 April 30, 2007 |
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| HIGHLIGHTS |
ACAP Welcomes CEO Jennifer Marchant and Carolina Crescent Health Plan as its Newest Member Carolina Crescent Health Plan located in South Carolina is the 30th and the most recent member of ACAP. Carolina Crescent is a new MCO that is being established in South Carolina. They are a not for profit plan that is owned by Virginia Commonwealth University (as is Virginia Premier who recruited them into ACAP.) They intend to have 10-15,000 lives by the end of a year, but will not start enrolling until July of 2007. South Carolina is initiating a voluntary Medicaid managed care program. The state will ask people to choose a plan first. If they don’t, they will auto assign them, but give them 90 days to opt out. ACAP now consists of 30 health plans dispersed amongst 17 states and representing more than 4 million lives. ACAP Plans Participate in Cover the Uninsured Week April 23-27, 2007 was “Cover the Uninsured” Week, sponsored by the Robert Wood Johnson Foundation. The purpose of the week is to advocate health insurance coverage for all Americans. Now in its fifth year, Cover the Uninsured Week (April 23-29) has become the largest nonpartisan mobilization in history seeking solutions for the nearly 45 million Americans who are uninsured. This year, Cover the Uninsured Week comes at a critical time, with Congress working to reauthorize the State Children's Health Insurance Program (SCHIP). (See Legislative Update, below.) Enacted in 1997, SCHIP provides each state with federal funds for a health insurance program for vulnerable children. Organizers of the Week say that if America's leaders fail to renew and sufficiently fund SCHIP, millions of children who desperately need health insurance will remain uninsured and without adequate health care. ACAP health plans participated this year by hosting events to promote health insurance coverage in conjunction with local provider groups and/or community health centers. CareSource Promotes Statewide Awareness Campaign In Support of National Cover the Uninsured Week CareSource rallied this week in support of Cover the Uninsured Week (April 23-29). This event, sponsored nationally by the Robert Wood Johnson Foundation, brings together healthcare leaders, public officials and community advocates to shine a spotlight on the need to secure health coverage for all Americans. CareSource sponsored a public service announcement in television markets statewide. Partnering with the Children’s Hunger Alliance, additional information about free or low-cost insurance was distributed to the parents of nearly 25,000 children. There are 1.3 million uninsured Ohioans, more than 220,000 are children. "It is CareSource’s mission to provide quality healthcare to underserved populations, which is why we were proud to support this effort to bring awareness of available health care options for the uninsured in Ohio," said Pamela B. Morris, President and CEO of CareSource. “As a community we all must work diligently to ensure more people have access to adequate healthcare.”Dianne A. Radigan, the Chief Operating Officer of the Children’s Hunger Alliance, agreed that community collaboration is the key to working on this issue. “CareSource and the Children’s Hunger Alliance will to continue to help uninsured Ohioans become aware of free or low-cost health care for their children,” she said. This year, Cover the Uninsured Week comes at a critical time, with Congress working to reauthorize the State Children's Health Insurance Program (SCHIP). Enacted in 1997, SCHIP provides each state with federal funds for a health insurance program for vulnerable children. Organizers of the week say that if America's leaders fail to renew and sufficiently fund SCHIP, millions of children who desperately need health insurance will remain uninsured and without adequate health care. According to the U.S. Census Bureau, nearly 45 million Americans have no health insurance, including about 9 million children. Thousands of people participated in multiple Cover the Uninsured Week community service and education events, including events in every state. In addition to SCHIP enrollment events, planned activities include seminars for business owners, community discussions, campus activities and faith-based events. Cover the Uninsured Week brings together business owners, union members, educators, students, patients, physicians, nurses, faith leaders and their congregants, and organizations in all 50 states and the District of Columbia to demand that our nation's leaders find solutions for Americans living without health insurance, especially children. |
| PUBLIC POLICY AND ADVOCACY |
Legislative Update In the first major legislative showdown of the year, the Democratically-controlled Congress and President George W. Bush will come to blows over legislation that funds the Iraq and Afghanistan wars but also establishes firm deadlines for American troop withdrawal from Iraq. Along with this funding are a number of other provisions, including a provision that would address states’ shortfalls in SCHIP funding. According to a report from the staff of the Senate Finance Committee, the bill will provide up to $650 million in federal funding to cover SCHIP shortfalls for 14 states, with full enhanced SCHIP match rates for all covered populations. To pay for the provision, the bill will require the use of tamper-resistant prescription drug pads in Medicaid prescribing to reduce fraudulent prescribing and extend the Wisconsin Pharmacy Plus waiver until 2010. The bill will also delay DHHS’ implementation of the Medicaid provider reimbursement and GME rule that it issued. This rule has been strongly