invites you to nominate an individual to be a member of the Dual Eligibles Advisory Subcommittee. The subcommittee will make recommendations related to the Demonstration and other issues affecting fully dual eligible individuals. The subcommittee’s chair and the Dual Eligibles Project Manager will attend other advisory committee meetings.

For information about the subcommittee’s purpose, composition, and responsibilities, please see the frequently asked questions in the Subcommittee packet (link here). If you would like to nominate an individual to the Dual Eligibles Advisory Subcommittee, please submit an application no later than Friday, July 27 (the packet includes nomination instructions on page three). For additional information about the Demonstration to Integrate Care for Dual Eligible Individuals, please see the Demonstration’s web page on HCPF's website.

CRHC Responds to Supreme Court Decision

As most of you know (probably ad nauseam at this point), the Supreme Court of the United States delivered their ruling today on the constitutionality of the Affordable Care Act (ACA).

Q. So what happened this morning?

A. Ultimately, the ACA was upheld. Likely the most controversial component, the requirement that every American buy insurance, was upheld. But there was a twist; the Supreme Court said it does not violate the commerce clause because the mandate doesn’t regulate existing commercial activity. Instead, it compels individuals to become active in commerce by purchasing a product. Therefore, Americans can choose not to buy health insurance, but will instead pay a tax. The expansion of the Medicaid program up to 133% of the Federal Poverty Level (FPL) was also among the top controversies in the law. The Supreme Court ruled that states will have a choice about whether or not to participate in the expansion. So if states choose not to participate, they will not be penalized by losing their current Medicaid dollars (as written in the ACA). If states opt for the expansion, they will get money to participate, but they must comply with the conditions attached to the new expansion funds.

Q. What position did CRHC take on the ACA?

A. The Colorado Rural Health Center did not take a position on the Affordable Care Act. Our policy agenda is directed by our membership, and the membership did not come to consensus on all provisions of the ACA. However, membership supported the rural provisions which contribute to CRHC’s vision to ensure that all rural Coloradans have access to comprehensive, affordable, high quality healthcare.

Q. What happens with the rural provisions in the law?

A. Given the decisions made this morning, it means that all rural provisions included in the ACA were upheld in entirety. As a reminder, some of the rural provisions included additional funding for the National Health Service Corps program, residency allocation, and creation of Rural Physician Training grants, as well as establishment and funding for the Centers for Medicare and Medicaid Services (CMS) Innovation Center, Primary Care Incentive payments, “Extenders,” and modification of the low volume hospital adjustment. So the workforce modifications, innovation dollars and payment modifications will be administered as outlined in the law.

Q. Does this mean it’s all over?

A. Not at all. There will be additional legal challenges concerning implementation and regarding Medicaid participation, and the political mudslinging has already begun!

CRHC will continue providing training and technical assistance to Critical Access Hospitals and Rural Health Clinics, offering workshops and conferences, administering grant programs, offering the Colorado Provider Recruitment Program and advocating on behalf of rural facilities and communities. We will be in Washington, D.C. at the end of July to fight against the cuts that will disproportionality impact rural and to provide Congress with a real picture of rural health in Colorado.

And we will work with rural communities and facilities on creative solutions that will continue to improve patient health, improve community health, and contain cost, all the while ensuring hospitals and clinics in rural areas remain viable practices that ensure access to their communities.