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ACAP-ASSISTED 18TH ANNUAL MEDICAID MANAGED CARE CONGRESS TO BE
IN BALTIMORe: ACAP DINNER PLANNED
The 18th Annual Medicaid Managed
Care Congress will be held May 17th through May 19th at the
Baltimore Hyatt Regency. At this critical crossroad for US
healthcare reform, it is essential to obtain the most
comprehensive answers to the challenges that lie ahead. In its
18th year, IIR's
Medicaid Managed Care Congress is a place that brings
together the nation’s preeminent thought leaders to help you
navigate reform from policy to practice. Annually, over 300
attendees convene to hear 50+ government and industry experts
from State and Federal Medicaid, Managed Care plans, and
National Policy, as they present the latest strategies and ideas
to help you achieve quality, manage cost, and prepare for the
latest policy changes.
In 2010, ACAP continues its
involvement in the planning of this meeting, and this year the
agenda highlights presentations by ACAP’s Chief Executive
Officer Meg Murray, as well as CEOs and/or staff from a number
of ACAP health plans including Boston Medical Center HealthNet
Plan, CalOptima, CareSource, Cook Children’s Health Plan, Health
of San Mateo, Horizon NJ Health, Hudson Health Plan,
Metropolitan Jewish in NY, Neighborhood Health Plan,
Neighborhood Health Plan of Rhode Island, and VNS Choice.
Featured Keynote presenters include Mark McClellan, Director,
Engelberg Center for Healthcare Reform at the Brookings
Institution, and Patrick J. Kennedy, Representative, State of
Rhode Island, US House of Representatives.
Because of ACAP’s involvement,
all ACAP colleagues are entitled to 20 percent off the standard
registration price. Just mention priority code XP1526ACAP. For
complete program details, visit the conference website at
www.mmccongress.com or
download the conference brochure.
In conjunction with the Medicaid Managed Care Congress, ACAP
will again host a dinner the evening of Tuesday, May 18th at
6:00 pm for all ACAP members attending the meeting. If you
plan to attend the dinner, please let Stephen Cox know at
scox@communityplans.net.
The dinner location and logistics will be sent out closer to
the meeting.
CMS ISSUES FINAL MEDICARE PART C AND D POLICY AND TECHNICAL
CHANGES REGULATION
The Centers for Medicare and
Medicaid Services (CMS) issued a final rule April 6 revising
regulations governing the Medicare Advantage program (Part C)
and prescription drug benefit program (Part D). The final rule
strengthens beneficiary protections and ensures that plan
offerings to beneficiaries include meaningful differences.
Other important program requirements include the establishment
of cost-sharing thresholds for Parts A and B services, as well
as medical record review appeal rights in the Risk Adjustment
Data Validation (RADV) appeals process.
CMS published the draft rules on October 22 and 114
organizations, including ACAP, commented. The rule, CMS 4085-F,
is effective June 7, 2010.
CMS ISSUES SMD LETTER ON NEW OPTION FOR COVERAGE OF INDIVIDUALS
UNDER MEDICAID
On April 9, without fanfare, CMS
distributed a letter to State Medicaid Directors describing the
Medicaid expansion to populations with incomes up to 133 percent
of the federal poverty level, quietly issuing in the most
significant expansion of a public program in decades.
The letter describes covered populations (individuals who are
under age 65 and who are not pregnant or eligible for Medicare,
or otherwise eligible for Medicaid), the benefits packages that
will be allowable for the new population (benchmark coverage
described in section 1937(b)(1)), and outlines policy related to
an option for states to expand or phase-in coverage to the new
population as early as April 1, 2010. States will receive
regular match for early expansions until 2014, and will not
receive the extra FMAP provided by the American Recovery and
Reinvestment Act (ARRA). CMS writes that a state plan template
will be made available in the near future.
ACAP has been among the strongest voices in favor of the
Medicaid expansion throughout the health reform debate, lobbying
forcefully for a significant expansion of Medicaid, publishing
letters in key media outlets, and placing advertisements in
critical Capitol Hill newspapers with our partners in the safety
net provider and advocacy communities.
CMS will issue separate guidance on the matching rate provisions
in the new health insurance reform legislation. The full letter
can be viewed
here.
HHS CALLS ON NONPROFIT ORGANIZATIONS TO HELP IMPLEMENT TEMPORARY
HIGH RISK POOLS
HHS issued a Sources Sought
Notice on April 20 to determine the availability of nonprofit
organizations to provide services starting this year through
2013 under a temporary high risk health insurance pool program
established in the health reform law. In the event that a state
does not submit an acceptable application to HHS to operate a
high risk pool program, HHS will administer the program directly
or contract with a non-profit private entity or entities to
provide coverage in such states. Because of the brief timeframe
allowed by the law to establish high risk pools, HHS is using
this Notice to identify potential partners before knowing in
which states it will need to administer or contract out for the
high risk pool program directly.
