Health Law and Policy Commons^™

Providing Outreach And Enrollment Assistance: Lessons Learned From Community Health Centers In Massachusetts, Julia Paradise, Sara J. Rosenbaum, Peter Shin, Jessica Sharac, Carmen Alvarez, Julia Zur, Leighton C. Ku

Health Policy and Management Faculty Publications

Six years ago, Massachusetts implemented a broad expansion of health coverage to the uninsured population in the state. Understanding that outreach and enrollment assistance would be essential to the success of the expansion, state policymakers provided for public education campaigns, but also for person-to-person, hands-on assistance, especially in communities with large numbers of uninsured people. Community health centers play a central role in this effort. As states and communities gear up to provide outreach and enrollment assistance under the ACA, the experience of the Massachusetts health centers offers lessons that can help inform current efforts to reach and enroll millions …

Medicare Advantage Update: Benefits, Enrollment, And Payments After The Aca, Kathryn Linehan

National Health Policy Forum

In 2012, the Medicare program paid private health plans $136 billion to cover about 13 million beneficiaries who received Part A and B benefits through the Medicare Advantage (MA) program rather than traditional fee-for-service (FFS) Medicare. Private plans have been a part of the program since the 1970s. Debate about the policy goals—Should they cost less per beneficiary than FFS Medicare? Should they be available to all beneficiaries? Should they be able to offer additional benefits?—has long accompanied Medicare's private plan option. This debate is reflected in the history of Medicare payment policy, and policy decisions over the …

Cms's Proposed Rule Implementing The Aca-Mandated Medicaid Dsh Reductions, Kathryn Linehan

National Health Policy Forum

State Medicaid programs make Medicaid disproportionate share hospital (DSH) payments to hospitals to help offset costs of uncompensated care for Medicaid and uninsured patients. Unlike most Medicaid spending, annual DSH allotments for each state are capped. Under the Patient Protection and Affordable Care Act of 2010 (ACA), DSH payments will decrease starting in fiscal year (FY) 2014 and continuing through FY 2020. This paper describes the proposed rule for reducing these federal allotments, which was released on May 15, 2013, by the Centers for Medicare & Medicaid Services (CMS). Comments on the proposed rule are due July 12, 2013.

2014 …

Annual Report 2012, Forum Staff

National Health Policy Forum

This annual report describes the activities of the Forum during the 2012 calendar year, and provides a snapshot of our resources.

Community Health Centers In An Era Of Health Reform: An Overview And Key Challenges To Health Center Growth, Susan F. Wood, Debora Goetz Goldberg, Brian K. Bruen, Kay Johnson, Holly Mead, Peter Shin, Tishra Beeson, Julie Lewis, Shavon Artis, Katherine J. Hayes, Merle Cunningham, Xiaoxiao Lu, Trent White, Sara Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

The "Coopetition" Model: Caring For San Diego's Low-Income Population, Lisa Sprague, Jessamyn Taylor

National Health Policy Forum

This site visit explored aspects of health care delivery for Medicaid beneficiaries and the uninsured in a California county marked by a diverse population, dominant managed care, and stakeholder dedication to solving problems in a spirit of "coopetition." The program looked at the impact of California's Bridge to Reform (the state's Medicaid section 1115 waiver) on federally qualified health centers and the people they serve. Eligibility and enrollment expansions in the Low Income Health Program and Medi-Cal, health information technology adoption and its use to improve care delivery and health, and patient-centered medical homes and care coordination were discussed. The …

Assisted Living: Facilities, Financing, And Oversight, Carol O'Shaughnessy

National Health Policy Forum

This publication briefly describes assisted living facilities that provide long-term services and supports to people with functional or cognitive impairments who do not need the level of skilled nursing care offered in nursing homes but cannot live independently. It also describes selected resident characteristics, reviews cost and financing arrangements, and reviews state responsibilities for regulation and oversight of assisted living facilities.

Family Caregivers: The Primary Providers Of Assistance To People With Functional Limitations And Chronic Impairments, Carol O'Shaughnessy

National Health Policy Forum

An extensive body of research conducted over the past several decades has documented that family or other unpaid caregivers provide the majority of care to people who need assistance because of functional limitations or multiple and complex chronic conditions. Families play a central role not only in assisting impaired family members with personal care needs, but also in helping them coordinate health care and supportive services, and, increasingly, providing and/or supervising home-based medical care. This paper presents background information on family caregiving, briefly describes federal programs that provide direct assistance to caregivers, and discusses possible future policy and practice directions.

