Health Care Reform 201 The Affordable Care Act

Health Care Reform 201 The Affordable Care Act and School-Based Health Care November 18, 2010

Introduction: How We Got Here Health Reform 101: l Health Reform 102: l Health Reform 202: l Health Care Reform 201: November 2010 NASBHC’s Agenda SBHC Grants Implementation

Health Reform 101 NASBHC’s Federal Policy Agenda l l l Create a federal grant program for SBHCs Support reimbursement opportunities for SBHCs Position SBHCs to receive support in federal legislation and in governmental agencies Health Care Reform 201: November 2010

Health Reform 101, cont. Affordable Care Act l l l Includes a federal grant program for SBHCs Supports reimbursement opportunities for SBHCs Positions SBHCs to receive support in federal legislation and in governmental agencies Health Care Reform 201: November 2010

SBHC Grants Section 4101(a): Short-Term Appropriations l l Grants for the Establishment of School-based Health Centers – $200 million over 4 years, starting in FY 2010 – Limitations: only for expenditures acquiring or improving land, facilities and equipment No funds for personnel or to provide health services. Health Care Reform 201: November 2010 Section 4101(b): Authorized Federal Program l Grants for Operation of School-based Health Centers – Equipment; training; management and operation; and salaries for physicians, nurses, and other personnel l Authorizes spending but doesn’t allocate it.

SBHCC Highlights Can be used for alteration/renovation, new construction, equipment l Can cover past equipment purchases or construction (to March 23, 2010) l Preference for programs that serve a large population of children and adolescents eligible for Medicaid and CHIP l Health Care Reform 201: November 2010

Health Reform 201 We will always be reforming our health care system. In that broader sense, implementation is forever. -- Drew Altman, President and CEO Kaiser Family Foundation Health Care Reform 201: November 2010

Affordable Care Act Overview I. III. Regulates private health insurance Investments in prevention, wellness, primary care Expands access to coverage through: a. Subsidies b. Expansion of public insurance c. Creation of health insurance exchanges IV. Cost containment strategies – Improving quality/cost effectiveness Health Care Reform 201: November 2010

I. Regulating private insurance (1 of 2) Extends dependent coverage up to age 26 l As of September 2010, insurers can’t l – Deny coverage to kids with pre-existing conditions – Put lifetime limits on benefits – Cancel a policy without proving fraud – Deny claims without a chance for appeal l New protections, particularly for CYSHCN Health Care Reform 201: November 2010

I. Private insurance (2 of 2) l 2011: Health plans must report medical loss ratios – 80 -85% of premiums must spent on clinical services 2014: Preexisting conditions must be covered for all l 2018: Excise tax on high-cost insurance plans l Health Care Reform 201: November 2010

II. Investments in prevention l Prevention and Public Health Fund – $5 B for 2010 through 2014; then $2 B/year l l New Prevention Council/National Prevention Strategy Coverage of Preventative Benefits – Rated A or B by USPSTF, recommended by AAP’s Bright Futures guidelines – Copayments eliminated for new plans now – Eliminates Medicaid cost-sharing in 2011 l Extends EPSDT to all children covered by Medicaid Health Care Reform 201: November 2010

II. Investments in primary care l Workforce investments – $1. 5 billion mandatory funding for the National Health Service Corps – Support 15, 000 primary care providers in shortage areas – $250 million from Prevention Trust Fund – Other appropriations: l l l $168 million for 500 new primary care physicians by 2015 $32 million for more than 600 new physician assistants $30 million to train 600 nurse practitioners $15 million for 10 nurse-managed health clinics $5 million for states to plan and implement innovative strategies to expand their primary care workforce Health Care Reform 201: November 2010

III. Access to coverage (1 of 3) l 32 M more Americans will be insured – Including 9 million kids by 2014 – 2009’s CHIP reauthorization covered 6. 5 M kids (4. 1 M uninsured) Young adults can stay on parents’ plans l Subsidies for private insurance l Expanded eligibility for public insurance l Health Care Reform 201: November 2010

III. Access to coverage (2 of 3) Expands Medicaid coverage to all under 133% of FPL l States will receive 23% increase in CHIP match rate (by 2015) l Community Transformation Grants l – Planning grants to address disparities – Not appropriated Health Care Reform 201: November 2010

III. Access to coverage (3 of 3) l Creation of state-level health insurance exchanges; funding to states starts in 2011, must be established by 2014 – Available those over 400% FPL – List of essential health benefits is in ACA – NASBHC has submitted comments to HHS to urge SBHCs be eligible as an as “essential community provider” Health Care Reform 201: November 2010

IV. Cost Containment (1 of 2) – Use of EMR – Federal review of premium increases – Tax on high-cost plans – Comparative effectiveness research – National quality improvement strategy – Data collection on disparities – Medical home (discussed earlier today) Health Care Reform 201: November 2010

IV. Cost Containment (2 of 2) l Accountable Care Organizations – Movement away from fee-for-service – Toward prevention and wellness, and away from episodic care – $25 M in planning grants from CMS to states for demonstration models allow state to recognize pediatric ACOs (starting in Jan. 2012) Health Care Reform 201: November 2010

Accountable Care Organizations l Local health care organization plus a set of providers – Health care org. : often a hospital? l Providers accountable for – Cost of care – Quality of care (comparative results) l Providers would get cost savings under private or public insurance Health Care Reform 201: November 2010

Accountable Care Organizations Assumes providers, not insurers, know what’s best l Hospitals thought to part of most ACOs: l – Requires managers, not just providers – Requires a continuum of care, needs to plan budget and resource needs, and be able to comprehensively measure performance, Health Care Reform 201: November 2010

IV. Accountable Care Organizations l New concept. Many issues evolving – Design: Physician led? Hospital led? – Will provider participation be mandatory? – How will patients be brought in? – Payment methods? – How to measure quality Health Care Reform 201: November 2010

Key opportunities and other provisions (1 of 2) l l $200 M for SBHC equipment and construction $375 M for teen pregnancy prevention $125 M for [Teen] Pregnancy Assistance Fund $11 B for Community Health Centers – Plus $1. 5 B for CHC construction and renovation Health Care Reform 201: November 2010

Key opportunities and other provisions (2 of 2) l l l $25 M for childhood obesity demonstration programs through 2014 $40 M for CHIP outreach & enrollment Authorizes oral healthcare prevention and education Health Care Reform 201: November 2010

Challenges we are facing l l Implementation in the hands of the states Many funds are authorized but not appropriated What SBHCs will be eligible for with “Meaningful Use” Where SBHCs might fit in the Exchanges, Medical home, ACOs Health Care Reform 201: November 2010

Main Sources Kaiser Family Foundation l AMCHP l New England Journal of Medicine l Health Affairs/RWJF l CRS Reports (www. crsdocuments. com) l Health Care Reform 201: November 2010