Will Humble Uncategorized, Wills Blog

Senate Bill 1092 was passed in 2015 requiring AHCCCS to apply the Centers for Medicare and Medicaid Services (CMS) for a waiver or amendments to the current Section 1115 Waiver to allow the State to implement new eligibility requirements for “able-bodied adults”.

AHCCCS initially proposed implementing the following requirements for “able-bodied adults” receiving Medicaid services:

  • The requirement for all able-bodied adults to become employed or actively seeking employment or attend school or a job training program.
  • The requirement for able-bodied adults to verify on a monthly basis compliance with the work requirements and any changes in family income.
  • The authority for AHCCCS to ban an eligible person from enrollment for one year if the eligible person knowingly failed to report a change in family income or made a false statement regarding compliance with the work requirements.
  • The authority for AHCCCS to limit lifetime coverage for all able-bodied adults to five years except for certain circumstances.

Hundreds of comments were submitted urging the agency to consider modifications to the initial waiver request.  While AHCCCS hasn’t released the content of their final waiver request, they did issue a letter last week (link below) outlining what they intend to include in the Waiver.

It’s a lengthy letter and I can’t summarize it all here- but interestingly- it includes a wider list of persons that would be exempt from the initial eligibility restrictions (which already included persons with disabilities) including:

  • Persons over 55 years old;
  • Foster persons up to 26 years old;
  • Full time college and graduate students;
  • Victims of domestic violence;
  • Homeless persons; and
  • Parents of kids less than 13 years old.

We’ll continue to track this when the final waiver request is released.

AHCCCS Waiver Concept Letter (11/2017)
Will Humble Community Health Workers, Wills Blog

AzPHA Public Health Policy Update: November 29, 2017

Community Health Worker “Sunrise” Passes Committee!

The Joint Health Committee of Reference heard detailed testimony on the Sunrise Applications turned in by the Community Health Workers Association, the Arizona Naturopathic Medical Association, and Dental Care for AZ.

They gave a favorable recommendation for the Community Health Worker and Dental Therapist applications but didn’t approve the Arizona Naturopathic Medical Association request.

The Community Health Workers are asking for a pathway to set up a process for voluntary registration of CHWs; the Arizona Naturopathic Medical Association would like permission for Naturopaths to sign medical waivers from the state’s school vaccination requirements and Dental Care for AZ asks for authorization from the legislature to license a new class of dental professionals called Dental Therapists.

We took positions for the CHW proposal and against the Naturopath’s proposal.  We were neutral on the dental therapy application.

The committee’s recommendations will be sent to the Governor, President of the Senate, and Speaker of the House of Representatives.  This week’s vote doesn’t mean that Community Health Worker Voluntary Certification will become law.  For that to happen, the proposal needs to be put into a Bill format, get a sponsor, pass the House and Senate and then get signed by the Governor.

Congratulations to the Arizona Community Health Workers Association for their diligent work preparing their Sunrise Application and for working with stakeholders and partners to set up the infrastructure needed to implement their vision including developing core competencies, training and certificate education, and internship opportunities.  

Also, a huge shout out to the Vitalyst Health Foundation for financially supporting this kind of community health initiative through their grant programs!

Next step- Voluntary Certification!

 

AHCCCS Finds Temporary Solution for KidsCare

AHCCCS found a temporary contingency plan to keep Arizona’s Kids Care program going for the next few months.  AZs KidsCare program covers about 24,000 kids in lower income families.  The program provides low-cost health insurance to children whose parents earn too much to qualify for Medicaid but still make less than 200% of the federal poverty level (about $40,840 for a family of 3).  It’s not free, but premiums are reasonable (less than $50/month for one kid or $70 for multiple children.

Hopefully Congress will take action to extend the current CHIP Program (our CHIP program is called Kids Care) in the next few weeks. In the mean-time, AHCCCS has indicated that that they’ll use money from their regular Medicaid program to support the current program.  They indicated this week that there are only enough funds in the account to keep the KidsCare premiums paid into March 2018.

You can urge Senators McCain and Flake to reauthorize full funding of the Children’s Health Insurance Program by contacting  Sen. McCain at: (202) 224-2235 or (602) 952-2410 and Sen. Flake at: (202) 224-4521 or (602) 840-1891.