The Community Living Assistance Services And Supports (Class) Act: Major Legislative Provisions, Carol O'Shaughnessy

National Health Policy Forum

Update (January 3, 2013) — In 2010, Congress enacted the Community Living Assistance Services and Supports (CLASS) Act as part of the Patient Protection and Affordable Care Act (P.L. 111-148). The CLASS Act was repealed as part of the American Taxpayer Relief Act of 2012 signed by the President on January 2, 2013.

During 2011 the Department of Health and Human Services (HHS) conducted an analysis of possible CLASS implementation options consistent with the statutory requirements that the program be actuarially solvent over a 75-year period and self-funded. After a 19-month period of analysis, HHS officials stated in testimony before …

Readiness For Meaningful Use Of Health Information Technology And Patient Centered Medical Home Recognition Survey Results, Peter Shin, Jessica Sharac

Health Policy and Management Faculty Publications

Objective. Determine the factors that impact HIT use and MU readiness for community health centers (CHCs).

Background. The HITECH Act allocates funds to Medicaid and Medicare providers to encourage the adoption of electronic health records (EHR), in an effort to improve health care quality and patient outcomes, and to reduce health care costs.

Methods. We surveyed CHCs on their Readiness for Meaningful Use (MU) of Health Information Technology (HIT) and Patient Centered Medical Home (PCMH) Recognition, then we combined responses with 2009 Uniform Data System data to determine which factors impact use of HIT and MU readiness.

Results. Nearly 70% …

Changes In Latitudes, Changes In Attitudes: Fqhcs And Community Clinics In A Reformed Health Care Market, Jessamyn Taylor

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 and the Supreme Court’s related decision have significantly shifted the health care landscape for safety net providers. Federally qualified health centers (FQHCs) are a mainstay of primary care for the uninsured and those with limited access to care. This paper focuses on the impact of health reform on FQHCs given the significant federal investment in them through grants, Medicaid, and Medicare reimbursement. Where noteworthy, the effect on non-FQHC community clinics is also discussed. The implications of Medicaid coverage expansions (or lack thereof in states that choose not to expand), Medicaid disproportionate …

Community Health Workers: A Front Line For Primary Care?, Lisa Sprague

National Health Policy Forum

Among the potential changes invoked in discussions on health system transformation, a need to revitalize primary care remains paramount. One way of doing this, most agree, is to move more in the direction of team-based care. Professionals such as physician assistants and nurse practitioners may be able to ease some of the physician’s clinical care load, but some populations also need help accessing services and basic health education in a familiar setting. Enter the community health worker (CHW), known by many titles and playing a variety of roles, who comes from the community he or she is serving and therefore …

Health Professions Education And Professional Obligations, Lisa Sprague

National Health Policy Forum

While there are differences in academic degree and length of time spent preparing to practice, all health professionals must meet certain requirements to commence and remain in practice in the United States. This Basic outlines the educational requirements of the various professions and the processes designed to demonstrate continuing competence in practice.

Long-Term Services And Supports (Ltss): Arlington County's Integrated Approach, Carol O'Shaughnessy, Lisa Sprague

National Health Policy Forum

The National Health Policy Forum sponsored a local site visit looking at community-based aging programs and long-term services and supports (LTSS) in Arlington County, Virginia. Arlington County human services are integrated under an umbrella agency in the Department of Human Services (DHS) which administers multiple programs for the elderly and people with disabilities. These include the Older Americans Act services, Medicaid LTSS, transportation services, a nursing case management program, and mental health services for those living in nursing homes and assisted living facilities. Arlington County integrates its aging and disability programs under the auspices of an Administration on Aging-funded Aging …

Recent Proposals To Limit Medigap Coverage And Modify Medicare Cost Sharing, Kathryn Linehan