opposed by the Public Hospitals and other safety net providers. Ending months of speculation, Senator Rockefeller introduced his major SCHIP reauthorization bill - S.1224 at a public press conference April 26. In brief, the bill would change the SCHIP funding structure by making state allotments available for only two years (rather than three), would allow for periodic rebasing of allotments to prevent funding shortfalls (which are otherwise anticipated in 41 states by 2009), and would extend the “qualifying state” provision that allows use of SCHIP funds for children’s Medicaid expenditures in states that expanded Medicaid to higher-income children prior to SCHIP. The bill would also make several additional changes to the funding formula, indexing state spending by the growth in national health care spending and giving adequate weight to each state’s number of uninsured, low-income children. Programmatically, the bill makes several strong statements. States will continue to be allowed to cover enrollees at income levels higher than 200 percent of the federal poverty level, but in return for covering higher-income children, will have to agree to report on quality, adhere to best practices in outreach, provide continuous eligibility for children, and not impose waiting lists and asset tests. The bill does not prohibit continued coverage of parents, and mentions in a special “findings” section that coverage of adult family members enhances the chances of children to access needed services. The bill would also provide a “fix” for the DRA Medicaid citizenship documentation rule, allowing states to rescind the requirement at their option, and would allow states to provide Medicaid and SCHIP coverage to legal immigrants, thus overturning the “five-year bar” instituted by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). States demonstrating they cover over 90 percent of children eligible for Medicaid and that are willing to conduct additional quality reporting also will be provided a special enhanced match under that program. The bill includes a section specifically intended to impose new requirements – under SCHIP – on MCOs. In particular, this new section mirrors portions of section 1932 in the Medicaid statute and will require that MCOs serving SCHIP enrollees provide information on providers, enrollee rights and grievance procedures, that certain beneficiary protections and quality assurance standards be adhered to by MCOs, and that new measures be taken to protect against fraud and abuse (these include restrictions on marketing). New sanctions for noncompliance are also included in the bill. ACAP will be closely monitoring the debate around this bill, which is considered to be the starting point for a protracted SCHIP debate. (Please contact Jenny Babcock at jbabcock@communityplans.net if you would like a copy.) Meanwhile, ACAP continues to advocate for safety net health plans on a variety of different fronts. On health disparities and health IT, ACAP’s staff and lobbyist continue to work with Senator Kennedy’s office to ensure that there is a role for Safety Net Health Plans (SNHPs) in these bills. We have selectively activated ACAP’s grassroots and have been hearing back from the Hill that several plans have been making the calls and getting through to the Committee. This is great news and shows the real power of ACAP’s grassroots! In addition, we are working with Senator Jeff Bingaman to reintroduce the Medicaid drug rebate bill and have approached several key House members to introduce it in that body as well. Keep looking in your inbox for updates and action alerts to get your delegation involved in promoting ACAP’s legislative agenda! Medicare Advantage News Article Highlights Massachusetts ACAP Members in Universal Coverage Program An article in Medicare Advantage News says that Massachusetts has already enrolled nearly 65,000 formerly uninsured individuals into the State’s new health care reform program, and the overwhelming majority of these new enrollees have joined ACAP member plans. Network Health, Neighborhood Health Plan and Boston Medical Center HealthNet Plan have a combined new enrollment of over 60,000 in the Commonwealth Care Health Insurance Plan, which provides subsidized health insurance products to individuals with incomes below 300 percent of the federal poverty level. Since these three plans (plus Fallon, another Medicaid managed care organization) together exceeded an enrollment goal set by the State, exclusivity for plans that were already serving Medicaid will be preserved until June 2008. Christina Severin, ACAP Board member and CEO of Network Health, is quoted in the paper as saying that serving this new population is similar to working with Medicaid enrollees. “When you work with the Medicaid population, a lot of your job is teaching them about the health care system,” she said, and the situation is similar with the new members. She also said that the Commonwealth Care Health Insurance Plan addresses the enrollment “cliff” issue, allowing many low-income Medicaid enrollees who are in the program for only about a year because of federal participation rules to fall back on Commonwealth Care. Both Deb Enos, President of Neighborhood Health Plan, and Jean Haynes, Executive Director of Boston Medical Center HealthNet Plan, also expressed their optimism for the Commonwealth Care Health Insurance Plan in the article. ACAP is working with The Lewin Group to develop a paper on the special roles played by Medicaid MCOs in universal coverage initiatives in Massachusetts and California. The paper, which highlights the operational advantages of Medicaid MCOs in such programs, will be presented at ACAP’s 2007 CEO Summit in late July.
