 August 29, 2006 |
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Upcoming ACAP Calls
9/5: Medicare Call to Finalize Agenda for Oct. meeting in Phoenix, AZ 9/12: Medicare Roundtable for Operational Plans 9/21: CFO Roundtable 9/27-9/28: Compliance Officers Meeting in New York NYC
Upcoming Events Calendar
 
ACAP Links
 
ACAP Members
Affinity Health Plan Alameda Alliance for Health AlohaCare Boston Medical Center HealthNet Plan CareOregon CareSource Colorado Access Commonwealth Care Alliance Community Choice Health Plan Community Health Network of Connecticut Community Health Plan of Washington Contra Costa Health Plan Health Plus Health Right, Inc. Hudson Health Plan L.A. Care Health Plan MDWise Medically Fragile Children's Program Mercy Care Plan Monroe Plan for Medical Care, Inc. Neighborhood Health Plan Neighborhood Health Plan of Rhode Island Network Health Santa Clara Family Health Plan Total Care Virginia Premier |
| HIGHLIGHTS |
ACAP Hosts 4th Annual CEO Summit For the fourth year in a row, ACAP hosted a CEO Summit for over 80 CEOs and their senior staffs. The major themes resulting from the summit include:
Legislation Introduced Which Gives Safety Net Plans Unused DSH Funds Before the Senate left for August recess, Senator Jeff Bingaman (D-NM) was joined by Senators Gordon Smith (R-OR), Blanche Lincoln (D-AR), Mark Pryor (D-AR) and Daniel Akaka (D-HI) in introducing the "Strengthening the Safety Net Act of 2006." This legislation would allow "safety net health plans" and other safety net providers to join "health access networks" to provide a coordinated system of health care services to the uninsured. To obtain the funding, a health access network must submit a plan about how the plan intends to (1) manage costs, (2) improve access to and the availability of health care services, (3) enhance quality and coordination of care, (4) improve health status, and (5) reduce health disparities. This program would be funded by using unspent DSH hospital funding. This is the first place that "safety net health plans" have been specifically identified in Federal legislation. Although there is a slim chance of the legislation passing, it demonstrates that ACAP continues to make progress in promoting the awareness of safety net health plans in Congress. ACAP will continue to work with Senator Bingaman to promote the legislation.  |
| PUBLIC POLICY AND ADVOCACY |
Senator Sends Letter to States Questioning Rate Setting Process At the urging of ACAP, Senate Finance Committee Chairman Chuck Grassley has sent a letter to all 50 state Medicaid directors inquiring about their process for setting actuarial sound rates. The intent of this letter is for the Senate Finance Committee to get a better sense of which states are complying with Federal requirements governing payments to Medicaid health plans. Specifically, the letter asks states (1) what methods are used to determine if rates are actuarially sound, (2) what methods are used to confirm the accuracy of data used in computing actuarial soundness, (3) whether state officials or third parties certify the rates, (4) whether the states use any budget reduction factors in setting actuarially sound rates, (5) what methods are used to determine whether the application of budget reduction factors results in a set of rates that meet the test for actuarial soundness, (6) whether the Department of Insurance require entities to have a premium deficiency reserve if the entity's outside auditors believe that the rates certified by the state Medicaid program are not actuarially sound, (7) whether any managed care entity had to set aside a premium deficiency reserve or similar fund because the entity's outside auditors and the Department of Insurance believe that the rates certified by the state Medicaid program are not actuarially sound. States are required to respond to the Finance Committee by October 1. ACAP will monitor developments on the actuarial soundness front. Health IT Moving
ACAP Sharing Services
Senate Majority Leader Bill Frist has said that he would like to move several health bills to the President's desk for signature in September, including the Health Information Technology legislation. ACAP has been working overtime to raise awareness in the House and Senate about the role and health IT needs of safety net health plans. ACAP is sending a letter to the potential House and Senate conferees outlining our position on the House and Senate passed versions of the legislation. Specifically, ACAP is commenting that (1) any system of safe harbors providing for hospitals and other organizations to provide training and technology to providers should be coupled with a system of federal funding to ensure that all providers (including safety net providers) health IT systems are improved, (2) that "safety net health plans" should be eligible for the funding and other participatory opportunities provided for in the legislation, (3) that HHS should study the impact of health information exchanges on Medicaid, safety net providers, and Medicaid-focused health plans, and (4) that any safe harbors should allow safety net health plans to be protected if they provide technology or training to health care providers. ACAP sent out an action alert to ask all ACAP members to contact their Representatives and Senators to ask them to ensure that "safety net health plans" are included in the health IT legislation.In the members only section of our website, there are several areas that we want to remind you to look at periodically, including a large section of shared documents, which includes disaster recovery plans, compliance documents, job descriptions. We also have several surveys we have done of our plans. |
