Guide to Opinions on the Supreme Court Ruling

In advance of today's Supreme Court ruling on the Affordable Care Act, the SCOTUSblog offers up a digest of opinions and predictions. See the digest here or to access their liveblog.

Colorado's Essential Health Benefits Benchmark Plan

The Governor’s Office, the Division of Insurance, and the Colorado Health Benefit Exchange will convene a public webinar on Friday, June 29 from 10:00 - 11:00 AM to discuss the process of selecting an Essential Health Benefits (EHB) benchmark plan for Colorado. Colorado will choose an EHB benchmark plan in the coming months, which will establish minimum health benefits required for many health insurance plans beginning in 2014. The webinar will provide an introductory overview of a chart that details Colorado’s options for an EHB benchmark plan, in addition to answering common questions about the process. Click here to sign up for the webinar.

Applications for HB12-1052 Advisory Group Due June 22nd

HB12-1052 charges the Colorado Primary Care Office, in the Prevention Services Division of the Colorado Department of Public Health and Environment, with designating an Advisory Group composed of representatives of "the affected health care professions and individuals with expertise in health care workforce research, analysis and planning." Members of the Advisory Group will serve without compensation or reimbursement for actual or necessary expenses for their participation. The Advisory Group will consider, but is not limited in using, the Division of Registration's existing data fields as a structure for a robust statewide health care license data collection and reporting system including:

1. Each practice address of the health care professional;
2. The number of hours the health care professional provides direct patient care at each practice location;
3. Any specialties of the health care professional if applicable;
4. Information about each practice setting;
5. The health care professional's education and training related to his or her profession and;
6. The year of birth of the health care professional.

This link will take you to an electronic nomination form which, when completed, will transmit directly back to the Primary care Office. The Primary Care Office kindly asks for your assistance in distributing this email through your networks, clinics, facilities or contacts. You are welcome to self nominate as well. The Primary Care Office will begin reviewing completed nomination forms on June 22nd. The Advisory Committee will meet several times beginning in late July and intend to complete the work as quickly as possible and do not expect more than a few months of total effort.

Additional information regarding the scope and intent of HB12-1052 including the Advisory Group is available here.

New MedPAC Report Could Prove Harmful to Rural Patients and Providers; Your Voice is Needed to Tell the Real Story of Rural Health.

The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional agency established by the Balanced Budget Act of 1997 to advise Congress on issues affecting the Medicare Program, including analyzing access to care, quality of care, and other issues affecting Medicare.

MedPAC released a report to Congress this week, Medicare and the Health Care Delivery System, which examines issues central to the beneficiaries’ experience of the Medicare program. One chapter specifically examines care for beneficiaries in rural areas, including access to care for rural beneficiaries, the quality of the care they receive, special rural payments, and the adequacy of payments for rural provides.

The Commission reported there is little differences in health care service use by Medicare beneficiaries between rural and urban areas, patient satisfaction is similar, there are no major differences in quality between urban and rural providers, and rural hospital payments and financial margins are ample.

Rural health advocates are concerned that inaccuracies in the report could be harmful to rural Americans. We know access to care and inadequate reimbursement rates in rural Colorado and across America are problematic and programs and policies aimed at fixing these issues are crucial and cannot be allowed to expire. A report released in April by iVantage Health Analytics, Inc. (which also used Medicare data), found that Medicare spending is 3.7% less per beneficiary in rural markets than in urban markets, even though this spending includes “special payments” provided to rural hospitals and practitioners. The report found that rural hospitals nationally have equal or better quality outcomes, and cost less per Medicare beneficiary than their urban counterparts confirming rural hospitals and clinics are a good value for patients and for taxpayers.

Rural providers, patients and communities will pay the price if Congress acts based on information found in the MedPAC report, so we need your voice. We need data, stories, and examples to paint the real picture of rural health. CRHC staff will be traveling to Washington, D.C. in July to participate in NRHA’s March for Rural Hospitals and will be meeting with Colorado’s members of Congress. It is our chance to make your voice heard, so please contact Alicia Haywood or Jen Dunn with any questions you might have, as well as any information to illustrate the access and the financial challenges facing rural providers and patients.

March for Rural Hospitals

NRHA is hosting a free education and advocacy event July 30 – 31st in Washington, D.C.

