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Tuesday, November 27, 2012

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

Monday, November 26, 2012

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.

Wednesday, November 21, 2012

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.

Friday, November 16, 2012

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

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

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.

Friday, November 9, 2012

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

Thursday, November 8, 2012

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.