Implementation of the Affordable Care Act
The purpose of this Webinar was to highlight a new opportunity for funding community-based prevention services. As of January 1, 2014, a new Medicaid rule now allows reimbursement for preventive services delivered by non-licensed providers, upon referral from a licensed Medicaid provider. Presenters discussed implementation requirements for states and communities, examples of successful strategies for preventive service delivery by non-licensed providers such as Community Health Workers, and collaboration with state Medicaid agencies and Managed Care Organizations to pursue coverage for new reimbursement. Challenges discussed included implementing programs with non-licensed providers and developing partnerships with Medicaid. Presenters offered steps to overcome these barriers. This Webinar also included a discussion around identifying multiple opportunities for partnerships to address chronic disease prevention and establish long-term funding for sustainability.
By the end of this Webinar, awardees were expected to be able to:
• Describe the new opportunity for reimbursement of community prevention related to the Medicaid rule change.
• Identify at least two tools/resources for guidance on working with Medicaid agencies and how to pursue Medicaid reimbursement or coverage for preventive services post-Webinar.
• Initiate discussion around developing multiple partnerships for sustainability of chronic disease prevention efforts.
• Anne De Biasi, Director of Policy Development, Trust for America’s Health
• Pam Keach, Strategic Lead, CA4Health, a Community Transformation Grant initiative of the Public Health Institute, University of California, San Francisco
• Michael E. Rhein, President and CEO, Institute for Public Health Innovation
TFAH and Nemours hosted a convening on October 31, 2013 to discuss the potential impact of a new Rule on paying for prevention in Medicaid. The Medicaid Rule clarifies that states can reimburse for preventive services “recommended by a physician or other licensed practitioner…within the scope of their practice under State law”. Previously states were restricted to reimbursing only licensed providers. TFAH and Nemours had partnered to advocate for this rule change, which became law in July, 2013.
As of January 1, 2014, the Medicaid Rule allows reimbursement for preventive services delivered by non-licensed providers, upon recommendation from a licensed Medicaid provider. This Meeting Summary includes an explanation of the new Medicaid rule and what states and providers will need to do to implement it. This meeting summary also includes a questionnaire, developed by Nemours, that can help to guide advocates seeking to implement the rule change by outlining all the information a state will need to submit the required state plan amendment.
In November 2013, TFAH convened national experts and local innovators to define practical steps to build a system that improves population health and reduces health disparities. This document describes the key ideas and consensus recommendations which emerged from this discussion.
The Cancer Action Network’s new report highlights success stories from 17 states in its new report: “Prevention—through reduced tobacco use, improved nutrition, increased physical activity, and expanded use of established screening tests—could save half the people who die of cancer every year and many more who die of heart disease and complications from diabetes and other chronic diseases.”
With passage of the Affordable Care Act (ACA), the United States now has a national framework for health care that not only provides the mechanisms for extending health insurance coverage to tens of millions of Americans, but also sets a course for transforming the health care delivery system from a sick care to a well care system. This document summarizes a convening TFAH held to explore how provisions within the ACA can be leveraged to create a health system that is focused on population health, disease prevention and health promotion. Please read the meeting summary here.
The U.S. Government Accountability Office (GAO) report on the first two years of the Prevention and Public Health Fund received some additional attention amid some criticism of the expenditure of dollars. However, the report clearly makes the case that the majority of funds are being used for new programs and to help fund previously underfunded ongoing discretionary health programs. In addition, the report confirms the often misinterpreted role of Congressional appropriators in the allocation of funds, and also details the performance metrics for the largest funded programs supported by the Fund.
Fiscal Year 2012 Prevention and Public Health Fund dollars for the Centers for Disease Control and Prevention (CDC) have now been allocated. Attached is a chart, sorted by state, of cooperative agreements. A useful tool to have.
The White House Office of Management and Budget released its report on the effects of sequestration, you can read it here. It reflects the 8.2 percent decrease in non-defense discretionary programs and 7.6 percent for non-defense mandatory programs like the Prevention and Public Health Fund (a $76 million cut). Under sequestration, the Centers for Disease Control would be cut by over $560 million (including the Fund cut), and the National Institutes of Health by over $2.5 billion. Here’s the Coalition for Health Funding statement.
The Bipartisan Policy Center has released a new paper describing the significant health care cost and coverage implications of the Supreme Court’s recent decision on ACA, you can read it here . “Since the U.S. Supreme Court ruling Since the U.S. Supreme Court ruling on health reform, states are no longer required to expand Medicaid coverage to individuals earning up to 133 percent of the federal poverty level (FPL). As a result, a number of individuals who were expected to be covered by Medicaid will remain uninsured. On July 24, 2012, the Congressional Budget Office (CBO) assessed the impact of the Court’s ruling on the federal budget. BPC’s paper explains and offers insight into CBO’s budgetary assessment of the Court’s ruling.”
The Prevention Fund in action – The CDC published final data and results in August 31, 2012 Morbidity and Mortality Weekly Report (MMWR) for the Prevention Fund-supported Tips from Former Smokers (TIPS) campaign. According to the CDC, the campaign, “ features real people suffering as a result of smoking and exposure to secondhand smoke. Their compelling stories send a powerful message: Quit smoking now. Or better yet — don’t start.” According to the report, total call volume during the TIPS campaign was 365,194 calls, compared with 157,675 calls during the corresponding 12 weeks in 2011, for a total of 207,519 additional calls or a 132% increase. Compared with the corresponding weeks in 2011, weekly increases in calls during the campaign ranged from 86% to 160%. The website received 629,898 unique visitors during the TIPS campaign, compared with 119,327 during the same period in 2011, for a total of 510,571 additional unique visitors or a 428% increase.
The major drivers of health care costs are associated with chronic disease, many of which could be prevented if our health care system put health at the center, not just treatment. Transforming the US system into one that helps create health requires changes in practice, financing, and policy throughout the system – from payers and insurers to providers, public health agencies, and the community. To address this important goal, in August, 2012 TFAH convened a range of stakeholders in the fields of public health, primary care, philanthropy, government, advocacy, and community prevention to explore challenges and opportunities involved in engaging traditionally separate health domains into joint community-wide health promotion and disease prevention initiatives. Please read the summary here.
U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius has released updated information on the Medicare preventive services benefits of the ACA; you can read it here. “Medicare provides preventive benefits to keep you healthy including a yearly wellness visit, tobacco use cessation counseling, and a range of no-cost screenings for cancer, diabetes, and other chronic diseases.”
The Centers for Disease Control and Prevention (CDC) continues to update state-specific stories on the Prevention Fund-supported program, Strengthening Public Health Infrastructure for Improved Health Outcomes. The program, “supports state, tribal, local, and territorial health departments through the Prevention and Public Health Fund of the Affordable Care Act to make fundamental changes and enhancements in their organizations and implement practices that improve the delivery and impact of public health services.”