Health Care Reform Weekly June 6 2011

Last Updated on Saturday, 22 October 2011 07:20 Written by Natural Health Team Saturday, 22 October 2011 07:20

Health Information about Health Care Reform Weekly June 6 2011

Week of June 6, 2011

While the Affordable Care Act’s (ACA) medical loss ratio (MLR) and rate review provisions have been getting most of the media attention, a new coalition of business organizations has come together to draw attention to another important requirement of the ACA. Calling themselves Stop the HIT on Small Business, more than 25 national business organizations have joined forces to work toward repeal of new taxes the ACA would impose on private health insurance starting in 2014. Business leaders behind the effort say that small business owners, their employees and the self-employed will ultimately bear the brunt of $ 87 billion in additional health care costs in the first 10 years as a result of the new taxes. The group is planning Capitol Hill outreaches and grassroots efforts.

Federal

Support is growing in Congress (over 80 co-sponsors) for Mike Rogers’ (R-MI) and John Barrows’ (D-GA) legislation that would exclude agent commissions from the MLR calculation.  Currently, commissions count as administrative expenses in calculating insurers’ MLRs.  This support was highlighted in a House hearing last week before the Health Subcommittee of the Energy & Commerce Committee, where the larger issue of the MLR burden was front and center.  Witnesses representing agents and brokers, insurers and academia all testified against the unintended, negative consequences of the MLR requirement, with agents and brokers in particular noting the direct financial impact to small business and individual agents and their families. The Rogers/Barrows bill would simply not factor commissions into the MLR calculation. The day before the hearing, Congressman Tom Price ((R-GA) introduced an even more aggressive bill, as his proposal would repeal outright the MLR provision of ACA.  While it is unlikely that either bill will get traction in the Senate on its own, bipartisan support for the agents and genuine concern about unintended consequences puts this issue in play as part of any potential mega-deal on the budget/deficit/debt ceiling issue over the next few months. The Senate was not in Session last week; and the House is out this week.

States

COLORADO: Governor John Hickenlooper last week signed into law a bill establishing the Colorado Health Benefit Exchange. The legislation created a fair amount of controversy during the session, particularly among “Tea Party” Republicans. However, the final product represents the culmination of a bipartisan effort that remained inclusive of the business, advocacy and insurance industry constituencies.

CONNECTICUT: Although adjournment is set for June 8, a number of significant bills are still in process. The legislature passed a bill over the weekend that would create a health insurance exchange. The bill is expected to be signed by Governor Dannel Malloy, as the legislation, as passed, is an amended version of a bill proposed by the Malloy administration. It would create an 11-member exchange board and set rules and responsibilities for the exchange, but many policy decisions would be left for resolution at a later time. The exchange must be financially self-supporting by 2015, and the bill would allow the exchange to charge assessments or user fees to health insurance carriers to fund operations. Some lawmakers questioned the cost of the exchange. However, the nonpartisan Office of Fiscal Analysis says the planning process is not expected to require additional state money. The bill calls for exchange board members to have expertise in specific subjects, including small employer health insurance coverage, health care delivery systems, access issues that self-employed people face, barriers to individual health care coverage, health care finance and benefits plan administration.

Additional bills yet to be passed by both Houses include the SustiNet bill, now amended to create a health care reform advisory board and allow municipalities and not-for-profits to join the state employees plan. Also, a prohibition on “most favored nation” clauses in provider contracts and a broad rate review bill that would require public hearings for all rate increases over 10 percent have yet to be acted on.

ILLINOIS: A spring session of the General Assembly dominated by redistricting, workers’ compensation, budget, pensions and gambling adjourned on May 31, 2011.  Minimal health care legislation passed by both chambers is awaiting signature by the governor. One important legislative development is that Aetna helped turn back attempts to amend the “non-participating” physician law that was passed last year and went into effect on June 1, 2011. The law protects consumers from being overbilled by certain out-of-network, hospital-based physicians (i.e., anesthesiologists, radiologists) who provide direct services in hospitals and ambulatory surgery treatment centers. Under the law, the patient is taken out of the middle as it ensures patients will pay no more than they would have paid to one of their carrier’s participating providers. In addition, the law allows either the physician or the insurer to use binding arbitration to resolve disputes over the reasonableness of charges or reimbursements.

