s chool - based h ealth c enters : h ealth c are r eform and m edical h ome north carolina school...
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SCHOOL-BASED HEALTH CENTERS: HEALTH CARE REFORM AND MEDICAL HOME
NORTH CAROLINA SCHOOL COMMUNITY HEALTH ALLIANCE
2012 ANNUAL CONFERENCE
OBJECTIVES Review health care reform initiatives that are
relevant to school health Discuss background information concerning
Medicaid and CHIP Examine medical home options for school-
based health centers
REFLECTIONS Shortage/maldistribution of primary care
physicians Shortage of pediatricians who choose to
enter community pediatrics The growth of ACO (Accountable Care
Organization)-type entities Failure of school-based health centers to
generate sufficient revenue to justify their existence
PEDIATRICS 2020 AND BEYOND Sick children sicker
Mental health issues
Families more isolated
Increased diversity
Transitional care
HEALTH EQUITY
17% of children live in poverty
Poverty affects sequential generations of the same families
Poverty is a key contributor to poor health status
Generational violence robs lives
Incarcerated youth share a common history
Cabinet-level attention is needed
Requires that private insurance include the following consumer protections: No annual caps on coverage No rescissions (if a child or adult gets sick, coverage
can’t be lost) Children may stay covered on their parents’ policy
until age 26 Children may not be denied
care because of a pre-existing condition
Minimum medical loss ratios Cap on out of pocket costs
for families
What insurance reforms are included in the new law?
PREVENTABLE CAUSES OF DEATH IN N.C.
Preventable Causes of Death in North Carolina (2007)
531
606
758
910
1,364
1,516
1,743
2,350
2,653
12,583
13,720
0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000
Illicit Drug Use
Unsafe Sex
Uninsurance
Firearms
Motor Vehicles
Medical Error
Toxic Agents
Microbial Agents
Alcohol Consumption
Diet/Physical Inactivity
Tobacco Use
Estimated Number of deaths
State Center for Health Statistics, North Carolina Department of Health and Human Services, (2007).
WHAT IS A MEDICAL HOME?
An approach to providing health care services in a high-quality, comprehensive, and cost-effective manner
Provision of care through a primary care physician through partnership with other allied health care professionals and the family
Acts in best interest of children and youth to achieve maximum family potential
Many notions tested among children and youth with special health care needs – but principles and characteristics apply broadly to all children/families
MEDICAL HOME DEFINITION Primary care Family-centered partnership Community-based, interdisciplinary
approach to care Care that is: accessible, family-
centered, coordinated, compassionate, continuous, and culturally effective.
Preventive, acute and chronic care Quality improvement
ATTRIBUTES OF THE MEDICAL HOME Accessible Family Centered Continuous Comprehensive Coordinated Compassionate Culturally Competent
NCQA: PATIENT CENTERED MEDICAL HOME MEASUREMENT
Access and Communication Patient tracking and registries Care management Patient self management Electronic prescribing Test tracking Referral tracking Performance reporting and improving Enhanced electronic communications
MEDICAL HOME Pediatric Medical Home under CCNC
(Community Care of NC) Typical adult medicine medical home Information technology and the NC Health
Information Exchange School-based health centers and medical
home
CHIPRA (Children’s Health Insurance Program Reauthorization Act)
ARRA (American Recovery and Reinvestment Act)
HITECH Act
Affordable Care Act (ACA)
Health Care Reform
MEDICAID AND SCHIP
Birth to 1 Year
1 to 6 Years
6 to 19 Years
0 50 100 150 200 250
185
133
100
200
200
200
SCHIP Medicaid
MEDICAID EXPANSION (2014)
For patients younger than 65 who are not pregnant and have family incomes up to 133% of poverty
2014-2016: 100% federal funding After 2020: 90% federal funding Essential Health Benefits Package Eligible adults required to enroll their children
in Medicaid/CHIP
CHIPRA COMPONENTS
$32.8 billion over 4.5 years
300% FPL eligibility for CHIP match
$225m for quality and health IT
$100m for outreach and enrollment
8 enrollment improvements – if state chooses 5, boosts federal funding
Public/private partnership on premium subsidy – eliminates crowd out
CHIPRA
Strengthens AAP Access, Quality and Finance Pillars
Establishes Medicaid and CHIP Payment and Access Commission
Calls for development of a core set of health care quality measures for children enrolled in Medicaid or CHIP
Directs implementation of a GAO study and report on access to primary and specialty services.
