Our nation’s health care system has entered a new era with the enactment of federal health care reform. This landmark legislation is resulting in many changes in how health care is financed and delivered for years to come. For nearly two decades, CHA has been at the forefront in advocating for meaningful health care reform — and we will continue to help shape the future of hospital care far into the future. CHA’s vision of an “optimally healthy society” is now a reality within reach.
The Department of Health and Human Services (HHS) published the attached notice in the Federal Register on Nov. 19, proposing a quality rating system (QRS) for qualified health plans (QHPs) offered through health insurance exchanges. The Affordable Care Act requires HHS to create a system enabling consumers to compare QHPs based on relative quality, price and enrollee satisfaction. The notice outlines a proposed methodology for selecting QRS measures, organizing such measures into broad categories meaningful to consumers (e.g., care coordination, preventive services, patient safety, etc.), and calculating statistically valid global ratings for each QHP (as is now done under the Medicare Advantage 5-star rating system).
President Obama announced yesterday that health insurers and HMOs are not required by federal law to cancel existing policies. In the White House’s fact sheet on this issue, HHS indicates it is using its administrative authority to:
Allow insurers to renew their current policies for current enrollees without adopting the 2014 market rule changes. This will give consumers in the individual and small group markets the choice of staying in their plan or joining a new marketplace plan next year. HHS will consider the impact of this transitional policy in assessing whether to extend it beyond 2014.
Require insurers offering such renewals to ensure consumers are informed about their options. Specifically, insurers offering these renewals must inform all consumers who either already have or will receive cancellation letters about the protections their renewed plan will not include and how they can learn about the new options available to them through the marketplaces, which will offer better protections and possible financial assistance.
Covered California has released its fiscal year 2012-13 annual Report to the Governor and the Legislature, detailing its progress to implement the Affordable Care Act in California. The report, attached, provides details about how the new marketplace works, including scenarios of premiums and plan options; describes the steps that have been taken to encourage enrollment in health coverage; and provides information about the offerings for small businesses.
The Office of Statewide Health Planning and Development (OSHPD) has announced that, in an effort to ensure the continued protection of individual patient information, it has revised the annually released public use files (PUF) for hospital discharge, emergency department and ambulatory surgery data files. The files — widely used by hospitals, their consultants and vendors — make data about California-licensed hospitals available to any interested party, including the general public.
Despite the changes to the PUF, Assembly Bill 2876 (Chapter 434, Statutes of 2004) allows hospitals to receive HIPAA-limited safe harbor data files from OSHPD that contain data elements removed from public files. To obtain the AB 2876 files with the additional fields, hospitals must enter into a data use agreement with OSHPD. Sharing AB 2876 hospital data files with entities outside of the requesting hospital (such as external consultants) is subject to OSHPD director approval and federal laws regulating use of safe harbor data. CHA is working with OSHPD to identify ways the impact of these changes on hospitals can be minimized, both through process improvements related to how hospitals obtain these data and by providing input to OSHPD on its development of new data files and products.
The California Department of Health Care Services (DHCS) will offer a series of educational webinars for physicians and other providers on the Low Income Health Program (LIHP). The LIHP transition marks an important step toward moving LIHP enrollees into Medi-Cal on Jan. 1, 2014. During the transition, the majority of LIHP enrollees will shift from county-operated programs to a Medi-Cal managed care plan. The first webinar, a general provider training, will be held Nov. 14, 4 p.m. (PT).
The webinar will focus on provider-specific guidance on changes to existing processes. Topics will include: the process for transitioning enrollees into a Medi-Cal managed care plan; how to become a network provider; overlap in benefits/formulary; mental health and substance use disorders; complex conditions; twelve-month treatment continuation; and prisoner transitions. The webinar content will be relevant specifically for health care providers. DHCS asks that only provider associations, physicians and their staff, and other providers, including pharmacists, participate. DHCS will designate time for questions and answers.
The California Department of Social Services (DSS), the California Department of Health Care Services (DHCS) and the California Department of Aging (CDA) will convene the second Home and Community Based Universal Assessment Workgroup meeting on Nov. 7 from 10 a.m. to 4 p.m. (PT). The public is invited either to attend in person or to listen by telephone. A public comment period will be held at the end of the meeting.