Other health care bills defeated including taxes/insurance assessments; reporting of extensive premium loss data; and health insurance rate review.  Bills currently awaiting the governor’s signature include changes to the mental-health parity and clinical trials mandates, as well as insurer recoupment requirements that the industry ultimately agreed to.  Also, a health insurance exchange bill passed both chambers that would establish an exchange and appoint a study commission of legislators to report back to the Assembly by Sept. 30, 2011 regarding parameters for an exchange.  Follow-up legislation could potentially be considered in the fall veto session, beginning at the end of October 2011.

MAINE: Gov. Paul LePage and the legislature’s Republican leaders found a way to avoid an override of the Governor’s recent veto of the most-favored nation prohibition bill. The bill would bar insurers from requiring a health care provider to charge an insurance company the lowest rate the provider negotiates with any other insurance carrier. In his veto message on the bill, LePage said he strongly believes that businesses have a right to contract with each other as they deem appropriate. After some Republicans complained, LePage met last week with GOP leaders and co-chairs of the legislature’s Insurance and Financial Services Committee, which unanimously endorsed the bill last month.  Republican lawmakers agreed to vote to sustain the governor’s veto when the House acts on it, and the Governor agreed to submit compromise legislation. The new bill would ban most-favored nation clauses but also allow Maine’s superintendent of insurance to issue a waiver. It is unclear what conditions an insurer would have to meet to earn a waiver. The bill’s language is not yet available to the public. With session scheduled to adjourn June 15, the legislature is likely to wait until next year to take up the bill.

Governor LePage announced that Eric Cioppa, Deputy Superintendent of the Bureau of Insurance, Department of Professional and Financial will serve as Acting Superintendent effective immediately. Cioppa replaces former Superintendent Mila Kofman who resigned recently. In his former role as deputy superintendent, Cioppa was responsible for the Examination, Market Conduct, Financial Analysis, Alternative Risk Markets, Producer Licensing, Administrative Support Unit, and Research and Statistics Units of the Bureau.

MICHIGAN:  In the next couple of weeks, the state Senate is expected to vote on a $ 400 million paid-claims tax that would be levied on insurers and third-party administrators as proposed by Governor Snyder.  Specifically, the bill would establish an entirely new tax on health insurance claims as a way to match federal Medicaid funding. The 1 percent on tax on all medical claims paid under health, dental, automobile and workers’ compensation coverage would impact fully and self-insured business. Ultimately, the cost of the tax will be borne by the sponsor of that coverage – the employer or the individual who already pays for the coverage. As introduced, the tax would begin on October 1, 2011.  While working with lawmakers to help them understand the impact the tax would have on constituents, Aetna has mobilized its grassroots employee network to contact their state legislators regarding the issue. The bill has a strong chance of passing, and Aetna is urging all its constituents in the state to contact the Governor’s office and legislators to express any concerns they may have about the tax.

NEW YORK:  Session is scheduled to adjourn June 20, and no official exchange legislation has been advanced. The Senate Republican majority is said to have a bill draft ready that supports a market-based exchange, but it has not been introduced yet. The Administration plans to introduce a more expansive model that reportedly will include giving the governor the majority of the board appointments, the exchange de facto rate-setting authority, and the exchange authority to selectively contract and require plans to participate. The bills are expected by the second week in June. However, with many other significant issues still on the table, compromise on an exchange bill may be swept up into a larger negotiation.

A very broad autism mandate is still in play. A set of amendments was introduced to ensure that an autism coverage mandate not be broader than for any other disease coverage mandate, For example, a pharmacy rider would be required to get pharmacy coverage, and there would be a limitation on visits but no dollar or age limits. The bill is still more expansive than last year’s version, which was vetoed by then-Governor Paterson due to its $ 70 million fiscal note.  Governor Cuomo has not announced his position on the proposal.

NEVADA: The 2011 legislative session is winding down toward adjournment on June 6. Governor Brian Sandoval has on his desk a rate review bill that would implement a prior approval scheme, require greater transparency and public access to rate filings, and allow a Consumer Advocate to request a public hearing. The measure is sponsored by the Democratic Speaker and has the support of the commissioner who says that some aspects of the bill are needed for the state to comply with HHS rate review requirements. The Senate-sponsored bill creating the Silver State Health Exchange continues to move toward passage in the Assembly.

