PUBLIC BENEFITS TASK FORCE

Chair: Abena Williams
Senior Attorney Advocate: Victoria Robinson
Senior Paralegal Advocate: Barbara Coleman, Odella Oliver

Public Benefits Task Force

HHS Releases Proposed Rule on Medicaid, CHIP and Health Insurance Marketplaces

See below for the HHS announcement of the proposed Rule on Medicaid, CHIP, and Health Insurance Marketplace.  The fact sheet can be found at http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4504&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date along with a link to the proposed rule.

HHS Intergovernmental and External Affairs Notification

January 14, 2012

From:  Paul Dioguardi

Director, Office of Intergovernmental and External Affairs

U.S. Department of Health and Human Services

RE:     HHS Releases Proposed Rule on Medicaid, CHIP and Health Insurance Marketplaces

Today, the Department of Health and Human Services (HHS) released a proposed rule implementing key Affordable Care Act provisions relating to Medicaid and the Exchanges. This proposed rule codifies statutory eligibility provisions, lays out a structure and options for coordinating Medicaid, the Children’s Health Insurance Program (CHIP), and Exchange eligibility notices and appeals. It also proposes to modify existing benchmark benefits regulations for low-income adults, and codify several of the provisions included in the Children’s Health Insurance Program Reauthorization Act (CHIPRA).

This proposed rule includes information on how consumers will receive coordinated communications on eligibility determinations and can appeal eligibility determinations.  It gives states flexibility in designing benefits and determining cost sharing in the Medicaid program.  The proposed rule also provides flexibility to state-based Exchanges by allowing them to opt to rely on HHS for verifying whether an individual has employer-sponsored coverage and conducting some types of appeals.

The NPRM is available on display at the Federal Register here: http://www.ofr.gov/OFRUpload/OFRData/2013-00659_PI.pdf

A fact sheet with additional information regarding the changes made through this proposed rule will be available on Medicaid.gov and http://cciio.cms.gov/ later today.

Please direct questions to HHSIEA@hhs.gov.

MD gets $36.5 million for improving children's access to health insurance

From the Baltimore Sun:

--------------------
MD gets $36.5 million for improving children's access to health insurance
--------------------

By Andrea K. Walker

December 19 2012, 5:49 PM EST

The federal government has awarded Maryland $36.5 million for its success at getting children enrolled in government subsidized health programs.

The complete article can be viewed at:
http://www.baltimoresun.com/health/blog/bal-childrens-grant,0,731458.story

Save the dates! 2013 PBTF Meetings

PUBLIC BENEFITS TASK FORCE

Meeting Dates for 2013

First Thursday of alternate months

9:30 am – 12:30 pm

2nd Floor conference room in Baltimore City office and GoToMeeting

Tuesday, January 8

March 7

May 2

Tuesday, July 9

September 5

November 7

REMINDER: Tuesday, January 8, 2013 PBTF Meeting

 

Hello All,

On  Tuesday, January 8, 2013, we will be having our next Public Benefits Task Force meeting in the second floor conference room in the Baltimore City office of the Legal Aid Bureau and via GoToMeeting. Please contact me at awilliams@mdlab.org by close of business on Wednesday, January 2, 2012 if you have any agenda items you'd like to add for the meeting. I'll circulate an agenda on Thursday, January 3rd in advance of the meeting.

Happy holidays and look forward to seeing everyone in the new year!

Abena Y. Williams

Public Poll: “Silver and Blue – The Unfinished Business of Mental Health Care for Older Adults”

From the John A. Hartford Foundation:

http://www.jhartfound.org/learning-center/john-a-hartford-foundation-national-public-poll-silver-and-blue-the-unfinished-business-of-mental-health-care-for-older-adults/

“It was as if I were falling into a deep dark well and I could not climb out of it.” - Poll Respondent

Large majorities of older Americans with depression, anxiety, or other mental health disorders are receiving treatment that does not meet evidence-based standards, and many do not know that depression can put their health at increased risk, according to a national survey, “Silver and Blue: The Unfinished Business of Mental Health Care for Older Adults,” released on December 13, 2012 by the John A. Hartford Foundation.

The survey focused on 1,318 Americans age 65 and older. Key findings include: 

  • 46% of people currently receiving treatment say their provider did not follow up with them within a few weeks of starting treatment to see how they were doing – a critical component of effective care.

