 January 21, 2005 |
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Upcoming ACAP Calls
January 24: Executive Committee January 27: Medicare Roundtable February 1: Quality and Disease Management Roundtable February 2: Quality Management Committee February 2: Marketing Directors February 8: Best Practices Call February 10: Policy Roundtable
Upcoming Events Calendar
 
ACAP Links
 
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| HIGHLIGHTS |
Colorado Access Approved as Medicare Advantage Plan On January 10th, Colorado Access, the state’s largest managed care organization for Medicaid and Child Health Plan Plus and a member of ACAP, received approval from the Centers for Medicare and Medicaid Services to market Access Advantage. The Access Advantage health plan will be available in seven counties in the Denver metro area for beneficiaries with special needs who are eligible for Medicare and Medicaid. This is the first time this kind of plan will be available anywhere, and it is the first new Medicare plan in the region in five years. In his statement about the approval, Colorado Access President and CEO Don Hall, stated that enrollees eligible for Medicare and Medicaid, “… can now choose Access Advantage, a health plan that gives them more dental, vision and hearing benefits. We [Colorado Access] also have employees dedicated to helping them figure out the complex Medicare system and assist in developing linkages to vital community resources like food and affordable housing.” There are no co-pays or deductibles, and members will be assigned "personal resource coordinators" to help them access community resources and understand Medicare.
Book Now for ACAP's April Board Meeting
The expanded benefits for enrollees include: ACAP CEO's can now make reservations for the April 19-21 board meeting to be held in Honolulu, HI. More information about the preliminary agenda and hotel reservations can be found on the Members Only section of our website.
Commonwealth Care Alliance Joins ACAP The Association of Community Affiliated Plans welcomes its newest member - the Commonwealth Care Alliance, Inc. (CCA). CCA is a non-profit organization that operates out of Boston, Massachusetts and is currently run by Dr. Robert Master. It was founded by Community Catalyst (CC), Health Care for All (HCFA) and Boston Center for Independent Living (BCIL) and was designed to serve as a consumer-governed care system. CCA contracts with payers on a risk-adjusted prepaid basis to provide a full spectrum of care for high-risk Medicaid (and dually) eligible populations with complex needs. As a small program with clinical and consumer roots, CCA focuses on improving care and managing costs for the 12 percent of Medicaid and dually eligibles who account for 75 percent of expenditures. CCA's programs include:
Koller Named First RI Health Insurance Commissioner On January 13th, Rhode Island Governor Carcieri nominated Christopher Koller to serve as the state's first health insurance commissioner. Mr. Koller has served as the Chief Executive Officer of Neighborhood Health Plan of RI for the last 8 years. Mr. Koller also served as the founding Chairman of ACAP for four years. In his announcement Governor Carcieri stated, “As CEO of Neighborhood Health Plan, Chris is a nationally-recognized leader in the health care field. He has long been acknowledged as Rhode Island’s most innovative advocate for high quality, affordable health care. His long background in health care management, as well as his stewardship of Neighborhood Health Plan, makes him the perfect candidate for this job.” During the press briefing, Mr. Koller stated that although Rhode Island's health care system has many strengths, "the status quo can't hold. Rising health insurance rates are a real problem." If confirmed by the Senate, Mr. Koller will be responsible for approving health insurance rate hikes and helping set statewide policy on the issue. In this position Mr. Koller will serve as the top advisor to the Governor on health care policy and has been tasked with finding ways to make quality health care more affordable and accessible. Governor Carcieri also announced that Mr. Koller will chair a Health Care Cabinet. The newly created Cabinet will work with Mr. Koller to move forward initiatives and develop a plan to improve access, quality and affordability of health care in Rhode Island. Mr. Koller will be attending the February ACAP Board meeting in Washington. The staff and members of ACAP wish him well in his new role.  |
| PUBLIC POLICY AND ADVOCACY |
Partnership for Medicaid Solidifies Principles In January the Association for Community Affiliated Plans officially joined the Partnership for Medicaid. The Partnership is a non-partisan, nationwide effort by safety net providers and other key organizations to preserve and improve the Medicaid program. In the coming months, the Partnership will be working to raise awareness about the vital role played by the Medicaid program. At the January meeting of the Partnership, members began to lay out a strategy for informing the President and Members of Congress of the new organization and its agreed upon principles. ACAP has endorsed these principles which include:
Reminder: Congressional Meetings for February
