 January 16, 2007 |
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Upcoming ACAP Calls
1/16 at 3 PM EST: Program Committee Meeting 1/18 at 3 PM EST: Medicare SNP Roundtable 1/24 at 3 PM EST: Compliance Officers Roundtable 1/25 at 3 PM EST: Chief Operating Officers 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 Denver Health Health Plan of San Mateo Health Plus Health Right, Inc. Hudson Health Plan L.A. Care Health Plan MDWise Mercy Care Plan Monroe Plan for Medical Care, Inc. Neighborhood Health Plan Neighborhood Health Plan of Rhode Island Network Health NJ Horizon Healthcare Santa Clara Family Health Plan Total Care Virginia Premier |
| HIGHLIGHTS |
The Health Plan of San Mateo (HPSM) Joins ACAP The Health Plan of San Mateo (HPSM) has recently joined ACAP. HPSM is a mixed model managed health care plan that has been serving San Mateo County residents since December 1987. It is an independent public agency created by federal waiver, state law and a San Mateo County ordinance to provide access to health care for Medi-Cal eligible residents and other at risk populations of the county. It is governed by the San Mateo Health Commission, a nine-member body composed of representatives from the community, physicians, pharmacists, business concerns, members of the San Mateo County Board of Supervisors and the San Mateo County manager. Its current membership is approximately 56,000. The CEO is Maya Altman. HPSM currently operates five programs:
Horizon NJ has recently become ACAP's 29th member, raising the number of ACAP Medicaid beneficiaries to over 4 million in 15 states. Horizon NJ, led by Karen Clark, is New Jersey's largest health care management company serving publicly insured individuals in the Medicaid and NJ FamilyCare programs. Since its inception in 1993, Horizon NJ Health has grown to more than 278,000 members and provides services in all 21 New Jersey counties. Karen has been awarded recognition by the New Jersey Primary Care Association for her strong support for the vision and mission of New Jersey's 20 Federally Qualified Health Centers and the health outreach on behalf of women and children. Colorado Access Selects Marshall Thomas as New CEO Colorado Access announced in December that it has selected a new president and CEO to replace Don Hall, who resigned in August. Marshall Thomas, M.D., longstanding Colorado Access chief medical officer, has accepted the position. Thomas stated that Colorado Access will work toward re-entering the Medicaid market after its departure late last summer, and will continue to expand its Medicare Special Needs Plan (SNP) product for Medicare-Medicaid dual eligibles.  |
| PUBLIC POLICY AND ADVOCACY |
CAP Plans Legislative Fly-In for February 6,7 in Washington, DC ACAP CEOs and government relations executives will fly to Washington, DC February 6 and 7 to introduce themselves and the ACAP legislative agenda for Medicaid managed care to their Congresspeople and Senators. ACAP has scheduled a Congressional Fly-In to occur as early as possible during the new Congressional session, which started early in January. The Fly-In -- a special event for CEOs and policy staff to meet with their own Congressional members -- gives ACAP members the chance to lobby members on their own behalf and for ACAP and Medicaid managed care. In 2007, ACAP legislative proposals will include expanding the drug rebate to MCOs, promoting New York's facilitated enrollment model on a national scale, reauthorizing the SCHIP program, and ensuring that MCOs are included in health information technology. ACAP encourages as many members to attend as possible. Please contact Jenny Babcock at jbabcock@communityplans.net or 202-331-4605 as soon as possible if you plan to attend the fly-in and have not yet RSVP'd. In addition, please let ACAP know when you have scheduled Hill meetings. Congressional Outlook For the first time in twelve years, Congress was gaveled into session on January 4th by a Democratic Speaker of the House and a Democratic Senate Majority Leader. The impact of the November mid-term elections, which resulted in a 31 vote Democratic margin (233-202) in the House and a 2 vote margin in the Senate (51-49), was fully felt this week as Democrats' began moving their "100-Hour Agenda." This legislative agenda, discussed by Democrats throughout the fall campaign, is a package of politically popular initiatives, including the implementation of the 9/11 Commission recommendations, ethics reform, increasing the minimum wage, and investing in renewable energy sources. This agenda also included two health provisions – requiring the Secretary of Health and Human Services to negotiate the prices of prescription drugs for the Medicare drug benefit and allowing Federal funding of embryonic stem cell research. In addition to these provisions, other policy that also impacts health care is the restoration of pay-as-you-go, or PAYGO, rules that require any new expenditure of dollars or tax cuts to be offset in an equivalent amount. The PAYGO effort, used in part to help Democrats shed the perception that they are fiscally irresponsible, will likely have a serious impact on any new efforts to expand discretionary (and probably mandatory) health care programs. Although Republicans have criticized Democrats for moving these bills outside the regular committee process, it's expected that all these initiatives will pass the House by comfortable margins. The going will be much more difficult in the Senate due to the thinner margin and the rules governing debate in the Senate. The power shift brought about by the November elections is significant for ACAP plans and gives us new opportunities (and