 

CDC CME on Seasonal Influenza Vaccine Recommendations

CDC has a new and free continuing education opportunity regarding updated recommendations from the Advisory Committee on Immunization Practices on the use of seasonal influenza vaccines.  Here’s a description for Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2017–18 Influenza Season.

The learning objectives for the CME are to:

1.   Describe available influenza vaccines for the 2017–18 season, based on updated ACIP recommendations;

2.   Describe new and updated information and recommendations regarding influenza vaccination during the 2017–18 season, based on updated ACIP guidance; and

3.   Describe contraindications and precautions regarding influenza vaccination during the 2017–18 season, based on updated ACIP recommendations. 

You can access this free activity by visiting: https://www.cdc.gov/mmwr/cme/medscape_cme.html

You can register for free or login without a password and get unlimited access to all continuing education activities and other Medscape features.

 

Non-addictive Painkillers as Effective as Opioids
In a new study of patients who showed up to an emergency department, researchers found that a cocktail of two non-addictive, over-the-counter drugs relieved pain just as well as – and maybe just a little better than – a trio of widely prescribed opioid pain medications.

The trial involved 416 patients who entered Montefiore Medical Center’s Emergency Department in the Bronx with painful injuries. About 20% of them were diagnosed with a bone fracture. The rest suffered injuries such as a sprained ankle, a dislocated shoulder or a banged-up knee. Upon arrival, the patients were assigned to one of four groups. 

One group got a combination ibuprofen/acetaminophen tablet, containing the medications found in Advil and Tylenol. The other groups got a drug that contained a prescription narcotic, such as Percocet, Vicodin or Tylenol No. 3. Researchers asked patients to rate their pain upon arrival and two hours after they got their medication. Patients who got the acetaminophen/ibuprofen treatment reported pain relief just as substantial as did the patients who got one of the opioid painkillers.

Click here for the study and here for a news report.

Will Humble Medicaid, Wills Blog

AzPHA Public Health Policy Update – November 22, 2017

Az Supreme Court Upholds Hospital Assessment & Medicaid Restoration

There was a super important ruling last week by the State Supreme Court.  They decided that the hospital assessment authorized by the Legislature and enacted by AHCCCS to pay the state match for restoring “childless adult” eligibility back in ’13 was legal.  The effect of the ruling is that Governor Brewer’s initiative to restore and expand Medicaid stands.

Here’s an excerpt of what the court decided in their ruling last week.

“We hold that the hospital assessment is not subject to article 9, section 22 of the Arizona Constitution, which generally requires that acts providing for a net increase in state revenues be approved by a two-thirds vote in each house of the legislature.  This requirement does not apply to statutorily authorized assessments that “are not prescribed by formula, amount or limit, and are set by a state officer or agency.”  Ariz. Const. art. 9, § 22(C)(2).  Because the exception applies here, we reject the constitutional challenge to the assessment.”

The issue is now finally put to rest with last week’s ruling because the state’s highest court has found that the hospital assessment is a “… statutorily authorized assessment that is not prescribed by formula, amount or limit, and is set by a state officer or agency”.

 

Preventing and Controlling Infectious Disease Takes a Village

The public health system is an interconnected group of folks that use evidence based practices to improve the health of communities.  At first, one might think that the public health system consists of the CDC and state and county health departments.  The public health system is a whole lot bigger than that.

A public health system not only includes public health agencies at state and local levels, but also includes healthcare providers of all types, public safety and first responders, healthcare institutions, clinical and public health labs, human service and charity organizations, education and youth development organizations, recreation and arts-related organizations, economic and philanthropic organizations, and environmental agencies and organizations.

In many ways, the public health’s system to prevent and control the spread of infectious disease reflects some of the complexity of the public health system. The Arizona Department of Health Services published new rules (called Administrative Code) to govern infectious disease prevention and control that go into effect on January 1.  A review of those rules gives you a picture of the various players that assist the public health system to prevent and control the spread of infectious diseases.

 

New Communicable Diseases Reporting Rules

For the last 18 months the ADHS has been working with stakeholders in the public health system on revisions to the “Communicable Diseases and Infestation Reporting” rules for reporting and controlling infectious diseases.  The new rules will go into effect on January 1.