Join experts in D.C. to learn how to save Medicare Dependent Hospitals (MDHs) and the Low-Volume Hospital (LVH) program, and take this important message to Capitol Hill:

If congressional action is not taken by Oct. 1, millions of dollars in reimbursements to these facilities will be lost, hospital services will be reduced, and rural hospital doors will close.

Participation in the March for Rural Hospitals is free, but you must register. NRHA members register here. All other participants register here. For more information on MDHs and LVHs, click here.

Colorado Health Benefit Exchange Board Accepting Nominations for Work Groups through Close of Business TODAY

On April 23^rd the Colorado Health Benefit Exchange (COHBE) Board voted to move forward with creating advisory groups.  Applications for the advisory groups must be received by close of business today.  Nominations can be offered by Board members, organizations and interested individuals.  Advisory groups will be composed of approximately 15 – 20 members and will meet on a regular basis.  The advisory groups will begin meeting in late May/early June, and call in options will be available for those that are unable to attend in person. 

A list of the advisory groups and their description are listed below.      

1.      Small Business Health Options Program (SHOP) Advisory Group

This Advisory Group will inform the business processes, tools, and support functions available in the Small Business Health Options Program.

2.      Individual Experience Advisory Group

This Advisory Group will work to maximize the quality of the consumer shopping experience on the individual exchange.  This group will inform the way COHBE handles appeals from consumers and appropriate ways of notifying consumers about changes to their insurance status.  The role of individuals who will assist with providing Exchange services will also be addressed by this group. 

3.      Health Plan Advisory Group

This Advisory Group will inform the business processes, approach and technology needed to support balanced and successful working relationships between COHBE and carriers offering health plans on the Exchange. 

4.      Communications and Outreach Advisory Group

This Advisory Group will help to define the approaches and initiatives that will be used to educate consumers about the value of having insurance; educate customers about the services provided by COHBE; and, help to determine the most effective tools needed to assist COHBE customers in the choice of a health plan that best meets their needs.

Visit the Colorado Health Benefit Exchange website for more information and to sign up for a group today.   

Improvement in Colorado's Revenue Forecast Impact FY12-13 Budget

On March 19^th the Legislative Council (nonpartisan research staff of the CO General Assembly) released the latest economic and revenue forecast for Colorado.  Staff reported that the economy continues to gain strength.  The Fiscal Year 2011-12 General Fund budget is in balance, and an estimated $256 million left in the General Fund at the end of the year above the required reserve.  This is $108 million higher than the amount expected in December.  Click here to read the report. 

The budget-balancing package is expected to be introduced in the House next week.  Part of the proposed budget for FY 12-13 is the Senior Homestead Exemption, which exempts 50 percent of the first $200,000 of a home’s assessed value.  Voters approved the tax break in 2000, but the amendment allows the legislature to zero out the tax break if necessary.  Lawmakers have elected to zero out the tax break in all but four years since it was passed.   However, in light of the latest revenue forecast, the Joint Budget Committee said the state revenues are sufficient to restore the Exemption.  To get the benefit, a senior must be at least 65 years old and have lived in their home for the last 10 years. 

Ask Senators Udall and Bennet to Support the Rural Health Safety Net

Senators Kent Conrad and Chuck Grassley are currently gathering signatures for a letter to be sent to the Senate Appropriations Subcommittee on Health and Human Services.   Contact Senators Udall and Bennet today to voice your support for this letter (view here), and please ask them to cosign at this critical juncture.  The National Rural Health Association staff has contacted several offices but your voice is needed!

Webinar for Adults without Dependent Children Medicaid Expansion

Enrollment for the new Medicaid population begins soon.  The initial acceptance and processing of applications for Adults without Dependent Children (AwDC) begins April 1^st and runs through May 15^th.  There are 10,000 enrollment positions, and those determined eligible during that period will be assigned to one of the seven Accountable Care Collaborative regions.  The Connect Campaign is hosting a webinar for those who will be interacting with people interested in applying for AwDC Medicaid.  The webinar will help you direct patients to resources outside AwDC (such as the safety net, CICP and non-medical resources).  It will be held tomorrow (March 20^th) from 2:00 – 3:00 PM.  Click here to register.

