 March 27, 2007 |
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Upcoming ACAP Calls
3/27 at 3 PM EDT: Medicare SNP Roundtable 3/29 at 3 PM EDT: Provider Relations Roundtable 4/19 at 3 PM EDT: Quality Management Directors Roundtable 4/26 at 3 PM EDT: 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 |
ACAP Hosts Its Third Meeting for Medicare SNP Plans ACAP hosted its third meeting for ACAP plans operating Medicare SNPs (or considering launching a Medicare SNP) in Phoenix, AZ on March 6th and 7th, 2007. The meeting was held jointly with the ACAP Board meeting so that Medicare Directors and CEOs would have the opportunity to meet jointly to discuss Medicare SNP strategy and Medicare and Medicaid integration. Medicare CEOs and Medicare Directors also met to discuss ACAP’s Medicare SNP policy agenda for 2007. Highlights form the meeting included:
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| PUBLIC POLICY AND ADVOCACY |
Legislative Update Although scandals involving Walter Reed Medical Center and fired U.S. prosecutors are dominating Washington headlines, behind the headlines Congress is busily moving forward on significant policy, particularly within the context for the FY2008 budget process. Although positions on all issues seems to be hardening along party lines, it remains to be seen whether Democrats will be able to secure the wholesale support of their caucus on critical votes in the face of the certain unanimity in the Republican conference. Among the first budget confrontations to emerge was the debate over the War Supplemental and Emergency Spending appropriations. Moving outside the regular appropriations order because of its designation as emergency spending, this legislation would continue to fund the ongoing war effort in Iraq and Afghanistan and other “emergencies.” However, in an effort to secure enough support for their proposal to withdraw troops from Iraq, the Democratic leadership had added billions of dollars of additional spending to entice support for the bill. One of these sweeteners is additional funding to fill a shortfall in funding for the SCHIP program. As passed by the House Appropriations Committee, the proposal adds $750 million for SCHIP to ensure continued healthcare coverage for children in 14 states that face a budget shortfall in the program. As of submission of this report, it is unclear whether Democrats will have sufficient votes for this effort – in fact, the latest reports indicate that they do not. The House of Representatives passed this legislation last week by a vote of 218 to 212. The Senate has yet to take up this legislation. Regardless, President Bush has indicated that he would veto the legislation if it comes to his desk. Although the supplemental appropriation has been a focus of many, the big budget enchilada (in a public policy sense of the term) has been the Congressional Budget Resolution. The Budget Resolution provides a blueprint for spending on Federal programs and does not require the approval of the President. Both Congressional Budget committees have passed the legislation, and the Senate approved its version on Friday by a vote of 52-47. The $2.93 trillion budget is the first time in 12 years that Congressional Democrats have had an opportunity to put their imprint on the Federal budget with their priorities. Of interest to safety net health plans (SNHPs), the Senate’s FY08 budget would provide up to $50B over 5 years to expand coverage of the estimated six million children eligible but not enrolled in either SCHIP or Medicaid, and maintain coverage for all currently-enrolled children. The Senate budget also assumes savings from price negotiation for the Medicare drug benefit and establishes a $5 billion reserve fund to make improvements to the Medicare Part D benefit, such as changing asset requirements for the low-income subsidy, improving outreach efforts for the low-income subsidy, or providing coverage for certain mental health medicines currently excluded under the Medicare Modernization Act. In addition, the budget would provide a $536 million increase in the community health center program. During the Senate floor debate, ACAP was monitoring several key amendments of policy interest to SNHPs, including:
ACAP continues to work to position its top legislative priority, equalizing the treatment of the Medicaid drug rebate for managed care enrollees, as a reasonable offset to pay for the cost of reauthorizing the SCHIP program. ACAP is awaiting a redraft of the legislative language from outside counsel and hopes to be able to clear the revised language with ACAP member plans no later than the end of March. Finance Committee staff have indicated that they will need our legislative language in April to consider it for inclusion in the SCHIP reauthorization bill. Medicare Advantage also has taken on greater visibility in Congress as the House and Senate look for ways to offset different Democratic spending priorities. A big chunk of the offset would come from reductions in payments to health care providers – the biggest chunk likely to come from Medicare managed care plans. Although Democrats continue to say that they are not defunding