What are the rules? They determine which communicable diseases need to be reported, by whom, how quickly, and what information needs to be included (Article 2).  They also outline the intervention measures that various players should follow to prevent further disease spread (Article 3).  You’ll see that the interventions (described in Article 3) are the responsibility of many different entities: local public health departments, healthcare providers and institutions, and vector control agencies, among others.

One thing that’s really striking is how much of the heavy lifting is done by the local health departments.  One glance at the “control measures” shows you how much of the boots on the ground public health work is done at the local health department level in coordination with healthcare providers, schools, restaurants, and patients and their families.

Why were the rules changed? They were updated to include emerging diseases (e.g. Zika), account for changes in technology like new laboratory methodologies and electronic reporting, and to remove unnecessary requirements and improve clarity.

What will change? Reporting requirements for healthcare providers and clinical laboratories have been modified, with the removal of several conditions (e.g., aseptic meningitis, genital herpes; the addition or clarification of others (e.g., Zika, spotted fever rickettsiosis, carbapenem-resistant Enterobacteriaceae); and changes in timeframes for reporting of various specific conditions or organisms. 

For control measures, changes include: requiring inter-facility notification when persons with an active infection of a multidrug-resistant organism are transferred to a new healthcare facility; modifying the testing and criteria allowing persons in certain jobs to return to work after an illness (e.g. food handlers); giving more discretion to local public health officials for determining when people with certain illnesses can return to their usual activities; exclusions from aquatic venues (e.g. pools) for people with certain enteric illnesses; environmental assessments for several emerging mosquito-borne infections; and language to help county health departments issue additional control measures.  

Who should report? Health care providers, health care institutions and correctional facilities; and schools, child care establishments and shelters should report to their local health department. 

Clinical laboratories report to the ADHS.  These groups each have their own reporting requirements (see Article 2). State and local health departments work closely to use these reports to maintain statewide surveillance, conduct case investigations, and implement control measures. 

Where to find more information? More information about communicable disease reporting requirements can be found at http://azdhs.gov/reporting.  A copy of the new rules can be found at New Article 2 and 3 Rules, effective January 1, 2018 until published by the Secretary of State.   

Below is an example of what some of the reporting and control regulations look like.  I used Measles as an example because it gives a dynamic picture of the things that need to be done when there is a case of measles in the community.

R9-6-355. Measles (Rubeola)

Case control measures:

An administrator of a school or child care establishment, either personally or through a representative, shall:

·         Exclude a measles case from the school or child care establishment and from school- or child-care-establishment-sponsored events from the onset of illness through the fourth calendar day after the rash appears; and

·         Exclude a measles suspect case from the school or child care establishment and from school- or child-care-establishment-sponsored events until the local health agency has determined that the suspect case is unlikely to infect other individuals.

A diagnosing health care provider or an administrator of a health care institution, either personally or through a representative, shall isolate and institute airborne precautions for a measles case from onset of illness through the fourth calendar day after the rash appears.

An administrator of a health care institution, either personally or through a representative, shall exclude a measles:

·         Case from working at the health care institution from the onset of illness through the fourth calendar day after the rash appears; and

·         Suspect case from working at the health care institution until the local health agency has determined that the suspect case may return to work.

A local health agency shall:

·         Upon receiving a report under R9-6-202 or R9-6-203 of a measles case or suspect case, notify the Department within 24 hours after receiving the report and provide to the Department the information contained in the report;

·         Conduct an epidemiologic investigation of each reported measles case or suspect case;

·         For each measles case, submit to the Department, as specified in Table 2.4, the information required under R9-6-206(D); and

·         Ensure that one or more specimens from each measles case or suspect case, as required by the Department, are submitted to the Arizona State Laboratory.

An administrator of a correctional facility or shelter, either personally or through a representative, shall comply with the measles control measures recommended by a local health agency or the Department. When a measles case has been at a school or child care establishment, the administrator of the school or child care establishment, either personally or through a representative, shall:

·         Consult with the local health agency to determine who shall be excluded and how long each individual shall be excluded from the school or child care establishment, and

·         Comply with the local health agency’s recommendations for exclusion.

·         A local health agency shall determine which measles contacts will be quarantined or excluded, according to R96-303, to prevent transmission; and provide or arrange for immunization of each non-immune measles contact within 72 hours after last exposure, if possible.

