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Welcome. Health Care Reform Webinar January 21, 2011 We will begin promptly @ 1PM EST. Event Host John Lozier Executive Director, National Health Care for the Homeless Council.

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Welcome

Welcome

Health Care Reform Webinar

January 21, 2011

We will begin promptly @ 1PM EST

Event Host

John Lozier

Executive Director,

National Health Care for the Homeless Council

This presentation is supported through a Cooperative Agreement with the Health Resources and Services Administration.


Health care housing are human rights

Health Care & Housing Are Human Rights

Health Care Reform:

An Overview for HCH Grantees

January 21, 2011


Presenters

Presenters

Barbara DiPietro, PhD

Claire Goyer, M.Ed

Tom Andrews, BS

  • Director of Policy, National Health Care for the Homeless Council

  • Director of Policy, HCH of Baltimore, MD

  • Technical Assistance Program Coordinator, National Health Care for the Homeless Council

  • Executive Director (Retired), Duffy Health Center

  • President, St. Joseph’s Mercy Care Services

  • President, Board of Directors, National Health Care for the Homeless Council


Overview of today s presentation

Overview of Today’s Presentation

Current status of Health Reform law

Medicaid expansion

Remaining uninsured

Advocacy opportunities

Health Center funding opportunities

A Grantee perspective

Health Care & Housing Are Human Rights


Current status at federal level

Current Status at Federal Level

PPACA has been in effect for 10 months, but confusion remains among general public and controversy continues

Courts: Mixed federal court decisions regarding “individual mandate”; possible Supreme Court determination

Congress: Incoming Congress has pledged to repeal or reduce law’s impact/implementation

Administrations: HHS implementing current provisions and planning for future changes

Health Care & Housing Are Human Rights


Current status at state level

Current Status at State Level

States vary widely in political/policy philosophy and stages of planning; 20 states are part of federal lawsuit

Establishing State Exchange systems

Applying for federal planning grants & demonstration projects

Projecting impact of law on rate of uninsured, budget, and existing health care structure

Evaluating changes needed

Health Care & Housing Are Human Rights


Welcome

Medicaid Expansion

Expands Medicaid to 133% Federal Poverty Level*

$14,400/year for individual (in 2010)

$24,300/year for family of 3

Allows for 5% MAGI

Expect 16 million to 23 million new enrollees

Federal reimbursement to states for newly eligible

100%: 2014-2016

95%: 2017

94%: 2018

93%: 2019

90%: 2020 and thereafter

Health Care & Housing Are Human Rights


Welcome

Medicaid Expansion (cont’d)

Maintenance of Effort: states cannot reduce Medicaid or CHIP eligibility, increase premiums or enrollment fees, or otherwise restrict enrollment

Violations: Lose all federal matching funding for the entire Medicaid program until corrected

Benefit Package: Unknown how benefits for newly eligible will compare to those available to currently eligible

Option for Early Expansion (even at incremental levels)

Early Implementers to Date

Connecticut

DC

Health Care & Housing Are Human Rights


Welcome

Medicaid Expansion (cont’d)

Benefits of early expansion:

Reduces administrative burden in 2014 (“ramp up”)

Extends health care to those most in need

Reduces use of emergency departments and other high-cost venues

Early expansion factors for states to consider:

Current eligibility/participation

Balance cost of newly eligible with previously eligible

“Expansion States”

Different considerations for Arizona, Hawaii, Delaware, Maine, Massachusetts, Vermont, New York due to existing waiver for single adult coverage

Health Care & Housing Are Human Rights


A brief mention of the state exchanges

A Brief Mention of the State Exchanges

Online marketplaces designed to help individuals and small employers obtain private-market coverage; Focused on individual and small group markets; does not apply to self-insured plans (typically those offered by large employers)

Must be implemented by January 1, 2014

Subsidies and credits, based on income (which can fluctuate): 100%-400% FPL

Must contain insurance with “Essential Health Benefits” (yet to be defined), which may be less than current state requirements

Health Care & Housing Are Human Rights


Welcome

Medicaid Expansion (cont’d)

State challenges in planning for 2014

Handling large influx of enrollment

Determining newly eligible from previously eligible

Ensuring state Exchange and Medicaid are able to integrate and provide seamless transition

Boosting provider availability

Budgeting for rate increases

Unknowns: Impact of Medicaid expansion on other mainstream funding programs (e.g., block grants); specifics behind enrollment procedures; breadth of required services

Health Care & Housing Are Human Rights


Remaining uninsured

Remaining Uninsured

In 2016: 21 million non-elderly left uninsured

Medicaid eligible, but un-enrolled: 10-11 million

Undocumented: 7 million

Non-participating: 4 million

Penalty: Individual penalty payments are based on the income of the tax return. Those below filing threshold are exempt from penalty.