PENNSYLVANIA: State government had another better-than-expected revenue collection month in May and headed into the final month of the fiscal year with a nearly $ 540 million surplus. The news came last week as the debate in the Capitol intensified over the depth of spending cuts sought by Governor Tom Corbett. Legislative budget analysts said the state’s updated revenue collection figure through the end of May was 2 percent, or about $ 34 million, over the official estimate. That means the state has collected almost $ 24.3 billion through 11 months, or 2.3 percent above the official estimate. However, the state continues to face a projected multi-billion-dollar budget deficit in the fiscal year beginning July 1. The disappearing federal stimulus money that temporarily helped buttress the state’s recession-wracked tax collections is one of the largest contributing factors.

TEXAS: A special session of the legislature, called by Gov. Rick Perry to address education and health care issues left pending when the 140-day regular session ended May 30, got off to a slow start last week. But by the end of the week, the Senate Appropriations Committee unanimously voted in support of a massive health care measure that combines three weighty regular-session bills. Now headed for a full Senate vote, the package seeks $ 1.5 billion in Medicaid savings by expanding managed care to South Texas and restructuring insurance payment systems. It also would charge Medicaid patients for unnecessary emergency room visits and penalize doctors and hospitals for preventable complications.

Late Tuesday, Perry added another issue to the 30-day session: redrawing boundaries for Texas’ 36 congressional districts. School finance remains the main event of the overtime session. Another bill would resurrect the interstate health care compact, favored by Republicans because it would allow member states to opt out of the federal health care reform law. Democrats oppose the effort, saying Texas would save money by cutting more low-income people from Medicaid coverage. A bigger hurdle would be Congress, which must approve the compact. The special session will last a maximum of 30 days but could conclude earlier if the legislature finishes business and adjourns.

www.aspirace.com This video was prepared and presented by Substance Abuse and Mental Health Services Administration, titled OK to Remember. This video accompanies the Childhood Traumatic Grief Curriculum Guide found at AspiraCE.com as one of the several continuing education courses offered by AspiraCE. Visit AspiraCE at www.aspirace.com for all of your online ce requirements.
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Mental Healthcare Reform – Present Successes and Future Challenges

Last Updated on Monday, 10 October 2011 01:21 Written by Natural Health Team Monday, 10 October 2011 01:21

Health Information about Mental Healthcare Reform – Present Successes and Future Challenges

As is becoming a reality, there is much to celebrate within the mental health community. This includes passage of a healthcare reform package that includes parity for mental health and addiction services, expansion of Medicaid to 133% of Federal Poverty Level, inclusion of behavioral health organizations and individuals with mental illnesses in the new Medicaid medical home state option, and authorization and increased funding for grants co-locating mental health treatment and primary care. These and a host of other provisions expand the opportunities for individuals with mental illnesses and addictions to obtain and maintain insurance coverage and access needed services.

But this is not the end of the mental healthcare battle. Simply put, mental health advocates must be ready to play in a new game, in a world where increasing numbers of individuals – by virtue of Medicaid expansion, the emerging Health Insurance Exchanges, and parity regulations – will have access to behavioral health services. We expect to see an additional 15 million individuals – an increase of 43% – eligible for Medicaid alone, with more than 30 million individuals overall who will, in the not too distant future, have insurance coverage.

But this is far more than a matter of numbers – it’s about working smarter. Advocates of mental healthcare anticipate that healthcare reform-driven service delivery redesign and payment reform will unfold at a rapid pace. In order to bend the cost curve, payment reform and service delivery redesign will change how health, mental health, and substance use services are integrated, funded, and managed. Providers must learn to practice healthcare the way healthcare will be done.

As mental healthcare providers and advocates, we must become savvy about positioning ourselves to take advantage of new markets and new opportunities to help control the design and delivery of healthcare services. We must begin to build relationships within and across the entire healthcare sector. As we revisit the concept of “managing care” for individuals and whole populations, we have to be certain that our focus on person-centered, recovery-focused treatment and services is not subsumed by the drive to “bend the curve” in . We must be able to demonstrate our value not only to our customers, but also as key players in these new healthcare consortia.