the MA program, they have always been suspicious of Medicare Advantage as an effort by Republicans to shift Medicare into private sector plans, thereby eliminating the Federal health care bureaucracy, the Centers for Medicare and Medicaid Services. Now that Democrats are in control, they will be much harder on the program. In fact, the House Ways and Means Health Subcommittee held an oversight hearing on Wednesday that focused on the Medicare Advantage program. Subcommittee Chairman Pete Stark took to task claims by AHIP, BlueCross/BlueShield claims that the MA program disproportionately served the poor, showing that the proportions of poor and minority patients in MA plans reflects the proportion in the regular Medicare program. ACAP also continues to promote the interest of SNHPs on a number of other fronts, including health information technology and health disparities legislation. ACAP’s lobbyist has been working to educate key Congressional committees about the unique role of SNHPs in the health care system. Most recently ACAP has met with the HELP Committee staff to improve the health disparities legislation introduced last year that provided funding opportunities for health plans, but provided no special consideration or recognition for SNHPs among other safety net providers. ACAP hopes to continue making inroads in these issues and calls upon all ACAP members to be in a continuous process of educating their elected officials about SNHPs and the unique role they play. CMS Reverses Newborn Deemed Eligibility Rule CMS has reversed the policy it instituted last summer prohibiting states to deem Medicaid eligibility for infants born to unqualified immigrant mothers (either undocumented or legal in the U.S. for fewer than five years) whose births are paid by emergency Medicaid. Since 1984, federal Medicaid policy has required states to provide one year of automatic Medicaid eligibility to babies when the births were covered by Medicaid. Without modification to the law, CMS directed states not to provide automatic coverage to babies whose mothers do not meet the citizenship documentation requirements, despite the fact that the babies were born in the United States and Medicaid covered the cost of their birth. CMS distributed a press release late in the day on March 20 stating that it will publish a new interim rule in the near future reversing the policy instituted in 2006, and allow newborn babies whose mothers were on emergency Medicaid at the time of birth to again receive a full year of Medicaid eligibility. Washington State’s Governor Gregoire (D) filed a lawsuit against the Federal government in early March regarding the prohibition on deemed eligibility. In addition, Senator Charles Grassley (R – Iowa), the ranking Republican on the Senate Finance Committee, introduced legislation called “The Guaranteed Access to Medicaid for Newborns Act” to clarify that a child whose birth is paid for by Medicaid is deemed eligible for Medicaid for a year, regardless of the mother’s citizenship status.
ACAP Sharing Services
ACAP and Medicaid
Health Plans of America Release New Lewin Rate-Setting Case StudyIn 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. “Collaboration in Medicaid Managed Care Rate Setting,” a new case study produced by The Lewin Group and jointly funded by ACAP and Medicaid Health Plans of America, provides a close look at collaboration between states and Medicaid health plans during the rate-setting process. This report represents phase two of a two-part project, and follows an initial report on rate-setting and actuarial soundness made public in 2006. For phase one, Lewin conducted a survey of states and plans to assess their processes and level of collaboration, and found that in some states health plans have some input into the rate-setting process, but that in many states budgetary factors influence the final rates, and plan input does not always have a material impact on the plans’ cost of providing benefits. “Collaboration in Medicaid Managed Care Rate Setting” is a case study of three states and is derived from interviews with representatives from three Medicaid managed care plans. It finds that 1) the level of collaboration depends on the people involved at the state level, 2) in some states, the health plans are very involved in the process but their input may or may not lead to any changes in the rates, and 3) in other states, the Medicaid managed care rate-setting process has become more collaborative in recent years. The report also highlights a best practice – open and regular communication with the states during the rate-setting process – and several challenges for Medicaid plans, including tight timeframes and the need for legislative approval, use of budget considerations in the rate-setting process, and lack of responsiveness to plans’ market considerations. The report concludes that a collaborative process between states and plans is critical, adequate timeframes are needed, the effect of state budget considerations on Medicaid rates is of great concern to plans, and CMS, states and plans together need a shared understanding of how plan and program characteristics should be