Health Services Administration Commons^™

Telehealth: Into The Mainstream?, Lisa Sprague

National Health Policy Forum

Teleheath, and its subset telemedicine, extend across a range of technologies allowing patients to seek diagnosis, treatment, and other services from clinicians by electronic means. Telephone, videoconferencing, iPads, and apps are all employed. In its most established form, hospitals and medical centers use telehealth to reach patients in underserved rural areas. Proponents of telehealth suggest it can relieve medical workforce shortages; save patients time, money, and travel; reduce unnecessary hospital visits; improve the management of chronic conditions; and improve continuing medical education. But telehealth also faces ongoing challenges. States require physicians to be licensed in each state where they treat …

Money Follows The Person (Mfp) Rebalancing Demonstration: A Work In Progress, Carol O'Shaughnessy

National Health Policy Forum

In recent years, federal and state policy efforts have expanded opportunities for people to live in home- and community-based settings rather than in nursing homes and other institutions. As part of the Deficit Reduction Act of 2005, Congress enacted the Money Follows the Person Rebalancing (MFP) program, a Medicaid demonstration to help people who need long-term services and supports (LTSS) transition from nursing homes and other institutions to their own homes or other community settings. The Patient Protection and Affordable Care Act of 2010 extended the program through September 30, 2016. Now in its eighth year of operation, MFP grants …

Expanding Women’S Healthcare Access In The United States: The Patchwork “Universalism” Of The Affordable Care Act, Randy Albelda, Diana Salas Coronado

Center for Social Policy Publications

This paper explores the promise of the Patient Protection and Affordable Care Act, commonly called “Obamacare” (referred to here as the ACA), with attention to the ways gender matter by tracing the development and implementation of key US social protection systems, an examination of the current health system with particular attention to women’s coverage, and the potential impacts of the ACA, including how it conforms to international human rights norms for health care. The ACA promises to vastly improve the key dimensions of health coverage in the US, but it conforms with other US social policy by relying on market-based …

Crafting A Narrative For The Red State Option, Elizabeth Weeks Leonard

Scholarly Works

This Article examines the current state of play following the Supreme Court's decision in NFIB v. Sebelius to allow states the option of expanding their Medicaid programs in accordance with the Patient Protection and Affordable Care Act (ACA). Holding that mandatory expansion was unconstitutionally coercive, the Court created the Red State Option. Despite the enormously generous federal financial support for Medicaid expansion, close to half of the states have declined. At the same time, at least eight Republican-led states have crossed Tea Party lines to accept federal funding for expansion. Drawing lessons from these states, including Arkansas, Arizona, Michigan, and …

Medicaid Home- And Community-Based Services Programs Enacted By The Aca: Expanding Opportunities One Step At A Time, Carol O'Shaughnessy

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 (ACA) enacted the most significant opportunities for optional state expansion of Medicaid-financed home- and community-based services (HCBS) since 1981, when Congress enacted the section 1915(c) waiver program. Three of the ACA provisions, the Balancing Incentive Program (BIP), the Community First Choice (CFC) state plan option, and the health home state plan option, offer states enhanced federal Medicaid matching funds as long as they meet federal requirements. The ACA also expanded two HCBS programs established under the Deficit Reduction Act of 2005 (DRA) by extending the Money Follows the Person (MFP) Rebalancing …

Medicaid Home- And Community-Based Services Programs Enacted By The Aca: Expanding Opportunities One Step At A Time, Carol O'Shaughnessy

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 (ACA) enacted the most significant opportunities for optional state expansion of Medicaid-financed home- and community-based services (HCBS) since 1981, when Congress enacted the section 1915(c) waiver program. Three of the ACA provisions, the Balancing Incentive Program (BIP), the Community First Choice (CFC) state plan option, and the health home state plan option, offer states enhanced federal Medicaid matching funds as long as they meet federal requirements. The ACA also expanded two HCBS programs established under the Deficit Reduction Act of 2005 (DRA) by extending the Money Follows the Person (MFP) Rebalancing …

Seeking Value In Medicare: Performance Measurement For Clinical Professionals, Lisa Sprague

National Health Policy Forum

The Medicare program, despite its reputation of being a bill payer with little regard to the worth of the services it buys, has begun to put in place a range of programs aimed at assessing quality and value, with more to come. Attention to resource use and cost is nascent. The issues are complex, and it is no surprise that there is a level of contention between providers and regulators, even though both profess commitment to improved quality. This paper summarizes the quality and value programs that apply to physicians and other clinical professionals, as well as programs designed to …

Health Workforce Needs: Projections Complicated By Practice And Technology Changes, Rob Cunningham

National Health Policy Forum

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts posit whether sufficient health care providers will be able to meet that demand. Some argue there are too few providers already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how physician practices are changing in response to market forces such as payment changes, provider distributions, and technology innovations. This issue brief reviews what is known about evolving practice organizations, professional mixes, information technology support, and the implications of these …

The Commission On Long-Term Care: Background Behind The Mission, Carol O'Shaughnessy

National Health Policy Forum

The American Taxpayer Relief Act of 2012 (ATRA, P.L. 112-240) created a Commission on Long-Term Care charged with developing a plan for financing of long-term services and supports (LTSS) and issuing a report in September 2013. Significant research and advocacy have been devoted to LTSS financing issues and perceived inadequacies of the delivery system over the past several decades, but the most recent comprehensive review of financing options was in 1990 by the Pepper Commission. This publication presents brief background behind the mission of the Commission, including a time line of selected federal and national activities on LTSS financing and …

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.

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.

Commentary: Hospital Tax-Exempt Policy: A Comparison Of Schedule H And State Community Benefit Reporting Systems, Laura L. Hitchcock

Frontiers in Public Health Services and Systems Research

In Hospital Tax-Exempt Policy: A Comparison of Schedule H and State Community Benefit Reporting Systems, Rosenbaum et aldescribe the numerous variations between current state law in 24 states and federal requirements regarding nonprofit hospitals’ community benefit activities. The potential for nonprofit hospitals to help shape community health is great, and how states choose to address requirements regarding community benefit, and potentially reinforce the new federal requirements to incentivize hospital participation in addressing root causes of poor health, should be of significant interest to the public, policy makers and public and population health experts, given the large percentage of …

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 …

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 …

Emergency Preparedness And Public Health: The Lessons Of Hurricane Sandy, Tia Powell, Dan Hanfling, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

When Hurricane Sandy hit downtown Manhattan, three neighboring hospitals each made different decisions about when to evacuate. Across the metro region, more than five hospitals and over 20 nursing and assisted living facilities were evacuated, making this the central public health challenge of this calamitous event. It is a familiar story—a super storm comes ashore, infrastructure is overwhelmed, and healthcare facilities evacuate patients, with major delays in returning to normal functioning. Afterwards, policy makers evaluate lessons learned for the next disaster, but similar missteps are often repeated.

Although not identical, it is instructive to compare Hurricane Katrina with the still …

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 …