 October 3, 2006 |
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Upcoming ACAP Calls
10/5: COO Roundtable 10/12: CIO Roundtable (note different call-in number) 10/19: Ombudsman Roundtable 10/19: Medicare Roundtable for Operational Plans 10/26: Compliance Roundtable
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 |
Congress: End of Session Push Anxious to return to the highly competitive campaign trail, Congress ran through legislation (however innocuous) this past week like a hot knife through butter. While this legislation doesn't include much substance, it does give a way for members to show they are getting something done. Having said that, there are a number of outstanding health care issues that ACAP is monitoring -- including health disparities, reauthorization of the health center program, Medicare payments for physicians, and a possible Medicaid technical/extension of the Transitional Medical Assistance program (ACAP has expressed its support for this extension; see story under Policy). The most notable among these bills is the conference report on health information technology. ACAP has been contacted by HELP Committee staff regarding the inclusion of "safety net health plans" (SNHPs) for eligibility for grant funding, participation in regional health consortia, and coverage under safe harbor protections that would allow plans to help providers upgrade their technology. Currently, neither the House nor Senate packages would provide such opportunities for ACAP members. ACAP has provided conferees with a preferred definition to include the SNHPs in the legislation. In addition, ACAP has been working with Senators Kennedy and Clinton to ensure that SNHPs are included in bipartisan legislation introduced by Senator Frist to address health disparities. ACAP had urged Senators to be inclusive of safety net health plans and it appears that the use of a generic “health plan” term would allow ACAP members to participate. We have also urged the Senate to include a specific “safety net health plan” health disparities demonstration – while it does not currently appear in the legislation, ACAP will continue to promote the role of SNHPs in Senate health disparities legislation. With Congress using October to campaign until the November 7 election (don't forget to vote!!), there is much on the Congressional agenda that will only be accomplished in a lame duck session. None of the twelve appropriations bills have been sent to the President for his signature. Most observers believe that Congress will complete appropriations in either a continuing resolution (CR) or an omnibus package that could include a wide range of legislation, not just appropriations. Much of the strategy depends on the outcome of the fall elections -- Democrats assuming control of one or both of the houses would likely force Republicans to go on a forced march of Republican-preferred policies that cast Democrats is a bad light or push Republican bills through for the President's signature. Of course, all of this depends on the outcome of the elections. ACAP will be monitoring the election and how these changes (or not) will impact ACAP's agenda. ACAP Medicare Directors to Meet On October 4th and 5th, ACAP Medicare Directors from operational Medicare SNP plans (including those plans that will be operational by early 2007) will meet in Phoenix, AZ. Discussion topics include:
ACAP Board Meeting and Strategic Planning Conference in Richmond, VA November 2 & 3, 2006 ACAP Members don't forget to sign up for the conference. The cut off date for the hotel is October 2, 2006. The conference will be held at The Jefferson Hotel. Rooms have been put aside for ACAP at a rate of $195 per night plus tax. To make reservations for the hotel please call them at 1-(800) 424-8014 and tell them you're with the conference. Also, don't forget to register for the conference on ACAP's Website, click here to register and to view the agenda.  |
| PUBLIC POLICY AND ADVOCACY |
ACAP Signs Letter Urging Congress to Extend Transitional Medical Assistance for Working Families ACAP co-signed a letter asking the 109th Congress to extend Transitional Medical Assistance (TMA) at least through the end of FY 2007 before it adjourns next week. Established in 1988 and reauthorized numerous times, TMA provides temporary health care coverage to families who have become ineligible for Medicaid because of earnings, often because they have left welfare to enter the workforce. Unless Congress votes to extend the program, TMA will expire December 31, 2006, resulting in loss of Medicaid coverage of several hundred thousand low-income working families and their children. Loss of Medicaid may leave families without any coverage at all, since many people transitioning from welfare find low-wage entry-level positions that do not offer health insurance. The Administration's FY 07 Budget proposes to extend the TMA program through September 30, 2007. The National Governors' Association describes TMA as a "crucial work support" and supports its continuation as an essential element of welfare reform. Other co-signing organizations include Families USA and the Center on Budget Policy Priorities.
