ACAP Newsletter

May 5, 2006
 ACAP Newsletter

HIGHLIGHTS

Senate Health Week
As Congress returned amid nationwide outcry about skyrocketing gas prices, discussions continued about turning the week of May 8th into “Senate Health Week”—a legislative week dedicated to promoting the Republicans’ health agenda. 
Click to read this article.
PUBLIC POLICY AND ADVOCACY

ACAP Concerned About Consumer Directed Health Purchasing Waivers
Click to read this article.
Update on Medicaid Matters
Click to read this article.
EXCELLENCE AND ACCOUNTABILITY

Reminder: Supporting the Safety Net Award Due May 12
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Recap: CIO Roundtable
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Recap: Ombudsman Roundtable
Click to read this article.
Reminder: Provider Relations Roundtable
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Rescheduled: CFO Roundtable
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Reminder: Quality Management/Disease Management Roundtable
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Reminder: Compliance Officers Roundtable
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NEWSFLASH

ACAP Discount for 14th Annual Medicaid Managed Care Congress
Click to read this article.
Cover the Uninsured Week
Click to read this article.
CHCS Releases Paper on Disability Care Coordination Organizations
Click to read this article.
New Benefits Packages Approved in KY and WV Under DRA
Click to read this article.
Andrea Maresca Joins Medicaid Directors Association
Click to read this article.
Elizabeth Ward to Focus on Medicare
Click to read this article.
ACAP Seeks Senior Associate for Health Policy
Click to read this article.
    
Upcoming ACAP Calls
5/11: Provider Relations Roundtable
5/17: Rescheduled: CFO Roundtable
5/18: Quality Management Directors Roundtable
5/25: Compliance Officers Roundtable


Upcoming Events Calendar

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HIGHLIGHTS

Senate Health Week

As Congress returned amid nationwide outcry about skyrocketing gas prices, discussions continued about turning the week of May 8th into “Senate Health Week”—a legislative week dedicated to promoting the Republicans’ health agenda.  Bills that may be considered include a proposal to allow trade associations to offer health insurance to their membership, medical malpractice reform, expanding Health Savings Accounts, and other traditional Republican health policies.  However, some of these bills may have tough sledding in the Senate where nearly all of the provisions have proven contentious.  In fact, the policy centerpiece, Association Health Plans, is now jeopardized because efforts by the chief author, HELP Chairman Mike Enzi, to attract Democrats is souring Republicans on the proposal.  However, Senate Health Week has already been delayed a week and may be postponed again for any number of reasons—the current debate on the supplemental spending bill, energy legislation, or internal conflicts that prevent majority support for the legislation.  Some speculate that Health Week could be delayed another week, if it comes up in the Senate at all.

In addition, ACAP continues to promote a demonstration project that would allow safety net health plans to help in the Senate’s legislative efforts to reduce health disparities.  Several ACAP member plans are participating in private-sector efforts to reduce health disparities.  ACAP has argued that safety net health plans are uniquely situated in the health system and have a mission to improve the quality of care for all enrollees—including those from racial or ethnic minorities.  ACAP continues to work with key members of the Senate, including Senators Frist, Kennedy, Clinton, Enzi, and Obama, to include safety net health plans in disparities legislation.  ACAP will keep members in the loop as this effort progresses.

Likewise, ACAP has secured a commitment from Senator Jeff Bingaman to include safety net health plans in legislation he will introduce to expand the delivery of care to the uninsured.  The legislation would use unspent Medicaid DSH money to fund safety net health plans and other networks of providers to provide a system of care for the uninsured.  This proposal, promoted by the National Association of Public Hospitals and the National Association of Community Health Centers, would mark the first time that “safety net health plans” would be identified in any Federal legislation per se.  Although issues remain, ACAP is extremely pleased that the seeds we have planted to promote the role of safety net health plans on Capitol Hill are beginning to bearing fruit.