National Health Policy Forum

As policymakers look for savings from the Medicare program, some have proposed eliminating or discouraging “first-dollar coverage” available through privately purchased Medigap policies. Medigap coverage, which beneficiaries obtain to protect themselves from Medicare’s cost-sharing requirements and its lack of a cap on out-of-pocket spending, may discourage the judicious use of medical services by reducing or eliminating beneficiary cost sharing. It is estimated that eliminating such coverage, which has been shown to be associated with higher Medicare spending, and requiring some cost sharing would encourage beneficiaries to reduce their service use and thus reduce program spending. However, eliminating first-dollar coverage could …

Older Americans Act Of 1965: Programs And Funding, Carol O'Shaughnessy

National Health Policy Forum

This document offers a basic description of the Older Americans Act of 1965. The Act is considered the major vehicle for promoting the delivery of social services to the aging population. The Act's seven titles and multiple programs are described, along with a chart showing fiscal year 2012 federal appropriations.

The Aging Services Network: Serving A Vulnerable And Growing Elderly Population In Tough Economic Times, Carol O'Shaughnessy

National Health Policy Forum

In 1965, Congress enacted the Older Americans Act, establishing a federal agency and state agencies to address the social services needs of the aging population. The mission of the Older Americans Act is broad: to help older people maintain maximum independence in their homes and communities and to promote a continuum of care for the vulnerable elderly. In successive amendments, the Act created area agencies on aging and a host of social support programs. The "aging services network," broadly described, refers to the agencies, programs, and activities that are sponsored by the Older Americans Act. The Act’s funding for services …

Individual And Small-Group Market Health Insurance Rate Review And Disclosure: State And Federal Roles After Ppaca, Kathryn Linehan

National Health Policy Forum

Oversight of private insurance, including health insurance, is primarily a state responsibility. Each state establishes its own laws and regulations regarding insurer activities, including premium increases for the insurance products within its purview. The authority that state regulators have to review and deny requests for premium changes varies from state to state, as do the amount of resources available to state insurance departments for reviewing premium changes. In some markets where insurers have proposed or implemented steep increases, such changes have received considerable attention from the press, state regulators, and policymakers. The Patient Protection and Affordable Care Act (PPACA) requires …

Aligning Graduate Medical Education With Public Policy, Rob Cunningham

National Health Policy Forum

In late May–early June 2011, the Forum sponsored a site visit to Denver, Colorado, to observe innovative efforts to improve the health of Coloradans and reduce the cost of health care. The three-day agenda was designed to convey the breadth and interconnectedness of the efforts underway in Denver and to highlight both successes and challenges. The exploration concentrated on how three themes of national interest are unfolding in Denver: building and sustaining a robust and effective safety net in an evolving health care market; improving the health of people and their communities to prevent and reduce the need for health …

Influenza Vaccination Of The Healthcare Workforce: Developing A Model State Law, Alexandra M. Stewart, Marisa A Cox

Health Policy and Management Faculty Publications

No abstract provided.

Rocky Mountain Highs And Lows: Efforts To Improve Health And Reduce Costs In Denver, Michele J. Orza, Jessamyn Taylor

National Health Policy Forum

In late May–early June 2011, the Forum sponsored a site visit to Denver, Colorado, to observe innovative efforts to improve the health of Coloradans and reduce the cost of health care. The three-day agenda was designed to convey the breadth and interconnectedness of the efforts underway in Denver and to highlight both successes and challenges. The exploration concentrated on how three themes of national interest are unfolding in Denver: building and sustaining a robust and effective safety net in an evolving health care market; improving the health of people and their communities to prevent and reduce the need for health …

Home, But Not Alone: Evidence-Based Maternal, Infant, And Early Childhood Home Visitation, Eileen Salinsky

National Health Policy Forum

Home visitation services for young and expectant families have the potential to improve child and parent outcomes in a broad variety of ways, but the effectiveness of home visits may depend on the nature, frequency, and duration of these services. The Patient Protection and Affordable Care Act of 2010 (PPACA) created a new federal funding stream to promote the development and implementation of evidence-based home visiting programs. This issue brief provides an overview of the newly established Maternal, Infant, and Early Childhood Home Visiting program, describes existing approaches to home visitation, and discusses the implications of federal funding for state …

The Hospitalist: Better Value In Inpatient Care?, Lisa Sprague

National Health Policy Forum

From perhaps a few hundred practitioners in 1996 to an estimated 30,000 today, the discipline called hospital medicine has shown remarkably rapid growth. It represents a fundamental separation of the inpatient and outpatient components of internal and family medicine. The split has implications for the quality and efficiency of care delivery, the outlook for the physician workforce, and the development of new models such as accountable care organizations (ACOs).