To attend the meeting in-person:
California Department of Social Services Auditorium
744 P Street in Sacramento, OB 9, 2nd Floor, Room 205
Please allot time for check-in at the front desk and bring photo identification.
The U.S. Department of Health and Human Services (HHS) has released the attached guidance regarding third party payors being permitted to make premium payments to health insurance issuers for qualified health plans on behalf of individuals enrolled in marketplaces (exchanges). In the guidance, HHS states it has “significant concerns with this practice because it could skew the insurance risk pool and create an unleveled field in the Marketplaces.” HHS discourages the practice and encourages issuers to reject such third party payments, stating that it intends to monitor this practice and take appropriate action if necessary.
The American Hospital Association (AHA) has extended the submission date of its survey on health coverage activities under the Affordable Care Act to Oct. 31. The survey asks hospitals questions regarding their enrollment assistance activities, including participation in the Certified Enrollment Assistance program, as well as community outreach and partnering strategies. The survey also includes questions on hospitals’ use of vendors in determining eligibility and enrolling individuals in health coverage, and questions on participation in conducting Medicaid presumptive eligibility determinations. AHA emailed a reminder notice with instructions for completing the short online survey to all member hospital CEOs yesterday. For more information contact AHA Member Relations at (800) 424-4301.
The California Department of Health Care Services (DHCS) has released its 2013-17 Strategic Plan, defining priorities and the methods it will use to meet the challenges associated with the impending launch of the Affordable Care Act (ACA) and expansion of Medi-Cal. DHCS programs serve more than 8.5 million Californians, a number that will approach 10 million with the full implementation of the ACA. DHCS invests approximately $70 billion in public funds to provide low-income Californians with access to affordable, high-quality health care, including medical, dental, mental health, substance use disorder services and long-term services and supports, making it the largest health care purchaser in the state.
DHCS has included in the strategic plan its commitments to consumers, the public and employees, and defines broadly how each commitment will be achieved (strategies), as well as the specific initiatives necessary to achieve each strategy (actions). For an outline of DHCS commitments to consumers and the public, select “Read more” below. The complete strategic plan can be reviewed on the DHCS website.
The Covered California Board of Directors voted at its Oct. 24 meeting to issue available quality ratings for insurers offering coverage through the statewide exchange in time for next year’s open enrollment period. Under the Affordable Care Act, state exchanges are required to provide quality information to consumers by 2016. Initially, Covered California intended to make the quality ratings available two years ahead of schedule, but announced over the summer that it would delay release of quality information because such information would only be available for some, and not all, of the insurers.
Covered California believed it would be confusing for consumers to have quality information on certain insurers but not all. However, at last week’s meeting, Board members ultimately decided that consumers should have access to all available information when making their decisions, and announced it will issue available quality ratings next year for open enrollment. More information and background about the decision are available in the attached board discussion document.
The California Department of Social Services (DSS) has announced a webinar related to the Coordinated Care Initiative and hosted by its Home and Community Based Services (HCBS) Universal Assessment Workgroup, to be held Oct. 30 from 4 – 5 p.m. (PT). The HCBS Workgroup is responsible for gathering stakeholder input to develop a statewide approach to home and community-based services assessments that facilitate coordination, data sharing and care planning for improved consumer quality of care. Webinar registration is available online.
The California Department of Health Care Services (DHCS) will conduct its next quarterly stakeholder update regarding behavioral health integration in Cal MediConnect plans on Nov. 5 from 1 p.m. to 1:50 p.m. (PT). DHCS will provide stakeholders with an update of behavioral health coordination efforts underway in each of the eight Cal MediConnect demonstration counties. Stakeholders will have the opportunity to ask questions and provide recommendations to DHCS.
Covered California has announced the roll-out of its marketing campaign to reach Asian-language consumers statewide. The campaign is designed to get information about the new health insurance marketplace to Asians in their specific languages, using a wide range of media, and will complement Covered California’s general advertising campaign that is already serving English-speaking Asian communities. According to Covered California projections, Asians make up 14 percent of Californians eligible for federal subsidies when signing up for health care coverage that begins Jan. 1, 2014. According to census data, half of Asians in Californian speak limited English, prompting a need to communicate with them in their individual languages.