PUBLIC POLICY AND ADVOCACY

ACAP Concerned About Consumer Directed Health Purchasing Waivers

ACAP has developed a statement of policy on recent consumer-directed health purchasing waivers that expresses deep concern over these waivers. ACAP’s statement highlights that these waivers are untested, blunt cost-cutting tools that have enormous risks for beneficiaries and providers. The statement also urges the states and federal government to focus on proven approaches that both reduce health care expenses and improve health care quality. As demonstrated in the recent Lewin Group report released by ACAP, entitled Medicaid Capitation Expansion’s Potential Cost Savings, there is enormous potential to realize cost savings from expanding the use of Medicaid managed care. The Lewin Group estimates that the states and federal government could realize up to $83 billion in savings over ten years by expanding the use of Medicaid managed care to all appropriate TANF and Medicaid-only SSI populations. Additionally, Medicaid managed care offers beneficiaries many benefits, including access to primary and specialty care, care management, and other programs and services that improve quality and health care outcomes.

ACAP will be monitoring activity in the states and working with like-minded organizations to encourage more positive approaches to reforming the Medicaid program. ACAP’s statement on the consumer directed waivers can be found on its website at http://www.ahcahp.org/pandl/06policy_positions.asp.

Update on Medicaid Matters

Last November at ACAP’s CEO Summit, Rob Restuccia discussed Medicaid Matters, a national advocacy project initiated by Community Catalyst, other national advocacy organizations and ACAP member, Neighborhood Health Plan. The project was started in March, 2005, and established new communications and advocacy tools to combat proposed federal changes in Medicaid. NHP contributed the services of its design firm, Argus Communications, to produce visually exciting materials with tested, accessible messages centering on the theme “Medicaid Matters to Someone You Know.”

By the end of the year the http://www.medicaidmatters2005.org/ received 222,738 hits, and advocates around the country were downloading Medicaid Matters postcards, flyers, and posters to use in local events and campaigns. Lawmakers received e-cards sent through the website, and state leaders used the letters to the editor functions or responded to alerts sent out by the project as the federal budget process unfolded. Medicaid Matters contributed to the aggressive advocacy by numerous national and state organizations that helped to mitigate some of the deep cuts and damaging policy changes proposed by the administration and House Republicans.

To respond to future challenges to Medicaid, Medicaid Matters is expanding its communications, messaging, materials and other tools to assist Medicaid supporters who are giving voice to beneficiaries and educating the public, opinion leaders and lawmakers. Many ACAP members are supporting the project, including Neighborhood Health Plan, Network Health in Cambridge, MA, NHP Rhode Island, and Community Care Alliance.

MedicaidMatters would like to invite ACAP plans to become a Medicaid Matters supporter as well and to utilize http://www.medicaidmatters2006.org/.

Plans could consider these suggestions:
  1. Become a supporter of Medicaid Matters, link to its website, and promote it to peers (hospitals, health plans, health centers, caregivers in your state or nationally)
  2. Utilize Medicaid Matters e-cards, letter to the editor function, op ed templates, alerts and information on political and policy developments.
  3. Download and print Medicaid Matters postcards, posters, banners and flyers—or customize them. See the Medicaid Matters in Action page on the website for ideas or contact Marcia Hams at hams@communitycatalyst.org.
  4. Facilitate use of Medicaid Matters materials at health centers and hospitals and involve physicians and other staff in advocacy.
    • Display a Medicaid Matters banner; encourage patients and staff to send in MM postcards to policymakers; or collect patient and provider stories related to the importance of Medicaid.
    • For example, Care Oregon’s medical director spoke at a Medicaid Matters 40th Birthday event in July, 2005 where Medicaid Matters birthday postcards were distributed to supporters who sent them to Senators Smith and Wyden.
  5. Contribute to Medicaid Matters a new “best practices” page being developed to describe examples of practices that improve quality and protect beneficiaries while reducing Medicaid costs.

EXCELLENCE AND ACCOUNTABILITY

Reminder: Supporting the Safety Net Award Due May 12

This award will honor a plan partner (provider, community based non-profit, legislator, state regulator, etc.) who has worked tirelessly to improve the health of low-income and other vulnerable populations.

Nominees can be self-nominated or can be nominated by an ACAP plan. The short application (3-5 pages) and supporting documents are due on Friday May 12, 2006.