We must become accountable for efficient and effective services that show results across all health domains. We believe fee-for-service reimbursement will slowly become a thing of the past. So, too, will be the ability to claim that caseloads are full with no-show rates of 50% and more. We risk being left on the sidelines if we don’t move with deliberate speed to ensure continuity and timely access to care; comply with third-party payer requirements; coordinate care with a full range of health providers; and if necessary take on payers that refuse to honor the spirit and letter of the parity regulations.

We must become increasingly customer-focused, from the way we greet individuals who come through our door to the way we market our services. We should expect that with more money available in healthcare – particularly for mental health and addiction treatment – that new and well capitalized players will find behavioral health, traditionally a financially unattractive healthcare sector, far more appealing.

People will be insured and will have an increasing range of options available to them. What differentiates our mental healthcare services? Why should an individual choose to receive treatment and support from us? Are we offering services that will help them meet a full range of healthcare needs? Are our services culturally appropriate for the communities we serve? Can we help them understand and make appropriate use of their insurance coverage? We must retool our organizations with the knowledge that all individuals will now become true “consumers” of healthcare services.

At the same time, we must also be aware that our work is far from over at the state and federal level. Forty eight of 50 states are experiencing severe budget shortfalls. The threat is very real and the are fighting hard to hold on to current funding as legislatures see an opportunity to continue to withdraw needed funds. This is surely a bad idea – even the most generous healthcare benefits will likely not cover the full range of wraparound supports that people with mental illnesses and addictions need to fully recover.

Eleanor Roosevelt once said, “It takes as much energy to wish as it does to plan.” All of our planning, advocacy, and leadership to date have borne fruit, but we must not be content to wish it all works out well. We must fight for our future – and the future of the individuals we are privileged to serve – by acting as key players in the brave new world of healthcare.

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Four Issues of Mental Healthcare Reform that Still Need Improvement

Last Updated on Monday, 10 October 2011 10:21 Written by Natural Health Team Monday, 10 October 2011 10:21

Health Information about Four Issues of Mental Healthcare Reform that Still Need Improvement

Healthcare reform is becoming a reality and the importance of and behavioral healthcare is receiving due notice. We find evidence of this achievement throughout the law – mental health and substance use services must be provided by all plans that participate in the new exchanges, and these benefits must be offered at parity. Healthcare home and Accountable Care Organization pilots must address substance use and mental health disorders. Additionally, the law includes a number of provisions specific to mental health and substance use, including authorization for new grants to co-locate services as well as new workforce development grants.

Even with all the progress that has been made, many areas of policy and payment need to be improved for the sector to fulfill its intended role in a reformed healthcare system. National and community mental health organizations around U.S. are committed to advancing the following issues:

1.) Extension of the temporary Federal Medicaid Assistance Percentage increase

As part of the American Recovery and Reinvestment Act, Congress provided a temporary increase to the Federal Medicaid Assistance Percentage to help cash-strapped states meet their obligations. An extension of this important provision is critical, given the combination of state revenue projections and Medicaid growth.

2.) Federal policy and payment equity for behavioral health organizations

In recognition of the healthcare access and use challenges confronting communities that are low income or have high rates of illness and few medical providers, Congress has enacted a number of policy and payment preferences for “safety net” providers, including enhanced reimbursement under Medicaid, federal funding to provide care to uninsured people, loan guarantees, and access to federally subsidized malpractice insurance. Unfortunately, the safety net does not offer equity. To correct this situation, mental health advocates are working with other national organizations to advance the notion of federally qualified behavioral health centers. This effort includes establishing national treatment and reporting standards for organizations that choose to obtain this designation as well as a proposed reimbursement model that more accurately reflects the costs of providing services.

3.) Healthcare information technology funding fix

For healthcare reform to be successful, all medical providers need to share information to better coordinate care, reduce inefficiencies, and improve client outcomes. Behavioral healthcare providers need access to federal funding for the meaningful use of (information technology). One solution is to extend Medicare and Medicaid facility payments to community mental health and addiction organizations as well as private and public psychiatric hospitals.

