FW: Week In Review - Supreme Court Reviews Medicaid Cutbacks, Forecasting Essential Benefits, Baby First Test Challenge Awards, more

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Quote of the Week:

"Be a yardstick of quality. Some people aren't used to an environment where excellence is expected."- Steve Jobs

In This Issue

News Items

For Justices' First Day Back, a Knotty Case Involving Medicaid Cutbacks

Health Consumers Make Deficit Fight Personal

Panel Says U.S. Should Weigh Cost in Deciding 'Essential Health Benefits'

Affordable Care Act to Support Quality Improvement and Access to Primary Care for More Americans

Hard Work Pays Off for "Waiver Watchers"

Advocates for Disabled Optimistic that CLASS Act Program Won't be Scrapped

Pressing for Better Quality Across Healthcare

Resources

Forecasting What 'Essential Benefits' Recommendations Influential Panel Will Make

Events and Announcements

Got Transition Radio Episode 2: Healthcare Transition and College - It Doesn't Have to be Learned the Hard Way!

2012 Baby's First Test Challenge Awards

News You Can Use from Our Partners

The National Center for Medical Home Implementation Announces Two New Resources

Past Issues

Health and Human Services Secretary Adopts New Recommendation on Newborn Screening

News Items

For Justices' First Day Back, a Knotty Case Involving Medicaid Cutbacks

By: Adam Liptak

The New York Times

October 3, 2011

Federal law requires that states reimburse providers at rates high enough to ensure that they participate in the Medicaid program. So, do Medicaid providers and beneficiaries have the right to sue a state over their decision to cut Medicaid reimbursement rates? The Obama Administration and lawyers for the state of California say no; there is no federal law that allows individuals to sue states to enforce this standard. But Supreme Court Justice M. Kennedy suggests private lawsuits, such as this one, may be a way to enforce Medicaid rules. Senator Harry Reid, Representative Pelosi, and other Congressional Democrats agree. The Supreme Court justices began their new session by hearing arguments about this California lawsuit that, according to the article, may be a catch-22 for states, providers, and Medicaid beneficiaries. If states are found to be non-compliant with the rules, they can lose their federal funding, and as a result, beneficiaries can lose their access to Medicaid.

Health Consumers Make Deficit Fight Personal

By:

Reuters

October 4, 2011

Republican Congressman Jeb Hensarling was among the Texas lawmakers who received a copy of "Medicaid's Impact on Texas." Families USA, a national health care consumer advocacy organization, the American Cancer Society Cancer Action Network, the American Diabetes Association, and American Lung Association created this 16-page electronic publication, filled with statistics about Texas children and adults with chronic illnesses from low-income families. Their goal was to put a human face on the importance of Medicaid benefits. As co-chair of the

super committee tasked with finding ways to reduce the U.S. federal deficit by at least $1.2 trillion dollars over the next 10 years, Medicaid advocates wanted Congressman Hensarling to understand how cuts to Medicaid would affect his fellow Texans.

Panel Says U.S. Should Weigh Cost in Deciding 'Essential Health Benefits'

By: Pear

New York Times

October 6, 2011

The Affordable Care Act (ACA) calls for the U.S. Department of Health and Human Services (HHS) to decide the specifics of the essential benefit package in the individual and small group market and Exchange plans. An announcement of these specifics by HHS is expected by May 1, 2012. This article reports on the Institute of Medicine (IOM) recommendations to HHS on deciding the essential benefits, including consideration of cost as a significant factor. As HHS goes about this work, Secretary Kathleen Sebelius is planning to provide opportunities for Americans to voice their priorities at "listening

sessions."The ACA states the essential benefit package must be equivalent to the benefits provided by a "typical employer plan." The IOM's expert panel, in addition to making recommendations about the essential benefit package, also recommended that the government define "typical employer plan" and set the premiums for employer plans in 2014, which should help control overall health costs.

