Tuesday, July 19, 2011

CKSN Corner
Covering Kids with Special Needs
Wisconsin's CYSHCN Program is made up of a significant network of collaborators who work together to ensure access to care and coverage for children and youth with special health care needs.
The National Youth Leadership Network announces their new curriculum: Reap What You Sow: Harvesting Support Systems Curriculum Training Packages. Reap What You Sow brings youth and adults together to build support systems. For more information, click here.
July 25-27. Leadership, Legacy, and Community: A Retreat to Advance Maternal and Child Health (MCH) Scholarship and Practice. Hyatt McDonald's Lodge, Oak Brook, IL. Learn more information here, or register here.
September 21. Making Connections: Care in the Community Conference. Radisson Hotel, Wauwatosa, WI. Topics will include advocacy, mental health, transition and a health benefits update. For more information, visit maxishare.com.
September 22. Did you know? Now you know! Aging and Disability Resource Center of Manitowoc County, Manitowoc, WI. 5:30-8:30 p.m. Topic: Parents and partners on a journey; public support systems available to assist you and your child; private insurance and your provider. To register, call 877-568-5205 or email KVanVooren@chw.org.
October 1. Did you know? Now you know! Aging and Disability Resource Center of Manitowoc County, Manitowoc, WI. 9 a.m.-noon. Topic: More about Medicaid; advocating for systems change. To register, call 877-568-5205 or email KVanVooren@chw.org.

Ops Memos
On July 1, DHS issued an Operations Memo 11-35, effective July 1, 2011, instructing that Tribal members and close family relatives are EXEMPT from paying application processing fees and premiums. (See Table 51.1 in the BadgerCare+ Eligibility Handbook to see which recipients are receiving Medicaid-funded benefits.) This applies to:
  • Individuals receiving Title 19-funded BadgerCare Plus if they are a Tribal member, the son or daughter of a Tribal member, the grandson or granddaughter of a Tribal member, or they are otherwise eligible to receive Indian Health Services
  • Children who are Tribal members or who are the son or daughter of a Tribal member and eligible for Title 21-funded (separate CHIP program) BadgerCare Plus. (Previously, only children who were tribal members were exempt from premium payments.)
  • Anyone meeting the Medicaid definition of ‘Indian’ is also exempt from paying the processing fee for a Core Plan application or renewal.
  • These Title 19 premium exemptions do not apply to Medical Assistance Purchase Plan (MAPP) premiums, cost share amounts for Long Term Care Medicaid and patient liability for Institutional Medicaid.
Retroactive: Members who paid premiums between July 2009 and August 2011, who should have been exempt as a Tribal member, or son or daughter of a Tribal member, will be identified through a central process and the premiums will be refunded. The member must have verified that he or she is a Tribal member or son or daughter of a Tribal member to be considered exempt.

State & National News
Analysis and Comment

Building (and Governing) the Insurance Exchange

On Monday, July 11, Department of Health and Human Services Secretary Kathleen Sebelius announced the long anticipated proposed regulations governing how states should set up and run the health insurance exchanges envisioned in the Affordable Care Act. Wisconsin's Department of Health Services issued their own notice--a call for vendors to build Wisconsin's exchange, signaling that the state may abandon the progress made before the changing of administration.
The Affordable Care Act, (health reform) requires states to set up their own health insurance exchange or "marketplace" by 2014. Exchanges are new organizations or agencies that offer consumers "one stop shopping" for a variety of health insurance plans for individuals insurance marketplace consumers, small businesses and public benefits--potentially Medicaid, BadgerCare Plus, FoodShare and Wisconsin Shares in Wisconsin.
Health reform favored exchanges to increase the number of Americans covered by health insurance. The exchange was determined the best a means to create a more organized and competitive market for health insurance by:
  • Offering a choice of health plans,
  • Establishing common rules regarding the offer and pricing of insurance, and
  • Providing information to help consumers better understand their options.
A key component to the success of this model is a system of offering consumer assistance. Wisconsin eliminated that option in March 2011 when it sent back the over $500,000 remaining on the federal grant to create a Consumer Assistance Project in Wisconsin--meant to go hand-in-hand with helping consumers use exchanges. Wisconsin however held onto the "start-up" money HHS injected into 49 states to get the initial planning off the ground. Wisconsin applied for and received this first planning grant of $1 million and then an additional $37 million in an "Early Innovator Grant." Beyond meeting the benchmarks required in these two grants, Wisconsin will be evaluated on their progress in 2013. It is at this time that HHS will determine if it needs to step in and take over the exchange.
New Rules
On July 11, 2011, the U.S. Department of Health and Human Services (HHS) published two Notices of Proposed Rulemaking related to health insurance exchanges giving guidance to the states on what benchmarks they need to reach for their exchanges. The first proposed rule outlines how states can build insurance exchanges, while the second addresses standards related to reinsurance, risk corridors, and risk adjustment to assure stability in these newly established markets.
HHS published the proposed rule in the Federal Register on July 15 and will accept public comments for the next 75 days. HHS will also convene a series of "regional listening sessions and meetings" on the proposal to get additional public feedback.
Calling All Exchange Builders
Released July 8, 2011, the Office of Free Market Health Care issued a "Request for Information," to all "interested parties to demonstrate their product offerings." The Office is interested in learning "more about health insurance exchange systems and applications that serve the non-group and group health insurance markets." The demonstrations of products will take place August 1 & 2, 2011, and only those products with fully functional enrollment and plan comparison features need apply. Not required, but encouraged is functionality that shows health insurance education tools as they relate to purchasing health insurance and customer support--the "consumer assistance" pieces to the exchange. The same consumer assistance elements that Commissioner of Insurance Ted Nickel defunded on March 12, 2011. Curious whether the exchange built in autumn 2010 under the Doyle administration and debuted at the HealthWatch Wisconsin "The Changing Landscape" Health Reform Conference on October 28, 2010 will be among those demonstrated.

Walker administration reverses course, now backs health grants
David Wahlberg, Wisconsin State Journal, 14 July

"Public health advocates seeking federal grants to prevent chronic diseases now have the state’s support, after Gov. Scott Walker’s administration reversed its opposition to the grants."
37 Democrats urge feds to deny Gov. Walker's Family Care freeze
Rep. Richards to HHS Secretary Sebelius, 14 July

"Family Care empowers some of Wisconsin's most vulnerable residents, and their families, by giving them choices about the services they need to remain independent and maintain a high quality of life."
AARP: Fewer plans will make exchanges easier to use
Sam Baker, The Hill, 14 July

"A new AARP report on state insurance exchanges says consumers will have an easier time comparing health plans if they're not presented with too many options. AARP analyzed several existing Web portals for insurance to help states figure out the most effective designs for their exchanges' websites. The exchanges are envisioned as one-stop shops for individuals and small businesses to compare and purchase insurance policies."
State reverses course, supports city's bid for federal health grants
Guy Boulton, Milwaukee Journal Sentinel, 13 July

"Reversing its position, the state Department of Health Services has cleared the way for the City of Milwaukee and others to apply for federal grants totaling roughly $30 million over five years for public health initiatives to stop smoking, reduce obesity and promote healthier lifestyles."
Officials say the exchange rule includes flexibility for states
Kaiser Health News, 11 July

"Insurers want states to be granted great flexibility in how they design their exchanges – and don't want to be barred from seats on oversight boards. Consumer groups, however, would prefer that insurers not be allowed on the boards or, if they are, to meet strict conflict-of-interest rules."
Click here for more health care news!

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