| EXCELLENCE AND ACCOUNTABILITY |
ACAP Compliance Officers to Meet On September 27 and 28, ACAP Compliance Officers will meet in New York City. Discussion topics include:
ACAP Job Bank
First ACAP Supporting the Safety Net AwardACAP plans can post job announcements in our job bank. Please see our website for more details. You can email job announcements to Christina Boye at cboye@communityplans.net. Mardy Sandler and the Baby Love Program at the University of Rochester Medical Center in New York are the recipients of ACAP's first "Supporting the Safety Net" award. The Monroe Plan for Medical Care, an ACAP member, nominated Ms. Sandler and Baby Love to recognize the value of this home visiting prenatal program. Additionally, Baby Love has played an integral role in improving birth outcomes for Monroe's Medicaid members. Monroe Plan contracts with Baby Love to provide "high touch" social outreach for the plan's high-risk pregnant enrollees. Baby Love's services include an initial assessment and screening for risk factors such as domestic violence or depression, regular home visitation by an outreach worker, referrals to prenatal care, social services and mental health providers, and assistance with securing needed goods and services for childbirth and parenting. Since contracting with Baby Love in 2002, Monroe Plan has seen its NICU admissions decline from 89.3/1000 to 56.6/1000 in 2003 and drop again to 34.9/1000 in 2005. ACAP Continues Medicare SNP Work for Second Half of 2006 ACAP has developed a full agenda for the remainder of 2006 to support both members with operational Medicare SNPs and members that are actively planning to launch a Medicare SNP in 2008 or are interested in exploring the possibility. For our members with operational SNPs as of early 2007, we will be hosting a face to face meeting in October and plan to cover issues such as part D compliance and marketing. We will also host a Medicare roundtable series for operational SNPs that will cover topics such as care management and risk adjustment. For our members in the planning phase, we will host a Medicare roundtable series that focuses on relevant topics such as the Medicare SNP application process. In addition, ACAP will engage in select Medicare policy issues such as the issue of Medicare and Medicaid integration. ACAP will also be working with the board to develop an ACAP Medicare work plan for 2007. Since not all members are engaged in Medicare work at the present time, ACAP's 2006 Medicare work will be funded by a separate dues structure. |
| NEWSFLASH |
ACAP Gives Award to Senator DeWine Pamela Morris, President and CEO, CareSource Management Group, presented the first ACAP Congressional Health Leadership Award to Ohio Senator Mike DeWine earlier this week for his leadership in support of the Medicaid program. "Safety Net Health Plans owe Senator DeWine a deep debt of gratitude for doing what is right. I don't think that we can fully understand the pressure that can be brought against a Senator in Mr. DeWine's position," said Morris. "But regardless, Senator DeWine has consistently stood on the side of the Medicaid program and the more than 55 million beneficiaries that rely on the program. It is because of his courageous stands that we are giving him ACAP's 2006 Congressional Health Leadership Award." Citing Senator DeWine's long and distinguished career in public service in Ohio and the country, Morris thanked him for his more than 26 years of commitment to public life. "Over the last year, Senator DeWine has consistently taken the tough votes to protect and preserve Medicaid," said ACAP's Executive Director Margaret A. Murray. "While some members of Congress were calling for drastic and disproportionate cuts in Medicaid, Senator DeWine demonstrated his strong and consistent support for health care for the most vulnerable Americans. The Association for Community Affiliated Plans is grateful for Senator DeWine's leadership and recognizes that his courageous votes helped defeat extreme Medicaid proposals that would have hurt those that need Medicaid the most." Colorado Access President and CEO Resigns After Seven Years Colorado Access announced that President and CEO, Don Hall, M.P.H., has resigned his position effective October 2, 2006. Hall has served in the leadership role since 1999 when he joined the company from Blue Cross and Blue Shield of Texas, Inc. Hall is also the Vice-Chair of ACAP. "Colorado Access has survived many ups and downs over the past seven years, but I'm most proud of the fact that we improved access to quality healthcare for more than 750,000 of Colorado's most vulnerable residents," said Hall. "I've been honored to work with some of the most committed and caring people that I have met in my entire career. While I will truly miss working with them, I know that this company will continue to successfully meet all the challenges that confront a safety-net health plan." Hall indicated that he is leaving to provide an opportunity for the company to rebuild the relationship between Colorado Access and the Colorado Department of Healthcare Policy and Financing (HCPF). "I don't in anyway want to be a barrier between Colorado Access and HCPF moving on into the future together." The Board of Directors commended Hall on his leadership and commitment to building on the mission of the 11-year-old company. "The Board of Directors has reluctantly accepted Don's resignation. He has been a tremendous leader to his staff and has made a positive impact on improving access to care for this state's medically underserved populations," said Pete Leibig, Chair of the Board. The Board of Directors has begun a