Nominate Yourself to Participate in TBD Colorado

TBD Colorado is a nonpartisan, collaborative effort designed to generate informed and constructive conversations among Coloradans about some of the biggest issues facing the state.  Regional meetings will be held around the state beginning in April and will cover education, transportation, healthcare, state budget, state workforce/talent, higher education and P12 education.  In order to participate in these meetings, you need to have someone nominate you or nominate yourself.  Visit the website to learn more and to find the nomination form. 

Increase Seen in the Number of Preventable Dental Conditions as Primary Diagnosis in ERs

According to a recent report from the Pew Center on the States, preventable dental conditions were the primary diagnosis in 830,590 visits to ERs nationwide in 2009, a 16 percent increase from 2006.  Click here to read the report. 

Turning to hospitals to address oral health needs is costly and adds to the financial burdens on the state.  However, many times patients do not have a choice.    In Colorado, 22 counties have designations or are partially designated as geographic Dental Health Professional Shortage (based on dentist to population ratio), and 21 are designated as low income (below 200% of the Federal Poverty Level).  To see a map of Dental Health Professional Shortage Areas (DHPSAs) in Colorado, click here. 

A bill has been introduced in the in Colorado which seeks to offer dental benefits to pregnant women on Medicaid.  You may view the bill here.

Colorado Receives Grant for Health Benefit Exchange

Health insurance exchanges are online marketplaces for individuals and small businesses to compare plans that are similar in benefits for cost and quality and determine whether they are eligible for tax breaks.  Consumers will be able to go online for assistance and to get enrolled. 

Colorado received a Level I establishment grant in the amount of $17.9 million for the Colorado Health Benefit Exchange.  The Exchange will open for enrollment on October 1^st of 2013 and coverage will begin January 1^st of 2014.  Check out the Colorado Health Benefit Exchange website to follow developments or contact Alicia for more information. 

Weekly Bill Tracker

Check out our bill tracker to see which bills CRHC is reviewing or has taken a position. 

Update on Medicaid Expansion to Adults without Dependent Children

The planned Medicaid expansion for low-income adults without dependent children has undergone a few changes in its implementation plans.  First, the program will initially roll out on a limited basis, will only be available for those who have incomes below 10% of the federal poverty level, and will only be available for 10,000 persons.  The method of determining who will be the 10,000 is by random selection, as opposed to first come, first serve.  All others who would otherwise be eligible will be put on a wait list.

Applications can be first submitted in on April 1 of this year (but if received for processing earlier, the application will be denied), and the first random selection process will be run on May 15^th.  Each month thereafter, if there are spots that happen to open up on the Medicaid program, additional random selection processes will be run to keep the program filled.

This means that all estimated 49,511 adults without dependent children who live under 10% of the poverty level (or single adults earning less than $100 a month, or a couple earning less than $122 a month) will continue to have a chance to get on the program after its initial roll-out.  For more information about this program, check out these resources from the state Medicaid agency (HCPF).

While the state believes this program will roll out as expected, these new decisions are still pending approval from the Centers for Medicare and Medicaid Services (CMS) at the federal level.

Also, encouraging folks to apply for this new eligibility category, the hope is that more folks will receive the opportunity to receive other resources they are eligible for such as food and/or cash assistance and CICP.  Since clinics presumably are already seeing much of this population, assisting the newly eligible with their benefits and assisting the ineligible with applying for other services will be key to answering the needs of the entire population.  To help folks meet their needs outside of Medicaid, check out this list of statewide resources.

For more information, or to provide feedback, please contact Alicia Haywood. 

Take Action Today - Contact Congress Regarding Disproportionate Rural Impact on Budget Cuts

Votes will likely take place on the hill today regarding cuts which can be harmful to Critical Access Hospitals, Rural Health Clinics, and other safety net providers. Please contact your members of Congress to let them know that any reduction in services in rural areas will likely affect the health status of those residents who rely on safety net providers for essential health care services. New information and opportunities to contact your elected officials will be posted as these issues develop. You may use the message below when contacting your members.

"Recently we received a summary of the agreement that has reportedly been negotiated between House and Senate Conferees to temporarily “fix” the SGR problem, continue the payroll tax cut and address unemployment benefits and extend various expiring provisions.