The award recipient will be invited to attend ACAP’s CEO Summit on July 25-26, 2006 in Washington DC for an award ceremony. (The recipient’s travel and hotel expenses will be paid by ACAP and the CEO Summit registration fee will be waived). ACAP will also work with the award recipient and their plan partner to promote the award and develop a press release.

The award announcement is posted in Members Only/ACAP Announcements. Please contact Peggy Oehlmann (poehlmann@communityplans.net or 610-457-5739) with any questions.

Recap: CIO Roundtable

On their April 27 call, CIOs from ACAP plans discussed e-business strategies, standard HIPAA transactions that plans exchange with providers, the extent to which plans have portals, for what types of services, and the frequency of use by providers and/or members. Plans also discussed the expected impact of the National Provider Identifier (NPI) and the concern that some provider payments may be slowed if plans do not receive timely information on the providers’ new NPI. Most ACAP plans are still in the early stages of incorporating developing eHealth standards and National Health Information Network (NHIN) developments into the plan’s e-business strategy. The next CIO Roundtable is Thursday September 28.

Recap: Ombudsman Roundtable

On May 2, representatives from 11 ACAP plans participated in the first Ombudsman/Member Advocate Roundtable. Plans discussed the role of a member advocate/ombudsman, whether this was a dedicated function for one or more staff or whether it was built into member services, and compared mechanisms for building member feedback and suggestions into plan operations. Plans agreed that there was value in having future roundtable conference calls and creating a listserv/contact list for Ombudsman. Anyone interested in being added to the Ombudsman listserv/contact list should send their complete contact information (name, title, address, phone number) to Peggy Oehlmann (poehlmann@communityplans.net). The next Ombudsman Roundtable will be Thursday, October 19 at 3 pm Eastern time.

Reminder: Provider Relations Roundtable

The next Provider Relations Roundtable is Thursday, May 11 at 3 pm eastern time. A reminder email and agenda items will be circulated prior to the call. Please contact Peggy Oehlmann (poehlmann@communityplans.net) if you have items to add to the agenda.

Rescheduled: CFO Roundtable

The May 4 CFO Roundtable has been rescheduled for Wednesday May 17 at 3 pm eastern time. For this call, CFOs wanted to compare Stop Loss and Reinsurance programs and discuss the possibility of pursuing a group purchasing discount on such policies. Please send a copy of your plan’s stop loss and reinsurance plan to Peggy Oehlmann by Friday May 12. Please contact Peggy Oehlmann (poehlmann@communityplans.net) if you have any questions or items to add to the agenda.

Reminder: Quality Management/Disease Management Roundtable

The next QM/DM Directors call is scheduled for Thursday May 18 at 3 pm eastern time. A reminder email and discussion questions will be circulated prior to the call. Please contact Peggy Oehlmann (poehlmann@communityplans.net) if you have items to add to the agenda.

Reminder: Compliance Officers Roundtable

The next Compliance Officers Roundtable is Thursday, May 25 at 3 pm eastern time. On this call, ACAP Compliance Officers will review the preliminary agenda for the upcoming Compliance Officers meeting. A reminder email and the preliminary agenda for the meeting will be circulated prior to the call. Please contact Peggy Oehlmann (poehlmann@communityplans.net) if you have items to add to the agenda.


NEWSFLASH

ACAP Discount for 14th Annual Medicaid Managed Care Congress

The Institute for International Research will present the 14th Annual Medicaid Managed Care Congress, the best practices event for States and Plans looking to improve healthcare quality and control costs. The event is scheduled for June 19-21, 2006 at the Hyatt Regency in Baltimore, MD.  Participants will hear keynote presentations from Frederick P. Cerise, Secretary, Louisiana Dept. of Health & Hospitals, Patrick J. Kennedy, Congressman, Rhode Island, and G. Kirk Olsen, CEO, Molina Healthcare of Utah.

IIR's Medicaid Managed Care Congress includes 3-days of workshops, case studies and interactive panel discussions with the nation’s leading Medicaid experts. With representatives from over 20 states, the event provides strategies to improve fiscal operations with sessions on Managed Care expansion into SSI and Long Term Care, implementing Consumer Directed Care accounts for Medicaid populations and effective strategies for using encounter data for rate setting and quality improvement. 