national search for a replacement. In the interim, Sherry Rohlfing will step in as President and CEO. Rohlfing has served as Vice President of Market and Business Development for the company for the past seven years. Leibig indicated that the Board is focused on finding an individual committed to continuing to build on the success of the company's three product lines, as well as working with key Colorado stakeholders to explore opportunities to participate in other managed care programs that serve Colorado's neediest populations, including Medicaid. CMS Releases Guidance on Transformation Grants CMS recently released instructions on how states can apply for $150 million through "Medicaid Transformation Grants" which were authorized as part of the Deficit Reduction Act. The purpose of these grants is to help incentivize states to adopt innovative methods to improve efficiency and effectiveness in providing medical assistance in Medicaid. CMS has issued guidance on this new program in the form of a Letter to State Medicaid Directors (SMDL) and Application Instructions on July 25, 2006. The legislative report language and the CMS SMDL cite several examples of the permissible use of funds under this program, including, but not limited to, methods for:
It is important to understand that the applicant for these grants is the State, not a health center, PCA, safety net health plan, or health center network. Therefore, those entities wishing to take advantage of this funding opportunity should be aggressive in working with their state to develop a proposal and application. The deadline for submitting an application is September 15, 2006. Please let ACAP know if you are applying for such a grant with your state. Managed HealthCare Executive Interviews Hudson Health Plan's CEO Georganne Chapin on Her Views of Universal Coverage and Managed Care Georganne Chapin, the President and CEO of Hudson Health Plan, was recently profiled in the August issue of Managed HealthCare Executive regarding her views on universal coverage and managed care. She finds that universal healthcare and managed care should be synonymous with each other. She explains that managed care would play an integral role under a single-payer model. "We don't need more programs; we need fewer programs that cover more people," she states. "We don't need more categories of coverage or more limitations on the period of time people can be covered." She envisions local managed care organizations would continue to contract with physicians to make treatment decisions, manage chronic and acute diseases, and pay claims. She continues, "I don't believe there's any reason why we couldn't have a national healthcare system that contracts with local entities to contract with physicians to make treatment decisions, to manage chronic diseases and acute illnesses...and even pay claims." Additionally, she finds that by covering everybody and eliminating the costly, unhealthy gaps in care, more care and better quality of care would result from the savings gained. "Continuous coverage, similar to Medicare, would eliminate that costly gap and reduce the administrative costs." Chapin believes that the status quo will only radically change by a natural disaster that affects "the delivery of healthcare on the national level." Such a catastrophe would resemble that of Katrina or a flu pandemic across the country. Another cause for change according to Chapin would simply be "fatigue of the system." "We don't even realize the consequences our healthcare system has for the rest of our society," she says. "We have a labor force issue where people are staying in the labor force for longer periods of time because their health insurance needs simply cannot be accommodated any other way." Chapin claims that universal coverage would not need any additional funds "because the money is already in the system." She believes the problem is not financial, but ideological. "Nobody benefits from having so many people without coverage." http://www.managedhealthcareexecutive.com/mhe/article/articleDetail.jsp?id=363693 Bob Thompson Profiled in Rochester Business Journal Bob Thompson and the Monroe Plan were recently profiled in the June 30 issue of the Rochester Business Journal. Bob and his plan were were often mentioned to William Carpenter, the current Monroe County budget director, in his pursuit to learn more about the functionality and the important issues surrounding Medicaid. "I quickly recognized that Medicaid was the elephant in the room," Carpenter says. "And when I asked people about it I kept hearing, 'You need to talk to Bob Thompson.' I did talk to Bob Thompson and I can't tell you how smart I looked because of it." Thompson was not always involved in the healthcare sector. Originally a pastor for poorer communities, he decided to concentrate on poverty-focused healthcare when many of his poverty related programs were being cut by the church. Working for organizations such as the Health Systems Agency of New York, the Greater New York Hospital Association, as well as the New York County Medical Society, he worked on many issues and in many areas including development of Medicaid managed care programs in New York City and the surrounding areas. "This is the best job I ever had," Thompson says. "It's what I'll retire from." Today the Monroe Plan covers close to 90,000 people and was praised by the State Department of Health in 2005 as the top in quality among all New York Medicaid HMOs. And U.S. News and WorldReport the same year rated the Monroe Plan as 11th best in the country in quality. The plan Thompson runs account for some two-thirds of Monroe County's Medicaid HMO enrollees and