ACAP Newsletter

March 3, 2006
 ACAP Newsletter

HIGHLIGHTS

ACAP Releases Report on Actuarial Soundness
ACAP and the Medicaid Health Plans of America have released a report by the Lewin Group of the ways that states have implemented rules from the Balanced Budget Act of 1997 (BBA) regarding actuarial soundness. Those who participated in the survey represent managed care programs covering 12 million enrollees (68% of the national total).
Click to read this article.
Contra Costa Health Plans Joins ACAP
Contra Costa Health Plan (CCHP) in California became the 26th member of ACAP this month. Like three other ACAP members, CCHP is also a local initiative, two plan model HMO serving primarily Medi-Cal and SCHIP beneficiaries. CCHP serves over 65,000 people in Contra Costa County. CCHP has been serving the health needs for people in Contra Costa County for 30 years.
Click to read this article.
PUBLIC POLICY AND ADVOCACY

Senate Budget Committee Chairman Gregg Attacks Administration's FY07 Budget as 'Irresponsible,' 'Unrealistic'
Click to read this article.
ACAP Begins Work in House to Ensure Safety Net Health Plans Have Seat at Health IT Table
Click to read this article.
ACAP Sends Letter to CMS on Actuarial Soundness
Click to read this article.
Recap: Policy Roundtable
Click to read this article.
Recap: Medicare SNP Roundtable
Click to read this article.
Reminder: Medicare SNP Roundtable
Click to read this article.
EXCELLENCE AND ACCOUNTABILITY

2006 Schedule of Roundtables Now Available
Click to read this article.
AHRQ Announces Audio Newscast Series: Healthcare 411
Click to read this article.
Health IT Certification Panel Seeks Volunteers to Serve on Workgroups
Click to read this article.
Recap: Quality Management/Disease Management Directors Roundtable
Click to read this article.
Recap: Provider Relations Directors Roundtable
Click to read this article.
Recap: Pharmacy Directors Roundtable
Click to read this article.
Reminder: Chief Medical Officers Roundtable
Click to read this article.
Reminder: Marketing Directors Roundtable
Click to read this article.
Reminder: Customer Service Directors Roundtable
Click to read this article.
NEWSFLASH

Chapin Writes in Support of Facilitated Enrollment
Click to read this article.
NACHC's Tom Curtin and Co-Authors Publish Article in Journal of the American Medicine Association (JAMA) on Shortage of Medical Personnel in CHCs
Click to read this article.
    
Upcoming ACAP Calls
 March 9: ACAP CMO Roundtable
March 16: Marketing Directors Roundtable
March 23: Customer Service Directors Roundtable


Upcoming Events Calendar
Click to view calendar.
HIGHLIGHTS

ACAP Releases Report on Actuarial Soundness

ACAP and the Medicaid Health Plans of America have released a report by the Lewin Group of the ways that states have implemented rules from the Balanced Budget Act of 1997 (BBA) regarding actuarial soundness. Those who participated in the survey represent managed care programs covering 12 million enrollees (68% of the national total).

Key findings revealed that plans' actual costs are often not fully taken into consideration by the states, especially during tough fiscal times, even though both the American Academy of Actuaries and the Center for Medicare and Medicaid Services require that the rates not take into consideration budget difficulties that the states might have. Margaret A. Murray, Executive Director of ACAP said "We are pleased with the findings of the Lewin Group report as it supports our goal to provide optimum care while maintaining fiscal responsibility. The future of Medicaid managed care relies on the actuarial soundness of the rates paid to Medicaid health plans. Actuarially sound rates protect the plans that accept them, but more importantly protect the Medicaid beneficiaries that the plans serve by allowing them to pay adequate provider rates and support an infrastructure to monitor the quality of services provided. "

Imposed rates have been determined to be fair if they are in compliance with the Centers for Medicare and Medicaid Services' (CMS) regulations covering the process of rate setting, regardless of whether the rates actually cover the cost of care.