Starting in January 2014, the Affordable Care Act (ACA) gives hospitals a unique new opportunity to use presumptive eligibility to connect all patients to Medicaid, as long as they appear to meet the state’s income guidelines for Medicaid eligibility.
Through the new health benefit exchanges (or marketplaces) created by the Affordable Care Act, individuals may purchase coverage from participating qualified health plans. Recognizing that an individual’s share of the cost of a premium may be prohibitive, even with a federal subsidy, several hospitals and health systems nationwide have asked whether there are any legal barriers to offering financial assistance to a patient by paying their health insurance premiums. The American Hospital Association (AHA) has issued a legal advisory on the issue, indicating that there appear to be two potential barriers that could affect the ability of hospitals and health systems to offer this type of assistance: anti-kickback laws and federal tax exemption.
The rules, however, are more clear when applied to a hospital participating as a Covered California Certified Enrollment Entity (CEE), as recent regulations adopted by Covered California prohibit a CEE or Certified Enrollment Counselor from paying any part of the premium to or on behalf of an enrollee. These regulations would apply to a hospital that is a CEE.
CHA has released a video statement from President/CEO C. Duane Dauner, thanking Governor Brown and the State Legislature for their leadership in enacting SB 239
(Hernandez, D-West Covina/Steinberg, D-Sacramento). The new law eliminates Medi-Cal cuts for non-rural hospital-based skilled-nursing facilities (rural facilities were exempted in August) and lifts a rate freeze that was harming health care providers struggling to treat some of the most medically complex patients. It also delivers more than $10 billion in new federal Medicaid funds to California hospitals over the next three years and will provide $2.4 billion in additional revenue to the state General Fund.
“SB 239 creates protections for the state, for patients, and for hospitals without any tax increases,” Dauner explains in the video. “In all, patients and Californians are the real winners.”
HFM Magazine has published an article in its October issue on helping individuals obtain health coverage under the Affordable Care Act. The article highlights a CHA study of California hospitals that reveals best practices for reducing the number of uninsured patients — which could benefit many hospitals and their communities nationwide — as published in CHA’s guidebook, Helping Individuals Obtain Health Coverage Under the Affordable Care Act: Outreach and Enrollment Strategies for California Hospitals. Research was conducted through statewide interviews with key hospital management and supervisory staff responsible for patient registration, admissions services, patient access, financial counseling and eligibility services.
The California Department of Health Care Services (DHCS) will offer an educational webinar on the Coordinated Care Initiative (CCI) for physicians and other providers on Sept. 18 at 5 p.m. The CCI integrates delivery of medical, behavioral and long-term care services, and includes the Cal MediConnect program. Cal MediConnect offers individuals with both Medicare and Medi-Cal – commonly referred to as “dual eligible” beneficiaries – the opportunity to benefit from more coordinated care. The webinar will include a 30-minute overview of Cal MediConnect, including continuity of care provisions, and a 30-minute question-and-answer period.
The Department of Health Care Services (DHCS) will conduct a stakeholder webinar on Aug. 19 from 1 p.m. to 2 p.m. to provide an update on the Coordinated Care Initiative (CCI). The CCI integrates delivery of medical, behavioral and long-term care services. It also includes the Cal MediConnect program, which is an opportunity for individuals with both Medicare and Medi-Cal – commonly referred to as “dual eligible” beneficiaries – to benefit from more coordinated care.
Enrollment in the Cal MediConnect program is scheduled to begin no sooner than April 2014 in eight participating counties (Alameda, San Mateo, Santa Clara, Los Angeles, Orange, San Diego, Riverside and San Bernardino). For more information, visit the online registration site or www.calduals.org.
This week, the Internal Revenue Service issued temporary and proposed regulations that provide guidance to charitable hospital organizations regarding the requirement of a tax return to accompany payment of an excise tax. The excise tax has been enacted as part of the Affordable Care Act (ACA) for hospitals that fail to meet the community health needs assessment (CHNA) requirements for any taxable year. Under the temporary regulations, a charitable hospital organization that is liable for the excise tax must file a return on Form 4720 by the 15th day of the fifth month after the end of the organization’s taxable year during which the liability was incurred.