10,000 working parents in Arizona to lose health insurance (click title to entry - thank you)
State is unable to provide matching funds for federal program
by Casey Newton
Sept. 8, 2009 12:00 AM
The Arizona Republic
Nearly 10,000 working parents will lose their health insurance this month in the wake of state budget cuts, leaving some families with nowhere to turn as they seek affordable coverage.
KidsCare Parents, a program that provides low-income families with inexpensive insurance, will end Sept. 30. The Arizona Health Care Cost Containment System, which administers the program, could not pay the $6 million annual cost following cuts by the Legislature. The state faces a $3 billion budget shortfall.
The move comes as demand for government assistance is skyrocketing. Arizona has lost an estimated 240,000 jobs since December 2007, and AHCCCS has added 150,000 people to its rolls since January....
September 8, 2009 4:14 PM
Sen. Reid: Health Reform 90 Percent Done (click here)
Posted by Stephanie Condon
After meeting with President Obama and House Speaker Nancy Pelosi, Senate Majority Leader Harry Reid said today that health care reform is 90 percent done and that Republicans still have a seat at the negotiating table. President Obama has often said that Republicans and Democrats can agree on 80 percent of the health care reforms Congress should enact -- that it is the remaining 20 percent that has stalled legislation. "In our conversations today, we think we're up to 90 percent," Reid said from outside the White House. "We have 10 percent to work on, and we can do that."...
One of the purposes to USA health insurance reform is to promote efficient use of infrastructure while giving our citizens incentives to improve their longevity through good health practices. This section of the bill addresses ways to achieve better 'performing' health care keeping in mind the end result is to be a healthier and happier populous.
Page 443, Lines e through 21:
TITLE III—PROMOTING PRIMARY CARE, MENTAL HEALTH SERVICES, AND COORDINATED CARE
SEC. 1301. ACCOUNTABLE CARE ORGANIZATION PILOT PROGRAM.
Title XVIII of the Social Security Act is amended by inserting after section 1866C the following new section:
‘‘ACCOUNTABLE CARE ORGANIZATION PILOT PROGRAM
‘‘SEC. 1866D. (a) IN GENERAL.—The Secretary shall conduct a pilot program (in this section referred to as the ‘pilot program’) to test different payment incentive models, including (to the extent practicable) the specific payment incentive models described in subsection (c), designed to reduce the growth of expenditures and improve health outcomes in the provision of items and services under this title to applicable beneficiaries (as defined in subsection (d)) by qualifying accountable care organizations (as defined in subsection (b)(1)) in order to—
No one expects change to the American populous overnight. That is especially true for the people that already have health insurance. It is even more true for Americans that are lucky enough to belong to health insurance plans that provide incentives for better health through reductions in cost.
So, short of requiring every American to achieve The President's Physical Fitness Award, there can be models of new modalities of providing health care that will also provide 'feedback' regarding ways to incentivize a better more efficient health care delivery system that provides better outcomes to Americans.
This section addresses the opportunity to improve health care delivery and outcomes of patients. After all what good is health care insurance reform if does nothing about improving the outcome of patients?
Page 444, Lines 7 through 15:
‘‘(b) QUALIFYING ACCOUNTABLE CARE ORGANIZATIONS (ACOS).—
‘‘(1) QUALIFYING ACO DEFINED.—In this section:
‘‘(A) IN GENERAL.—The terms ‘qualifying accountable care organization’ and ‘qualifying
ACO’ mean a group of physicians or other physician organizational model (as defined in sub15
paragraph (D)) that—
It is interesting. This section of the Bill provides for monetary incentives to physicians and groups of physicians that provide documentable improvements in their patient conditions while reducing the cost of care delivery. If there is no remarkable improvement there will be no paid incentive. The section doesn't ask for payment to the Secretary if the circumstances prove to worsen though. Now, that would be a sincere disincentive.
Page 447, lines 1 through 14:
‘‘(E) The group provides notice to applicable beneficiaries regarding the pilot program (as determined appropriate by the Secretary).
‘‘(F) The group contributes to a best practices network or website, that shall be maintained by the Secretary for the purpose of sharing strategies on quality improvement, care coordination, and efficiency that the groups believe are effective.
‘‘(G) The group utilizes patient-centered processes of care, including those that emphasize patient and caregiver involvement in planning and monitoring of ongoing care management plan.
The 'idea' of posting outcomes of these pilot programs to a 'Best Practices Network or Website' reminds me of the 'short track' to medication approval by the FDA should it prove to be more a miracle medication than expected.
By posting statistics to the 'Best Practices Network' physicians from around the country can learn how to best streamline their practices to help improve patient outcomes while holding down costs.
It also is a 'transparent' method to monitor these programs so there can't be any abuse or short cuts that might actually compromise patient outcomes and safety. And there is nothing like Peer Review among providers regardless their specialty or credentials. I imagine one of the most frequent visitors might be administrators as well as Physician Peers.
