ACAP Newsletter

June 19, 2006
 ACAP Newsletter

HIGHLIGHTS

ACAP Scores Victory in House Health IT Debate
Click to read this article.
PUBLIC POLICY AND ADVOCACY

CHC Reauthorization Passes E/C Committee
Click to read this article.
HHS Appropriations Bill Passes Committee; CHC Increases Seen
Click to read this article.
EXCELLENCE AND ACCOUNTABILITY

Sherlock Group Benchmarking Opportunity
Click to read this article.
ER Diversion Project with NACHC
Click to read this article.
2006 CAHPS Surveys
Click to read this article.
Recap: Chief Medical Officers Roundtable
Click to read this article.
Reminder: Pharmacy Directors Roundtable
Click to read this article.
Reminder: Customer Service Directors Roundtable
Click to read this article.
Reminder: Marketing Directors Roundtable
Click to read this article.
NEWSFLASH

CareSource Establishes a New Foundation
Click to read this article.
Recent Findings and Analysis on Medicaid Enrollment and Spending Trends
Click to read this article.
Several ACAP States Join the National Initiative to Aid Consumers with Disabilities
Click to read this article.
ACAP Dinner at the Medicaid Managed Care Congress
Click to read this article.
ACAP CEO Summit Scheduled for July 25-26
Click to read this article.
Christina Boye Recently Joined ACAP Staff as Program Assistant
Click to read this article.
    
Upcoming ACAP Calls
 6/22: Pharmacy Directors Roundtable
6/22: Pharmacy Directors Roundtable
7/11: Marketing Directors Roundtable


Upcoming Events Calendar
Click to view calendar.
HIGHLIGHTS

ACAP Scores Victory in House Health IT Debate

The House Energy and Commerce Committee accepted an ACAP-proposed amendment to examine the impact of health information technology and “health information exchanges” on health plans that focus on Medicaid beneficiaries. The amendment also looked at the impact of health IT on the larger Medicaid and SCHIP programs, and on DSH hospitals and federally qualified health centers. The amendment, offered by Washington Representative Jay Inslee, is a small but significant sign that safety net health plans are beginning to be seen and understood by policy makers on Capitol Hill. Throughout the 5 hour long debate on the health IT bill, Democratic amendments were almost universally rejected. However, when Mr. Inslee offered his amendment the Committee Chairman, Joe Barton (R-TX), told Mr. Inslee that he had reviewed the amendment, found it acceptable and was prepared to accept it – clearing opposition from the Republican side. The amendment passed on a voice vote. The next step will be the House floor, if the amendment survives the pre-floor process (where two bills are merged into one). ACAP will keep you informed of the progress of the larger bill and the amendment.

PUBLIC POLICY AND ADVOCACY

CHC Reauthorization Passes E/C Committee

The House Energy and Commerce Committee passed legislation providing for a straight reauthorization of the consolidated/community health center program. H.R. 5573, the "Health Centers Renewal Act of 2006," reauthorizes the health center program through 2011. I have attached a copy of that legislation for your review. Numerous members of the Committee expressed their strong support for Community Health Centers and the personal relationship that they had with the health centers in their districts. While several amendments were offered, all amendments were withdrawn in favor of a clean reauthorization.

The legislation passed on a voice vote.

Amendments Offered

Rep. Tim Murphy (R-PA) raised concerns about sufficient staffing at federally qualified health centers. His amendment would provide liability protection for clinicians who volunteered their services at Federally qualified health centers (similar to the protections currently provided to clinicians who are employed by the FQHC). He later withdrew the amendment.

Rep. Michael Burgess (R-TX) and Mr. Bart Stupak (D-MI) raised concerns about the limited access to community health centers across the country, forcing them to seek care in less appropriate settings. They also raised concerns about HRSA's ability to provide waivers to organizations that didn't meet the requirements provided for by the health centers statute, but that wanted to provide services under that statutory authority. The Burgess/Stupak amendment would give HRSA the authority to provide a two-year limited waiver on governance and ownership requirements for entities under the health center program and would provide for a study of the improvements in access to health care as a result of this waiver. The amendment would also provide a waiver for a charitable hospital or academic hospital. This amendment was supported by the American Hospital Association, Catholic Health Association, Healthcare Leadership Council, nurses'organizations, and the Texas Hospital Association. Mr. Murphy spoke in favor of the amendment. This amendment was later withdrawn over questions of germaneness.