 

  • Among all respondents, very few understood the health risks of depression: only one out of five (21%) had heard that depression is believed to double an individual’s risk of developing dementia and only one in three (34%) knew it can double the risk of heart disease.

 

The poll revealed serious shortfalls in the quality of mental health care related to patient engagement and treatment follow-up and modification.  Older adults also reported that team-based depression care, known to increase effectiveness, is appealing.  In their own words, respondents shared what it feels like to live with depression or other mental illness.

Depression is a common and serious medical condition second only to heart disease in causing disability as well as harm to people’s health and quality of life. Mental health problems affect nearly one in five older adults, according to the Institute of Medicine. Depression is not a natural part of the aging process, but almost one in three people surveyed (27%) believed it was.

“It is a needless tragedy that so many older people are still receiving mental health care that does not measure up,” said Christopher Langston, PhD, program director for the John A. Hartford Foundation, which funded and directed the survey.

For more details on the poll findings, the below supporting materials are available for download and key findings are also listed at the bottom of this page.

 

For assistance and resources in communicating these findings to a variety of audiences, please contact Elliott Walker at Strategic Communications & Planning (ewalker@aboutscp.com; 610-687-5495) or Marcus Escobedo at the John A. Hartford Foundation (marcus.escobedo@jhartfound.org; 212-832-7788).

Mental Health and the Older AdultFor more information about this topic, see the John A. Hartford Foundation 2011 Annual Report, “Mental Health and the Older Adult,”  the Health AGEnda mental health blog series featuring videos of older adults and caregivers, and learn about the highly effective, evidence-based IMPACT depression care model being spread in the rural northwest through the Foundation’s Social Innovation Fund project.

U.N. Votes In Favor Of Universal Health Coverage

From washingtonpost.com: http://www.washingtonpost.com/blogs/worldviews/wp/2012/12/12/united-nations-universal-healthcare/

Obamacare everywhere: U.N. votes in favor of universal health coverage

Posted by Olga Khazan on December 12, 2012 at 2:46 pm

The United Nations General Assembly voted in favor of a draft resolution supporting universal health coverage, signaling the importance of universal healthcare to the international development agenda.

The resolution, which is backed by the United States, encourages governments to come up with systems that avoid direct payments at the point of delivery, include a way to prepay for financial contributions toward health care and a mechanism to pool risks among the population in order to avoid catastrophic expenses. Essentially, this amounts to a system where health insurance is either attainable and affordable for all, or the federal government picks up the tab for health care costs.

The U.N. also urged governments to “promote the inclusion of universal health coverage in the implementation of the internationally agreed development goals…as a means of promoting sustained, inclusive and equitable growth, social cohesion and well-being of the population.”

Universal healthcare is widely seen as a hallmark of a developed nation, with nearly all high- and many middle-income countries having some form of universal coverage in place.

Here’s a map my colleague Max Fisher once made depicting all the countries in the world that have universal healthcare coverage (in green); it also very nearly delineates the developed countries from the developing ones.

Health experts say 40 percent of the world’s population – about 2.8 billion people – have some form of risk-pooled health insurance. Opinions vary as to whether the United States’ Affordable Care Act actually counts as universal health care (this map excludes the United States, for example), but others say its mandate provision means it comes close enough.

Over the past few years, rich and poor countries alike have been moving toward universal coverage.

Following the WHO’s 2010 report, Health systems financing: the path to universal coverage, more than 60 middle- and low-income countries requested technical assistance and advice to implement universal health coverage.

Countries that were once considered universal-health “blind spots,” such as India and South Africa, are developing systems that provide access to medical care for nearly all of their citizens.

China, for example, is now attempting to reconcile its patchwork of health plans and it’s close to completing a $124 billion project that aims to insure 90 percent of the nation’s residents. In India, a system started in 2008 has provided hospital access to 100 million people who live below the poverty line.

Of course, U.N. resolutions are generally non-binding, so the resolution may not lead to meaningful change in the member nations or elsewhere. (There have been multiple resolutions calling for a moratorium on the death penalty, for example). But the U.N. has been pressured for a declaration on universal health care before and it does show an interesting consensus among countries about the importance of health access to broader development goals.

Briefs Examine CMS Rules Governing Changes to Medicaid Eligibility And Enrollment Under the Affordable Care Act

From the Kaiser Family Foundation:

Two new briefs from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured examine changes to Medicaid eligibility and enrollment rules under the Affordable Care Act, and how such changes are expected to affect those covered by the program, including people with disabilities.