challenges) in promoting our agenda. Because ACAP plans are disproportionately from Democratic states, the new Democratic majority has the potential to give ACAP plans a new voice in the legislative dialogue. In addition, the conventional wisdom is that Democrats will be less likely to cut Medicare and Medicaid, Federal programs of utmost importance to ACAP plans, and may, in fact, be more likely to expand these programs. However, there are also challenges for which ACAP plans must be prepared. Congressional Democrats have historically been skeptical of expanding managed care in the Medicare and Medicaid programs. In fact, from the BBA 1997 to the Medicare Modernization Act of 2003, the bulk of managed care expansion legislation (in either Medicaid or Medicare) was done when Republicans controlled Congress. ACAP's legislative staff believes that ACAP plans must be vigilant in ensuring that the new Congressional majority fully understands the important role that managed care organizations have in the Medicare and Medicaid programs. ACAP plans will have an opportunity to do this as the new Congressional order will bring many new Democratic chairmen with jurisdiction over Medicaid and Medicare to power. In the House of Representatives, the new Chair of the House Energy and Commerce Committee is Rep. John Dingell from Michigan and the Chair of the Health Subcommittee is Rep. Frank Pallone from New Jersey. The Energy and Commerce Committee has primary jurisdiction over Medicaid and public health programs and secondary jurisdiction over Medicare. The Chair of the House Ways and Means Committee is Rep. Charlie Rangel of New York and the Chair of the Health Subcommittee is Pete Stark from California. The Ways and Means Committee has primary jurisdiction over Medicare and shared jurisdiction over other health programs, such as health information technology. In the Senate, the Health Education Labor and Pensions Committee will be chaired by Senator Ted Kennedy from Massachusetts. The HELP Committee has jurisdiction over public health programs, including health disparities and health information technology. The Finance Committee, with Senate jurisdiction over Medicare and Medicaid, will be chaired by Senator Max Baucus of Montana. In all situations except for Finance, ACAP has member plans from these Chairmen's states or districts. Likewise, ACAP also has members with access to Speaker Nancy Pelosi and House Majority Leader Steny Hoyer. This gives us a unique entrée into the new Democratic leadership. ACAP plans will have an excellent opportunity to make their voice heard to these and other members on February 6th and 7th during ACAP's first annual legislative Fly-In. The Fly-In will give ACAP plans a first hand opportunity to speak with their House and Senate members about the issues important to our association. ACAP is urging all our members to participate in this opportunity to frame the debate and ensure that members of Congress include safety net health plans in their legislative vision for the future. For more information about the fly-in, please contact Jenny Babcock at jbabcock@communityplans.net.
ACAP Sharing Services
ACAP Signs Families USA
Letter to President Bush Asking for More Money for SCHIPIn 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. ACAP has signed a letter penned by Families USA containing a strong message to President Bush that he must include adequate funding in his 2008 budget to maintain and expand coverage for children covered by the SCHIP program. The letter credits SCHIP and Medicaid together with making substantial progress in covering the nation's children and states that "together, Medicaid and SCHIP provide otherwise uninsured children and their families regular health exams, preventive screenings, and other essential health care services." The letter also requests that the Bush Administration make covering America's children a top priority for 2007, and asks that he demonstrate this commitment by providing sufficient funding for SCHIP in the fiscal year 2008 budget. The letter will be sent to the Bush Administration in early January and can be viewed on the following website: http://www.familiesusa.org/issues/medicaid/medicaid-action/schip-sign-on.html. ACAP Members Encouraged to Promote SCHIP Funding with Centrist Legislators On January 9 ACAP alerted certain ACAP plans of the efforts of centrist Representatives Marion Berry (D-AR) and Heather Wilson (R-NM), who are sponsoring a bipartisan letter to the Budget Committee from all "Blue Dog Democrats" and "Main Street Republicans" in support of adequate SCHIP funding in the Congressional budget. The Blue Dog and Main Street coalition is pushing for enough money for SCHIP to maintain enrollment of all currently covered children plus expand coverage to all uninsured children and pregnant women under 200 percent of the FPL. ACAP encourages plans from California, Colorado, Connecticut, Michigan, New Jersey, New York, Ohio, Oregon, and Virginia to work with your Blue Dog and Main Street representatives so that they will sign on to this great (and early) effort. (Please contact Jenny Babcock at jbabcock@communityplans.net or 202-331-4605 for a full list of these representatives.) Deficit Reduction Act Provision on Employee Education on False Claims Recovery Effective January 1, 2007 A new law likely to impact all ACAP plans that was enacted as part of the Deficit Reduction Act of 2005 became effective January 1, 2007. In preparation for the effective date of the rule requiring Employee Education on False Claims Recovery, CMS distributed a Dear State Medicaid Director letter in mid-December. The guidance was directed to states, but all entities -- including Medicaid managed care organizations – doing more than $5,000,000 in business with the State Medicaid agency as of January 1, 2007 will be required to comply. Medicaid MCOs, and all other Medicaid entities, in this position will be required to take the following steps:
The letter and state plan amendment preprint (for state use) are available here: http://www.cms.hhs.gov/SMDL/SMD/list.asp?filterType=none&filterByDID=-99 &sortByDID=1&sortOrder=descending&intNumPerPage=10 |
| EXCELLENCE AND ACCOUNTABILITY |
ACAP Member Hudson Health Plan Debuts Mobile Enrollment Offices In what may be a health plan first, ACAP member Hudson Health Plan has launched a new program to make enrollment in free and low-cost health insurance programs more convenient. Hudson has commissioned four custom-designed Community Outreach Vehicles (COVs) (mobile offices on wheels) that will now visit busy sites throughout Hudson Health Plan"s six-county service area, including shopping plazas, community centers, health fairs, and other locations with high foot traffic. Hudson reports that "the eye-catching graphics on the exterior and an inviting setup inside have become an instant hit in the community." COVs contain full office suites, including waiting rooms and roomy office cubicles. The mobile offices have Internet access, allowing Hudson Health Plan to submit applications in real-time and avoid application delays. On-board DVD players occupy children while parents work with representatives. Some health services, such as blood pressure screenings, can be performed on board as well. Hudson Health Plan credits the COVs with accelerating enrollment rates, and are expected to be particularly important in rural counties such as Ulster and Sullivan, where residents need to travel great distances to reach a limited number of enrollment sites in the region. The COVs have also made it easier for Hudson Health Plan members to recertify their eligibility without making extra trips to stationary sites. Additional information about the location of the COVs is available through Hudson Health Plan's toll-free, multi-lingual customer service number, 1-800-339-4557.
ACAP Job Bank
CHCS Toolkit on Ethnic
Disparities Features Several ACAP Health PlansACAP 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. CHCS recently released its new Reducing Racial and Ethnic Disparities: Quality Improvement in Medicaid Managed Care Toolkit. This toolkit features highlights from twelve health plans and/or state agencies serving Medicaid populations. Participating ACAP health plans include: CareOregon, LA Care, Neighborhood Health Plan of Rhode Island, Monroe Plan for Medical Care, and Network Health. To download the toolkit or order a hardcopy, please go to: http://www.chcs.org/publications3960/publications_show.htm?doc_id=440684 CareOregon and Neighborhood Health Plan of Rhode Island to Participate in Collaborative on Child Welfare ACAP health plans CareOregon and Neighborhood Health Plan of Rhode Island will participate in a CHCS collaborative to Improve Outcomes for Children Involved in Child Welfare. Eleven managed care organizations from across the country will participate in the 24-month long initiative, which begins this month. These organizations will develop and pilot promising approaches to meet the health and behavioral care needs of children and youth in the child welfare system. For more information go to: http://www.chcs.org/info-url_nocat3961/info-url_nocat_show.htm?doc_id=403564 AHRQ Funding Available to Health Plans and Others to Study Safety and Quality The Agency for Healthcare Research and Quality (AHRQ) will fund up to $26 million in new research projects to improve the safety and quality of ambulatory health care. Four separate funding opportunity announcements under AHRQ's new Ambulatory Safety and Quality grant program were published in the December 5 NIH Guide.
Reminder: Medicare SNP Roundtable The next Medicare SNP roundtable is scheduled for Thursday, January 18th at 3PM EST. On the call, Beth Marootian from NHPRI will share her plans approach to training staff on Medicare issues and keeping staff current on an ongoing basis. Reminder: Compliance Officers Roundtable The next Compliance Officers Roundtable is Wednesday, January 24 at 3 pm EST. Topics for the call include: discussion of Connecticut"s recent Freedom of Information Act decision and its impact on CHCNT, follow up to the 1/10 CMS False Claims Act Information call, and discussion of model language for the employee education provisions of the False Claims Act. Reminder: Chief Operating Officers Roundtable The next Chief Operating Officers Roundtable is Thursday, January 25 at 3 pm EST. An agenda and discussion questions will be circulated prior to the call. Please email Peggy Oehlmann (poehlmann@communityplans.net) with any items to add to the agenda. |
| NEWSFLASH |
Accommodations in Phoenix Unfortunately because it is high season in Phoenix, AZ the Caleo Resort booked up very quickly. The Caleo will not be able to give us any more rooms at the lower rate and they are completely booked as a hotel as well. We have searched for other hotel options that have rooms available. As there are just a few ACAP'ers that need rooms, we have not be able to set aside a block of rooms at another hotel. However, we have found three hotels that semi close to Caleo and have rooms available. It would be helpful if you would notify us of the hotel that you were able to book a room at. Please also check rates of these hotels on www.orbitz.com or www.kayak.com they tend to show lower rates. Sorry for inconvenience and let us know if you have anymore questions.
