Arkansas Strategy for ACA Implementation

Transcription

1 Arkansas Strategy for ACA Implementation Heartland Genetics Services Collaborative Affordable Care Act Forum Phase II Kansas City, MO May 22, 2014 David Deere Director, Partners for Inclusive Communities

2 Health Care Changes in Arkansas (All these programs are designed by state) Efforts are underway to improve: Costs and Quality (Payment Improvement Initiative, Patient-Centered Medical Homes) Coordination (Health Information Technology) Care Options (Increasing the number of health care providers & Community First Choice Option) Access (Health Insurance Marketplace & Medicaid Expansion)

3 Payment Improvement Initiative Includes Medicaid and major private insurance companies Pays a set amount for an episode of care (rather than a fee for service for each procedure) Shares saving with provider Penalizes provider for high costs or poor outcomes Roll out beginning with most expensive conditions

4 Patient-Centered Medical Home A medical practice may elect to participate Enhanced payments to provide services that are a part of medical homes Essentially, a managed care model Like Payment Improvement Initiative, rewards quality care and cost savings, and penalizes high costs and poor quality

5 Components of Medical Home Model Care that is: accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective.

6 Health Information Technology Requires use of an Electronic Medical Record Designed to make various provider and network EMRs compatible Affordable Care Act funds available to practices to convert to EMRs and upgrade systems to support participation in the health information technology system (AR has a team coordinating this effort) HIPAA was enacted to facilitate this system, while protecting this information

7 Health Care Workforce Shift to emphasis on primary care With more people covered with health insurance, the demand for services will increase AR anticipates needing an additional 5% primary care providers Medical school added physician assistant program (2 universities are looking at DO programs) Payment shifts to reimburse primary care at a higher rate Will take some time to catch up with the demand

8 Community First Choice Option

9 Alternative to Home and Community-based Waiver CFCO is expected to end the waiting list for the HCBS Waiver. Must be person-centered plan of care CFCO will allow more flexibility in the services a person receives.

10 Community First Choice Option The amount of money available for a person will depend on their needed supports (determined by an initial assessment). CFCO will apply to disabilities, aging, and mental health.

11 Funding for CFCO Center for Medicare and Medicaid Services will provide the state an extra 6% in their Federal Medical Assistance Percentage (FMAP) Savings from institutional care will be applied to community-based services

12 Timeline for CFCO Assessments have been completed on many, but not all of the expected participants July 2014 is projected start date for first participants Full implementation is expected to take 18 months

13

14 Background on Health Insurance in Arkansas in 2013 More than 500,000 Arkansans were uninsured About half of those uninsured were eligible for Medicaid expansion Before the ACA, the average plan cost $1500 more due to those who were uninsured

15 Participation Choices by the State Arkansas opted for a federal-state partnership (allowed state to be involved in plan management and consumer assistance) Arkansas also is participating in Medicaid expansion called Private Option

16 10 Essential H e a l t h Benefits (Included in All Health Insurance Plans) Outpatient services Hospitalization Emergency services Maternity and newborn care Mental health and substance use disorder treatment Prescription drugs Rehabilitative and habilitative services/devices Laboratory services Preventive, wellness, chronic disease management Pediatric services, including dental and vision

17 Defining Habilitative Services States were given options if benchmark plan did not include habilitative services Default to the federal definition Write own definition and coverage requirements

18 Arkansas s Definition Of Habilitative Services Habilitative Services are services provided in order for a person to attain and maintain a skill or function that was never learned or acquired and is due to a disabling condition. Coverage originally included only occupational therapy, physical therapy, and speech language therapy. After advocates spoke up, it now includes therapy designed to assist patients to acquire activities of daily living (does not require OT, PT, or SLP license).

19 Coverage of Habilitative Services Subject to permissible terms, conditions, exclusions and limitations, health benefit plans, when required to provide essential health benefits, shall provide coverage for physical, occupational and speech therapies, developmental services and durable medical equipment for developmental delay, developmental disability, developmental speech or language disorder, developmental coordination disorder and mixed developmental disorder.

20 Experience with Enrollment Arkansas enrolled more than 150,000 people in Medicaid and more than 40,000 in plans with advance premium tax credits During the next open enrollment, the Departments of Insurance, Human Services, and Health will not be involved in outreach, education, and enrollment

21 Private Option (AR Version of Medicaid Expansion) Medicaid dollars are used to pay for the Marketplace plan selected, with no premium cost for consumer In first years 100% of cost paid by federal government In future years state will pay 10% of cost and US will pay 90% Medically frail (about 10%) still covered under traditional Medicaid Certain services still covered by traditional Medicaid (transportation)

22 Benefits of Private Option Reimburses physician at a higher rate than traditional Medicaid Eliminates the problem of churning, or movement between Medicaid and private insurance Removes some of the stigma associated with Medicaid Estimated to save AR between $80-90 million annually Important to hospitals to cover funding previously received from Medicare to cover uncompensated care Businesses will not have to pay penalties for not covering employees who are in the Private Option

23 Role of Genetic Counselors Help people understand health care changes and reasons for the changes Help people to look at options available through the Insurance Marketplace and understand the coverage offered by each plan Direct people to a guide or navigator in their area Advocate for future revisions to improve experience of people with genetic conditions (particularly, look at qualified health plans and habilitative services) Learn if your state is involved in reform measures such as Medicare-Medicaid Dual Eligible Programs and Community First Choice Option. Make your views known.

24 Health Reform State Decisions Source: Marketplace Type Expanding Medicaid Health Home Dual Eligibles CFCO Arkansas Partnership X X X Iowa Partnership X X X Kansas Federal X Missouri Federal Debating X Withdrawn Nebraska Federal North Dakota Federal X Oklahoma Federal X X South Dakota Federal X