Affordable Care Act to Support Quality Improvement and Access to Primary Care for More Americans

U.S. Department of Health and Human Services Press Office

September 29, 2011

Last month, the U.S. Department of Health and Human Services' Health Resources and Services Administration (HRSA) awarded $32 million to more than 900 community health centers throughout the country. The Substance Abuse and Mental Health Services Administration (SAMHSA) distributed an additional $15 million in

grants to community-based mental health settings and departments of public health. The funding, made available through the Affordable Care Act (ACA), will help these community-based organizations not only improve quality and access to primary care, but also improve behavioral health services for individuals with mental and substance abuse disorders. Community health centers can use the money to fund activities, such as care-planning and improved models of service delivery, to help them become patient-centered medical homes. Community-based mental health settings and departments of public health can use SAMSHA grant funds to support improvements in coordination of health care services.

Hard Work Pays Off for "Waiver Watchers"

By: Wesley Prater

Say Ahhh! A Children's Health Policy Blog

September 26, 2011

This blog post from the town University Center for Children and Families describes plans by New Jersey, Texas, and Utah to apply for Section 1115 Research and Demonstration waivers as a way to control Medicaid costs, and the successful advocacy efforts that derailed these states' efforts to implement changes that would have been detrimental to low income families. The Affordable Care Act (ACA) includes "maintenance of effort" or MOE, which requires states to get approval from the Centers for Medicare and Medicaid Services (CMS) before they reduce Medicaid eligibility or

services. New Jersey proposed cutting Medicaid eligibility for adults to 28% of the federal poverty level and implementing a co-payment of $25 for using emergency rooms for care in non-emergent situations. Texas' 1115 waiver requested permission to expand Medicaid managed care, and at the same time, impose a limit of three prescription medications for adults. Despite research that proves needed care is reduced or delayed when families incur co-payments, Utah proposed letting Accountable Care Organizations (ACOs) determine the amount of co-payments to charge for children's health services. Again, advocates were able to make a case for elimination of co-pays.

Advocates for Disabled Optimistic that CLASS Act Program Won't be Scrapped

By: n Pecquet

Healthwatch, THE HILL'S Healthcare Blog

September 29, 2011

This blog post reports on the uncertain fate of the Community Living Assistance Services and Support (CLASS) Act. The purpose of the CLASS Act, included as part of the Affordable Care Act (ACA), is to help working adults plan for long-term care needs if they become disabled; the equivalent of a program that helps people save money for a rainy day. Participants in this voluntary program would pay monthly premiums for at least five years. If they became cognitively or functionally disabled, they would be eligible for CLASS payments to purchase services, such as home health care or adult day care, that will help them retain their independence so they can continue to live in the community. According to this blog, only 8% of adults have long-term care insurance, so there is a need for this type of program; however, the many unknowns, including the amount of the monthly

premiums and doubt about the long-term fiscal integrity of this program, put it in jeopardy. The U.S. Department of Health and Human Services is reviewing an analysis of several CLASS plans. They will release their recommendations about the CLASS Act later in October. For more information about the CLASS Act, read the Kaiser Family Foundation fact sheet.

Pressing for Better Quality Across Healthcare

By: Noam N. Levey

Los Angeles Times

October 4, 2011

When Dr. Don Berwick, the Administrator of the Centers for Medicare and Medicaid Services (CMS) was looking for innovative strategies to reduce medical errors, cut costs, and increase the quality of care, he visited the cardiac intensive care unit (ICU) at Egleston Children's Hospital in Atlanta, Georgia. Two years ago, hospital leaders created a MedZone, a quiet corner of the ICU, where nurses could measure out medications without distractions. Medication errors have since decreased by two-thirds.

Resource

Forecasting What 'Essential Benefits' Recommendations Influential Panel Will Make

Kaiser Health News

October 4, 2011

This short video with Jackie Judd, Vice President and Senior Advisor for Communications at the Kaiser Family Foundation and Appleby, from Kaiser Health News, is a discussion about the

Institute of Medicine's (IOM) recommendations for essential benefits - the services that every insurer in the health exchange must provide. The U.S. Department of Health and Human Services (HHS) will consider the IOM recommendations, but ultimately, HHS will decide which services to cover. No one knows how specific HHS will be and if they will only decide which services are covered, or if they will also specify an amount and duration of those services. Read the IOM's "Essential Health Benefits: Balancing Coverage and Cost" report.

Events and Announcements

Got Transition Radio Episode 2: Healthcare Transition and College - It Doesn't Have to be Learned the Hard Way!