An administrator of a health care institution shall ensure that a paid or volunteer full-time or part-time worker at a health care institution does not participate in the direct care of a measles case or suspect case unless the worker is able to provide evidence of immunity to measles through one of the following:

·         A record of immunization against measles with two doses of live virus vaccine given on or after the first birthday and at least one month apart;

·         A statement signed by a physician, physician assistant, registered nurse practitioner, state health officer, or local health officer affirming serologic evidence of immunity to measles; or

·         Documentary evidence of birth before January 1, 1957.

 

November Month’s AZ Asthma Coalition Meeting

Wednesday, November 29th from 3:00 – 5:00 pm

Super-Brain Approach to Tobacco Cessation

Mercy Care Plan and Mercy Maricopa Integrated Care developed a “gold standard tobacco cessation program” in partnership with ASHLine. During this presentation, you’ll learn about this system-level program and the importance of partnerships to achieve a collective impact which Mercy Care refers to as the Super-Brain Approach to tobacco cessation.

Date:    Wednesday, November 29, 2017 from 3:00 to 5:00 p.m.

Location: Vitalyst Health Foundation, 2929 N Central Ave, Suite 1550, Phoenix

Join at https://zoom.us/j/466379282 or Telephone: US: +1 646 876 9923 or +1 669 900 6833 or +1 408 638 0968

Will Humble Social Determinants, Wills Blog

AzPHA Public Health Policy Update- November 16, 2017

AZ’s New Minimum Wage Law Expected to Improve Infant Mortality

We’ve known for a long time in public health that a primary driver of health status is family income.  More family resources generally result in better health outcomes. New data suggest (not surprisingly) that increases in the minimum wage result in lower infant mortality.

Could the passage of Proposition 206 in November of 2016 be an evidence-based public health intervention that will lower infant mortality in Arizona?  The answer is yes!

In 2014, Arizona’s infant mortality rate was 6.2 deaths per 1,000 live births- well above other comparable countries including Japan (2.1), France (3.5), and the UK (3.9).  The national rate in the US is 5.8/1,000.  Here are Arizona’s Infant Mortality Rates: PDF | Excel

A team of researchers recently published a study in the American Journal of Public Health examining the effects of state minimum wage laws on infant mortality and low birthweight rates.  They found that a $1 increase in the minimum wage is associated with a 4% decrease in infant mortality and a 1% to 2% decrease in low birthweight births.  They concluded that…  “if all states in 2014 had increased their minimum wages by $1 dollar there would likely have been 2,790 fewer low birthweight births and 518 fewer post-neonatal deaths for the year.”

This research adds to a growing scientific literature on the beneficial effects of various income supports on improved birth outcomes and reinforces the fact that social determinants of health related to income have a significant impact on population and public health outcomes.

Of course, there are many factors at play when it comes to infant mortality and low birth weight- but it looks like Proposition 206, which raised the minimum wage in AZ to $10 this year and to $12 by 2020 will help us on our quest to improve Arizona’s infant mortality and low birth weight rates. 

 

AzPHA’s Positions on the Sunrise Hearings

Whenever health related professions ask to be regulated or want to expand their scope of practice a state law says that the regulation needs to be done only to protect the public interest.  Applicants that want to go through the process need to submit a report to the state legislature explaining the factors demonstrating that their request meets these standards.

A “Committee of Reference” studies the sunrise applications and delivers its recommendations to House and Senate leadership. This year there are 3 applications in the hopper and they’ll be heard on Tuesday, November 28 starting at 9 am in the House of Representatives.

In a nutshell, the Community Health Workers Sunrise Application asks for a pathway to set up a process for voluntary registration of CHWs; the Arizona Naturopathic Medical Association would like permission for them to sign medical waivers from the state’s school vaccination requirements; and the Dental Care for AZ Sunrise Application asks for authorization from the legislature to license a new class of dental professionals.

Here are AzPHA’s statements to the House and Senate Committee of Reference for the upcoming November 28 Sunrise Hearings.  We’re taking positions on the CHW and Naturopath Sunrise Applications (but not the Dental Therapist application).

 

Arizona Community Health Workers Association

We urge the Committee to recommend approval of the application submitted by the Arizona Community Health Workers Association for Certification/Registration for Community Health Workers.