One brief provides a summary of the Centers for Medicare and Medicaid Services’ (CMS) March 23, 2012 final rule to implement the ACA provisions relating to Medicaid eligibility, enrollment simplification and coordination. The rule, which is effective Jan. 1, 2014, lays out procedures for states to implement the Medicaid expansion and the streamlined and integrated eligibility and enrollment system created under the ACA. Achieving this goal will require substantial process and system changes among state Medicaid agencies and close coordination between Medicaid, the new health insurance Exchanges and other insurance affordability programs.

A companion brief provides a short summary of Medicaid eligibility and benefits for people with disabilities today and explains how they will be affected by the ACA in light of CMS’s new regulations. Provisions of the new Exchange regulations are discussed briefly to the extent that they related to Medicaid eligibility determinations for people with disabilities.

Final MOLST Regulations and Form

From OHCQ and the Ombudsman:

The final Maryland MOLST regulations and form will be printed in the Maryland Register on December 14, 2012, with an effective date of January 1, 2013. Beginning July 1, 2013, certain facilities will be mandated to complete the form for certain patients, including nursing homes, assisted living facilities, home health agencies, hospices, dialysis centers, and hospitals. The current version of the MOLST form will never expire and will continue to be honored. The new version of the MOLST form will be posted on the website on January 1, 2013. For further information, contact Maryland.molst@maryland.gov

 

Join the Maryland MOLST group on LinkedIn for announcements, updates, and discussions.

 

 

 

The End of Social Security Checks: The 2013 Transition to Electronic Payments

Date: 
Wed, 12/05/2012 - 2:00pm - 3:30pm

Title:

The End of Social Security Checks: The 2013 Transition to Electronic Payments

Date:

Wednesday, December 5, 2012

Time:

2:00 PM - 3:30 PM EST

Space is limited.
Reserve your Webinar seat now at:
https://www1.gotomeeting.com/register/447464544

 

In March 2013, most individuals who are currently receiving Social Security, veterans' benefits, and other federal payments by paper check will be required to change to electronic payment. This webinar will address what will happen next year, what options seniors have, and how you can help them make the transition.  We will also discuss new protections for bank accounts, the Direct Express prepaid card, and privately purchased prepaid cards.

Speakers:

Walt Henderson, Director, EFT Strategy Division, U.S. Department of the Treasury
Margot Saunders, Of Counsel, National Consumer Law Center
Lauren Saunders, Managing Attorney, National Consumer Law Center

Additional sponsorship for this Webinar is provided by a grant from the Administration on Aging.  This webinar is part of a series of National Elder Rights Training Project webinars for the National Legal Resource Center.

There is no charge for this webinar.
All time listings are in Eastern Standard Time.

If you have any questions email trainings@nclc.org

Sponsor: 
National Consumer Law Center

Introduction to Quality Measures in Managed Long-Term Services and Supports

Date: 
Fri, 11/30/2012 - 2:00pm - 3:30pm

Friday Morning Collaborative Webinar Series:

Introduction to Quality Measures in Managed Long-Term Services and Supports

States are increasingly establishing or expanding Medicaid managed long-term services and supports (MLTSS) programs.
 
LTSS quality measures and monitoring activities are essential tools for consumers and states to ensure protections, enhance choice and plan performance, and align incentives to meet desired goals such as rebalancing or promoting options for self-direction.

This webinar is the first in a series that will promote learning and discussion to build the capacity of stakeholders on these issues.

Speakers:

  • Sarah Scholle, National Committee on Quality Assurance
  • Alice Lind, Center for Health Care Strategies

Space is limited, so please register early and share lines when possible. The webinar will be recorded and posted online.

Host:

The Friday Morning Collaborative is a coalition of national aging and disability organizations working together to protect and strengthen Medicaid home and community-based services. With support from The SCAN Foundation, the coalition is hosting ongoing webinars to provide information and resources to state advocates.

Learn More: Join Our HCBS Online Community!

A special group on the NCOA Crossroads online community unites state advocates in the aging and disability fields working to strengthen and protect Medicaid HCBS:

  • Share what's happening in your state. 
  • Communicate with advocates in other states and nationally. 
  • Get information and resources related to Medicaid HCBS.

Join us now—and after the webinar to discuss what you heard!

