 February 16, 2007 |
|
|
Upcoming ACAP Calls
2/15 at 3 PM EST: Chief Information Officers Roundtable 2/22 at 3 PM EST: Pharmacy Directors Roundtable 2/27 at 3 PM EST: Policy Roundtable 3/22 at 3 PM EST: Marketing Directors Roundtable 3/27 at 3 PM EST: Medicare SNP Roundtable 3/29 at 3 PM EST: Provider Relations 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 |
ACAP’s Fly-in and Other Congressional Activity This Week ACAP made a big step forward in the evolution of its government relations strategy by hosting its first annual Congressional Fly-In on February 7. Seven ACAP plans met with their Representatives and Senators and were successful in obtaining commitments from many of their elected officials that they would be supportive of safety net health plans. Two other ACAP members plan on separate Hill visits later this month. ACAP plans had over 30 meetings in the offices of Senator Hillary Clinton, Senator Ted Kennedy, House Minority Leader John Boehner, Senator John Kerry, Finance Chairman Max Baucus and other Congressional big-wigs. Although ACAP staff will be debriefing on the fly-in next week, the overall sense of the event was that we made great progress in educating our elected officials about issues impacting safety net health plans and identified people who support our work and mission. In these meetings, ACAP representatives outlined the ACAP 2007 legislative agenda, which includes:
Evaluations of the relative successes and lessons learned of each Hill meeting will be aggregated and analyzed before being made available to all ACAP members. Discussion is already underway to plan for another fly-in, so please stay tuned. ACAP to Host Third Meeting for Medicare SNP Plans ACAP will host its third meeting for ACAP plans operating Medicare SNPs (or considering launching a Medicare SNP) in Phoenix, AZ on March 6th and 7th, 2007. Medicare Directors and ACAP plan CEOs will be holding concurrent meeting in Phoenix March 6-7 and will have the opportunity to meet jointly on the morning of March 6th to discuss Medicare SNP strategy and Medicare and Medicaid integration. Medicare Directors will then proceed with a Medicare SNP-focused meeting for the remainder of March 6th and March 7th (concluding at noon on March 7th). Our guest speaker will be Kirk Strawn, M.D., President of PopManHealth and an expert on risk adjustment strategies for small and medium sized SNP plans. Kirk will discuss the risk adjusted payment system and the options for plans to ensure their payments reflect the health risk of their member population. Some additional agenda items include:
|
| PUBLIC POLICY AND ADVOCACY |
President’s Budget Proposals Unveiled ACAP’s Fly-In was particularly timely as President Bush issued his FY2008 budget proposal on Monday. The budget provides $2.9 trillion in government spending, would seek to balance the budget by 2012 and would increase billions of dollars of funding for national security and homeland defense while cutting funding for many social programs, including Medicare and Medicaid. On Medicare, although the Medicare Advantage program was largely unscathed, the Administration proposed to cut more than $76 billion over five years. Among the numerous proposals in Medicare, the Administration proposes $41 billion in cuts to hospitals, skilled nursing facilities, inpatient rehab facilities, hospices and home health agencies. President Bush’s budget also proposed a 4-year phase-out of Medicare bad debt payments, means-testing for Medicare Part D premiums, and eliminating annual indexing of income-related Part B premiums. The Administration also proposes a net cut in Medicaid and SCHIP of $19.8 billion over five years. In the Medicaid program, the Administration proposes streamlining Administrative match rates, eliminating Medicaid graduate medical education, allowing states to use private-sector-type formularies in controlling prescription drug use, and reimbursing targeted case management at 50%. On SCHIP, the Administration supports reauthorization of the program, but would seek to “restore SCHIP to its original purpose” – covering low-income children. Therefore, the Administration proposes limiting the SCHIP match rates only to those children under 200% of the Federal poverty level. In addition, critics say that the funding level provided by the Administration budget would not fully fund kids currently covered by the program and certainly would not provide funding for children that are eligible, but not enrolled. The budget was almost immediately dismissed by Democrats on Capitol Hill who have their own approach to funding the Federal budget and getting to a balanced budget in five years. While the Administration would reauthorize expiring tax cuts, most Democrats would allow those cuts to lapse and use the funds to help fund priorities and balance the budget. In addition, Democrats were stating that cuts in Medicare and Medicaid weren’t going to happen. “The President calls for nearly $2 trillion in tax cuts, so in the name of balancing the budget by 2012, he hits domestic priorities such as health care, education, and the environment,” said House Budget Committee Chairman John Spratt of South Carolina. “The Bush budget calls for $252 billion in Medicare cost reduction over 10 years without reinvesting those savings in Medicare program improvements, plus $25.7 billion in legislated Medicaid cost reductions; and provides less than needed to renew the Children’s Health Insurance Program so that it continues to insure the number of kids now covered.” Senate Budget Committee Chair Kent Conrad echoed Spratt’s sentiments: “The President has…missed an historic opportunity to reach out to Democrats