Page 450, lines 1 through 12:
‘‘(i) IN GENERAL.—Subject to clause
(ii), a qualifying ACO that meet or exceeds annual quality and performance targets for a year shall receive an incentive payment for such year equal to a portion (as determined appropriate by the Secretary) of the amount by which payments under this title for such year relative are estimated to be below the performance target for such year, as determined by the Secretary. The Secretary may establish a cap on incentive payments for a year for a qualifying ACO.
There isn't anything about this House Bill that hasn't been well planned or considered.
Page 453, lines 22 through 25
‘‘(1) STARTING DATE.—The pilot program shall begin no later than January 1, 2012. An agreement with a qualifying ACO under the pilot program may cover a multi-year period of between 3 and 5 years.
Page 455, lines 18 through 25 and Page 456, lines 1 through 3:
‘‘(g) EXTENSION OF PILOT AGREEMENT WITH SUCCESSFUL ORGANIZATIONS.—
‘‘(1) REPORTS TO CONGRESS.—Not later than 2 years after the date the first agreement is entered into under this section, and biennially thereafter for six years, the Secretary shall submit to Congress and make publicly available a report on the use of authorities under the pilot program. Each report
Page 456, lines 16 through 21:
‘‘(3) TERMINATION.—The Secretary may terminate an agreement with a qualifying ACO under the pilot program if such ACO did not receive incentive payments or consistently failed to meet quality standards in any of the first 3 years under the program.
Page 457, lines 13 through 19:
‘‘(B) CERTIFICATION.—The Chief Actuary of the Centers for Medicare & Medicaid Services shall certify that 1 or more of such models described in subparagraph (A) would result in estimated spending that would be less than what spending would otherwise be estimated to be in the absence of such expansion.
Just in case anyone is wondering why this Bill is always discussing Medicare and Medicaid, it is obvious; the USA government has authority to change the structure of these institutions to accommodate better performance of care models to insure outcomes. But, there is also a provision to include private payers as well. So, I imagine some of the better known health systems will be first in line for the incentive.
Page 459, lines 4 through 8:
‘‘(3) INVOLVEMENT IN PRIVATE PAYER ARRANGEMENTS.—Nothing in this section shall be construed as preventing qualifying ACOs participating in the pilot program from negotiating similar contracts with private payers.
There is also a pilot program incentive for Home Health Care:
Page 460, lines 17 through 26 and Page 461, lines 1 through 3:
‘‘(1) ESTABLISHMENT OF PILOT PROGRAM.— The Secretary shall establish a medical home pilot program (in this section referred to as the ‘pilot program’) for the purpose of evaluating the feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical home services (as defined under subsection (b)(1)) to high need beneficiaries (as defined in subsection (d)(1)(C)) and to targeted high need beneficiaries (as defined in subsection (c)(1)(C)).
‘‘(2) SCOPE.—Subject to subsection (g), the pilot program shall include urban, rural, and underserved areas.
Here again some of the finest health care delivery systems will be participating as they probably already have models in place that can set the trend early and successfully. The rules and regs go on for some pages, but, then it enters into increased payment reimbursement for Certified Nurse Midwives. I doubt that is much about Medicare, but, I am sure there are the exceptions.
Page 483, lines 10 through 20 provides for Preventive Care Services:
SEC. 1305. COVERAGE AND WAIVER OF COST-SHARING FOR PREVENTIVE SERVICES.
(a) MEDICARE COVERED PREVENTIVE SERVICES DEFINED.—Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 1235(a)(2), is amended by adding at the end the following new subsection:
‘‘Medicare Covered Preventive Services
‘‘(iii)(1) Subject to the succeeding provisions of this subsection, the term ‘Medicare covered preventive services’ means the following: prostate cancer screening, colorectal cancer screening, diabetes self management training services, glaucoma screening, medical nutrition services, preventive physical exam, cardiovascular screening blood tests (cholesterol is my guess), diabetes screening, ultrasound screening for AAA (abdominal aortic aneursym), pneumonia, influenza and hepatitis B vaccines, mammograms, pap smears, bone density screenings, kidney disease education and other not yet specified preventive services.
There will no longer by Clinical Social Work Services provided at Skilled Nursing Facilities. There are plenty of other professionals at SNFs so excluding Social Work Services is more than appropriate when viewed as duplication of expertise. It will be considered included in the lump sum payment to the facility.
There will be Marriage and Family Counceling Services and Mental Health Councelor Services.
Page 489, lines 19 through 25 and Page 490, lines 1 and 2:
SEC. 1308. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES AND MENTAL HEALTH COUNSELOR SERVICES.
(a) COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES.—
(1) COVERAGE OF SERVICES.—Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by section 1235, is amended—
The coverage will be 75% of the cost. The Marriage and Family Councelor services are very limited in a Skilled Nursing Facility. Reimbursement is in conjuction with referral by a physician.
The next major section begins on Page 501, entitled "TITLE IV—QUALITY, Subtitle A - Comparative Effectiveness Research
...until tomorrow's read...