Next Steps

The next step for H.R. 5573 is the House floor. Given the bill's relatively non-controversial status, it is possible that this legislation will be moved on the suspensions calendar (for non-controversial legislation requiring two-thirds votes in favor) during the Republican health week that is tentatively scheduled for next week. However, that timing may slip if legislation isn't ready in time for debate.

The Senate Health, Education, Labor and Pensions Committee has not yet to taken up legislation on health center reauthorization.

HHS Appropriations Bill Passes Committee; CHC Increases Seen

The House Appropriations Committee passed their version of the 2007 Labor, HHS Appropriations bill on Tuesday, June 13, 2006. The legislation increased funding for programs under this bill over the President's budget request by approximately $4B dollars. I have attached a detailed chart of the funding under the Health and Human Services portion of the legislation for your review.

The following is a summary of the highlights of the legislation:

Bill Funding:

FY06 Comparable$141.088 billion ($460 billion mandatory)
FY07 Budget Request$137.794 billion
FY07 Bill$141.930 billion ($454.6 billion mandatory spending)


Increasing Immunizations for Needy Children

The bill earmarks a substantial increase to assist states to immunize poor children through the Centers for Disease Control and Prevention. This increase will enable over 380 thousand children to receive critical immunizations. The bill provides $540 million, $102 million above the request and $70 million above last year.

Maximizing Access to Community-Based Health Care

Total funding provided for Community Health Centers is $2 billion, $206 million above last year and $25 million above the request. This funding increase will allow the creation or expansion of 300 medical facilities across the country.

Supporting Healthier Neighborhoods and Strengthening Health Care Infrastructure
  • Centers for Disease Control funding is $6.2 billion, within those funds, resources were increased for emerging infectious diseases, including HIV/AIDS and immunization activities.
  • Health Professions Training—The bill restores cuts in the budget request to critical programs that improve the availability of well-trained health care professionals to underserved areas. The bill earmarks $313 million, $154 million above the request and $18 million above last year. The bill also restores a major cut to programs that provide Scholarships to disadvantaged students. The bill earmarks $47 million for this purpose, the same as last year's level and $37 million above the President's requests. Funds to support graduate level medical programs at Children's hospital are increased by $3 million over last year and $201 million over the budget request.
    • Rural Health Programs—In addition to providing record levels of funding for Community Health Centers, the bill rejects many of the Administration's budget cuts to critical rural health programs and earmarks funds that will expand health care opportunities for rural communities.
    • Area Health Education Centers—The bill provides $29 million to level fund efforts which establish community-based training programs in rural and underserved areas. The budget request zero funded for this program.
    • National Health Service Corps—The bill earmarks $132 million to ensure that health professionals are serving in areas where they are needed most. This is a $6 million increase to both the FY06 and the requested level.
    • Rural Outreach Grants—The bill earmarks $40 million to improve health care services to rural Americans which $1 million above last year and $30 million above the request.
    • Rural Hospital Flexibility Grants—The bill provides $40 million for these grants, rejecting the Administration's proposal to eliminate funding for this important program.
    • Rural Health Research—The bill fully funds the requested level of $9 million to support rural health centers of research. In addition, the bill rejects the administration's attempts to terminate the Rural and Community Access to Emergency Devices programs by earmarking $2 million for this initiative.
    • State Offices of Rural Health—In order to better coordinate a national strategy for rural health care challenges, State Offices of Rural Health are funded at $8 million, slightly above last year and the budget request.
    • Rural Community Facilities program—This program is fully restored to last year's level of $7 million.
    • Telehealth—The bill includes an increase of $3 million for a funding level of $10 million for telehealth activities.
  • Domestic HIV/AIDS—For the Ryan White AIDS program, the bill provides an increase of $70 million over last year and $25 million below the request with total funding of $2.1 billion. This increase will permit States to provide needed medications for those with the greatest need. In addition, the Committee includes $63 million for a new testing initiative at CDC to help stop the spread of this disease through increased levels of testing.
  • National Institutes of Health—Medical research at the National Institutes of Health is funded at a program level of $28.3 billion, slightly above last year's level and equal to the budget request. This represents a 120% increase from a decade ago. The bill fully supports the peer review approach to the distribution of medical research grants by essentially following the NIH's recommended funding distribution among the various institutes.
  • Child Care and Development Block Grant—The bill fully funds the administration's $2.1 billion request for this program.
  • Low Income Home Energy Assistance Program (LIHEAP) is essentially level funded at $2 billion, $329 million above the budget request.
  • Abstinence Education—Provides level funded of $113 million for community-based abstinence education program.
  • Social Services Block Grant is level funded at $1.7 billion, an increase of $500 million over the President's request.
  • Member Earmarks—The bill provides approximately $1 billion for Member projects, $100 million less than previous, comparable levels and less than 1% of the total funding in the bill.
The next step for this legislation will be the House floor. The Senate Appropriations Committee has not yet scheduled a mark-up on its version of the Labor, HHS appropriations bill.