ACAP Joins Coalition in Sending Letter to President ACAP staff is available to schedule meetings with Members of Congress and their staff for ACAP plans on Wednesday February 16th and will provide you with talking points. You can also schedule them on your own and let us know so we can accompany you. Please contact Andrea at amaresca@communityplans.net for more information. ACAP joined 240 national organization and nearly 800 state groups from all 50 states and the District of Columbia in signing a letter to the President opposing cuts and caps in Medicaid. Similar to other letters ACAP has supported, this latest communication urged the President not to cut Medicaid or make changes that would fundamentally alter the structure of the program in his budget proposal for fiscal year 2006. The groups stated that while there is clearly a need to address the rising health care costs that face our nation, the signatories remain opposed to changes in the current structure of the Medicaid program that include converting the program into a block grant or otherwise imposing caps on federal funding. The text of the letter can be found on the Policy and Legislative page of ACAP's website at: http://www.ahcahp.org/pandl/default.asp Medicaid Spotlighted During Hearings on HHS Nominee Leavitt This week Michael Leavitt, the President's nominee to become the next Secretary of Health and Human Services, testified before the Senate Health, Education, Labor and Pensions (HELP) and Senate Finance committees. Although Mr. Leavitt is expected to win approval in the Senate, questions from some Senators sparked intense discussion on several issues, including Medicaid reform. During both hearings, Mr. Leavitt stated that Medicaid is a "vital program" that isn't meeting its potential. He went on to say that states need more flexibility to decide how to structure the program because rising costs are eating away at other areas of their budgets. During the Senate Finance Committee hearing, several members questioned Mr. Leavitt on the extent to which he plans to adopt Utah's Medicaid waiver plan for nationwide changes to the program. As Governor of Utah, Mr. Leavitt oversaw the design and implementation of the waiver which has since received mixed reviews. Mr. Leavitt said he would not try to duplicate his Medicaid plan on a national scale. "The waiver was not intended to show the way for any national approach," he said. "It was designed to solve a unique problem." Among the other concerns raised by certain senators was whether Mr. Leavitt and the administration would try to lower costs by placing limits on how much the federal government would pay per person to cover certain optional Medicaid populations. In response, Mr. Leavitt said he was unaware of any block grant proposal drafted by the Administration but that he would consider a proposal to impose limits on optional benefits or optional beneficiaries. He promised "only to oppose changes ... for the remaining 'mandatory' beneficiaries." Another theme that came through in Mr. Leavitt's remarks was that the Administration would move forward with initiatives to reign in intergovernmental transfers (IGTs) that states use to increase federal Medicaid matching funds. Mr. Leavitt was also pressed on long-term care and its costs - another hot topic in health care. The senators urged him to examine ways to boost long-term care provided in homes and community care centers as a way to hold down expensive nursing home costs and improve care. Mr. Leavitt agreed that long-term care "is the most significant challenge we face in Medicare and Medicaid." Earlier this week at the Senate HELP Committee hearing, Mr. Leavitt fielded tough questions from Massachusetts Senator Ted Kennedy who asked about reports that the administration planned deep reductions in the rate of growth of Medicaid and Medicare and "whether we're going to be squeezing and denying health benefits." In his oft repeated response Mr. Leavitt said, "It's always been my belief that we can expand the number of people we serve with the available resources." Senate Budget Chairman Puts Entitlement Programs on the Table While House and Senate staff agrees that Medicaid will be among the top priorities of the Administration and Congress, they also agree that it would be difficult to pass a cap on Medicaid in the Senate. Even amid these doubts from staff and budget experts, Senate Budget Committee Chairman Judd Gregg (R-NH) offered a different take in recent interviews, saying he expects his committee will consider legislation to make it more difficult to increase long-term unfunded obligations of entitlement programs such as Social Security and Medicare, and possibly Medicaid. In one interview Senator Gregg stated that he thought Congress would, "try to rein in Medicaid spending by easing restrictions on how states use Medicaid funds while reducing the federal contribution." Reminder: Feb. 10 Policy Roundtable ACAP has scheduled a Policy Roundtable call for Thursday, February 10th. The agenda will include the following topics:
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| EXCELLENCE AND ACCOUNTABILITY |
Feb. 2: New Webcast Call Scheduled for Marketing Staff This call will be webcast. Please check the Marketing Directors Roundtable page on the ACAP website for instructions on accessing the webcast. On February 2, ACAP will host a follow-up call to the December Roundtable conversation about the proposal from New Kirk Publications. The proposal was for a reduced fee for New Kirk Publication's "On Demand" product for ACAP member plans. On Demand helps health plans manage printing, production and inventory for member materials such as welcome packets, ID cards, provider directories, etc. Jim Panusuk at New Kirk publications will provide more information about the product. He has also organized a webcast to demonstrate his product and answer any questions about their capabilities. Please contact Peggy Oehlmann at poehlmann@communityplans.net with any questions.