ACAP Sharing Services
Public Citizen Report
Finds State Medicaid Programs Lacking, Is Silent on Value of
Medicaid Managed CareIn 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 consumer watchdog group Public Citizen published an analysis in mid-April concluding that the Medicaid program is failing to deliver adequate services to millions of people because of lack of portability, and differing state eligibility requirements, benefits and performance. The report, called Unsettling Scores, ranks states based on the extent to which state policies exceed federal mandates in the areas of eligibility, scope of services, quality of care and provider reimbursement. These four areas were in turn measured by 55 indicators, and the resulting scores were weighted according to the relative value assigned them by the report authors. The highest possible score was 1000, but the highest ranking state – Massachusetts – achieved a score of only 646.2 points. The lowest scoring state received 318.1 points. Of the ten highest ranking states, half are in the northeast and three are in the midwest, including Massachusetts, Nebraska, Vermont, Alaska, Wisconsin, Rhode Island, Minnesota, New York, Washington and New Hampshire. The eight lowest ranking states are Mississippi, Idaho, Texas, Oklahoma, Indiana, South Carolina, Alabama and Missouri. The report, along with an online database allowing the public to view how states compare to one another, is available at http://www2.citizen.org/hrg/medicaid/. The report does not offer an analysis of the value of different service delivery systems, including managed care, which may have provided insight to how Medicaid services may be improved for enrollees. Dennis Smith, Director of the Center for Medicaid and State Operations, responded to the report negatively, by saying “it misses the fundamental nature of Medicaid and 40-year history that states have authority to administer program within [a] federal framework.” (Kaiser Daily Reports, April 19, 2007) Health organizations such as Families USA and the National Academy for State Health Policy (NASHP) did not laud the report either, suggesting that Medicaid deserves acknowledgment for serving as a critical safety net for the nation’s low-income populations. This report updates a similar analysis conducted by Public Citizen in 1987. IOM Report Finds Disabled Need Better Health Care System, Touches on Managed Care as Possible Solution A new Institute of Medicine report examines the United States health care system in reference to caring for individuals with disabilities, and concludes that a better system is needed to provide care for the disabled. The report, spurred by the growing number of elderly and disabled in the nation, devotes minimal space to managed care as a delivery option and does not include expanding managed care as a recommendation, but does mention it in several helpful contexts. For example, in describing the reluctance of some providers from accepting full-risk capitation for patients, the report cites evidence suggesting that additional information and analyses are needed for development of reliable risk adjustments for plans that care for children and young adults with disabilities. In addition, the report states that “capitated payment theoretically allows more flexibility in how professionals manage care, including how they delegate services to nonphysicians,” and “also offers the potential for providers to benefit from the savings achieved through more effective management.” The paper also cites a recent study that examined models of chronic care, which concluded that “it is more difficult to support the management of patients with complex chronic conditions in a fee-for-service setting than in a capitated setting (Berenson, 2006).” At another point the report says that “government efforts to promote competition among managed care and other health plans and to enroll people with disabilities in such plans” have been hindered by the tendency of Medicaid and Medicare to overpay for individuals with few health conditions and underpay for people with serious health conditions or disabilities. The report can be read online at http://www.nap.edu/catalog.php?record_id=11898. |
| EXCELLENCE AND ACCOUNTABILITY |