EXCELLENCE AND ACCOUNTABILITY

Sherlock Group Benchmarking Opportunity

As part of the effort to address ACAP plan interest in benchmarks, ACAP has worked with The Sherlock Group to develop a project that would give ACAP plans access to an ACAP specific benchmark report. The Sherlock Group is currently working with interested plans to identify and clarify data elements for the benchmarking process. Interested plans should contact Doug Sherlock (Sherlock@sherlockco.com) for more information.

ER Diversion Project with NACHC

During the summer, interns at the National Association for Community Health Centers (NACHC) will be working with ACAP to research and write a paper on emergency room use in safety net populations and what health centers and plans are doing to reduce inappropriate emergency room use. ACAP is currently gathering information on which health plans have Emergency Room diversion programs and nurse triage lines. This was discussed briefly on the June 1st CMO Roundtable, but if there are other plans that have ER programs they would like to share, please contact Peggy Oehlmann (poehlmann@communityplans.net) for more information on the project.

2006 CAHPS Surveys

ACAP again will participate in the annual CAHPS comparison done by the National CAHPS Benchmarking Database (NCBD). A memo has been distributed to ACAP CEOs, CMOs, and Quality Management Directors outlining procedures. Plans that collect and submit their own CAHPS data directly to NCBD need to submit that data by June 30, 2006. Plans that are in states where the state collects CAHPS data that is sent to NCBD need to contact their state Medicaid agencies and request that their members be included in the ACAP analysis. This request must be received by June 30, 2006. Please contact Peggy Oehlmann for more information.

Recap: Chief Medical Officers Roundtable

On June 1, CMOs discuss procedures for participation in the 2006 NCBD Data Submission process for an ACAP CAHPS analysis. Please see further discussion of this in the 2006 CAHPS survey summary above. CMOs also discussed ER diversion and nurse triage programs used by ACAP plans. Future discussion topics for upcoming CMO roundtables include: better understanding of substance abuse and its impact on ER utilization, promoting greater scientific understanding of behavioral health medication and management of practice variation, and genetic testing for members with high risk factors.

Reminder: Pharmacy Directors Roundtable

The next Pharmacy Directors Roundtable call is scheduled for Thursday June 22 at 3 pm eastern time. On this call, we will discuss PBMs and risk sharing programs as well as specialty pharmacy management. Please check the members only/pharmacy roundtable section of the website for the discussion questions. Please contact Peggy Oehlmann (poehlmann@communityplans.net) if you have items to add to the agenda.

Reminder: Customer Service Directors Roundtable

The next Customer Service Directors Roundtable is Wednesday, June 29 at 3 pm eastern time. On the last Customer Service Directors call, Customer Service Directors agreed to send a list of "Top 10 inquiries" received by the Customer Service department. Please see the email sent on June 14 and/or the members only/Customer Service roundtable section of the website for the survey. Please complete the survey and respond by Monday June 26. A reminder email will be sent and a matrix ranking "Top 10 inquiries" will be posted to the website prior to the call. Please contact Peggy Oehlmann (poehlmann@communityplans.net) if you have items to add to the agenda.

Reminder: Marketing Directors Roundtable

The Marketing Directors Roundtable has been moved to Tuesday July 11 at 3 pm eastern time. On this call we will share and discuss member marketing campaigns. Please send electronic copies of member marketing materials to Peggy Oehlmann by Thursday July 6. Kristanne Thompson, Director of Marketing and Corporate Communications at Community Health Plan of Washington will begin the discussion by highlighting the new advertising campaign recently launched by her plan. A reminder email will be circulated prior to the call. Please contact Peggy Oehlmann (poehlmann@communityplans.net) if you have items to add to the agenda.