all of its ChildHealth Plus business. Massachusetts Medicaid Managed Care Plans Developing New Offerings Under State's Health Insurance Requirement; Planned Enrollment Changes Some Massachusetts companies offering managed care coverage to state Medicaid beneficiaries are beginning to develop new coverage options in accordance with the state's new health care law, the Boston Globe reports. Under the new law, all residents must have health insurance and those who do not will face penalties. The law also allows the state to expand Medicaid coverage to low-income individuals. Massachusetts has four Medicaid managed care plans, and the companies running those plans will be able to keep control of the Medicaid managed care market for three years if they have 40,000 beneficiaries enrolled in one year and 80,000 within two years. As part of the new law, the companies are developing new products called the Commonwealth Connector Health Insurance Plan, or C-Chip, under which individuals with annual incomes between 100% and 300% of the federal poverty level can purchase subsidized health coverage. Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority, the agency responsible for implementing the state's new health care law, states that he "wants the four companies designing Medicaid plans to focus on simplicity at the expense of innovation." As such, the plans will compete based on price, provider networks and customer service. Kingsdale has also instructed the companies to develop two plans: one with lower monthly premiums and higher copayments and one with higher premiums and lower copays. Christina Severin, head of Cambridge Health Alliance's Network Health plan, which has 80,000 Medicaid beneficiaries, said "I'm disappointed that we are not going to be able to do some of the things we had originally thought we'd be able to do. I also understand that the Connector needs to be ready to offer a product on Oct. 1." Kingsdale said, "Already, there's some variation." He continued "We're going to invite them to submit creative, innovative benefit designs, and we'll see what they come up with versus the advantages of more standardization." None of the insurers' plans have been finalized or approved by the Connector's board of directors (Boston Globe, 8/2). Kingsdale in a status report filed with the state Legislature said that the Connector would be ready to enroll only the poorest residents in the subsidized plans on Oct. 1 as planned. Residents with slightly higher incomes -- up to 300% of the poverty level -- would be able to enroll in the plans likely by Jan. 1, according to the report. Kingsdale said, "We're bound and determined to start enrollment by Oct. 1, and we're rolling out the program for the most vulnerable population first" (Kowalczyk, Boston Globe, 8/3). Judge Oversees Hearing on Whether Connecticut Medicaid Managed Care Plans Must Publicly Disclose Rates Superior Court Judge George Levine oversaw a hearing involving a dispute over whether four Connecticut managed care plans must make public their reimbursement rates and other information, the Hartford Courant reports. The plans, Anthem Health Plans, Community Health Network of Connecticut, Health Net of Connecticut and WellCare of Connecticut/First Choice Health of Connecticut, receive $744 million in state money to administer health coverage for 310,000 Medicaid beneficiaries. A group of New Haven clinics found that their Medicaid patients had a difficult time obtaining appointments with specialists. When the Department of Social Services refused to disclose the rates of its contracted managed care plans, freedom of information complaints were filed. Former HHS Secretary Thompson Expected to Release Paper Suggesting Changes to Medicaid Former HHS Secretary Tommy Thompson plans to release a "white paper" in which he recommends that the responsibility for long-term care of elderly Medicaid beneficiaries shift from joint state and federal funding to the federal government. Thompson recommends that states focus on acute care for Medicaid beneficiaries younger than 65. In addition, he recommends that Medicaid begin to use electronic health records and other technologies to improve case management and health information collection. He also recommends that Medicaid beneficiaries receive education on health literacy and disease prevention. The recommendations would result in long-term savings that states could use to provide health insurance for more uninsured residents." Thompson said, adding, "And as these people get older and they move over into the federal responsibility, they will be less expensive for the federal side as well, because you're inheriting a healthier population." |
| Upcoming Events |
September Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
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1 |
2/3 |
| 4 |
5 Medicare call to finalize agenda for October meeting in Phoenix, AZ |
6 |
7 |
8 |
9/10 |
| 11 |
12 Medicare Roundtable for operational plans |
13 |
14 |
15 |
16/17 |
| 18 |
19 |
20 |
21 CFO Roundtable |
22 |
23/24 |
| 25 |
26 |
27 Compliance Officers Meeting in NYC |
28 Compliance Officers Meeting in NYC |
29 |
30/1 |
October Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
| 2 |
3 |
4 Medicare Meeting in Phoenix, AZ |
5 Medicare Meeting in Phoenix, AZ COO Roundtable |
6 |
7/8 |
| 9 |
10 |
11 |
12 CIO Roundtable Policy Roundtable |
13 |
14/15 |
| 16 |
17 |
18 |
19 Ombudsman Roundtable Medicare Roundtable for operational plans |
20 |
21/22 |
| 23 |
24 |
25 |
26 Compliance Roundtable |
27 |
28/29 |
| 30 |
31 |
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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 Contact Us |