Issues addressed in the study include:
  • the views of the managed health care plans of state practices in the rate setting process;
  • various states' guidelines on the determination on what is a medical cost or an administrative cost;
  • actuarial issues;
  • data sources and medical cost trends; and
  • risk adjustment and risk corridors.
As stated in the report, "It is clear that the new actuarial soundness requirements have not severed the link between Medicaid managed care payment rates on the one hand and state budget considerations on the other. If states prioritize short-term budget concerns over actuarial soundness, it could lead to the undermining of their Medicaid managed care programs and of the benefits - such as higher quality health care and greater access to care - that these programs have brought to their Medicaid populations." The study can be found on the ACAP website at http://www.communityplans.net/publications/working%20papers.asp

Contra Costa Health Plans Joins ACAP

Contra Costa Health Plan (CCHP) in California became the 26th member of ACAP this month. Like three other ACAP members, CCHP is also a local initiative, two plan model HMO serving primarily Medi-Cal and SCHIP beneficiaries. CCHP serves over 65,000 people in Contra Costa County. CCHP has been serving the health needs for people in Contra Costa County for 30 years. CCHP was the first federally qualified, state licensed, county sponsored HMO in the United States. In 1973, they became the first county sponsored health plan in California to offer Medi-Cal Managed Care coverage and in 1976, they became the first county run HMO to serve Medicare beneficiaries.

In addition to Medi-Cal and SCHIP clients, they also cover other public or low-income populations, including:
  • Two Medicare benefit plans are for beneficiaries who live in Contra Costa.
  • A comprehensive medical and dental program offered to Homecare Providers using 8 Health Centers and the Contra Costa County Regional Medical Center.
  • They offer coverage to Contra Costa County Employees as well.
  • They offer a Healthy Families Benefit of low cost state-sponsored health, dental and vision coverage for children from birth to their 19th birthday, for low income families who do not get health insurance through an employer and are not eligible for no-cost Medi-Cal.
 They also offer two commercial products: For people who live in Contra Costa County, they offer two benefit plans. Members have their choice of accessing care through their 8 Health Centers or from a list of contracted Community Physicians. There are special plans just for kids, teens and young adults. They offer coverage to small and large companies with employees in Contra Costa County.

The CEO is Richard Harrison.


PUBLIC POLICY AND ADVOCACY

Senate Budget Committee Chairman Gregg Attacks Administration's FY07 Budget as 'Irresponsible,' 'Unrealistic'

Already suffering from low poll numbers and repeated self-inflicted wounds, the Bush Administration was dealt another blow this week on the budget when Senate Budget Committee Chairman Judd Gregg attacked the Administration's FY07 budget as "irresponsible" and "unrealistic" and minimized the likelihood that there would be budget reconciliation this year. Specifically, Gregg attacked the Administration's practice of keeping significant portions of defense spending out of the regular budget process saying, "I don't think they have any credibility on budgets." Still, Gregg and House Majority Whip Roy Blunt (R-MO) expressed their own support for a reconciliation package—although that package might be smaller than requested by the Administration, recognizing that significant Medicare cuts are unlikely in an election year. ACAP will continue monitoring the progress on the budget as it moves through Congress.

ACAP Begins Work in House to Ensure Safety Net Health Plans Have Seat at Health IT Table

ACAP's lobbyist has been meeting with key House committee members and continues to work to get SNHPs into health information technology (IT) legislation. In addition, ACAP has asked its members to write their House members to ask them to ensure that SNHPs are involved in health IT consortia and eligible for funding when available. It is expected that the House of Representatives may act on Health IT legislation later this spring or early summer.

ACAP Sends Letter to CMS on Actuarial Soundness

In follow up to the Lewin Report on actuarial soundness that ACAP and the Medicaid Health Plans of America released this week, ACAP and MHPOA have jointly signed a letter to CMS calling for them to craft a State Medicaid Director letter clarifying the requirements for the rate setting process.