Included in the summary is an explanation of a provision (Section 3201) dealing with cuts to Medicare bad debt payments to certain providers. Absent from the explanation is any mention of the fact that a significant percentage of the savings attributable to this change will come from the phase-down of Medicare bad debt payments to Critical Access Hospitals and Rural Health Clinics. In fact, the summary fails to mention that this will affect RHCs or CAHs – the smallest and most vulnerable rural providers.

Because of this oversight, we are concerned that you might not be aware of how RHCs and CAHs will be harmed by enactment of this legislation.

The summary states that over a three year period, Medicare bad debt payments to providers receiving 100% of bad debt will be have their bad debt payments limited to 65% of allowable bad debt."

Check out the Colorado Rural Health Center's State Bill Tracker

CRHC monitors legislation at the state and federal level to assess potential impacts on rural providers and communities.  You can see which state bills CRHC is supporting, monitoring or opposing by clicking here.  This link is a static link.  You may save it into your favorites and open it at any time to see the bills that have been introduced which may impact the healthcare in rural Colorado, as well as to check their status and see CRHC’s position.  For more information, contact Alicia Haywood. 

National Rural Health Association and Policy Partners Ask Congress to Protect the Rural Health Safety Net

More than 450 rural health advocates attended the NRHA’s 2012 Rural Health Policy Institute in January.  The Colorado Rural Health Center and other rural advocacy partners asked our members of Congress to support the fragile rural healthcare delivery system with three legislative requests. 

  

1. Protect and extend vital rural Medicare programs.  Failure to extend these important provisions past their 2012 expiration dates will harm rural providers and the patients they serve.

2. Send the message that sequestration will disproportionately harm rural providers. The Budget Control Act mandated a Medicare spending sequester that will disproportionately harm rural providers and should be modified to avoid crises in access to care.

3. Support strong funding for the rural health safety net.  Strengthen the "rural health safety net" by providing critical funding in fiscal year 2013 for programs vital to the efficient and effective delivery of health care in rural America.

Check out the NRHA Policy Institute Action Kit to read more about these rural programs, the sequestration and the potential impacts on rural providers and communities.

New Seats on the ACC Advisory Committee

The Department of Health Care Policy and Financing is adding two new seats to the Accountable Care Collaborative (ACC) Program Improvement Advisory Committee.  One seat will represent dually eligible individuals (Medicare and Medicaid), and one seat will represent the adults without dependent children.  These committee members will act as liaisons between the ACC Program Improvement Advisory Committee and the AwDC Advisory Committee and Duals Stakeholder Groups, as the Department plans to enroll both dually eligible individuals and adults without dependent children into the ACC program.  Information about the committee, as well as an application, may be found here.   


Applications are due March 15th.  You may return your application to the Department by faxing it to (303) 866.2803, or you may attach it in an email and send it to ACC@hcpf.state.co.us.  For more information, contact Alicia Haywood at CRHC, or Kathryn Jantz at the Department.   

2012 Legislative Session Begins

The first day of the 2012 legislative session is set to begin Wednesday, January 11^th and continue until May 9^th.  Senate President Brandon Shaffer and Speaker of the House Frank McNulty will address each chamber beginning at 10:00 AM, and Governor Hickenlooper will deliver the State of the State address at 11:00 AM on Thursday, January 12^th.  The speeches can be watched on the Colorado Channel.  

During the legislative session, the Colorado Rural Health Center will focus on policy priorities to protect funding for rural providers and facilities, to expand the rural healthcare workforce and support innovative models of care, to build support for Rural Health Clinics (RHC) and Community-funded Safety Net Clinics (CSNC), to promote affordable health insurance options that work for Coloradans and to expand rural access to health information technology.  To read more about each priority area, please visit our website.  You may also visit the CRHC website to find a link to our bill tracker, which will be updated weekly throughout the session.  

Update from CRHC and The Rural Voice

Posts in this week’s issue of The Rural Voice will be my last. With a mix of sadness and excitement, I will be leaving CRHC and joining the Colorado Health Institute later this month. It has been an honor to work with you and my CRHC colleagues, especially my co-analyst Alicia Haywood, in support of rural healthcare. The Rural Voice will continue to provide current news and policy updates and be a resource for state and federal issues that impact our rural communities. Please contact Alicia if you need assistance or information on policy topics. 
Thank you and take care, Sara