Thank you

A big thank you to Sandra Brushart and Sara Wilkinson for their suggestions of substantive changes.  We will be submitting the final copy for the printer's first draft this week.

 

Disaster Unemployment Assistance in Wake of Hurricane Sandy

Workers who lost their jobs as a result of Hurricane Sandy -- and who aren't eligible for regular state unemployment insurance, e.g., the self-employed -- may be eligible for Disaster Unemployment  Assistance, a federal program that provides up to 26 weeks of jobless aid.

To qualify, individuals must have lost their jobs as a result of a major disaster in an area so declared by the president.  To date, a number of counties in NY, NJ, and CT have been declared major disaster areas.  Check out our fact  sheet at http://unemployedworkers.org/sites/unemployedworkers/index.php/site/blog_entry/disaster_unemployment_assistance_how_workers_can_access_the_program_sandy for more info.

And be sure to visit NELP's Immigrant Worker Justice Blog at http://www.immigrantworkerjustice.org/blog to read about how the storm has impacted immigrant worker communities on the East Coast.

Agenda for November 1 Public Benefits Task Force meeting

Please join us on Thursday, November 1 at 9:30 am for our next Public Benefits Task Force meeting in the second floor conference room in the Baltimore City office of the Legal Aid Bureau and via GoToMeeting. Below is the agenda for the meeting:

 

  1. Welcome and Introductions
  2. 2013 Meeting Dates
  3. 2013 MD Legislative session
  4. COMAR 10.01.04.01B(3): “authorized representative” regulation
  5. Problems with DHMH Board of Review
  6. Medicaid Advisory Committee update
  7. Language Access issues – recent meeting with DHR
  8. Human Rights discussion
  9. Sept-Oct Clearinghouse Review issue on hunger/food access issues
  10. conferences and trainings
    1. Social Security training in conjunction with DC NLS
  11. case staffings

 

Medicaid Hearings

At the last PBTF we discussed how the MA fair hearing regulations are being interpreted by OAH to mean that legal counsel must enter an affirmative statement entering their appearance at the time the appeal is filed or face exclusion from the case for its duration.  Paralegals are being asked for a power of attorney or something in writing from the client naming the paralegal as the authorized representative.  Now, we need your stories if you have been affected by this practice.  The stories will be included in letters to DHMH and OAH advocating for changes in the regulations and in how the regulation is being interpreted.  

Please email a synopsis of your experience to Francine Hahn at fhahn@hprplaw.org no later than Wednesday, October 24.

Thank you!

 

Public Benefits Task Force meeting on Thursday, November 1

On Thursday, November 1 at 9:30 am, we will be having our next Public Benefits Task Force meeting in the second floor conference room in the Baltimore City office of the Legal Aid Bureau and via GoToMeeting. Please contact me at klang@mdlab.org by close of business on Wednesday, October 24 if you have any agenda items you'd like to add for the meeting. I'll circulate an agenda on Thursday, October 25 in advance of the meeting.

Health care reform: Caring about costs, too

From the Baltimore Sun opinion page:

Health care reform: Caring about costs, too
--------------------

Expanding health coverage won't be sustainable unless Maryland can reduce expenses by emphasizing primary care

By Joshua M. Sharfstein, Laura Herrera, and Charles Milligan

September 27 2012, 6:00 AM EDT

By establishing a health benefit exchange and expanding Medicaid coverage, Maryland is on a path to extend access to affordable health care to hundreds of thousands of individuals, families and small businesses. For our progress to be sustainable, however, the growth in health care spending must be slowed and brought into balance.

The complete article can be viewed at:
http://www.baltimoresun.com/news/opinion/oped/bs-ed-health-spending-20120926,0,5965015.story

 

Maryland Chooses Essential Health Benefits Benchmark

At the Sept. 27, 2012 Health Care Reform Coordinating Council meeting, Maryland chose the state employee health plan as the benchmark for Maryland's essential health benefits (EHB). 

See http://www.healthreform.maryland.gov/maryland-moving-forward/essential-health-benefits/ for the materials from the meeting and reports from the EHB Advisory Committee and Wakely Consulting.

Media coverage includes:

Md. health reform panel approves state health plan as benchmark in health care reform
 
 By Associated Press
 
 ANNAPOLIS, Md. — A Maryland panel working on implementing federal health care reform voted Thursday to use the state employee health plan as a benchmark for other plans that will be available to small businesses and individuals for two years, starting in 2014.
 
