children’s dental health project | 1020 19 th street nw, suite 400 washington, dc 20036 |...
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Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Health Reform Implementation – Focus on the States
February 11, 2011
Marcy Frosh Meg Booth & Colin Reusch
Children’s Dental Health Project
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Implementation of oral health provisions
• Example of a problem the ACA sought to address?• Status of challenges to the law?• What are the timelines and opportunities around
the state exchanges and the pediatric dental benefit?
• What are some steps states can take to influence the exchange and benefit processes?
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
The “upside down” problem: Children with most need
have least care
Example of a problem that requires an innovative solution that:
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
The “fix” : Children with most need
get most care
As the Children’s Dental Health Project (CDHP) sees it:
The challenge is to:
1. Reduce disease burden2. Improved access to quality
care
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
How federal Health Care Reform can innovate:
• Comprehensive systems approach, building on CHIPRA
• Health coverage bill – estimated by 2019, 92% non-elderly will have health insurance
• Provides dental coverage to nearly all children
• Coverage is supported by numerous additional provisions
• Unfortunately, many of these provisions still await funding
Prevention & Health Promotion
Quality Treatment
Oral Health Infrastructure & Capacity
Community Awareness/Education
Effective Coverage
Family-levelPrevention
Effective
Workforce
Child-level disease management
Effective
Delivery Systems
Surveillance, Evaluation, CQI
Systems Framework
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Prevention & Health Promotion
Dental Caries Disease Management
Establishes a national grant program to demonstrate the effectiveness of research-based dental caries disease management
School-based Dental Sealant Programs
Requires that states receive grants for school-based dental sealant programs
Oral Health Public Education Campaign
Requires HHS Secretary to establish a 5-year public education campaign to promote oral health
Prevention and Public Health Trust Fund
Establishes a fund to provide an expanded and sustained national investment in prevention and public health programs – may include oral health
National Prevention, Health Promotion, and Public Health Council
Charged with coordinating Federal prevention policy and developing a national prevention strategic plan
Community Transformation Grants
Establishes grants to state and local agencies and community organizations for prevention efforts outside the doctor’s office
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Workforce and Training
Alternative Dental Health Care Providers
Establishes a 15-site demonstration project to train or employ alternative dental health care professionals
National Health Care Workforce Commission
Establishes the Commission and makes the oral health care workforce a high priority for review
Dental Training Programs
Establishes a number of provisions to promote and encourage the training of dental professionals including loan repayment
Primary Care Residency Programs
Establishes three-year, $500,000 grants for new primary care residency programs, including oral health
Graduate Medical Education Programs
Provides funding for new and expanded graduate medical education, including dental education
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Delivery System
Federally Qualified Community Health Centers
Provides funding for construction, capital improvements and service expansions, including dental program expansions
School-based Health Centers
Provides Grants to SBHCs and includes oral health services in qualified services provided by SBHCs
Center for Medicare and Medicaid Innovation (CMMI)
Establishes and funds a CMS Center to explore new models of care delivery (coordinated care, medical homes, dual eligibles etc.) and care financing. Opportunities for state demonstration grants available.
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Infrastructure, Quality & Surveillance
Oral Health InfrastructureRequires the CDC to provide cooperative agreements to states for improving oral health infrastructure (from 19 states 50 states, territories, & tribes)
Pregnancy Risk Assessment and Monitoring System
Requires that oral health measurements be included in PRAMS
National Health and Nutrition Examination Survey
Retains “tooth-level” surveillance in NHANES
Medical Expenditure Panel Requires a “look-back” validation for dental - parity with medical
National Oral Health Surveillance System
Requires that NOHSS include measurement of early childhood caries and authorizes funding to expand the system to all 50 states
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Mandatory ACA Funding
Oral Health Services for Children (Dental Benefit)
Required
Prevention and Public Health Trust Fund 2010 – $500 million, 2011 – $750 million, 2012 – $1 billiion, 2013 – $1.25 billion,2014 – $1.5 billion , 2015 – $2 billion
School-Based Health Centers Capital Program $200 million through 2013 for construction and improvements
Community Health Center Expansion (operations, construction, and improvements)
$11 billion through 2015
Health Insurance Exchanges Amounts necessary to award state planning and establishment grants
Center for Medicare and Medicaid Innovation $15 billion through 2019,
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Future of Health Care Reform Law
• Congress: Attempts to repeal & to modify
• U.S. Supreme Court: Does Congress have the power to require people to buy health insurance?
Arguments:-- Yes – within power to regulate interstate commerce, to impose taxes and to pass laws that are necessary and proper to carry out its intentions.
-- No (and whole law is potentially unconstitutional) - exceeds Commerce Clause power to reform and regulate the market
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Timeline for Federal Appropriations:
• September 2010: Congress passed a continuing resolution (CR) for FY11 until December 3.
