State/Local Health Care Reform Efforts

State/Local Health Care Reform Efforts

• 1.
  State and Local HealthCare Reform Efforts DBHIDS Health Care Reform Steering Committee 16 December 2011
• 2.
  Benefits of ACAin Pennsylvania (August 2011)  Medicare  2.3 million Medicare beneficiaries receiving primary care services with no copay  247,686 Medicare prescription drug beneficiaries received $250 tax-free rebates in 2010  Currently, Medicare beneficiaries receiving 50% discount on brand name drugs in donut hole  By 2020 donut hole will be closed  Insurance Reform  7.7 million residents are without lifetime limits on coverage  32,100 young adults received coverage through parent’s plans  657,000 children can not be denied coverage due to pre-existing conditions
• 3.
  Financial Benefits toPA
• 4.
  Recent Happenings PA InsuranceDept. Announcement re: state-based exchange Joan King’s Report, Bringing Together Physical and Behavioral Health Care: An Exploration of Current Practice and Future Directions in Pennsylvania CMS Innovation Challenge Legislative Updates
• 5.
  PA Health Insurance ExchangeUpdate  On November 21 the PA Insurance Dept. announced it would be establishing a statebased Exchange  Released a report by KPMG  Yet, still few details www.pahealthoptions.com
• 6.
  Report Findings
• 8.
  Summary of KPMGReport Exchange Requirements Accessibility Eligibility and Monitoring Support and Assistance Communications and Notifications Demand Estimate that 2-2.2 million individuals would participate in Exchange
• 9.
  KPMG Analysis Active purchaserv. Market Organizer Models Program Integration Organization Quasi-government Non-profit Existing Agency Multi-state Financial Management Governance Technology Certification and Quality Rating Eligibility and Enrollment
• 10.
  Bringing Together Physicaland Behavioral Heath Care by Joan King  Overcoming Geography as a Barrier to Integration  Community Services Group- central Pennsylvania  Overcoming Financing Barriers through an Entrepreneurial Approach  Delaware County Professional Services Group- Philadelphia  Development Across the Continuum  Abbottsford Falls Health Center- Philadelphia  Co-located Integrated  Family Services of Western Pennsylvania- Greater Pittsburgh http://www.dvg.org/resource/resmgr/research_reports/integratedca rereport-final_2.pdf
• 11.
  Legislative Update  SB1336 Passed in General Assembly  Pro: Large commercial plans will be subject to some type of review  Cons: Allows insurers to file rate hikes up to 10% with no review  Rate hikes can take place without pre approval  Information does not need to be made public  No protections for small businesses (e.g. businesses do not have a right to a hearing; reserved for insurance companies only)
• 12.
  CMS Innovation Challenge Providing up to $1 billion in grants to “innovative” projects  DBHIDS Involvement  Received interest to participate with 12  Criteria: organizations  Engage partners to identify and  Providing letters of support, test new delivery and payment descriptive data and limited models advisory support  Identify new workforce models  Support innovators who can rapidly deploy (6 months or less)  Goals: better health, improved care and lower costs to people enrolled in Medicare, Medicaid and CHIP
• 13.
  Happy Holidays!