NEWSFLASH

CareSource Establishes a New Foundation

The managed care services group CareSource recently announced the launch of the CareSource Foundation, a new philanthropic organization dedicated to supporting the health care needs of the underserved. The foundation's focus will include "issues of the uninsured, such as access to public health care, prevention and intervention in community health issues, critical health trends such as childhood obesity and partnerships with regional and national foundations." Cathy Ponitz currently the director of community relations will serve as the executive director of the CareSource Foundation. She will engage and advise the company on pressing health issues. www.caresourcefoundation.com

Recent Findings and Analysis on Medicaid Enrollment and Spending Trends

Recently the Kaiser Commission on Medicaid and the Uninsured (KCMU) released a new fact sheet and report describing and analyzing the latest trends in Medicaid spending and enrollment. The report found that overall spending grew by 6.9% in 02-03 and 7.6% in 03-04, well below the average growth levels in 00-02 of 11.9%. On a per capita basis, Medicaid acute care spending grew more slowly than health care spending for those with private insurance. Increases in the number of people covered, not higher spending per enrollee, drove the program’s growth.

For the trend report and fact sheet: http://www.kff.org/medicaid/kcmu053006pkg.cfm

Several ACAP States Join the National Initiative to Aid Consumers with Disabilities

State Medicaid programs continue to show increasing concern for their consumers with disabilities and their managed care options. In order to explore ideas of cost control and quality assurance the Center for Health Care Strategies (CHCS) developed a target program to aide states in developing and improving managed care options for people with disabilities.

ACAP represented states including California, New York, Pennsylvania, and Washington will all participate in "CHCS Purchasing Institute on Managed Care for People with Disabilities." These states will join Nevada and Indiana to create and to operate managed care programs for adults with disabilities. CHCS Purchasing Institute will offer two training sessions during the two year program for the participating states to engage with each other. They will culminate ideas and share experiences their on the best implementation methods. The topics of the training sessions will include implementation and expansion of risk-based managed care programs for adults with disabilities that will critically examine care management, behavioral health integration, and performance measurement.

Through the two year program these states will evaluate the efficiency and the effectiveness of areas that are not covered by national standard measures. Conclusions and recommendations drawn from the pilot initiatives will be available to other states contemplating managed care programs for adults with disabilities.

ACAP Dinner at the 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. ACAP will also coordinate a dinner for ACAP plan representatives attending the meeting. The dinner will be held on Tuesday, June 20th at 6 pm at the Legal Seafood in the Inner Harbor. Please call or email Peggy Oehlmann if you would like to attend.

ACAP CEO Summit Scheduled for July 25-26

This invitation-only meeting brings CEOs of Medicaid-focused health plans and their Senior staff together to discuss where Medicaid managed care is going after the implementation of the Deficit Reduction Act. Ample time will be allotted for open and frank discussion among and between the CEOs and the speakers. In particular, we will leave time for open discussion on actuarial soundness and other issues plans are facing in their states.

Speakers include:
Bob Hurley, The Financial Status of Medicaid Focused Health Plans
Chuck Milligan, Consumer Directed Health Plans in Medicaid
Matt Salo, State Implementation of the DRA
Deb Enos, Health Plans' Role in Massachusetts Health Reform

Other topics include:
Designing Effective Provider Incentives
Dueling Regulation of Medicaid and SNP programs
View from the Medicaid Directors on the DRA
View from Capital Hill: Whither Medicaid?
Health IT: Is it Really Here?
Open Discussion on Actuarial Soundness

The registration form can be found at www.communityplans.net.

Christina Boye Recently Joined ACAP Staff as Program Assistant

Christina is a recent graduate of Davidson College located in Charlotte, NC. She received her A.B. in Political Science in conjunction with a Medical Humanities concentration. Outside of Davidson she worked/ interned with Carolinas Medical Center, New Mexico Representative Heather Wilson's Washington, DC Congressional Office, the Commonwealth's Attorney Office in Virginia Beach, VA, and Legal Aid of North Carolina. At Davidson she also participated in many seminars and independent studies composing papers focusing on health related issues. She can be reached at 202.331.4601 or cboye@communityplans.net.


Upcoming Events

June Events

Mon Tues Wed Thurs Fri Sat/Sun
29 
Memorial Day		 30 
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 1 
CMO Roundtable		 2 
 3/4 
5 
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Marketing Directors Roundtable		 8 
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 10/11 
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Program Committee		 13 
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Medicare Roundtable		 16 
 17/18 
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ACAP dinner at MMCC
Email Peggy for info		 21 
 22 
Pharmacy Directors Roundtable		 23 
 24/25 
26 
 27 
Finance Committee		 28 
Quality Management Board Committee		 29 
Customer Service Directors Roundtable 		30 
CAHPS Survey Requests Due to NCBD 		 

July Events

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3 
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Independence Day		 5 
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 8/9 
10 
 11 
Marketing Directors Roundtable

Executive Committee Call		 12 
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 15/16 
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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.

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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