The following requests were made of CMS:
  • ACAP and MHPOA encourage CMS to draft a State Medicaid Director letter encouraging all states to provide to plans information on the data, trends and methods used to set rates. This open process would better ensure that the rates adequately reflect the reality of the marketplace that the plans are working in, thereby protecting Medicaid beneficiaries. ACAP and MHPOA also recommends that CMS provide plans with an opportunity to comment to CMS on the data, trends and methods used to set rates. ACAP and MHPOA believe that such a disclosure and comment process would assist CMS to identify faulty assumptions of which it would not otherwise be aware.
  • ACAP and MHPOA encourage CMS to include a statement in a State Medicaid Directors letter that it is impermissible for state rate setting methodologies to include a rate reduction that is applied at the end of the rate setting process based on budget constraints.
  • ACAP and MHPOA urge CMS to amend the checklist to require states to use the experience of their plans in calculating the level of drug rebates.
  • ACAP and MHPOA encourage CMS to once again fund an updated and comprehensive evaluation of Medicaid HEDIS statistics and to include as many health plans as possible.
  • The Associations encourage CMS to clarify in a State Medicaid Director (SMD) letter that case management is a medical service and not an administrative service. We would like for the SMD letter to also encourage states to allow plans to substitute state accreditation requirements with accreditation from national organizations like NCQA or JCAHO as they are allowed to under the BBA.
  • The Associations would like to encourage CMS to mandate that all states risk adjust their rates for health status for all populations. This is especially important to safety net plans which typically receive sicker patients because of the nature of their network.
  • ACAP and MHPOA also urge CMS to convene meetings of the Regional Office staff, states and plans to discuss CMS's interpretation of how States should be implementing actuarial soundness in each region. In addition, the Associations would like CMS to address with the plans and the states the circumstances in which retroactive payments are possible under contracts signed subsequent to the initial deadlines for the approval by CMS.
 The letter can be found on the ACAP website at http://www.ahcahp.org/pandl/06policy_positions.asp.

Recap: Policy Roundtable

On this call, Chris Koppen, ACAP's lobbyist briefed plans on the Administration's FY 2007 Healthcare Budget. For anyone that missed the call, there is a memo outlining the major health policy proposals on our website at http://www.communityplans.net/members/policyroundtable.asp

Recap: Medicare SNP Roundtable

On this call, plans discussed the marketing strategies they are employing or planning to employ for the SNP population. Plans generally agreed that traditional marketing used for the MA population is less effective and too costly for the Medicare SNP population, and that more community-based approaches are a better choice.

Reminder: Medicare SNP Roundtable

The next Medicare call is scheduled for March 13th at 3 PM EST. We will discuss the major issues and challenges in designing a benefit package for the Medicare SNP population and the processes plans are using to develop their benefit packages. David DiGiuseppe will share the Community Health Plan of Washington's experiences as they plan to launch their Medicare SNP in 2007. We will also try to cover two questions that plans have asked us to discuss. One question concerns network development, contracting, and implementation. Another question concerns what plans are doing regarding reimbursement of providers that receive cost-based rather than fee schedule based reimbursement from CMS' carriers and FI's, specifically regarding contracting and reimbursement for Critical Access Hospitals, Home Health Agencies, and Rural Health Clinics.


EXCELLENCE AND ACCOUNTABILITY

2006 Schedule of Roundtables Now Available

The schedule of roundtable conference calls for ACAP senior staffing groups (CMOs, CFOs, Compliance, etc.) is now available in the Members Only section of ACAP's website.

AHRQ Announces Audio Newscast Series: Healthcare 411

The Agency for Health Research and Quality (AHRQ) has a new free service to help keep you informed of the Agency's latest health care research findings, news, and information. It's Healthcare 411—a weekly audio newscast that features synopses of the latest AHRQ findings and information on current health care topics. Go to www.healthcare411.ahrq.gov to hear the newscasts through your computer or download them to a portable digital player such as an iPod®.

The first audio newscast was a Special Report with AHRQ Director, Dr. Carolyn Clancy, answering questions about health care quality. She discussed preventive care, medical errors, and what people can do to ensure they get quality health care. Regular newscasts include short audio reports on a variety of AHRQ-supported research and always include an interview with one of the researchers. Each Healthcare 411 newscast is about 10 to 15 minutes long. All new and archived newscasts remain available on the Healthcare 411 site.