reflected in the administrative cost component of the capitation rates. ACAP distributed this paper to the Board at the March Arizona Board meeting Click Here to view the Lewin Paper. ACAP Signs Policy Letters to CMS to Stop Medicaid Cuts, Provide Health Care to Legal Immigrants On March 19, ACAP signed on to a Families USA comment letter to CMS about proposed cuts to Medicaid payments to public and safety net providers. The cuts, described in CMS’s interim final rule entitled “Cost Limit for Providers Operated by Units of Government and Provisions to Ensure the Integrity of Federal-State Financial Partnership,” were published January 18, 2007, and are likely have a severe negative impact on public providers, partners in many cases to ACAP members. In addition, the cuts will also drain funding from the Medicaid program in general. The letter states that “Ultimately, individuals with health care needs will pay the price. Cutting public provider reimbursement and squeezing state budgets will lead to substantial reductions or outright elimination of critical services for Medicaid beneficiaries and the uninsured.” The Families USA letter was also signed by numerous provider groups, and serves as a formal comment to CMS. At its discretion, CMS may use the comments it receives to alter the final version of the rule. Earlier in the month, ACAP also signed a letter circulated by the National Immigrant Law Center (NILC) requesting that the Immigrant Children’s Health Improvement Act (ICHIA), be included in any SCHIP bill considered by Congress. ICHIA would restore Medicaid and SCHIP benefits to lawfully present immigrant children and pregnant women, reversing the “five year bar” instituted by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). The text of the letter references research demonstrating that immigrant children are less likely to obtain medical care than native-born children, and that failing to provide basic preventive care for immigrant children jeopardizes their health and creates a need for more expensive subsequent care. The text of the letter can be found on the following website: http://www.democracyinaction.org/dia/organizationsORG/NILC/signUp.jsp?key=2115. The NILC states that in the past ICHIA has been supported by the National Governors Association and the National Conference of State Legislators. New York Times Article Describes Impact of Citizenship Documentation Requirements On March 12, a New York Times article written by Robert Pear stated that the citizenship documentation requirement implemented July 1, 2006 and designed to keep illegal immigrants off Medicaid has instead prevented eligibility for thousands of United States citizens. The article demonstrates that seven states, including Florida, Iowa, Kansas, Louisiana, New Mexico, Ohio and Virginia, have been able to attribute unprecedented declines in enrollment to the rule, which requires applicants claiming to be U.S. citizens to show birth certificates and other documents proving their citizenship. Many applicants have difficulty locating the appropriate documentation, which delays or prevents their enrollment in Medicaid. Applicants must submit original documents or copies certified by the issuing agency. In Virginia, home to ACAP member Virginia Premier, the article reports that because health insurance for children has been prioritized over the past several years by State officials, the State has witnessed an increase in Medicaid-enrolled children during this time. However, since implementation of the new rule, the number of children on Medicaid in Virginia has declined by 13,300. NACHC Asks for Support for Community Health Center Funding The National Association for Community Health Centers (NACHC) has asked its members and friends to urge elected officials from all states to sign on to two Congressional letters, one circulating in the House of Representatives, written by Frank Pallone (D – New Jersey) and Nathan Deal (R – Georgia), and one in the Senate, sponsored by Debbie Stabenow (D – Michigan) and Kit Bond (R – Missouri). The letters, available at http://www.nachc.com/advocacy/letter08.asp, represent the first step in the "ACCESS Across America" growth plan to reach 30 million community health center patients by 2015, and ask for support for a $200 million funding increase for Health Centers in both Houses of Congress. A list of members of Congress and Senators that have already signed the letters can also be seen at the website printed above. The deadline for signatures in the House will be March 30 and in the Senate April 15. |
| EXCELLENCE AND ACCOUNTABILITY |
New State Resources: Designing Managed Care for People with Complex Needs Earlier this month the Center for Health Care Strategies (CHCS) distributed a toolbox of resources for states to help them determine which managed care practices are best for enrollees with complex needs, including adults with chronic conditions and disabilities and low-income senior citizens. CHCS is working with states to define care management strategies, develop measures to effectively evaluate programs, and review best practices in consumer and advocate outreach and engagement. CHCS directs states considering expanding managed care programs for SSI-eligible populations to the following websites:
ACAP Job Bank
Recap: Marketing
Directors 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. On their March 22 roundtable, Marketing Directors from ACAP plans finalized plans for a Marketing benchmarking survey. The survey is in the Marketing Directors Roundtable section of the website with the timeline for completion. Please contact Peggy Oehlmann with any questions about the survey. Marketing directors also discussed new programs in Massachusetts and California to address health care needs of the uninsured as well as the Citizen Documentation Requirements of the Deficit Reduction Act and discussed enrollment changes that plans have experienced since the requirements went into effect. The next Marketing Directors roundtable will be on June 14 at 3 pm Eastern time. Reminder: Provider Relations Directors Roundtable The next Provider Relations Directors Roundtable is Thursday, March 29 at 3 pm eastern time. On this call, we will discuss strategies for addressing provider network instability. Discussion questions and a background paper on the issue have been posted to the Provider Relations Directors Roundtable section of the website. Please contact Peggy Oehlmann (poehlmann@communityplans.net) if you have items to add to the agenda. Reminder: SNP Roundtable The next Medicare SNP roundtable is scheduled for Tuesday, March 27th at 3PM EST. Keith Bell from Community Health Plan of Washington will lead a discussion on the organizational design of their Medicare SNP plan which they launched in January 2007. He will discuss how CHP supports their Medicare SNP, which Medicare functions have dedicated FTE, and for which functions they use (or considered using) vendors. If you have any specific questions you would like to discuss, please e-mail them to me in advance and I will pass them along. Please let Liz Ward eward@communityplans.net if you will be on the call. |
| NEWSFLASH |
Santa Clara Family Health Plan Welcomes a New Chief Financial Officer Santa Clara Family Health Plan is pleased to announce that Michael Weatherford been appointed to the position of Chief Financial Officer. In recent years, Mike has been the Chief Financial Officer of the Physician Foundation at Sutter's California Pacific Medical Center (CPMC), San Francisco. His previous stints included Chief Operating Officer of the Central Coast Alliance for Health, serving 85,000 members in Santa Cruz and Monterey Counties; Vice President and CFO, Catholic Healthcare West's Monterey Bay Region (Dominican Santa Cruz Hospital and Affiliates); Vice President and CFO, Scripps Clinic, San Diego, a 300-physician multi-specialty medical group; CFO, Children's Hospital of Orange County; Director of Finance, Scripps Memorial Hospitals, San Diego. Please join us in wishing Mike Weatherford and the Santa Clara Family Health Plan well. |
| ACAP VENDOR ALLIANCES |
The 4th Annual World Health Care Congress April 22 - 24, 2007 | Washington Convention Center | Washington, DC www.whcc2007.com The 4th Annual World Health Care Congress, co-sponsored by The Wall Street Journal, will convene over 1,800 CEOs, senior executives and government officials from the nation's largest, hospitals, health systems, health plans, employers, pharmaceutical and biotech companies, and leading government agencies. Join other senior executives in creating a new healthcare model based on value, quality and consumer choice. As an ACAP Member you will receive a discount of $300 off the Standard rate! Mention promotional code ACAP at the time of registration. www.whcc2007.com – 800-817-8601 – wcreg@worldcongress.com |
| Upcoming Events |
March Events |
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1 3 PM EST ACAP Congressional Fly-In Debriefing |
2 |
3/4 |
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5 ACAP Board Meeting & SNP Meeting, Phoenix, AZ |
6 ACAP Board Meeting & SNP Meeting, Phoenix, AZ |
7 ACAP Board Meeting & SNP Meeting, Phoenix, AZ |
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9 |
10/11 |
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12 |
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14 |
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16 |
17/18 |
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19 |
20 |
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22 3 PM EST Marketing Directors Roundtable |
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24/25 |
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26 |
27 3 PM EST Medicare SNP Roundtable |
28 |
29 3 PM EST Provider Relations Roundtable |
30 |
31/1 |
April Events |
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7/8 |
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14/15 |
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19 3 PM EDT Quality Management Directors Roundtable |
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21/22 |
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26 3 PM EDT Chief Operating Officers Roundtable |
27 |
28/29 |
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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 |