 To view the entire article, go to http://www.washingtonpost.com/local/md-health-reform-panel-to-vote-on-states-benchmark-health-benefit-plan/2012/09/27/e188303a-0862-11e2-9eea-333857f6a7bd_story.html?wpisrc=emailtoafriend
 

 

Maryland picks model for essential health insurance benefits
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Coverage includes acupuncture and pediatric dental

By Andrea K. Walker, The Baltimore Sun

September 27 2012, 8:57 PM EDT

Under national health care reform, insurance policies in Maryland will be required to cover acupuncture for pain management and chiropractic care in certain cases.

The complete article can be viewed at:
http://www.baltimoresun.com/health/maryland-health/bs-hs-health-reform-vote-20120927,0,7774664.story Maryland picks model for essential health insurance benefits
--------------------

Summary of Benefits and Coverage and Uniform Glossary

From the National Health Law Program:

Beginning today, consumers in the individual health insurance market will have access to a Summary of Benefits and Coverage (SBC) and a Uniform Glossary of medical and insurance terms to help them better understand their health insurance coverage and compare coverage between plans.  Individuals in group health plans will have access to these documents at the start of their next plan year or during the next open enrollment period beginning on or after September 23, 2012.

All insurance companies must use a standardized SBC template to provide consumers with the same information in easy to understand language. The SBC includes a list of benefits covered and the attendant out of pocket costs if received from in-network or out-of-network providers, as well as any limitations and exceptions to coverage.  Below is the official announcement from the Department of Health & Human Services (HHS) with links to the SBC template, the Uniform Glossary of Terms, and other related information.

 

FOR IMMEDIATE RELEASE

Monday, September 24, 2012

 

Health care law ensures consumers get clear, consistent information about health coverage

 Because of the health care law, millions of Americans will have access to standardized, easy-to-understand information about health plan benefits and coverage.  Insurance companies and employers are now required to provide consumers in the private health insurance market with a brief summary of what a health insurance policy or employer plan covers, called a Summary of Benefits and Coverage (SBC). Additionally, consumers will have access to a Uniform Glossary that defines insurance and medical terms in standard, consumer-friendly terms.

These tools will also assist employers in finding the best coverage for their business and employees. 

 “Thanks to the health care law, Americans will now get clear, consistent and comparable information when shopping for health coverage,” said Health and Human Services (HHS) Secretary Kathleen Sebelius.  “These new tools empower consumers to make informed decisions about their health coverage options and to choose the plan that is best for them, their families, and their business.”

 The SBC includes a new comparison tool, called Coverage Examples, which is modeled on the Nutrition Facts label required for packaged food, that helps consumers compare coverage options by showing a standardized sample of what each health plan will cover for two common medical situations—having a baby and managing type 2 diabetes. 

 The SBC will include information about the covered health benefits, out-of-pocket costs, and the network of providers. The glossary defines terms commonly used in the health insurance market, such as “deductible” and “co-pay,” using clear language.    

 Before today, people often lacked uniform and comparable information when shopping for coverage, often relying only on marketing materials to make decisions.  Starting this fall, consumers will receive the SBC free of charge and in writing from the consumers’ insurance company or employer.  This information can be requested at any time, but it will also be made available when shopping for, enrolling in or renewing coverage.  It will also be provided whenever information in the SBC changes significantly. 

 The SBC will be available beginning today for consumers in the individual health insurance market.  For enrollees in group health plans enrolling during an open enrollment period, it will be available during the next open enrollment period that starts on or after Sept. 23, 2012. For enrollees who enroll outside of an open enrollment period, it will be available at the start of the next plan year that begins on or after Sept. 23, 2012.

 The SBC and Glossary were developed in collaboration with the Department of Labor, Department of Treasury, consumer groups, the insurance industry, State Insurance Commissioners, and other stakeholders.

 For more information on today’s announcement, please visit:

http://www.healthcare.gov/law/features/rights/sbc/index.html

 For a sample SBC, please see: http://cciio.cms.gov/resources/files/sbc-sample.pdf

 For the SBC template, please visit: http://cciio.cms.gov/resources/files/sbc-template.pdf

 For the Uniform Glossary, please visit: http://cciio.cms.gov/resources/files/Files2/02102012/uniform-glossary-final.pdf

 

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