CHIPRA COMPONENTS
Immigrant Children's Health Improvement Act (ICHIA) – states can remove 5-year wait for legal immigrants
Translation Services now at 75% FMAP
Coverage of pregnant women up to 200%
Dental benefits required
Mental health parity, if provide mental health
DAVID T. TAYLOE, JR., MD, FAAP
2706 Medical Office Place Goldsboro, NC 27534 919-734-4736 919-580-1017 (fax) [email protected] December 4, 2012
FIRST DOLLAR COVERAGE FOR PREVENTIVE SERVICES
September 23, 2010 Bright Futures: Guidelines for Health
Supervision of Infants, Children, and Adolescents (AAP, MCHB)
Does not apply to “grandfathered” plans Does not apply to Medicaid plans
HEALTH CARE HOMES Grants available to state Medicaid programs
as of January 1, 2011 Enrollees must have:2 chronic conditions1 chronic condition and at-risk for second1 serious mental health condition
CENTER FOR MEDICARE AND MEDICAID INNOVATION (CMI)
Fiscal Year 2011-2019 $5 million available to organizations for design of
projects $10 billion available for implementation of
projects Project design/regulations pending
GRANDFATHERED PLANS
Existing group health plans or health insurance coverage in which a person was enrolled as of March 23, 2010
Prohibition on Pre-existing Conditions for Children, September 23, 2010
Prohibition on Pre-existing Conditions for Adults, January 1, 2014
Coverage of and Prohibition on Co-payments and Deductibles for Preventive Care, September 23, 2010
PREVENTION AND PUBLIC HEALTH FUND
$15 billion: FY 2010-2020 The fund will support programs authorized by
the Public Health Service Act for prevention, wellness, and public health activities, including prevention research and health screenings and initiatives.
www.hhs.gov/news/press/2010pres/06/20100618g.html
PREVENTION AND PUBLIC HEALTH FUND $250 million: community-based health
settings; obesity prevention and fitness; tobacco cessation; infectious disease outbreaks; CDC’s Clinical Preventive Services Task Force recommendations; public health workforce and training centers
$250 million: US primary care workforce projects (residency slots; PA’s; NP’s;nurses)
SCHOOL-BASED HEALTH CENTERS (SBHC’S)
$200 million for FY 2010-2013 Target SBHC’s that serve large numbers of
children eligible for Medicaid and CHIP Infrastructure only (not for paying for
personnel or services)
IMMUNIZATION COVERAGE IMPROVEMENT PROGRAM
FY 2010-2014 Grants to states to improve the provision of
recommended immunizations to children, adolescents, and adults
Permanently reauthorizes the state immunization grant program in section 317(j) of the Public Health Service Act
COMMUNITY TRANSFORMATION GRANTS FY 2010-2014 Funds for the implementation, evaluation,
and dissemination of evidence-based community preventive health activities to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence base of effective prevention programming.
PERSONAL RESPONSIBILITY EDUCATION
FY 2010-2014 Grants to states for programs to educate
adolescents on both abstinence and contraception and sexually transmitted infections, including HIV/AIDS
AMERICAN RECOVERY AND REINVESTMENT ACT (ARRA)
$87b in FMAP increase Hold enrollment at 7-1-08 levels Prompt payment 6.2% minimum increase
$19b in Health IT infrastructure (2011) (HITECH Act, Title IV) 20% Medicaid patient threshold State planning and implementation grants
ARRA $10.4 billion to NIH
$1 billion for Prevention and Wellness Fund
$500 million to HRSA workforce development
$200 million for Title VII and VIII programs
$300 million for the National Health Service Corps
$2 billion for Child Care Development Block Grant
PEDIATRIC ACCOUNTABLE CARE ORGANIZATION (ACO)
Incentive payments to stimulate improvements in quality and cost-effectiveness
Fee-for-service to providers who contract directly with payers
Quality improvement payments to the ACO January 1, 2012 – December 31, 2016
AAP RESOURCE State Implementation of the Patient
Protection and Affordable Care Act (ACA)
www.aap.org/moc and go to “Advocacy” (lower left hand corner), and then “State Government Affairs,” then look for the document “State Health – State Implementation of the Patient Protection and Affordable Care Act (ACA)”
FEDERAL ACA WEB PORTAL
www.hhs.gov/ociio/regulations/webportal/index/html
www.healthcare.gov