Sources: Congressional Budget Office (CBO), March 20, 2010. Letter to Speaker Pelosi.

CBO, Payments of Penalties for Being Uninsured Under the PPACA, April 22, 2010.

Health Care & Housing Are Human Rights


Advocacy opportunities

Advocacy Opportunities

Encourage your state to consider advance implementation of the Medicaid expansion (even at the lowest FPL levels), greater benefits & ongoing services for those remaining uninsured

Implement assertive outreach and enrollment, reach as many as possible to minimize the uninsured population; establish best practices for teams

Participate in State Implementation Task Forces/ Councils/Committees: attend meetings, provide comments, educate policymakers about needs of individuals experiencing homelessness

 Conduct site visits!! 

Health Care & Housing Are Human Rights


Health center funding

Health Center Funding

Allocates $11 billion in health center funding over 5 years (in addition to annual appropriations)

Operations Funding: $9.5 billion total

FY2011: $1 billion

FY2012: $1.2 billion

FY2013: $1.5 billion

FY2014: $2.2 billion

FY2015: $3.6 billion

Capital Funding: $1.5 billion

National Goal: Increase number of health center patients from 20 million in 2010 to 40 million in 2015

Health Care & Housing Are Human Rights


Anticipated funding opportunities

Anticipated Funding Opportunities

New Access Points

New service delivery site for the provision of comprehensive primary and preventive health care

New Starts

Satellite Applicant

Expanded Services

Medical

Behavioral Health

Enabling

Health Care & Housing Are Human Rights


Maximizing funding opportunities be ready

Maximizing Funding Opportunities:Be Ready!

Have a clear organization-wide plan

What’s your long range vision?

How have you identified your priorities?

What are your strategic objectives?

What will your outcome measures be?

How will you evaluate your programs?

What’s the process for continuous improvement?

What constitutes success?

Health Care & Housing Are Human Rights


Readiness target population and community landscape

Readiness: Target Population and Community Landscape

Who is homeless in your local area?

What are the most prevalent health care needs?

Who is un-served or underserved?

What makes up your health & safety net?

What are the gaps?

Health Care & Housing Are Human Rights


Readiness key relationships

Readiness: Key Relationships

Examine your current partnerships

Local hospital

Discharge planning sources

Referral sources

Emergency responders – police & fire

Political leaders

Business community

Continuum of Care

Don’t be afraid to “step out of the box”!

Health Care & Housing Are Human Rights


Readiness patient centered medical home

Readiness: Patient Centered Medical Home

Current Status of:

Team functioning

Consumer voice

Comprehensive services

Certification processes

Health Care & Housing Are Human Rights


Readiness meaningful use

Readiness: Meaningful Use

EMR Status

Outcomes Development and Management

Clinical Measures

Health Care & Housing Are Human Rights


Readiness stating your case

Readiness: Stating Your Case

Document your ideal service delivery model and identify what you need to get to that goal

Integrated care model status

Implementation of Evidence Based Practices

Staffing Needs

Facility

Utilization Trends

Finances

Health Care & Housing Are Human Rights


Readiness quality improvement quality assurance

Readiness: Quality Improvement/ Quality Assurance

How are you collecting data?

How are you using data to improve?

How are you doing in terms of HRSA’s Clinical and Financial Performance Measures?

How are you measuring consumer satisfaction?

Health Care & Housing Are Human Rights


Readiness governance

Readiness: Governance

330 compliance

Board membership

Board functioning

Consumer input

Health Care & Housing Are Human Rights


Readiness finances

Readiness: Finances

Financial Management

Policies and procedures

Billing and collection systems

Systems for collecting, organizing and tracking key financial performance data

Payment Reform

Global payments

ACOs

Health Care & Housing Are Human Rights


Grantee response anticipating funding opportunities

Grantee Response:Anticipating Funding Opportunities

Updated Needs Assessment – Local School of Public Health Student Project

Safety-Net Initiative (4 FQHC’s & Public Hospital) – Supported by Local Foundations

Access to primary care – formal assessment – School of Public Policy

Creation of new open access clinic to divert emergency room visits and refer patients to patient centered medical home