Medicare's Bundling Pilot: Including Post-Acute Care Services, Laura A. Dummit

National Health Policy Forum

Fee-for-service Medicare, in which a separate payment is made for each service, rewards health care providers for delivering more services, but not necessarily coordinating those services over time or across settings. To help address these concerns, the Patient Protection and Affordable Care Act of 2010 requires Medicare to experiment with making a bundled payment for a hospitalization plus post-acute care, that is, the recuperative or rehabilitative care following a hospital discharge. This bundled payment approach is intended to promote more efficient care across the acute/post-acute episode because the entity that receives the payment has financial incentives to keep episode costs …

Self-Insurance And The Potential Effects Of Health Reform On The Small-Group Market, Kathryn Linehan

National Health Policy Forum

The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care Education Reconciliation Act of 2010 makes landmark changes to health insurance markets. Individual and small-group insurance plans and markets will see the biggest changes, but PPACA also affects large employer and self-insured plans by imposing rules for benefit design and health plan practices. Over half of workers—most often those in very large firms—are covered by self-insured health plans in which employers (or employee groups) bear all or some of the risk of providing insurance coverage to a defined population of workers and their dependents. As PPACA …

The Elder Justice Act: Addressing Elder Abuse, Neglect, And Exploitation, Carol O'Shaughnessy

National Health Policy Forum

Elder abuse, neglect, and exploitation is a social problem that affects older people across all socioeconomic groups and care settings. Although national data on the full extent of the problem are elusive, one study found that 11 percent of older people living in community settings had experienced physical, emotional, or sexual abuse, or potential neglect during one year. Abuse and neglect of residents of nursing facilities and other institutions have been a continuing concern of policymakers and advocates for many years. The Elder Justice Act (EJA), enacted as part of the Patient Protection and Affordable Care Act (PPACA) on March …

Aging And Disability Resource Centers (Adrcs): Federal And State Efforts To Guide Consumers Through The Long-Term Services And Supports Maze, Carol O'Shaughnessy

National Health Policy Forum

Since 2003, the U.S. Administration on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS) have made a series of grants to states to develop Aging and Disability Resource Centers (ADRCs). The ADRC program’s purpose is to help people of all ages, disabilities, and income levels more easily access long-term services and supports through single points of entry, make more efficient use of care options, and maximize the services available. Almost $111 million in joint AoA-CMS funding has been devoted to the ADRC initiative since its inception in fiscal year 2003. As of October 2010, 325 ADRC sites …

Premium Assistance: An Update, Cynthia Shirk

National Health Policy Forum

This background paper explores the use of premium assistance in publicly financed health insurance coverage programs. In Medicaid and the Children’s Health Insurance Program, premium assistance involves using federal and state funds to subsidize premiums for the purchase of private insurance coverage for eligible individuals. This paper reviews the statutory authority for premium assistance, including two new options made available under the Children’s Health Insurance Program Reauthorization Act of 2009. It examines the status of premium assistance programs in the states and offers some insights into how premium assistance programs may fare under the Patient Protection and Affordable Care Act.

The Primary Care Safety Net: Strained, Transitioning, Critical, Jessamyn Taylor

National Health Policy Forum

This background paper examines the primary care safety net. It describes key primary care safety net providers, including federally qualified health centers, free clinics, local health departments, and safety net hospital outpatient departments and clinics, among others. The paper also explores the changing role of the primary care safety net in a post–health reform marketplace.

High Hopes: Public Health Approaches To Reducing The Need For Health Care, Michele J. Orza

National Health Policy Forum

Driven in part by a desire to contain health care costs, policymakers are looking beyond medical care for opportunities to reduce the need for expensive services. This paper briefly reviews current public health concepts and strategies for improving health that emphasize nonmedical factors such as behavior, socioeconomic status, and environment. It also provides examples of how these concepts and strategies undergird many of the public health provisions of the Patient Protection and Affordable Care Act, other legislation, and several programs and initiatives. These concepts include prevention, health in all policies, global health, the One Health Initiative, and climate change and …