ACAP members receive a 15% discount.  Please contact Peggy Oehlmann at poehlmann@communityplans.net for information on the ACAP discount.  A more detailed agenda is available at: http://www.iirusa.com/MMCC06.

ACAP will also coordinate a dinner for ACAP plan representatives attending the meeting. Please contact Peggy Oehlmann if you are interested in attending the ACAP dinner.

Cover the Uninsured Week

May 1-7, 2006 is Cover the Uninsured Week and many ACAP plans have planned events to promote the need for greater access to health insurance coverage. If your plan is participating in Cover the Uninsured Week, please send a copy of your press release or a quick summary of planned events to Peggy Oehlmann (poehlmann@communityplans.net). For more information on Cover the Uninsured Week, please go to: http://covertheuninsured.org/.

CHCS Releases Paper on Disability Care Coordination Organizations

As a growing number of states expand managed care programs for SSI-eligible adults, innovative managed care programs that integrate health and social services for people with disabilities are emerging to respond to the unique needs of this population. This report released in May by the Center for Health Care Strategies, which refers to these new entities as Disability Care Coordination Organizations (DCCOs), details programs in six states, describing the governance, financing, benefits and services provided, operational structure, care coordination activities, and quality programs.

The paper outlines seven key recommendations for states to consider as they design and implement DCCOs for adults with disabilities:
  1. Ensure that DCCOs are grounded in the infrastructure of the community served.
  2. Develop mechanisms for formal input by beneficiaries into governance.
  3. Design fully capitated  programs if possible; if not, at least partially capitate and ensure that DCCOs can financially benefit from care coordination savings.
  4. Allow DCCOs to compile all data on carved-out services, such as mental health or pharmacy expenditures.
  5. Ensure that DCCOs have a sophisticated management information system.
  6. Track quality of life outcomes, in addition to satisfaction, clinical, utilization, and financial outcomes.
  7. Track utilization and pay for care coordination services. 
  The report can be found at http://www.chcs.org/.

New Benefits Packages Approved in KY and WV Under DRA

Medicaid enrollees in Kentucky and West Virginia will be first in the nation to have benefits customized to meet their needs based on age and health status—changes allowed by the Deficit Reduction Act of 2005, HHS Secretary Mike Leavitt announced today. Prior to enactment of the DRA, states generally could not target benefits to groups of enrollees.

Under the plan approved this week, Kentucky will offer differing benefit packages aimed at meeting the health care needs of different groups—children, the elderly and people with disabilities who need institutional care, and the general Medicaid population.

Medicaid enrollees will be offered the most appropriate benefit plan based on their needs. The Family Choices program will serve healthy children, while Comprehensive Choices and Optimum Choices will serve individuals with more complex health care needs. Global Choices, similar to the state's previous Medicaid program, will serve other vulnerable populations.

With today's approval, some Medicaid enrollees will also gain enhanced disease management benefits to help them live healthy and productive lives, despite having health conditions such as diabetes or Cardiac Obstructive Pulmonary Disease (COPD). Special incentives, called "Get Healthy" Benefits, will be offered to further encourage healthy behaviors for these groups. These "Get Healthy" Benefits may include additional services such as, dental, vision, nutritional counseling and smoking cessation programs.

The plan approved today also reduces enrollee cost sharing from the current Medicaid program for the Comprehensive Choices and Optimum Choices benefit plans as follows:
  • Medicaid enrollees will be required to pay a $10 co-pay per hospital inpatient admission.
  • Co-payments will not be required for physician services, vision services, dental services, chiropractic services and hearing and audiometric services.
Disease management programs will be developed and phased in by geographic area to assist enrollees with specific chronic illnesses. Also, "Get Healthy" benefits will provide incentives to Medicaid enrollees practicing healthy behaviors. After one year of successful participation in a disease management program, enrollees may receive additional services.

Kentucky will also help Medicaid enrollees purchase health care coverage through their employers. If an enrollee chooses employer coverage instead of regular Medicaid, the state will help them pay the cost, but the individual will be subject to the benefit package, cost sharing and co-payment provisions of that particular employer program.