Got TransitionDate: Wednesday, October 26, 2011 3:00 - 3:30 EDT

Got Transition? the National Health Care Transition Center broadcasts its second installment of Got Transition Radio, with hosts Mallory Cyr and Eileen Forlenza. Mallory and Eileen will share their perspectives about what all high school students can do to prepare for the transition to college. Listeners are encouraged to share their experiences and lessons learned, as well as to ask questions and make comments. Register for this radio show event.

2012 Baby's First Test Challenge Awards

Genetic Alliance

October 6, 2011

The Genetic Alliance invites nonprofit organizations, public health groups, research institutions, and private-sector companies to submit proposals for the 2012 Baby's First Test Challenge Awards. Successful candidates will receive up to $20,000 for creative ideas to integrate Baby's First

Test, a website about newborn screening, into new or existing outreach, engagement, or educational efforts. Read about current Awardees in the September 21, 2011, edition of the Genetic Alliance newsletter. The Genetic Alliance will host a question and answer webinar about the Challenge Awards on

October 21, 2011, from 12 noon - 1 p.m. EST. Challenge Award Proposals are due by 6:00 pm EST on November 7, 2011.

News You Can Use from Our Partners The National Center for Medical Home Implementation Announces Two New ResourcesOctober 2011

Spotlight on Child Health Issues is a new e-publication for providers, families, and states from the National Center for Medical Home Implementation (NCMHI). It provides timely medical home resources to supplement the monthly

Medical Homes @ Work e-newsletters. The first Spotlight, Transitioning From a Pediatric to an Adult Medical Home, highlights how challenging this transition can be, especially for youth with special health care needs. Spotlight highlights promising practices that support families, youth, young adults, and providers and systems changes in states that provide technical assistance, training, and resources to pediatric and adult providers. Mallory Cyr, a young adult with special health needs, shares her transition story. The Spotlight concludes with resources for providers, youth, and

families.

The 2011 Medical Home Implementation CME Series is four-part webinar hosted earlier this year by the American Academy of Pediatrics (AAP). Pediatric health providers learned about resources and strategies for implementing a medical home and improving quality of care and

parent/family partnerships. This four-part webinar series covered the following topics: 1) The Role of Preventive and Acute Care in the Medical Home, 2) The Role of the Medical Home in Chronic Care Management, 3) The Role of the Medical Home in Care of Children and Youth with Complex Chronic Conditions, and 4) Patient and Family-Centered Care in the Medical Home. Visit the link above to watch the audio/video recording or see the slide presentation for each webinar. CME credit is available, free of charge.

In case you missed it...here is the most popular news item from our last issue of the Week In Review

Health and Human Services Secretary Adopts New Recommendation on Newborn Screening

By: Natasha Bonhomme

Genetic Alliance

September 22, 2011

In every 1000 live births, seven to nine babies will have some form of Critical Congenital Heart Disease (CCHD). Early detection of CCHD helps ensure newborns receive needed interventions and reduces infant mortality. The Secretary's Advisory Committee on Heritable Disorders in Newborns and Children (SACHDNC) has recommended including screening for Critical Congenital Heart Disease (CCHD) in the Recommended Universal Screening Panel (RUSP). This press release from the Genetic Alliance applauds Health and Human Services Secretary Kathleen Sebelius' decision to adopt this recommendation. Read Secretary Sebelius' decision on the SACHDNC website. Learn more about CCHD on baby's first test website.

To view more articles from past issues of the Week In Review, visit the Catalyst Center website. If you have suggestions for news

items related to coverage and financing of care for CYSHCN please email Week in Revieweditor and Catalyst Center Research Assistant Sheila Phicil by 12 pm EST on Friday at sphicil@....

The Catalyst Center is a national center dedicated to improving health care insurance and financing for Children and Youth with Special Health Care Needs (CYSHCN). For more information please visit us at www.catalystctr.org or contact Meg Comeau, Program Director at mcomeau@....

The Catalyst Center

Health & Disability Working Group

Boston University School of Public Health

715 Albany Street

Boston, MA 02118-2526 The Catalyst Center is funded under grant #U41MC13618 from the Maternal and Child Health Bureau, Health Resources and Services AdministrationU.S. Department of Health and Human Services.

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