• Senate Appropriations Committee and House Labor HHS Appropriations Subcommittee proposals included oral health, but fell short of full funding
• December 2010: Congress passed 2nd CR for FY11 until December 21.• December 2010: Congress passed 3rd CR for FY11 until March 3, 2011.• Despite lack of funding, Federal government is moving forward with
implementation through regulations & rulemaking, ARRA funding, and shifting money between agencies (e.g. Title VII)
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
MN not a party to the health reform challenge . . .
Governor Mark Dayton is on record with:• Support for most of the federal health care reform law,
including requirements on allowing individuals with pre-existing conditions to purchase insurance, and is in favor of asking for and accepting most grants and other incentives
• A proposal to create a “health care helpline” to advocate for patients regarding insurers, providing a public option, reducing paperwork, e-prescribing, telehealth, and home-based care
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Current State Action: Insurance Exchanges
Key Players:1. National Association of Insurance Commissioners (NAIC)2. Office of Consumer Information and Insurance Oversight
(OCIIO) at HHS
3. State Insurance Commissioners & Departments of Insurance
4. Governors’ Offices & State Health Agencies
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
State Insurance Exchanges: Timeline
20102014
2011 2012 2013
Fall: Initial guidance released
Exchange planning grants awarded
NAIC Model Legislation released
January: Second round of state planning and establishment grants now available.
January: Exchanges must
be certified by HHS
January: States indicate whether they will operate
an exchange
Winter/Spring: Finals rules on
Exchanges issued
Fall: Exchange rules for public comment
January: State and/or Federal
Exchanges up and running
State Exchange Planning Process
2011 & 2012: Stakeholder engagement, exchange governance decisions, plan selection, rates review, etc.
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
State Insurance Exchange Planning Grants: MN is one of 2 states with no award but is reportedly
pursuing an expedited application
• Alabama• Arizona• Arkansas• California• Colorado• Connecticut• Delaware• D.C.• Florida• Georgia• Hawaii• Idaho
• Illinois• Indiana• Iowa• Kansas• Kentucky• Louisiana• Maine• Maryland• Massachusetts• Michigan• Mississippi• Missouri
• Montana• Nebraska• Nevada• New Hampshire• New Jersey• New Mexico• New York• North Carolina• North Dakota• Ohio• Oklahoma• Oregon
• Pennsylvania• Rhode Island• South Carolina• South Dakota• Tennessee• Texas• Utah• Vermont• Virginia• Washington• West Virginia• Wisconsin• Wyoming
Award details available at: www.healthcare.gov/news/factsheets/grantawardslist.html
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Oral health on the radar screen
Approaches to consider:1) Advocate to include oral health in exchange planning
application (indication that the establishment grants should be adequate to accomplish well-developed proposals)
2) Ensure capacity to address oral health in new benefit structure
3) Emphasis state capacity needs to integrate oral health into a plan for seamless interface among Medicaid, CHIP, and the new ACA provisions
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Connect with State Insurance Authorities
Defining stakeholder input with or without aplanning grant:
1. Who are interested stakeholders both within oral health and beyond? How can you partner?
2. What are the opportunities for stakeholder input (e.g., consumer protections, ensuring viable provider networks, plan options, etc?)
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Benefit Design: Timeline
20102014
2011 2012 2013
Fall: DOL begins review of employer benefits
January: IOM public meeting on determination of essential benefits study
January: State and/or Federal Exchanges up
and running with Essential Benefits
Packages and Qualified Health
Plans
March-Sept: IOM study recommendations on essential benefits published
March: DOL report on employer plans released
Fall: Determination of Essential Benefits by HHS
IOM Ongoing Review of Essential Benefits
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
At the national level, CDHP is working on:
1. Ensuring Medicaid & CHIP access and stability2. Getting the lay of the land (e.g., timelines, champions for
individual provisions), etc.)3. Stakeholder input: 70 organizations signed on to a May
2010 letter requesting funding for the ACA oral health provisions
4. Engaging in determination of benefit design (e.g., that the law’s “essential benefit” for oral pediatric services is defined by medical necessity)
5. Awareness & influence consumer protections
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Quick Recap!
Health Care Reform at the moment:
• State insurance Commissioners have power w/ consumer protections, networks, & plan options!
• Messages on Medicaid/CHIP dental benefit need to be reinforced!
• Federal funding for the ACA oral health provisions is key!
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Resources
• ACA Summary and Talking Points, CDHP Healthcare Reform Center: www.cdhp.org/cdhp_healthcare_reform_center
• Sample correspondence concerning ACA rules & regulations: www.cdhp.org/cdhp_healthcare_reform_center
• Comment on Rules and Regs, Office of Consumer Information & Insurance Oversight www.hhs.gov/ociio
• NAIC Model Exchange Legislation: www.naic.org/documents/committees_b_exchanges_adopted_health_benefit_exchanges.pdf
• IOM Essential Health Benefits Survey Results: www.nami.org/Content/ContentGroups/Policy/Issues_Spotlights/Health_Reform/NAMICommentsIOM1210.pdf
Visit the CDHP website at: www.cdhp.org
Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org
Thank You!
Visit the Children’s Dental Health Projectat: www.cdhp.org