ACAP Sharing Services
Save the Date: CBPP
Holds Call for MCOs on Citizenship Documentation Requirements,
October 24In 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. The Center on Budget and Policy Priorities has announced that it will convene a conference call for managed care organizations and health care providers Tuesday, October 24 at 2 pm EST to discuss how to monitor the new citizenship documentation requirement, which was enacted in the DRA and became effective July 1. Attendance is by invitation only, so interested groups should contact CBPP's Melanie Nathanson at nathanson@cbpp.org to RSVP. Further detail will be released closer to the date of the meeting. CBPP will convene two additional meetings on citizenship documentation, including "Convening a Monitoring Coalition, The Consequences of Citizenship Documentation: What to Measure and How to Measure It" on Tuesday, October 3 at 2 pm EST, and "Data Matching: State Efforts to Obtain Citizenship and Identity Documents Electronically" on Tuesday, October 10, 2 pm EST. |
| EXCELLENCE AND ACCOUNTABILITY |
CIO Roundtable The next ACAP CIO Roundtable is Thursday, October 12 at 3 pm eastern time. On this call, we will discuss the status of health IT legislation in Congress. Please contact Peggy Oehlmann (poehlmann@communityplans.net) with any additional agenda items. An agenda and any materials will be posted prior to the call at: http://www.communityplans.net/members/ cio%20roundtable.asp COO Roundtable The next ACAP COO Roundtable is Thursday, October 5 at 3 pm eastern time. An agenda and materials will be posted prior to the call at: http://www.communityplans.net/members/coo%20roundtable.asp
ACAP Job Bank
Ombudsman RoundtableACAP 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. The next ACAP Ombudsman Roundtable is Thursday, October 19 at 3 pm eastern time. An agenda and any materials will be posted prior to the call at: http://www.communityplans.net/members/Ombudsman%20roundtable.asp Medicare SNP Roundtable The next ACAP Medicare SNP Roundtable is Thursday, October 19 at 3 pm eastern time. An agenda and any materials will be posted prior to the call at: http://www.ahcahp.org/bppo/snpconfcalls.asp Compliance Officer Roundtable The next ACAP Compliance Officer Roundtable is Thursday, October 26 at 3 pm eastern time. On this call, we will review key themes and any follow up items from the September Compliance Officers meeting. An agenda and any materials will be posted prior to the call at: http://www.communityplans.net/members/compliance%20officers.asp Recap: CFO Roundtable On the September 21 CFO Roundtable, CFOs continued their discussion of reinsurance and exploring the possibility of a group discount for reinsurance products for ACAP plans. CFOs discussed a grid that compared key features of the major reinsurers and considerations for different types of coverage. ACAP will refer this to its Vendor Relations committee for further pursuit of a group discount strategy. |
| NEWSFLASH |
Leslie Norwalk Appointed Acting CMS Administrator DHHS Secretary Michael O. Leavitt and departing CMS Administrator Mark McClellan announced September 25 that Leslie Norwalk has been named Acting Administrator for the Centers for Medicare and Medicaid Services. Norwalk has served CMS in leadership roles for years, most recently as Deputy Administrator, but also as Chief Operating Officer and Acting Director of the Centers for Beneficiary Choices. Norwalk played a central role in the implementation of the prescription drug benefit and other Medicare and Medicaid reforms, and has worked on the Louisiana health care system redesign in the wake of Hurricane Katrina. Norwalk will assume the Administrator position October 15 after McClellan leaves the agency. Herb Kuhn, now head of the agency's Center for Medicare Management has been named acting CMS deputy administrator. Fear in Colorado Over Coverage for Medicaid Patients A recent article in The Denver Business Journal looks at the troubles surrounding Colorado and who is going to cover Medicaid patients. The journal reported, "A year after the state said it wanted more managed health plans to care for state Medicaid patients, there isn't an HMO in the state that wants to participate in the program." The state of Colorado lost its last Medicaid HMO when Colorado Access left the program in August. Colorado Access' departure was due to the state imposed 15 percent rate decrease in the company's reimbursement for insuring Medicaid patients. "As a result, nearly all the doctors and hospitals who care for the 400,000 Coloradans receiving care under Medicaid are getting paid under a financial system called "fee for service" that critics argue provides no incentive to limit services or improve patients' health." Don Hall, CEO of Colorado Access, commented on the issue. "The citizens of Colorado should be outraged. One of the biggest programs is now back to no management of this population." Hall