4.) Medicare parity implementation

In June 2008, Congress enacted payment parity in Medicare’s Part B benefit, which provides copayment equity for mental health and addiction services. Although this is an important step, much more needs to be done in Medicare for there to be true parity. First, the types of outpatient mental health interventions paid for by Medicare need to be extended to include, for example, case management, psychiatric rehabilitation, and other intensive community-based interventions. Medicare also must recognize mental health counselors and marriage and family therapists as independent practitioners.

The policy successes of the last few years would not have been possible without the active involvement of advocates of mental health – down to the individual level. Passage of healthcare reform is only the first of many steps necessary to improve the lives of people with addiction disorders and . National and community mental health organizations must continue to reply on the support and voice of the general public to bring this “unfinished business” to completion.

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Health Care Reform and Behavioral Health: Responding to New Demands and Emerging Health Crises

Last Updated on Sunday, 9 October 2011 10:20 Written by Natural Health Team Sunday, 9 October 2011 10:20

Health Information about Health Care Reform and Behavioral Health: Responding to New Demands and Emerging Health Crises

All signs point to Congress passing a comprehensive health care reform bill in 2009, potentially expanding health insurance coverage to 46 million uninsured Americans. This objective will be achieved through a combination of Medicaid eligibility expansions as well as the creation of a new health insurance exchange – basically a new health insurance market place – for persons earning above 100% of the Federal Poverty Level. Premiums for participants in the exchange will be heavily subsidized by the federal government. In return for this expansion of coverage, Congress will be seeking opportunities to introduce greater provider accountability and consumer responsibility into the health care system, while promoting initiatives which increase efficiency and reduce medical errors.

Since many who receive care in CBHOs are low income uninsured (or underinsured) individuals, CBHOs and other community providers stand to greatly benefit from coverage expansions. However, confronted with a once-in-a-generation opportunity to secure significant additional resources for the public behavioral health system, many mental health organizations are pursuing a federal health care reform agenda which not only takes into consideration the overarching principles of the current health care reform debate, but strongly advocates for greater resources to community behavioral health providers to better equip them to address the health concerns of individuals with mental illness and substance use disorders.
What Factors are Driving Us?

The Substance Abuse and Mental Health Services Administration’s state survey shows that persons with serious mental illnesses served by public mental health agencies have the HIGHEST mortality rate of ANY population ANYWHERE in America’s public health system. Specifically, the average life expectancy for this population now rivals people living with HIV/AIDS. In addition, among psychiatric patients, the probability of dying is 55% higher for patients diagnosed as having substance use disorders than among those without a substance use diagnosis.

Provider Accountability
In order to stop the predicted cost growth in coming years, both the Obama Administration and Congress are committed to promoting evidenced-based practices and increasing provider accountability. This trend is reflected in new federal commitments of $ 1 billion for comparative effectiveness research and $ 20 billion to encourage the adoption and utilization of electronic health records. Both of these initiatives are based on several themes of the current health care debate: a.) provider accountability for clinical outcomes; b.) systemic application of evidenced-based interventions, c.) reduced reimbursement for sub-optimal outcomes, and d.) specific reporting of detailed encounter data.

To help community behavioral health providers prepare for a new era of accountability in health care while attempting to stem the mortality rates cited above, we are pursuing four priority initiatives:

Mental Health/Substance Use Disorders Included in Benefit Packages In the Exchange
Like the Massachusetts health care reform program, the Obama Administration endorses an approach that finances private health insurance for low income uninsured individuals via a health insurance exchange. Many private insurance companies, such as Blue Cross/Blue Shield and Aetna, would participate in this new program/health insurance market place. Many mental health organizations seek to ensure: mental health and substance abuse benefits are part of any nationwide minimum benefit package; comprehensive parity is applied to all benefit packages offered in the exchange or connector; enhanced case management must be provided to new enrollees with cognitive impairments to help them navigate the exchange/connector.

Federal Status for Behavioral Health Organizations
A new federal definition for Federally Qualified Behavioral Health Centers (FQBHC) that would a) establish federal status for CBHOs who volunteer to meet the standards of an FQBHC, b) provide a definition for such an entity that clearly identifies treatment objectives and updates the minimum core services required, and c) establish clearly-defined national standards for this entity. In return for this new federal status, providers working within FQBHCs will be asked to meet new provider accountability standards (as mentioned previously).