This Notice follows an April 2, 2010 letter issued by the
Secretary issued to states asking for interest in participating
in the temporary high risk pool program. That letter outlines
several options for states to participate in developing and
operating high risk pools under this program. HHS anticipates
learning from states by April 30, 2010 as to whether they will
operate such a high risk pool program.
Potential nonprofit contractors must be able to demonstrate
specific capabilities outlined in the Notice. The full Notice
can be viewed
here.
NATIONAL HEALTH CARE QUALITY AND DISPARITIES REPORTS
The Agency for Healthcare
Research and Quality's (AHRQ) annual quality and disparities
reports, which are mandated by Congress, are based on more than
200 health care measures categorized in four areas of quality:
effectiveness, patient safety, timeliness, and
patient-centeredness. The newly released 2009 National
Healthcare Disparities Report includes:
- Resources on training health
care personnel to deliver culturally and linguistically
competent care for diverse populations.
- Data on recent immigrant and
limited-English-proficient populations.
- Data on the diversity of
dental professionals in the workforce.
The quality and disparities
reports are available online at
http://www.ahrq.gov/qual/qrdr09.htm, by calling
1-800-358-9295, or by sending an e-mail to
ahrqpubs@ahrq.hhs.gov.
TRAINING: HEALTH LITERACY FOR THE PUBLIC HEALTH PROFESSIONALS
To help public health
professionals respond to the problem of limited health literacy,
the Centers for Disease Control and Prevention (CDC) have
launched a free "Health Literacy for Public Health Professionals
Online Training" program. The purpose of this training is to
educate public health professionals about limited health
literacy and their role in addressing it in a public health
context.
This is a web-based course and can be accessed 24/7 by any
computer with Internet access. It takes 1.5 to 2 hours to
complete. Trainees can earn a variety of continuing education
credits. You can access the training program from the
CDC website.
For a link to CDC's and other HHS' agencies' health literacy
sites, check out AHRQ's Health Literacy and Cultural Competence
Resource Links at:
http://www.ahrq.gov/browse/hlitres.htm.
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VENDOR ALLIANCES |
ACAP WELCOMES SUNRx AS A PREFERRED VENDOR
SUNRx helps healthcare safety net
organizations and payors implement discount drug programs that
reduce prescription costs, expand access to affordable
medications and improve community health care. Our flagship 340B
Simplified solution is trusted by community health organizations
nationwide to provide patients with convenient access to
discounted medications through networks of contract pharmacies.
SUNRx creates partnerships between managed care organizations
and 340B eligible entities to allow health plans to share in
these savings and significantly reduce prescription costs. Our
MCO Advantage solution offers safety net health plans:
- Savings. MCOs can
save up to 25% off the cost of drugs, with no up front
costs.
- Disruption-free. 340B
MCO Advantage is seamless for managed Medicaid members,
providers, pharmacies and processors.
- 100% compliance.
SUNRx’s fully automated system includes built-in safeguards
to prevent drug diversion and ensures that Managed Care
Organizations and health centers remain fully complaint with
all 340B regulations.
For more information contact:
Jeff Rollins
Chief Sales and Marketing Officer
SUNRx
(302) 598-5433
jeff.rollins@340bsimplified.com
SUMMIT REINSURANCE TO HOST EXECUTIVE SUMMIT AND NETWORKING
RETREAT
Summit Reinsurance Services, one
of ACAP’s preferred vendors, is holding its 5th annual Executive
Summit & Networking Retreat on April 26-28 at the Charleston
Harbor Resort & Marina in Charleston, SC. The theme is “Health
Care Reform: Now What?” The event brings together health care
executives from across the country to share ideas, discuss “best
practices” and hear how others are tackling the problems we face
in an increasingly challenging environment. Presentations will
include “Healthcare Trends: the Accountable Care Organization
Concept and a Return to Provider Risk”, “Stretching the Claim
Dollars: How Far Can You Go?”, “Medicaid Managed Care: A
Successful Public-Private Collaboration”, “Medicare’s Value
Chain: A Survival Guide”, “ProvenHealth Navigator: Geisinger
Health System’s Medical Home Model”, “Benefit Design Based on
Medical Effectiveness Research: Challenges and Feasibility”,
“Improving Birth Outcomes with Preconception Care”, and “Rising
Drug Spend: How to Get the Most from your Pharmacy Benefit
Manager”. For more information visit
http://www.summit-re.com/.
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