health care reform 201 the affordable care act and school-based health care november 18, 2010
TRANSCRIPT
Health Care Reform 201
The Affordable Care Act and School-Based Health Care
November 18, 2010
Introduction: How We Got Here
Health Reform 101: NASBHC’s Agenda
Health Reform 102: SBHC GrantsHealth Reform 202: Implementation
Health Care Reform 201: November 2010
Health Reform 101
NASBHC’s Federal Policy Agenda Create a federal grant program for SBHCs Support reimbursement opportunities for
SBHCs Position SBHCs to receive support in federal
legislation and in governmental agencies
Health Care Reform 201: November 2010
Health Reform 101, cont.
Affordable Care Act Includes a federal grant program for SBHCs Supports reimbursement opportunities for
SBHCs Positions SBHCs to receive support in federal
legislation and in governmental agencies
Health Care Reform 201: November 2010
SBHC GrantsSection 4101(a):Short-Term Appropriations Grants for the Establishment
of School-based Health Centers– $200 million over 4 years,
starting in FY2010– Limitations: only for
expenditures acquiring or improving land, facilities and equipment
No funds for personnel or to provide health services.
Section 4101(b): Authorized Federal Program Grants for Operation of
School-based Health Centers– Equipment; training;
management and operation; and salaries for physicians, nurses, and other personnel
Authorizes spending but doesn’t allocate it.
Health Care Reform 201: November 2010
SBHCC Highlights
Can be used for alteration/renovation, new construction, equipment
Can cover past equipment purchases or construction (to March 23, 2010)
Preference for programs that serve a large population of children and adolescents eligible for Medicaid and CHIP
Health Care Reform 201: November 2010
Health Reform 201We will always be reforming our health care system. In that broader sense,
implementation
is forever.-- Drew Altman, President and CEO
Kaiser Family FoundationHealth Care Reform 201: November 2010
Affordable Care ActOverview
I. Regulates private health insuranceII. Investments in prevention, wellness,
primary careIII. Expands access to coverage through:
a. Subsidiesb. Expansion of public insurancec. Creation of health insurance exchanges
IV. Cost containment strategies– Improving quality/cost effectiveness
Health Care Reform 201: November 2010
I. Regulating private insurance (1 of 2)
Extends dependent coverage up to age 26As of September 2010, insurers can’t
– Deny coverage to kids with pre-existing conditions
– Put lifetime limits on benefits– Cancel a policy without proving fraud– Deny claims without a chance for appeal
New protections, particularly for CYSHCN
Health Care Reform 201: November 2010
I. Private insurance (2 of 2)
2011: Health plans must report medical loss ratios– 80-85% of premiums must spent on clinical
services2014: Preexisting conditions must be
covered for all2018: Excise tax on high-cost insurance
plans
Health Care Reform 201: November 2010
II. Investments in prevention
Prevention and Public Health Fund– $5B for 2010 through 2014; then $2B/year
New Prevention Council/National Prevention Strategy
Coverage of Preventative Benefits– Rated A or B by USPSTF, recommended by AAP’s
Bright Futures guidelines– Copayments eliminated for new plans now– Eliminates Medicaid cost-sharing in 2011
Extends EPSDT to all children covered by Medicaid
Health Care Reform 201: November 2010
II. Investments in primary care Workforce investments
– $1.5 billion mandatory funding for the National Health Service Corps– Support 15,000 primary care providers in shortage areas
– $250 million from Prevention Trust Fund– Other appropriations:
$168 million for 500 new primary care physicians by 2015 $32 million for more than 600 new physician assistants $30 million to train 600 nurse practitioners $15 million for 10 nurse-managed health clinics $5 million for states to plan and implement innovative strategies to
expand their primary care workforce
Health Care Reform 201: November 2010
III. Access to coverage (1 of 3)
32M more Americans will be insured– Including 9 million kids by 2014– 2009’s CHIP reauthorization covered 6.5M
kids (4.1M uninsured)Young adults can stay on parents’ plansSubsidies for private insuranceExpanded eligibility for public insurance
Health Care Reform 201: November 2010
III. Access to coverage (2 of 3)
Expands Medicaid coverage to all under 133% of FPL
States will receive 23% increase in CHIP match rate (by 2015)
Community Transformation Grants– Planning grants to address disparities– Not appropriated
Health Care Reform 201: November 2010
III. Access to coverage (3 of 3)
Creation of state-level health insurance exchanges; funding to states starts in 2011, must be established by 2014– Available those over 400% FPL– List of essential health benefits is in ACA– NASBHC has submitted comments to
HHS to urge SBHCs be eligible as an as “essential community provider”
Health Care Reform 201: November 2010
IV. Cost Containment (1 of 2)
– Use of EMR – Federal review of premium increases– Tax on high-cost plans– Comparative effectiveness research– National quality improvement strategy– Data collection on disparities– Medical home (discussed earlier today)
Health Care Reform 201: November 2010
IV. Cost Containment (2 of 2)
Accountable Care Organizations– Movement away from fee-for-service– Toward prevention and wellness, and
away from episodic care– $25M in planning grants from CMS to
states for demonstration models allow state to recognize pediatric ACOs (starting in Jan. 2012)
Health Care Reform 201: November 2010
Accountable Care Organizations
Local health care organization plus a set of providers– Health care org.: often a hospital?
Providers accountable for– Cost of care– Quality of care (comparative results)
Providers would get cost savings under private or public insurance
Health Care Reform 201: November 2010
Accountable Care Organizations
Assumes providers, not insurers, know what’s best
Hospitals thought to part of most ACOs:– Requires managers, not just providers– Requires a continuum of care, needs to
plan budget and resource needs, and be able to comprehensively measure performance,
Health Care Reform 201: November 2010
IV. Accountable Care Organizations
New concept. Many issues evolving– Design: Physician led? Hospital led?– Will provider participation be mandatory?– How will patients be brought in?– Payment methods?– How to measure quality
Health Care Reform 201: November 2010
Key opportunities and other provisions (1 of 2)
$200M for SBHC equipment and construction
$375M for teen pregnancy prevention $125M for [Teen] Pregnancy
Assistance Fund $11B for Community Health Centers
– Plus $1.5B for CHC construction and renovation
Health Care Reform 201: November 2010
$25M for childhood obesity demonstration programs through 2014
$40M for CHIP outreach & enrollment Authorizes oral healthcare prevention and
education
Health Care Reform 201: November 2010
Key opportunities and other provisions (2 of 2)
Challenges we are facing
Implementation in the hands of the states Many funds are authorized but not
appropriated What SBHCs will be eligible for with
“Meaningful Use” Where SBHCs might fit in the Exchanges,
Medical home, ACOs
Health Care Reform 201: November 2010
Main Sources
Kaiser Family FoundationAMCHPNew England Journal of MedicineHealth Affairs/RWJFCRS Reports
(www.crsdocuments.com)
Health Care Reform 201: November 2010