Community Health Workers (CHWs) are an established group of health professionals that build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support, and advocacy. 

A variety of agencies use CHWs to serve communities in ways including access to primary care, prenatal care, chronic disease self-management, long-term care, utilization of services, and behavioral health.  CHW services are effective at improving health outcomes and reducing costs and providing a unique opportunity for provider groups as they increasingly adopt value-based purchasing practices.

There is currently no simple way for health care providers and members of the community to verify that a CHW is proficient in core competencies. Certification and registration will assure that CHWs meet minimum standards including education, continuing education, training, experience, and other qualifications. With certification and registration, payors reimbursing CHWs for services would have clarity about CHWs core competencies and their scope of practice allowing this workforce to become integrated with a medical team and/or in the community.

CHWs work with vulnerable populations. Registration of CHWs meeting minimum standards is essential for patient safety by assuring that CHWs have a background check, follow HIPAA regulations, and safeguard against inappropriate actions and/or behaviors.

In short, we are supportive of this application because CHW services are effective at improving health outcomes and reducing costs. In the absence of certification/registration, the community cannot be assured of CHWs’ core competencies, scope of practice, and that procedures are in place to safeguard patients.

 

Arizona Naturopathic Medical Association

We urge the Committee to recommend denial of the application submitted by the Arizona Naturopathic Medical Association to expand their scope to include medical exemptions from Arizona’s school vaccination requirements.

The Arizona Public Health Association is concerned about several aspects of this application, most importantly, that it could further erode Arizona’s vaccination rates resulting in the loss of herd immunity. 

We believe that medical exemptions are an important component of Arizona’s school vaccine requirement system. However, medical exemptions should be signed by physicians that are current with the latest scientific literature regarding vaccines. New vaccinations and combinations of vaccinations are approved on an ongoing basis by the Food and Drug Administration and are evaluated consistently by the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP).

Guidance and recommendations from the CDC and ACIP are critical for physicians to understand the nuances of the various vaccines, their complex schedules, and data regarding evidence-based reasons for medical exemptions.  Medical exemptions are best signed by physicians that are current with these resources.

Our review of data regarding vaccines suggest that Naturopathic Physicians provide very few vaccinations in Arizona (less than 0.01% of all vaccinations in Arizona are provided by Naturopaths).  Because so few Naturopathic Physicians (NDs) provide vaccines, our concern is that they will not be well informed about when a medical exemption is appropriate, and that some NDs will err on the side of signing medical exemptions rather than study the detail provided by the FDA, CDC and ACIP. There is also a risk that a relatively small number of NDs could sign large numbers of medical exemptions and jeopardize herd immunity.

We urge the Committee to recommend denial of the application submitted by the Arizona Naturopathic Medical Association to expand their scope to include medical exemptions from Arizona’s school vaccination requirements.

 

Restaurant Calorie Labeling Back on Track?

One of the things that was tucked into the Affordable Care Act was a provision that requires restaurants with 20 or more locations to post calorie content information for standard menu items directly on the menu and menu boards- a potentially powerful public health intervention in our effort to reduce obesity.

The FDA issued proposed draft regulations way back in 2011… but various delays have kept the rules from being implemented (by both the Obama and Trump Administrations).  Some places have been voluntarily posting nutrition information- but it’s still not officially required.

This kind of nutrition clarity is a real opportunity for public health change.  Not only will the new labels give the public key information to help them make better decisions about what they buy for themselves and their families- it’ll give pause to restaurants before they label their menus- giving them an opportunity to change ingredients to lower calorie counts.  It may even spur a trend away from “super-sizes” and toward more appropriate and reasonable serving sizes.  With 32% of the calories consumed in the US tied to eating outside the home- this is an important opportunity.  

Last week the FDA released draft implementation guidance addressing menu labeling issues like caloric disclosure, compliance and enforcement, and marketing materials.  The new guidance suggests that the compliance start day will now be May of 2018.

The new draft guidance includes expanded and new interpretations of policy, and identifies places where FDA intends to be more flexible in its approach. It also includes many graphical depictions conveying the FDA’s thinking on various topics and provides examples of options for implementation.