SMI Healthcare Home Demo to Support Co-Location of Primary Care in CBHOs
The Mental Illness Chronic Care Improvement Act of 2009 was introduced in the Senate (S. 1136) on May 21, 2009 by Senator Debbie Stabenow and in the House on June 26, 2009 (H.R. 3065) by Representative Janice Schakowsky. This bill would among many other things, co-locate primary care capacity in Community Mental Health Centers and other community-based mental health and substance abuse providers. This integrated treatment approach is aimed squarely at reducing the mortality and morbidity rates among clients in the public behavioral health system. While mental health organizations have been able to engineer a new $ 7 million SAMHSA program in 2008 with a similar structure and treatment goals, this demo, targeted to Medicaid beneficiaries, will more directly impact the single largest purchaser of mental health and addiction disorders.

Inclusion of CBHOs in Federal HIT Funding Initiatives
The Health Information Technology for Economic and Clinical Health Act (HITECH Act) was enacted as part of the economic recovery bill passed by Congress earlier this year. It creates a new $ 17 billion Medicare and Medicaid reimbursement system to help physicians, hospitals and Community Mental Health Centers purchase and maintain health information technology for the purpose of widespread adoption and utilization of electronic health records. Although psychiatrists may access these incentive payments, CBHOs, as facilities, are not eligible for this funding. Many mental health organizations are seeking inclusion of CBHOs in any federal HIT initiatives to ensure that individuals with mental illnesses and addictions have access to the benefits of HIT via the providers that serve them.

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5 Facts About Mental Health Coverage And Health Insurance Reform

Last Updated on Tuesday, 30 August 2011 04:20 Written by Natural Health Team Tuesday, 30 August 2011 04:20

Health Information about 5 Facts About Mental Health Coverage And Health Insurance Reform

Many mental health advocates are cheering healthcare reform. Although there was a separate bill requiring mental health parity in insurance coverage–meaning that it should be treated equally to physical conditions when it comes to benefits–passed in 2008, this legislation goes farther. Here are five facts about the health insurance reform bill and its impact on the treatment of mental health conditions.

With the eventual ban from denying people with pre-existing conditions, those with mental health conditions will have easier access to affordable health insurance. Many times, health insurers refuse to underwrite someone with a diagnosis of depression, anxiety disorder, bipolar disorder, or schizophrenia. That is regardless of how well-controlled the condition may be, and regardless of their physical health. The newly passed bill changes that. Insurers will also no longer be allowed to exclude that particular condition from any coverage they extend.

Small businesses with under 50 employees are now subject to the mental health parity laws, while they were not under the previous bill. Their previous exclusion was due to the increased cost of coverage, but Democrats and other supporters of reform believe that the upcoming exchange markets (run by the states) will assist small employers. The plans sold in the exchanges will meet the parity standards.

The bill doesn’t necessarily mean that people will receive gold-plated mental health coverage. Instead, it states that the coverage should be equal to physical health coverage. If someone picks a bare-bones, high-deductible health insurance plan, their coverage will be limited all-around. What is outlawed is inequality; for example, an insurer cannot charge a higher co-payment for a psychiatrist visit than they would for any other medical specialist. Neither can they deny a patient the opportunity to receive out-of-network mental health treatment, if patients are allowed to seek medical care out-of-network. Also, they cannot limit the number of visits or days of inpatient treatment for substance abuse or mental illness any more strictly than they would for surgery or physical illnesses.

The elimination of lifetime and annual caps on benefits will also be helpful. Mental health treatment can be very costly. Inpatient rehabilitation for substance abuse or eating disorders can cost tens of thousands of dollars per month, which can quickly eat up the limits of most health insurance plans. Fewer patients will suffer from incomplete treatment due to their inability to afford continued help.

The bill’s expansion of Medicaid eligibility will help the mentally ill, whom many experts believe are more likely to be uninsured. Moreover, all Medicaid coverage (not just managed care programs) will now offer equal coverage for mental health conditions.

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