Colorado Access has announced an 18 percent reduction in its workforce as part of an overall administrative cost reduction plan, which began in August 2006. In August, the company was forced to reduce staff after it elected not to renew its Medicaid physical health contract due to a proposed 15 percent rate reduction from the Colorado Department of Health Care Policy and Financing. Effective Friday, Jan. 12, 2007, 25 full-time positions (out of a total of 139) will be eliminated. "This represents the second wave of a six-month process to get us to a staff size needed to effectively operate our three remaining lines of business," said Marshall Thomas, MD, president and CEO of Colorado Access. For more than 10 years, Colorado Access has served as the state's leading health plan for low-income populations. The company's three lines of business are Access Advantage, Child Health Plan Plus and Access Behavioral Care. Colorado Access is sponsored by The Children's Hospital, Colorado Community Managed Care Network and University of Colorado Hospital/University Physicians, Inc. More information is available at www.coaccess.com. CareSource Foundation Awards Second Round of Grants The CareSource Foundation, launched this past June, recently announced in December its seco d round of health care grant awards. The Foundation focuses funding on four key areas including issues of the uninsured, critical health trends, community health issues and broad collaboration with other organizations and funders. Awards totaling $150,000 have been granted to the following organizations:
CHCS Suggests Reform Strategies for Governors in 2007 and Mentions the Monroe Health Plan In Mid-December the Center for Health Care Strategies (CHCS) published Medicaid "Best Buys" for 2007, which outlines five of the most promising opportunities to improve the health of high-risk Medicaid beneficiaries and curb spending growth. States adopting these strategies can lead the health care system in providing cost-effective and high-quality care within Medicaid and beyond. There five recommendations consist of:
CHCS published this brief through funding from the Robert Wood Johnson Foundation and with the assistance of the Government Innovators Network at the Harvard University Kennedy School of Government. For complete article click link and download PDF file. http://www.chcs.org/publications3960/publications_show.htm?doc_id=434341 Governor Schwarzenegger Announces Plan to Cover All Californians Governor Arnold Schwarzenegger last Monday announced a proposal to require all state residents to obtain health insurance coverage. Schwarzenegger's plan, strongly reminiscent of Massachusetts Health Reform, would distribute the costs of coverage among employers, individuals, health care providers, health insurers and the government. The plan mandates that all employers with 10 or more employees offer coverage or face a financial penalty, and allows employees to purchase coverage with pre-tax dollars but threatens reductions to state income tax refunds or wage garnishes to residents who fail to find coverage. Health insurers would be required to sell policies to all state residents, regardless of preexisting medical conditions. In addition, the proposal expands coverage under Medi-Cal, California's Medicaid program, to all adults with annual incomes of up to 100 percent of the federal poverty level and to children -- regardless of immigration status -- with household incomes of up to 300 percent of the federal poverty level. Subsidies would help state residents with annual incomes up to 250 percent of the federal poverty level purchase health insurance. Employer and individual penalties would accrue to a state pool that would help workers purchase coverage. The proposal also would increase reimbursements to health care providers under Medi-Cal by $4 billion. The program will be party funded by a 2 percent tax on physician revenue and a 4 percent tax on hospital revenue, and will also benefit from approximately $5 billion in federal matching funds that the State will receive from restructuring several health care programs, and from state funds currently devoted to charity care. Currently, approximately 6.5 million California residents lack health insurance, equaling nearly 20 percent of the State"s population. |
| Upcoming Events |
January Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
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1 |
2 |
3 |
4 |
5 |
6/7 |
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8 |
9 |
10 |
11 |
12 |
13/14 |
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15 |
16 Program Committee Meeting |
17 |
18 Medicare SNP Call on Staff Training for Medicare |
19 |
20/21 |
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22 |
23 |
24 3 PM EST Compliance Officers Roundtable |
25 3 PM EST Chief Operating Officers Roundtable |
26 |
27/28 |
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29 |
30 |
31 |
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February Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
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1 11 AM EST Board Quality Management Committee Meeting 3 PM EST Chief Financial Officers Roundtable |
2 |
3/4 |
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5 |
6 ACAP Fly-in |
7 ACAP Fly-in |
8 3 PM EST Chief Medical Officers Roundtable |
9 |
10/11 |
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12 |
13 ACAP Finance Committee Call |
14 |
15 3 PM EST Chief Information Officers Roundtable |
16 |
17/18 |
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19 |
20 Executive Committee Call |
21 |
22 3 PM EST Pharmacy Directors Roundtable |
23 |
24/25 |
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26 |
27 |
28 |
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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 |