The new guidance addresses calorie disclosure signage for self-service foods like buffets, various methods for providing calorie disclosure information (including pizza which has been a big hang-up because its’ so often delivered), and compliance and enforcement.

 

President Nominates New HHS Secretary
The President selected Alex Azar, a former pharmaceutical executive and a top health official during the George W. Bush administration, to lead HHS. Azar also served as president of Lilly USA (an affiliate of Eli Lilly and Co.) and as a health-care consultant. During the Bush administration he was chief counsel a deputy director.

He has been highly critical of the ACA and supports converting Medicaid from an entitlement program into block grants. However, Dr. Georges Benjamin (Executive Director of the American Public Health Association, said “Azar is far less partisan than his predecessor. He’s smart, practical, listens to all sides…  We’ve got somebody whose heart is in the right place.” Time will tell.

 

Open Enrollment for Marketplace Health Insurance

The Affordable Care Act remains the law, and insurance enrollment for Arizonans runs through 12/15.  The University of Arizona Center for Rural Health (AzCRH) has certified staff (Navigators) to answer questions and help you enroll in health insurance coverage. Navigator services are free http://crh.arizona.edu/programs/navigator

Will Humble Opioids, Wills Blog

AzPHA Public Health Policy Update: November 9

AzRHA & AzPHA Webinar Tomorrow RE 2018 Legislative Session

Tomorrow we’ll be participating in a joint webinar regarding next year’s legislative session entitled: “Anticipating 2018!!! Arizona’s Fifty-Fourth State Legislature”.  It’s organized by the Arizona Rural Health Association in cooperation with AzPHA and the UA’s Telemedicine Program. You can tune in from 1-2:30 pm Thursday by visiting https://streaming.biocom.arizona.edu/event/?id=27824.

More information is on AzRHA’s website www.azrhassociation.org or by contacting Claudia Gonzalez at [email protected].

 

National Opioid Commission Recommendations

Last week the President’s Commission on Combating Drug Addiction and the Opioid Crisis released its final report setting out 56 recommendations for addressing the national opioid crisis. The recommendations address issues like federal funding and programs, opioid addiction prevention like prescribing guidelines, prescription drug monitoring programs, and supply reduction and overdose reversal.

You’ll remember that the Acting Secretary for HHS declared that the national opioid epidemic is a Public Health Emergency. Here’s the Secretary’s one sentence declaration.  Presumably some of the recommendations from last week’s final report will make their way into the various HHS agency policies (e.g. CMS). The report is quite long so I didn’t have time to read it all – but this did catch my eye:

“A key contributor to the opioid epidemic has been the excess prescribing of opioids for common pain complaints and for postsurgical pain. Although in some conditions, behavioral programs, acupuncture, surgery, as well as FDA-approved multimodal pain strategies have been proven to reduce the use of opioids, while providing effective pain management, current CMS reimbursement policies create barriers to the adoption of these strategies. In the third Commission meeting, the Commission heard about the need for proper reimbursement of non-opioid pain medications to increase uptake among healthcare providers and limit the use of opioids.”

 

Free Online CME Credits for Arizona Prescribers

There’s increasing evidence that opioid medications are over-prescribed and poorly managed because prescribers aren’t aware of appropriate opioid risk management strategies and non-opioid approaches to treating chronic pain. A new and free Continuing Medical Education course is now available to familiarize prescribers with current guidelines for opioid use and prescribing & educate prescribers about non-opioid strategies for pain management.

Opioid Prescribing CME Courses: Responding to the Public Health Emergency Available Online at:  http://www.vlh.com/AZPrescribing/

Learning Objectives:

  • Manage acute and chronic back pain
  • Assess the functional effects of pain in patients.
  • Appropriately utilize a range of therapeutic options when managing patients with chronic pain.
  • Comply with current opioid risk-management practices, including the use of pain contracts and urine drug testing.
  • Educate patients on the proper use, storage, and disposal of opioid medications.

Cost: FREE for Arizona Prescribers   

Arizona Prescribers Registration:  http://www.vlh.com/AZPrescribing/

Supported by a grant through the Governor’s Office for Children, Youth and Families. Developed in Partnership with Arizona Prescription Drug Misuse & Abuse Initiative, University of Arizona College of Public Health, University of Arizona College of Medicine & ADHS.