Access ACAP Roundtable and Best Practices Conference Calls

The call-in number is 1-719-457-0336. Passcode: 109833
All calls at 3 pm Eastern time, 2 pm Central, 1 pm Mountain, 12 pm Pacific, and 10 am Hawaii, unless otherwise noted.
The technology of this newscast is often called podcasting, which is a way of making a radio-type broadcast available on demand. If your computer has a sound card and speakers and can play mp3 audio files, you will be able to listen to the audio on your computer. But if you want to receive all AHRQ newscasts automatically, you will need subscription software. The AHRQ subscription is free.

In addition to the Healthcare 411 Web site, the weekly newscasts will be distributed through Apple® iTunes®, Yahoo® PodCasts, and other Web sites that provide health information to their customers, patients, students, employees, or health care personnel. Additional information on the AHRQ newscasts, podcasting, and subscriber software can be found on the Healthcare 411 Web site (www.healthcare411.ahrq.gov).

Health IT Certification Panel Seeks Volunteers to Serve on Workgroups

The Certification Commission on Health Information Technology seeks applications by March 3 for volunteers to serve as co-chairs or members of its five workgroups. The commission has a contract with the Department of Health and Human Services to develop a process to certify health information technology products, and is about to begin work on a certification process for hospital inpatient electronic health records. It is considering an approach for inpatient EHRs that would focus on the "quality and safety support chain," which includes computerized provider order entry, clinical decision support, pharmacy, and medication administration. For more information or to apply online, visit the commission's Web site.


Recap: Quality Management/Disease Management Directors Roundtable

On the QM/DM Roundtable, QM Directors discussed the ACAP benchmarking initiative and discussed key quality indicators that QM Directors are most interested in including in this benchmarking study. If QM Directors that were not on the call want to discuss particular indicators they are interested in including, please contact Peggy Oehlmann at poehlmann@communityplans.net. ACAP QM Directors we also notified that plan Health Risk Assessment forms had been added to the Members Only/Plan Documents section of our website. A broader discussion of Health Risk Assessments is planned for the QM/DM Directors Roundtable on May 18, 2006.

Recap: Provider Relations Directors Roundtable

On the Provider Relations Roundtable, Provider Relations Directors discussed the ACAP benchmarking initiative and discussed key indicators related to provider relations and provider performance that they are most interested in including in this benchmarking study. There was significant discussion about measures related to "Access to Care" and "Network Adequacy" and plans then compared how they are monitoring these measures. Some plans use provider self reports, member complaints, and/or use a "secret shopper" to call the plan's member line with questions about how to find a provider. Any Provider Relations Directors that were not on the call and want to discuss particular indicators should contact Peggy Oehlmann at poehlmann@communityplans.net.

Recap: Pharmacy Directors Roundtable

On the Pharmacy Directors Roundtable, Pharmacy Directors discussed the ACAP benchmarking initiative and discussed key pharmacy indicators that Pharmacy Directors are most interested in including in this benchmarking study. Any Pharmacy Directors that were not on the call and want to discuss particular indicators should contact Peggy Oehlmann at poehlmann@communityplans.net.


Reminder: Chief Medical Officers Roundtable

The next Chief Medical Officers Roundtable is Thursday, March 9 at 3 pm Eastern time. On this call, CMOs will discuss how plans are developing an e-strategy to more effectively use health information technology with members and providers. CMOs will also discuss ACAP's proposed Benchmarking initiative and discuss relevant measures they would like to see captured in such a project. Relevant materials and discussion questions will be circulated prior to the call. Please contact Peggy Oehlmann at poehlmann@communityplans.net with questions or additional agenda items.