and work with a new Congress to address the nation’s long-term fiscal problems. Our long-term imbalance has significantly worsened since President Bush took office, yet his budget offers no credible options for putting us back on a sustainable path. The President has chosen again to reject compromise and stay the course.” On February 7th, Senate Finance Committee Chair Max Baucus issued a list of priorities that he will follow in reauthorizing the SCHIP program. In identifying his priorities, he said, “We must give CHIP enough money to maintain coverage for those whom it already serves. We must work to reach the six million uninsured children now left behind — those who are eligible for CHIP or Medicaid but not enrolled. We must support state efforts to use CHIP to cover more children. We must improve the quality of health care under CHIP. And we must not increase the number of Americans without health insurance.” Baucus has identified the reauthorization of the SCHIP program as the top health priority of his Committee. The ACAP Policy Roundtable will discuss the budget document on its call on February 27. ACAP Delivers Welcome Packets to 110th Congress ACAP, with the help of the NACHC interns, delivered a welcome packet - 235 in total – to every Senator and Member of Congress in each of the eighteen states housing at least one ACAP member plan. The ACAP packets congratulated the legislators on starting a new legislative session, and expressed ACAP’s willingness to work with each of them throughout the 110th Congress. The informational folders included a personalized letter from Meg Murray indicating the specific names of the ACAP plans in each Congressperson’s or Senator’s state. The folders also included a new brief on Medicaid managed care basics, a short description of each of the issues ACAP will include in its legislative agenda, and a full list of all ACAP member plans and of ACAP’s publications. ACAP members are urged to build on this message with welcome letters of their own, and are encouraged to use the ACAP template if they choose to do so.
ACAP Sharing Services
Senate Finance
Committee Holds First SCHIP Reauthorization Hearing, Debates
Coverage of AdultsIn 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 Senate Finance Committee on February 1 held the first hearing focused on reauthorization of the State Children’s Health Insurance Program (SCHIP) in the new Congress, inviting a Maryland family to testify, along with Governor Sonny Perdue of Georgia, Kathryn Allen, Director of Health Care at the GAO, Cindy Mann, SCHIP expert and Executive Director of the Center for Children and Families at Georgetown University Health Policy Institute, and Anita Smith, Chief Bureau of Medical Supports within the Iowa Department of Human Services. According to news sources, coverage of adults by some states – including parents and guardians as well as childless adults – was heavily criticized by some Committee members, but lauded as beneficial for children and communities by others. Division of opinion on coverage of adults tended to follow party line, with Republicans speaking out against the practice. Some Democrats, notably Senate Finance Chairman Max Baucus, felt otherwise. Baucus repeated the sentiments of former Centers for Medicare and Medicaid Services (CMS) Administrator that existing data shows that "covering parents in CHIP actually increases access. And he [McClellan] said that it helped retain children in CHIP programs.” The cost of reauthorization of the SCHIP program varies depending on the source of the estimate and the programmatic elements included the particular conceptualization of reauthorization. Noted above, the President’s budget estimates reauthorization to cost approximately $30 billion over five years ($5 billion per year baseline, plus an extra $5 billion over five years), but ratchets coverage of children back to 200 percent of the federal poverty level. (Sixteen states currently are approved by CMS to cover children with incomes above 200 percent of the federal poverty level.) It is estimated that maintenance of all currently covered kids will cost $12 billion to $15 billion in new money, in addition to the $25 billion baseline. Other groups, including some policy analysts and child advocates, indicate that $60 billion in new dollars plus the $25 baseline over five years will provide sufficient funding to cover all currently-enrolled children, plus all children who are eligible but not enrolled, legal immigrant children, and additional expansion populations. Georgia Republican Governor Perdue’s state covers children only up to 200 percent of the federal poverty level and does not cover adults with the SCHIP program. The Governor testified in favor of coverage of more children rather than adults, and suggested that the federal funding formula was partly at fault, leaving some states with excess funding to be spent on expansion populations, while others struggle to cover only very low-income children. |
| EXCELLENCE AND ACCOUNTABILITY |
Recap: Chief Financial Officers Roundtable ACAP CFOs had their first roundtable of the year on February 1. On this call, CFOs discussed how they defined administrative versus medical expenses. CFOs followed the statutory guidelines required by either their state Medicaid agencies and/or their insurance departments. Of the plans on the call, NY and MA required plans to count all medical management as administrative expenses, but other states, such as WA and RI provided greater flexibility. WA is similar to NY and MA except that some limited quality improvement initiatives can be counted as a medical expense. The next CFO roundtable is on May 17.