 

Information about HHS’ Proposed Rules RE: Marketplace Insurance

HHS published an annual set of proposed rules for the Affordable Care Act marketplaces on October 27. Called the “Notice of Benefit and Payment Parameters,” the rules set out expectations for insurers and the states that regulate them.  

It’s a really long proposed Rule and I haven’t been able to find the time to analyze it all (nor am I really capable of doing a detailed analysis) but I found a pretty good summary regarding the proposals.  The proposed Rule changes focus on: 1) Essential Health Benefits; 2) Qualifying Health Plan Certification Standards; 3) Rate Reviews; 4) Medical Loss Ratios; and 5) Risk Adjustment.

 

New Bulletins from CMS about Waiver Reviews & Approvals

Last week CMS released two information bulletins outlining activities they say they’ll undertake to improve the transparency and efficiency of the various processes for Medicaid Waivers and State Plan Amendment review and approvals. The 2 bulletins are procedural commitments to move waivers and SPAs more quickly through the review and approval process.

The “State Plan Amendment and 1915 Waiver Process Improvements to Improve Transparency and Efficiency and Reduce Burden” bulletin and the “Section 1115 Demonstration Process Improvements” bulletin are both online at https://www.medicaid.gov/federal-policy-guidance/federal-policy-guidance.html

 

First Things First Parent Kit

From the day a child is born, the care, attention, love and support they experience lays the foundation for their future. The First Things First Parent Kit is online to help you meet the challenges of being a parent and do your best in supporting the healthy development of your baby, toddler or preschooler.

You’ll find information and resources on child development, health and safety, quality child care and school readiness:  Go to the Parent Kit.

Will Humble Affordable Care Act, Wills Blog

AzPHA Public Health Policy Update- November 2, 2017

ASU’s Executive Fellowship in Health Policy Accepting Applications

ASU’s College of Nursing and Health Innovation has developed a new fellowship program for health professionals interested in policy and advocacy and is taking applications through November 30th. The Executive Fellowship in Health Policy is a one-year cohort-based program, providing health leaders in-depth insights into the public policy world. Fellows will build connections and skills enabling them to lead change within their organizations to advocate for the work that they do and the populations they serve.

Fellows will also learn about health policy directly from the people who shape it. Through in-person immersions, webinar presentations, and online modules, lawmakers and health advocates from around the country will provide an intimate look at the politics and policy changes actively shaping our health systems today. Faculty mentors will guide and support Fellows to further develop their skills as effective health advocates through the creation of a tangible project based on a real-world situation from their organization.

The program has been developed by Faculty Director and Assistant Dean Heather Carter, EdD. Her vision for this new program is to empower health professionals to be more involved in the health policy arena. In addition to her work at ASU, Dr. Carter serves as an Arizona State Representative & Chairwoman of the House Health Committee.

The program is currently accepting applicants through November 30, 2017. Program tuition is $16K for the year, plus travel expenses for two in-person immersions located in Phoenix, AZ and Washington, D.C.

More information about the Fellowship and the application process can be found at efhp.asu.edu, or by contacting the project manager at [email protected] or 602-496-0414.

 

North Country HealthCare Receives Accreditation for Residency Program

Congrats to North Country HealthCare for achieving final accreditation last week from the Accreditation Council for Graduate Medical Education for their Family Medicine Residency Program.  The new program will improve access to comprehensive, affordable, culturally competent primary care across northern Arizona by increasing the number of practicing primary care physicians for years to come.

The program will engage family medicine residents in rotations throughout North Country HealthCare’s service region of Coconino, Mohave, Navajo and Apache Counties with rural rotations in Tuba City, Polacca and Whiteriver.

This novel residency program will help prepare family medicine physicians for autonomous practice in rural and frontier northern Arizona and will be the only graduate medical education program in the country with a required rotation in Indian Country.

A huge shout out to AzPHA member and NAHEC Executive Director Sean Clendaniel, MPH who’s the brain-child and work-horse behind the effort. Next we need to replicate the model in other areas of rural AZ. 

We all know that we have an acute physician shortage in rural AZ- and rural residency programs are probably the single most effective long-term tool we have to intervene- because where a physician does their residency has a huge impact on where they decide to practice.