Reminder: Marketing Directors Roundtable

The next Marketing Directors Roundtable is Thursday, March 16 at 3 pm Eastern time. On this call, Marketing Directors will discuss promotion of ACAP's Supporting the Safety Net Award. Relevant materials and discussion questions will be circulated prior to the call. Please contact Peggy Oehlmann at poehlmann@communityplans.net with questions or additional agenda items.

Reminder: Customer Service Directors Roundtable

The next Customer Service Directors Roundtable is Thursday, March 23 at 3 pm Eastern time. Topics and an agenda will be circulated prior to the call. Please contact Peggy Oehlmann at poehlmann@communityplans.net with questions or additional agenda items.


NEWSFLASH

Chapin Writes in Support of Facilitated Enrollment

ACAP Job Bank
 ACAP maintains a job bank for a range of openings at member plans and health care related organizations. Please send any postings and job announcements to: mmurray@communityplans.net
Georganne Chapin, President & CEO of Hudson Health Plan, argued for the extension of the New York Facilitated Enrollment program in the February 13 edition of the Westchester County Business Journal. Ms. Chapin was part of a delegation of New York State Coalition for Prepaid Services Plans that visited Washington, D.C., on Feb. 3 to ask congressional members to write to CMS in support of the extension. New York's facilitated enrollment program will end March 31 unless the CMS extends the federal waiver allowing the state to use Medicaid funds to pay for facilitated enrollment.

Ms. Chapin's makes these points in her article:
  1. The state requires face-to-face interviews with potential beneficiaries of Medicaid, Family Health Plus, and Child Health Plus. Without the waiver, applicants would overwhelm local departments of social services.
  2. Without the waiver, applicants would have to miss one or two days of work to apply during normal business owners. Facilitated enrollers work six or seven days a week, early in the morning and late at night, to enroll people at health clinics, churches, community centers, bodegas and schools. They even visit people in their homes.
  3. Millions of children, teens, and adults have been enrolled by FEs since the program was launched in 2000.
  4. Everyone benefits from the program—doctors and hospitals who are paid, not uncompensated; and care is more cost-effective, providing more prevention and less after-the-fact treatment.
 NACHC's Tom Curtin and Co-Authors Publish Article in Journal of the American Medicine Association (JAMA) on Shortage of Medical Personnel in CHCs

The article is titled Shortages of Medical Personnel at Community Health Centers: Implications for Planned Expansion and is authored by Roger A. Rosenblatt, MD, MPH; C. Holly A. Andrilla, MS; Thomas Curtin, MD; L. Gary Hart, PhD. The authors surveyed 846 CHCs to assess the staffing patterns and vacancies of major clinical disciplines. They found that there were vacancies for 13.3% of family physician positions, 20.8% of obstetrician/gynecologist positions, and 22.6% of psychiatrist positions. Rural CHCs had a higher proportion of vacancies and longer-term vacancies and reported greater difficulty filling positions compared with urban CHCs. The authors conclude that CHCs face substantial challenges in the recruitment of clinical staff, particularly in rural areas. The largest numbers of unfilled positions were for family physicians at a time of declining interest in family medicine among graduating US medical students. They also note that the success of the current US national policy to expand CHCs may be challenged by these workforce issues.



March Events

Mon Tues Wed Thurs Fri Sat/Sun
 
  
 1 
ACAP Finance Committee Call		 2 
ACAP Executive Committee Call		 3 
 4/5 
6 
 7 
ACAP Policy Roundtable		 8 
 9 
ACAP CMO Roundtable		 10 
 11/12 
13 
Medicare SNP Roundtable		 14 
 15 
 16 
Marketing Directors Roundtable		 17 
 18/19 
20 
ACAP Board Meeting, Los Angeles		 21 
ACAP Board Meeting, Los Angeles		 22 
 23 
Customer Service Directors Roundtable		 24 
 25/26 
27 
 28 
 29 
 30 
 31 
  

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.

Darnell Dent, Chairman Margaret A. Murray, Executive Director,
mmurray@communityplans.net, 202.331.4601

Association for Community Affiliated Plans
1400 Eye Street, NW, Suite 330
  Washington, DC 20005
http://www.communityplans.net
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