Staff Roundtable Call Schedule
Upcoming Best Practices Call on NICU Management Please visit the Members' Only section of ACAP's website for a complete listing of roundtable calls. On February 8th at 3 pm EST (2 pm Central, 1 pm Mountain, 12 pm Pacific, 10 am Hawaii), Jim Glauber, MD of Neighborhood Health Plan of Massachusetts and Peggy Waters, RN of Network Health will discuss their plans' respective approaches to NICU management. Neighborhood Health Plan recently outsourced its NICU management to a vendor and will discuss the "build versus buy" decision as well as a basic overview of their NICU management model. Network Health will discuss its in-house NICU case management program and how it provides NICU families with support and links to community resources both in the hospital and upon discharge. Plan materials will be posted in the Best Practices section of ACAP's website prior to the call. Reminder: Jan 27 Call on ACAP Plans Entering Medicare ACAP plans will discuss the new Medicare application expected to be released in mid-January and compare notes on application issues and challenges. Note: All ACAP plans are welcome to participate but this call is specifically focused on application issues for those considering an application to be a Medicare Special Needs plan. The call will be begin at 3 pm eastern standard/2 pm central/1 pm mountain/12 pm pacific/10 am Hawaii. Recap of Human Resources Roundtable On January 12th, 14 people participated in ACAP's first Human Resources roundtable to discuss staff performance measurement. Several plans are in the process of implementing "360 Evaluations," which allow peers to review each other. A number of ACAP plans are also in the process of moving from anniversary date appraisals to focal date appraisals, where appraisals and merit increases are completed at specific times of the year. The HR directors agreed that a regular schedule of calls to discuss HR topics would be beneficial. ACAP will be announcing dates for future calls on our website and via the newsletter. Recap of IT Best Practices Call On January 13th, Doug Bach and Marty Mattei discussed Colorado Access’ efforts to work with its providers to enhance technology and information exchange. Twenty people participated in the webcast call. The presenters discussed the value of working with providers to implement Electronic Medical Records (EMRs) and a provider portal. Colorado access also recently implemented a formulary hosting service, which is a data tool that helps doctors get real time formulary and prescription information. Copies of their presentation can be found in the Best Practices section of ACAP's website at: http://www.ahcahp.org/bppo/default.asp. |
| FUNDING OPPORTUNITIES & NEWS |
Promoting Health Behaviors in Primary Care Research The "Prescription for Health: Promoting Healthy Behaviors in Primary Care Research Networks" is a five-year program to develop, test, evaluate, and disseminate creative, practical strategies to promote healthy behaviors in primary care practices. The program, a national initiative of the Robert Wood Johnson Foundation, will target four behaviors: lack of physical activity, poor diet, tobacco use, and risky use of alcohol. Any primary care Practice-Based Research Network (PBRN) with headquarters in the U.S. is eligible to apply. As many as nine 24-month grants of up to $300,000 each will be awarded in this round of funding. More information is available at: http://fdncenter.org/pnd/rfp/rfp_item.jhtml?id=92300037 |
| NEWSFLASH |
Congress Requests Medicaid Documents from Hospitals Last week the chairman of the House Energy and Commerce Committee, Rep. Joe Barton (R-TX) sent a letter to 20 hospitals in 10 states asking them to provide information for the committee's investigation into Medicaid financing mechanisms used by states to generate additional federal Medicaid matching funds. The hospitals are being asked to, "account for all financial arrangements with Medicaid funds in a straightforward and worthy manner." In his letter, Chairman Barton asks the hospital facilities for their net patient revenue, gross Medicaid revenue, overall cost-to-charge ratio, and total Medicaid funds received from each year dating back to 2000. It also asks the facility to detail any state/provider financing mechanism it has considered or engaged in since 2000, including the use of intergovernmental transfers (IGTs). CMS Releases New Figures on Health Care Spending According