The new benefit design will be implemented this month in all areas of the state except for the Louisville area, where an existing Medicaid health care reform demonstration, Passport, will continue to operate.

HHS also approved a Medicaid state plan amendment to allow enrollees in West Virginia to receive new, enhanced benefits. West Virginia will offer enrollees a choice of two benefit packages, a basic plan based on the current Medicaid service package and an enhanced package that includes benefits not traditionally offered under Medicaid.

To enroll in the new advanced benefit package, enrollees will be asked to sign a member agreement with the state that they will comply with all recommended medical treatment and wellness behaviors. Enrollees who chose not to join the enhanced plan or who decide they do not wish to continue in it will receive the standard Medicaid benefit package.

The initial target group for the new plans will be healthy children and adults. Those who choose the enhanced package will receive tobacco cessation, nutritional education, diabetes care and chemical dependency/mental health services. In addition, children in the enhanced package will receive skilled nursing care and orthotics/prosthetics. Both the basic and enhanced plans will continue to include the Early, Periodic Screening, Diagnostic and Treatment (EPSDT) benefits for children, a hallmark of the traditional Medicaid program

In addition to the array of standard benefits, adults in the enhanced package will receive cardiac rehabilitation, chiropractic services, and emergent dental services.

The state will measure both medical outcomes and compliance with the member agreement by tracking four indicators in the first year. The indicators include receiving screenings as directed by the health care provider, adherence to health improvement programs designed for them, attending scheduled appointments, and taking medication as directed. Failure to comply with the agreement could result in the enrollees losing access to the enhanced package of benefits.

Andrea Maresca Joins Medicaid Directors Association

Andrea Maresca has left the National Association for Community Health Centers to join the National Association of State Medicaid Directors. Andrea was formerly a Program Associate at ACAP.

Elizabeth Ward to Focus on Medicare

Liz Ward will transition from her work as the Assistant Director of Legislation to work as a Medicare Consultant for ACAP. All Medicaid policy issues should be addressed to Meg Murray at mmurray@communityplans.net.

ACAP Seeks Senior Associate for Health Policy

A Senior Associate for Health Policy is sought for a variety of activities within the Association for Community Affiliated Plans, a non-profit trade association of Medicaid-focused health plans. The Senior Associate will be asked to:
  • Research policy issues related to Medicaid managed care
  • Develop ACAP positions on federal policy issues and vet with ACAP members
  • Develop annual federal legislative agenda
  • Oversee contract lobbyist and work with lobbyist to develop strategy for achieving legislative priorities
  • Track and monitor legislative and regulatory developments
  • Manage the ACAP Board Committee that oversees ACAP policy and program issues
  • Brief Plan staff on various policy issues through-out the year, usually via teleconference
  • Craft Action Alerts to engage ACAP members in Congressional policy debates
  • Provide technical assistance to plans on Medicaid managed care policy issues
  • Conduct and analyzing surveys
  • Participate in various Medicaid coalitions
  • Conduct other duties as assigned.
Candidates must possess the following background and skills:
  • Masters degree completed or working towards it or Bachelors Degree with 3-4 years of work experience
  • Preference given to applicants with strong experience in federal Medicaid and health policy
  • Capitol Hill experience preferred
  • Strong writing, analytical, and organizational skills.
  • Ability to work well independently.
The salary range is commensurate with work experience and educational level. A competitive benefit package is offered. The employee will be employed by the National Association for Community Health Centers and will support the work of the Association for Community Affiliated Plans. Please contact Meg Murray at 202.331.4601 or mmurray@communityplans.net.


Upcoming Events

May Events

Mon Tues Wed Thurs Fri Sat/Sun
1 
 2 
New! Ombudsman/Member Advocate Roundtable		 3 
 4 
CFO Roundtable		 5 
 6/7 
8 
 9 
 10 
 11 
Provider Relations Roundtable

Vendor Relations Committee Call
11 a.m.		 12 
Supporting the Safety Net Nominees Due!		 13/14 
15 
 16 
 17 
 18 
Quality Management/Disease Management Directors Roundtable		 19 
 20/21 
22 
 23 
 24 
 25 
Compliance Roundtable		 26 
 27/28 
29 
Memorial Day		 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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