 

Open Enrollment for Marketplace is Here through December 15

Open enrollment for the Marketplace insurance plans under the Affordable Care Act started today and runs through December 15.  We’re recommending that folks that are interested in getting their health insurance through the federal Marketplace by going to  coveraz.org/connector first (rather than healthcare.gov) because the assisters and navigators at coveraz.org/connector are more familiar with the AZ products as well as our state’s Medicaid programs.

Make sure everyone who needs coverage knows this: a convenient assister appointment is just clicks away, at coveraz.org/connector or by calling the Coalition’s statewide assistance line at 800-577-3536.

 

CMS Proposes New Rule Letting States Define their Own “Essential Health Benefits”

Late last Friday the Centers for Medicare and Medicaid Services released a proposed rule that would allow states to define the minimum essential health benefits that health insurers selling plans on the Affordable Care Act exchanges are required to offer. 

The proposed rule would give states greater latitude in choosing which benefits insurers must cover.  Perhaps most significantly, it would allow states to choose a benchmark plan from wider pool of existing plans including health plans from other states. Each state’s “benchmark plan” defines what essential benefits other Marketplace plans must cover. Right now, Governors choose each state’s benchmark plan from a list of existing state plans in various categories.  Governors Brewer & Ducey each chose the State of Arizona EPO Employee Health Plan as Arizona’s benchmark.

CMS’ stated goal is to give states more flexibility that could potentially lead to more affordable health plan options in 2019. They concede the changes some states will make will result in less comprehensive plans and dropped services.

The ACA requires health plans on the individual and small group markets to cover 10 minimum essential health benefits including emergency services, hospitalization, prescription drug coverage, maternity care and care for mental health and substance abuse disorders.  What this new proposal essentially does is allow states to weaken (but not eliminate) the 10 essential services. The proposal bars states from making their essential health benefits more generous than they are currently.

For example, if the new rule is implemented, states could choose an employer plan with 5,000 enrollees that excludes inpatient mental health services or coverage for HIV or AIDS as their benchmark- and that plan would be considered OK.

The proposed rule is almost 400 pages long.  AzPHA is planning to work with other stakeholders in Arizona and coordinate comments to CMS on their proposed rule.

 

House Vote this Week Would Cut the Prevention & Public Health Fund

This week the U.S. House will be voting on a bill that will cut critical funding from the Prevention and Public Health Fund to offset the cost of funding community health centers and other important health programs that have expired.

Established in 2010 as the nation’s first funding stream dedicated to improving public health, the Fund invests over $9 million per year to protect Arizona from disease outbreaks and to reduce downstream health care costs.  We wrote a report that examines the Fund’s investments in Arizona, which include immunizations, smoking cessation, diabetes prevention, opioid treatment, and more.

While AzPHA supports reauthorizing funding for community health centers and the National Health Service Corps, we don’t support doing it at the expense of the prevention fund and the important public health programs that already depend on this funding.

Take the time to contact your representative and tell them to oppose the CHAMPION Act and any future effort to undermine the integrity of the Prevention and Public Health Fund!

 

HHS Acting Secretary Declares Opioid Epidemic a Public Health Emergency

Last week the Acting Secretary for HHS declared that the national opioid epidemic is a Public Health Emergency under Section 319 of the Public Health Service Act. Here’s the Secretary’s one sentence declaration.

Section 319 authorizes the HHS Secretary to lead federal public health and medical response to public health emergencies, determine that a public health emergency exists, and assist states in their response activities.

The Secretary’s declaration was only one sentence long- so there’s not much detail about what they might do, but among the things that HHS could do are: 1) waive or modify certain requirements under Medicare, Medicaid and HIPAA; 2) waive certain prescription and dispensing requirements; and 3) adjust Medicare reimbursement for certain Part B drugs.

The most meaningful things that they could do include;

  • Removing the Medicaid Institutions for Mental Diseases (IMD) exclusion to allow facilities to receive reimbursement for substance abuse treatment (the IMD exclusion prohibits the use of Medicaid financing for care provided to most patients in residential treatment facilities larger than 16 beds);

  • Allowing Medicaid to pay for substance abuse treatment in correctional facilities; and

  • Allowing physicians to treat more patients with Suboxone.

Right now we don’t know which if any of these things HHS will choose to do because they haven’t disclosed their plans and the one sentence emergency declaration provides no detail.