to economists from the Office of the Actuary at the Centers for Medicaid and Medicare Services (CMS), health care spending in the United States grew at 7.7 percent in 2003. This was the slowest pace in seven years. Still, the overall health care spending was $1.7 trillion - the highest ever - which translates into $5,670 per person. This $1.7 trillion figure also represents a record high 15.3 percent of the U.S. gross domestic product. Health care spending outpaced the nation's overall economic growth by 3 percentage points. Cynthia Smith, the lead author of the federal report, offered several reasons for the slowed rate in health care spending, including cuts in Medicaid and Medicare spending and a push to use cheaper generic drugs and over-the-counter medications. More specifically, in the report published in the January/February 2005 issue of the journal Health Affairs, she stated that by tightening eligibility and restricting benefits, fiscally challenged states cut the growth in Medicaid spending to 7.1 percent in 2003, compared with more than 12 percent in 2002. Specific findings reported in the study include:
HHS Announces Reallocation of SCHIP Funds On Wednesday, January 19th, Health and Human Services Secretary Tommy Thompson officially announced that $643 million in unspent 2002 dollars from the State Children's Insurance Program (SCHIP) would be reallocated to help states avoid shortfalls in 2005. The reallocation seeks to ensure that no child loses health insurance because the states do not have funds to administer the program. States have three years to spend each year's SCHIP allotment. In previous years, Congress has allowed a portion of funds left unspent to be redistributed to states that have exhausted their money. This year, Secretary Thompson used his own authority to redistribute unspent 2002 funds to states that demonstrated the need for additional SCHIP funds. According to the HHS press release, twenty-eight states will receive supplemental funds. Without the redistribution, five of the states, including Arizona, Minnesota, Mississippi, New Jersey and Rhode Island, would have run out of federal funding for their SCHIP programs. Governor Moves Forward with TennCare Reforms This month Tennessee Governor Bredesen (D) announced plans for reforming TennCare, the state's safety net insurance program for poor, disabled and uninsured residents. The Governor has proposed eliminating health-care coverage for as many as 323,000 adults who are not eligible for Medicaid but are currently enrolled in TennCare. Although the Governor stated he understands the cuts will cause hardship, he also said the new ''basic TennCare'' program, which could take effect in April, will look more like the programs in other states. All of the 612,000 children enrolled in the state program will be excluded from the cut. However, for the remaining 396,000 adults Bredesen has proposed strict limits on the number of trips to the doctor and the prescriptions they can fill each month. According to the Governor, these cuts will dramatically slow the rate of TennCare's projected cost increases. With the changes, the program is expected to cost an additional $75 million in the next fiscal year versus the $650 million extra that was predicted prior to the proposal's release. New York Medicaid Program Slated for Cuts In the budget proposal released this week, New York Governor George Pataki (R) included a $1.1 billion reduction in state Medicaid spending to help close a projected $4.2 billion deficit. Provisions of the proposal included:
This month California Governor Arnold Schwarzenegger released a budget proposal that would make substantial changes to the state's Medicaid program. In his proposal, about 550,000 Medicaid beneficiaries with incomes above 100% of the federal poverty level would have to pay a monthly premium of $10 per adult and $4 per child but there would be a family cap of $27. Other provisions of his proposal included:
Earlier this month Florida Governor Jeb Bush (R) released a Medicaid reform proposal that would have the state pay HMOs and other health networks rather than paying doctors and hospitals directly for treating Medicaid patients. The state would seek to entice insurance companies to enter and stay in the Medicaid market by capping Medicaid benefits. To entice insurance companies to take on some of Florida's sickest, poorest residents, the state would cap Medicaid benefits, just as private insurance plans do. Patients needing more care would be covered by a catastrophic fund financed through a percentage of Medicaid premiums. The proposal envisions managed care companies and other networks designing the plans for Medicaid patients. These plans would cover the same basic services, such as doctors' visits, prescription drugs, diagnostic tests and emergency services covered by the state's mandatory and optional Medicaid programs. It would then be at the discretion of the health plans whether and to what extent they would offer additional services In addition to the Medicaid reform proposal this week Governor Bush released budget recommendations that included additional changes in the state's Medicaid program. He proposed a freeze on Medicaid payment rates for hospitals, doctors, nursing homes and health management companies. The proposal also calls for the elimination of physician visits and hospital stays provided through the $398 million Medically Needy program, which provides health care coverage to about 36,000 state residents who are unable to obtain other insurance. Centene Corp Acquires SummaCare's Medicaid Assets Centene Corp. recently signed an agreement to acquire the Medicaid assets of SummaCare, Inc. based in Akron, Ohio. In addition to the Medicaid assets, the $31 million agreement includes long-term provider contracts with Summa Health System. The agreement will expand the lives covered by Centene's Ohio subsidiary Buckeye Community Health Plan by 39,000 and make BCHP the second largest Medicaid health plan in the state. |
| JOBS |
SFHP Seeks Medical Director San Francisco Health Plan, a not-for-profit, provider-focused health plan committed to expanding access to health care and driving quality, is looking for a creative and energetic Medical Director. The Medical Director supervises the utilization management, pharmacy, and quality improvement functions, making the final decisions relating to all clinical issues. In addition, the Medical Director serves a critical external function, maintaining and enhancing SFHP's relations with providers, through personal interactions and through the supervision of the provider relations function. The complete job description and information on how to apply can be found at the ACAP Job Bank site: http://www.ahcahp.org/jobs/jobs.asp Reminder: ACAP Job Bank You can find recent job postings at ACAP's job bank at: http://www.ahcahp.org/jobs/jobs.asp. For more information about posting a job please contact Andrea Maresca at amaresca@communityplans.net. |
| Upcoming Events |
January Events |
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1/2 New Years Day |
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4 Congress reconvenes |
5 CFO Roundtable |
6 |
7 |
8/9 |
| 10 Finance Committee Call |
11 |
12 HR Roundtable |
13 Best Practices Call |
14 Hotel registration deadline for ACAP's CEO-CFO Meeting in DC |
15/16 |
| 17 Martin Luther King, Jr. Holiday |
18 |
19 |
20 Presidential Inauguration |
21 |
22/23 |
| 24 Executive Committee Call |
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26 |
27 Medicare Roundtable |
28 |
29/30 |
| 31 |
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| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
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1 Quality/Disease Management Roundtable 3 pm EST |
2 Quality Management Committee 11am EST Marketing Directors Call 3pm EST |
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5/6 |
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8 Best Practices Call: NICU Management |
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10 Policy Roundtable |
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12/13 13th ACAP CEO-CFO Dinner |
| 14 ACAP CEO-CFO Conference |
15 ACAP CEO-CFO Conference |
16 ACAP Congressional Meetings |
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18 |
19/20 |
| 21 President's Day Holiday |
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23 |
24 CFO Roundtable |
25 |
26/27 |
| 28 |
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ACAP Mission: To improve the health of vulnerable populations through the support of Medicaid-focused community affiliated health plans committed to these populations and the providers who serve them. James Hooley, Chairman Margaret A. Murray, Executive Director |
Association for Community Affiliated Plans 2001 L Street, NW, 2nd Floor Washington, DC 20036 Contact Us |