Submit Your Nominees for ACAP’s 2nd Annual Supporting the Safety Net Award The 2007 Supporting the Safety Net Award award will be presented to a community-based organization (CHC, hospital, community provider, etc.) or individual whose work goes clearly beyond the norm and whose services are recognized as best practices that stand as a model for replication and spread in the safety net environment. In 2006, the award was presented to Ms. Mardy Sandler of the Baby Love Program at the University of Rochester Medical Center in New York. The Monroe Plan for Medical Care, an ACAP member plan, contracted with Baby Love, to provide “high touch” social outreach for the plan’s high-risk pregnant members. Nominees can be self-nominated or can be nominated by an ACAP plan. The short application (3-5 pages) and supporting information (outlined in the announcement) are due on Tuesday, May 22, 2007. Eligibility criteria, questions to address in the application, and selection criteria are outlined in the attached document. The award recipient will be invited to attend ACAP’s CEO Summit on July 24-25, 2007 in Washington DC for an award ceremony. (The recipient’s travel and hotel expenses will be paid by ACAP and the CEO Summit registration fee will be waived). ACAP will also work with the award recipient and their plan partner to promote the award and develop a press release. Please forward the announcement to your community partners and please think about any potential plan partners that have demonstrated substantial commitment to serving safety net populations. Please contact Peggy Oehlmann at poehlmann@communityplans.net with any questions you may have about the award or nomination process. Click Here for More Information!
ACAP Job Bank
Recap: Medicare SNP
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 the April 17, 2007 Medicare SNP Roundtable, Jill Cousins, Medicare Director at Virginia Premier Health Plan, provided a detailed overview of the plan’s CMS site visit on the Medicare SNP product. Since Virginia Premier had just one week to prepare for the scheduled 4- to 5-day visit, the information presented was intended to assist other plans in preparing for the visit by alerting them to timeframes, required documentation for review, selection of key staff for interviews, and site visit closure. Recap: COO Roundtable On this call, COOs discussed changes to NCQA’s accreditation requirements concerning member access to electronic/web-based health tools. Discussion focused on how ACAP health plans use their Web sites for member communication about health issues. The next COO roundtable is scheduled for October 11, 2007. |
| NEWSFLASH |
ACAP Signs Agreement to Conduct Medicare SNP Study ACAP has signed an agreement with Avalere Health, a leading policy consulting firm in Washington, DC to conduct a Medicare SNP study. The study will include case studies of six ACAP plans and will focus on key questions raised by policy makers and researchers during conversations with ACAP, including but not limited to:
ACAP Meets With CMS to Discuss ACAP Medicare SNP Work On April 24th, ACAP met with CMS staff to formally discuss the work ACAP is doing with Medicare SNPs and also to discuss the Medicare SNP study ACAP is conducting (see above). CMS staff were enthusiastic about our work and have asked that ACAP return to talk with both Medicare and Medicaid staff. 15th Annual Medicaid Managed Care Congress to be Held June 13-15 in Baltimore The Institute for International Research will present the 15th Annual Medicaid Managed Care Congress, The event is scheduled for June 13-15, 2007 at the Baltimore Marriot Waterfront, MD. Participants will hear featured presentations from Bruce Johnson, CMS; Robert Mollica, National Academy of State Health Policy; Ron Pollack, Families USA; and Theresa Pratt, CMS. Georganne Chapin, President and CEO, and Janet Sullivan, M.D, Chief Medical Officer, both of Hudson Health Plan, will participate in a panel called “How are States and Health Plans Collaborating to Improve the Quality and Enhance Access to Care”. This session will be moderated by Jenny Babcock, Assistant Director for Policy at ACAP. IIR's Medicaid Managed Care Congress includes 3-days of workshops, case studies and interactive panel discussions with the nation’s leading Medicaid experts. With representatives from over 25 states, the event provides strategies to improve fiscal operations with sessions on actuarial soundness, Health IT, Long Term Care, coordinating Medicaid and Medicare for SNPs & Dual Eligibles, and the impact of the DRA on the Medicaid Program. ACAP members receive a 15% discount. Please enter priority code P1258ACAP when registering to get the 15% off the current registration price. A detailed agenda is available at: http://www.iirusa.com/MMCC ACAP will host a dinner for ACAP members attending the Medicaid Managed Care Congress Thursday night, June 14 at Charleston Restaurant, which is a short walk from the hotel (http://www.charlestonrestaurant.com/). Please let Jenny Babcock know if you would like to attend (jbabcock@communityplans.net). L.A. Care Uses Grants to Make Free and Low-Cost Dental Services Available to Low-Income Children and Adults L.A. Care Health Plan and First 5 LA are partnering to award $2.1 million in grants to 16 clinics for free and low-cost dental services for low-income children and adults. The grants