Possible Accountable Care Organization (ACO)

Health Care & Housing Are Human Rights


Grantee response anticipating funding opportunities cont d

Grantee Response:Anticipating Funding Opportunities (cont’d)

Capital Campaign & Expansion Project

Purchase of new mobile coach – ARRA funding

Addition of diagnostic services (radiology/ultrasound) – ARRA funding

Addition of vision services – private funding

EMR in all clinics and EDR recently installed

Health Care & Housing Are Human Rights


Grantee response maximizing funding opportunities

Grantee Response:Maximizing Funding Opportunities

New Access Point Application – December, 2010

After-hours/weekend clinic - partnership with local public hospital and homeless women’s service provider

Diversion from ED, walk-in and outreach

Patient navigator – Referral to medical home (private funding)

Expanded Services Application – January, 2011

Behavioral health (integrated model) – two clinics

Add 4 new mobile clinic locations with new coach

New Ryan White Funding – Expand Early Intervention Clinic

Health Care & Housing Are Human Rights


Grantee response readiness community landscape target population key relationships

Grantee Response: Readiness: Community Landscape, Target Population & Key Relationships

Launching strategic planning process – 1st Quarter, 2011

Build on needs assessment - new five year plan

Expanded relationships with public hospital (NAP), other FQHC’s and Morehouse School of Medicine (behavioral health services)

New relationships for mobile clinics sites

Transitional and supportive housing

Evening clinics at shelters

Health Care & Housing Are Human Rights


Grantee response readiness patient centered medical home meaningful use quality improvement

Grantee Response:Readiness: Patient Centered Medical Home, Meaningful Use & Quality Improvement

Initiated medical home education program

Clinics sites

Outreach activities

Collaboration with other homeless service providers

Service Area Competition Application (November, 2010)

Clinical Performance Measures focused on criteria related to Patient Centered Medical Home

Financial Performance Measures focused on Meaningful Use

Health Care & Housing Are Human Rights


Grantee response readiness patient centered medical home meaningful use quality improvement cont d

Grantee Response:Readiness: Patient Centered Medical Home, Meaningful Use & Quality Improvement (cont’d)

Patient navigators – Two-Three Clinics (Americorp)

Linkage to partner agencies for referrals (public hospital, other service providers)

SSI and patient assistance programs

Referrals for other services

Enabling services

Discussion with PCA to move into IT network

Support all EHR applications/Meaningful Use requirements

Lower cost

Health Information Exchange with public hospital & other FQHC’s

Health Care & Housing Are Human Rights


Grantee response readiness governance finance

Grantee Response:Readiness: Governance & Finance

Bylaw changes – December, 2010

New 330 governance requirements

Term limits and some change in leadership

Expanded activities for Client Advisory Committee

Focus groups

Expanded volunteer and staffing opportunities

New Market Tax Credit

Participation in all managed care programs & proactively communicating with patients on medical home

Health Care & Housing Are Human Rights


Grantee response medicaid expansion

Grantee Response:Medicaid Expansion

Status of Georgia – NOT GOOD

Current eligibility does not include most homeless

Participating in federal lawsuit/new Governor on record as opposing expansion

Other opportunities

SSI benefits – Patient navigators

Expanded FQHC access/collaboration - ACO

Other advocacy efforts: mental health funding & incarceration discharge planning

Future programs: Readiness activities in “Blue” states

Health Care & Housing Are Human Rights


More information

More Information

The National Health Care for the Homeless Council is a membership organization for those who work to improve the health of homeless people and who seek housing, health care, and adequate incomes for everyone.

Additional health reform materials at:http://www.nhchc.org/healthcarereform.html

NHCHC offers free individual memberships at:http://www.nhchc.org/council.html#membership

Sign up for advocacy-related Mobilizers at:http://www.nhchc.org/mobilizer.html

Next webinar: Meaningful Use on January 26 at 2:00 EST. To register:http://www.nhchc.org/Webinars/DMUwebinar.html

Health Care & Housing Are Human Rights


Questions answers

Questions & Answers

Claire Goyer, M.Ed

Tom Andrews, BS

Barbara DiPietro, PhD

  • Director of Policy, National Health Care for the Homeless Council

  • Director of Policy, HCH of Baltimore, MD

  • Technical Assistance Program Coordinator, National Health Care for the Homeless Council

  • Executive Director (Retired), Duffy Health Center

  • President, St. Joseph’s Mercy Care Services

  • President, Board of Directors, National Health Care for the Homeless Council


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