further believes policy missteps led Colorado to pay more money for lower-quality care and indirectly contribute to higher private insurance rates. Steve Tool, executive director of the Colorado Department of Health Care Policy and Financing, commented for the state. "The state is not necessarily paying more for lower-quality care. However, the department is still very much committed to managed care, but its hands were tied by state laws dictating how rates are set for the program." Tool continued, "That's not the department's fault. We are just doing what was mandated by the Legislature. The first step is to look at how rates are calculated for managed-care organizations, and we have in our plans to move forward with some proposals next legislative session to revisit the rate-setting process." Furthermore, the Governor's administration feels that the managed Medicaid program is strong. They claim from that 1999 to today the program's budget has increased about the same percentage as the caseload: 75 percent to 80 percent. Don Hopkins, a spokesman for the governor, commented, "The average cost per case has stayed approximately the same as it was eight years ago, $4,900, a significant accomplishment considering how overall medical costs have been increasing. It is simply not true that ... we are paying more dollars for lower-quality care. The increased costs are almost entirely driven by the increased case load, and the numbers bear that out." Others feel that the state is not meeting the needs of the managed care program. Jim Hertel, publisher of Colorado Managed Care, finds Medicaid to be one of the biggest failures of Governor Bill Owens' administration. "A decision was made to stand back from any significant changes in the Medicaid program. There is an interest in utilizing the benefits of managed care and a difficulty in grappling with the actual cost and reimbursement that should be provided to manage care providers." Additionally, Rep. Bernie Buescher, D-Grand Junction, said he is also working on legislative fixes and calls the laws that set payment rates "badly flawed." Buescher, who is running for re-election in November, is chairman of the Joint Budget Committee. "If we do management of care properly, we can save money for the state and substantially improve the quality of care," he said. Jennifer Babcock Is New ACAP Assistant Director for Policy Jenny Babcock has started as the Assistant Director for Policy at ACAP. She will oversee policy development and legislative affairs. Previously, Jenny was Medicaid and SCHIP analyst for the Department of Health and Human Services Assistant Secretary of Planning and Evaluation (ASPE), and project officer for the State Children's Health Insurance Program (SCHIP) at the Centers for Medicare and Medicaid Services (CMS). Prior to joining CMS, Jennifer worked for the Maryland Department of Health and Mental Hygiene and The Lewin Group. She has a Masters of Public Health from the University of Michigan and a Bachelor of Arts from Kalamazoo College. She can be reached at 202.331.4605 or jbabcock@communityplans.net Liz Ward, formerly the ACAP Assistant Director for Policy and now our Assistant Director for Medicare, can be reached at (202) 257-8500 and eward@communityplans.net. |
| Upcoming Events |
October Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
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2 |
3 |
4 Medicare Meeting in Phoenix, AZ for Operational SNPs |
5 Medicare Meeting in Phoenix, AZ for Operational SNPs COO Roundtable |
6 |
7/8 |
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9 |
10 Executive Committee Call |
11 |
12 CIO Roundtable (note different call-in number) Policy Roundtable |
13 |
14/15 |
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16 Finance Committee Call |
17 |
18 |
19 Ombudsman Roundtable Medicare Roundtable for Operational Plans |
20 |
21/22 |
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23 Program Committee Call |
24 Executive Committee Call |
25 Policy Roundtable Call |
26 Compliance Roundtable |
27 |
28/29 |
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30 |
31 |
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November Events |
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2 ACAP Strategic Planning Session |
3 ACAP Strategic Planning Session |
4/5 |
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6 |
7 |
8 |
9 |
10 |
11/12 |
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13 |
14 |
15 |
16 |
17 |
18/19 |
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20 |
21 |
22 |
23 |
24 |
25/26 |
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27 |
28 |
29 |
30 |
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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 |
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Association for Community Affiliated Plans 1400 Eye Street, NW, Suite 330 Washington, DC 20005 http://www.communityplans.net Contact Us |