are a part of L.A. Care’s Oral Health Initiative, begun in 2003. In the current grant cycle, L.A. Care is contributing $1.5 million and First 5 LA is contributing nearly $682,000. The recent awards bring L.A. Care’s total investment in the Oral Health Initiative to $6.3 million. “Many people don’t realize that oral diseases have a significant impact on a person’s overall health and well-being,” said Dr. Elaine Batchlor, Chief Medical Officer of L.A. Care Health Plan. “Poor oral health can lead to a number of systemic diseases, including gum disease, heart disease, lung disease and diabetes. We’re glad to partner with First 5 LA to address this potentially life-threatening problem.” Since 2003, L.A. Care’s Oral Health Initiative has provided over 110,000 Los Angeles County residents with free and low-cost dental services. In addition to funding dental services, L.A. Care’s Oral Health Initiative has also provided funding to train health care providers to conduct oral health screenings as a result early detection and treatment is possible. John Warren Says Goodbye to Colorado Access John Warren, former Executive Director of Access Advantage with Colorado Access, has accepted a position as Vice President of Government programs with TriZetto. Trizetto is based in California but have a Denver office and he will remain in Denver. In the new role he will be in charge of creating products and services that will help Medicaid and SNP plans with day to day operations so life can be easier for the plan and staff. He asked us to pass on to everyone that it has been great working with them and he hopes to do so again. His New Contact Information: John Warren VP, Market Executive Medicare and Medicaid Markets The TriZetto Group, Inc. 303-542-2436 phone/fax John.Warren@trizetto.com CareSource Management Group Announces Two Executive Level Appointments Daniel R. Paquin has been hired as Chief Operating Officer for CareSource Management Group. He brings more than 15 years of executive experience in both Medicaid and Medicare, as well as experience in long term care. Prior to joining CareSource Management Group, Paquin served as senior vice president of operations for Fidelis Senior Care in St. Louis, Missouri, and held executive positions with Centene Corporation, AmeriChoice Health Services, Comprehensive Care Corporation and the Devereux Foundation. He received a bachelor’s degree in Business Administration from the University of New England, a bachelor’s of science degree in Healthcare Administration from Southern Illinois University, and a master’s degree in Health Services Administration from Central Michigan University. In addition, Kevin T. Wells has joined CareSource Management Group as Vice President of Sales and Marketing. Wells spent 14 years with Reynolds & Reynolds prior to CSMG, holding executive level positions in sales, marketing, corporate diversity and recruitment. In addition, Wells worked in marketing and sales for the Ford Motor Company. He earned a bachelor’s degree in business management from Indiana State University.  |
| Upcoming Events |
May Events |
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2 Ad Hoc Roundtable on Dental Care for Children |
3 Compliance Roundtable |
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5/6 |
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7 |
8 |
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10 CIO Roundtable |
11 |
12/13 |
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14 |
15 |
16 Quality Management Directors/Medicare Directors Roundtable |
17 CFO Roundtable |
18 |
19/20 |
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21 |
22 Medicare SNP Roundtable Supporting the Safety New Award Applications Due |
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24 CMO Roundtable |
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26/27 |
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28 |
29 |
30 |
31 |
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June Events |
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2/3 |
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4 |
5 |
6 |
7 Pharmacy Roundtable (New Date) |
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9/10 |
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11 |
12 |
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14 Marketing Roundtable ACAP Dinner at Medicaid Managed Care Congress in Baltimore |
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16/17 |
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21 Provider Relations Roundtable |
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23/24 |
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25 |
26 |
27 |
28 |
29 |
30/1 |
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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 |