ACAP Job Bank
Recap: Chief Medical
Officers Roundtable ACAP 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. ACAP CMOs held their first roundtable of the year on February 8. On this call, CMOs discussed pay for performance and incentive programs tried in the past, successes and challenges of those programs, and new initiatives plans have heard about but wanted more information on. Several ACAP plans had programs in place for years and have had varying degrees of success in terms of improved HEDIS scores. Generally those programs that are more narrow in scope (focusing on five or few measures at a time) seemed to be most effective. Materials posted on the CMO section of the website included a summary of pay for performance initiatives tried by ACAP plans and/or the states they do business in. The next CMO roundtable is on May 24. Reminder: Chief Information Officers Roundtable The next Chief Information Officers Roundtable is Thursday, February 15 at 3 pm eastern time. An agenda and materials will be distributed prior to the call. Reminder: Pharmacy Directors Roundtable The next Pharmacy Directors Roundtable is Thursday, February 22 at 3 pm eastern time. An agenda and materials will be distributed prior to the call. |
| NEWSFLASH |
ACAP’s Hill Lobbying Noted by Capital Hill Newspaper According to “The Hill,” a bipartisan newspaper devoted to the doings of Capital Hill, ACAP plans are lobbying hard on behalf of SCHIP reauthorization. “Those with the greatest interest in the outcome of the SCHIP debate are relatively small, not-for-profit, local and regional health-insurance businesses. A seven-year-old trade group called the Association for Community Affiliated Plans (ACAP) represents the SCHIP health insurers in Washington. Community health centers, public hospitals or local communities typically own the plans, ACAP’s executive director, Margaret Murray, said. Although ACAP’s member companies would be the most directly affected private-sector interest, the group lacks the clout to exert its agenda on its own.” Bob Thompson, CEO of the Monroe Plan and Vice-Chair of ACAP is quoted as saying, “ACAP doesn’t see itself as the driver. It sees itself as part of the train.” ACAP seeks, at a minimum, to maintain the current level of coverage under SCHIP, but would prefer to see the program expanded to include not only children who are already eligible but not enrolled, but also children from higher-income families than SCHIP currently covers, Thompson said. For their agenda to be successful, Thompson said, the SCHIP health plans must rely on the efforts of other lobbying organizations. CareSource Reaches Half a Million in Membership CareSource recently celebrated reaching its half million membership milestone. In January CareSource received approval from the Ohio Department of Insurance to expand its service area statewide to offer Medicaid managed care to both the Covered Families and Children, and Aged, Blind and Disabled populations. CareSource, the largest HMO in Ohio, attributes its impressive growth to its commitment to customer service for both members and providers. The health plan covers all state-required services and offers other benefits such as a 24-hour nurse advice line, transportation to doctor’s appointments, and case management for members. Pam Morris commented on the expansion, “This remarkable success is the result of our partnership with providers and the State of Ohio to make quality healthcare available to underserved populations. CareSource has been at the forefront of providing Medicaid managed health care for nearly 18 years, and we could not have reached this milestone without the daily commitment of our employees to CareSource’s mission.” |
| Upcoming Events |
February Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
|
|
|
|
1 11 AM EST Board Quality Management Committee Call 3 PM EST Chief Financial Officers Roundtable Salary and Benefits Survey DUE ACAP Plan Survey DUE |
2 |
3/4 |
|
5 |
6 ACAP Fly-in |
7 ACAP Fly-in |
8 3 PM EST Chief Medical Officers Roundtable |
9 |
10/11 |
|
12 |
13 ACAP Finance Committee Call |
14 |
15 3 PM EST Chief Information Officers Roundtable |
16 |
17/18 |
|
19 |
20 Executive Committee Call |
21 |
22 3 PM EST Pharmacy Directors Roundtable |
23 |
24/25 |
|
26 |
27 3 PM EST Policy Roundtable |
28 |
|
|
|
March Events |
| Mon | Tues | Wed | Thurs | Fri | Sat/Sun |
|
|
|
|
1 |
2 |
3/4 |
|
5 ACAP Board Meeting & SNP Meeting, Phoenix, AZ |
6 ACAP Board Meeting & SNP Meeting, Phoenix, AZ |
7 ACAP Board Meeting & SNP Meeting, Phoenix, AZ |
8 |
9 |
10/11 |
|
12 |
13 |
14 |
15 |
16 |
17/18 |
|
19 |
20 |
21 |
22 3 PM EST Marketing Directors Roundtable |
23 |
24/25 |
|
26 |
27 3 PM EST Medicare SNP Roundtable |
28 |
29 3 PM EST Provider Relations Roundtable |
30 |
31/1 |
|
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 |