Health Care Reform 201

1. Health Care Reform 201 The Affordable Care Act and School-Based Health Care November 18, 2010

2. Introduction: How We Got Here Health Care Reform 201: November 2010 Health Reform 101: NASBHC’s Agenda Health Reform 102: SBHC Grants Health Reform 202: Implementation

3. Health Reform 101 Health Care Reform 201: November 2010 NASBHC’s Federal Policy Agenda Create a federal grant program for SBHCs Support reimbursement opportunities for SBHCs Position SBHCs to receive support in federal legislation and in governmental agencies

4. Health Reform 101, cont. Health Care Reform 201: November 2010 Affordable Care Act Includes a federal grant program for SBHCs Supports reimbursement opportunities for SBHCs Positions SBHCs to receive support in federal legislation and in governmental agencies

5. SBHC Grants Section 4101(a): Short-Term Appropriations Section 4101(b): Authorized Federal Program Grants for Operation of School-based Health Centers Equipment; training; management and operation; and salaries for physicians, nurses, and other personnel Authorizes spending but doesn’t allocate it. • Grants for the Establishment of School-based Health Centers • $200 million over 4 years, starting in FY2010 • Limitations: only for expenditures acquiring or improving land, facilities and equipment • No funds for personnel or to provide health services. Health Care Reform 201: November 2010

6. SBHCC Highlights Health Care Reform 201: November 2010 Can be used for alteration/renovation, new construction, equipment Can cover past equipment purchases or construction (to March 23, 2010) Preference for programs that serve a large population of children and adolescents eligible for Medicaid and CHIP

7. Health Reform 201 Health Care Reform 201: November 2010 We will always be reforming our health care system. In that broader sense, implementation is forever. -- Drew Altman, President and CEO Kaiser Family Foundation

8. Affordable Care ActOverview Health Care Reform 201: November 2010 • Regulates private health insurance • Investments in prevention, wellness, primary care • Expands access to coverage through: • Subsidies • Expansion of public insurance • Creation of health insurance exchanges • Cost containment strategies • Improving quality/cost effectiveness

9. I. Regulating private insurance (1 of 2) Health Care Reform 201: November 2010 • Extends dependent coverage up to age 26 • As of September 2010, insurers can’t • Deny coverage to kids with pre-existing conditions • Put lifetime limits on benefits • Cancel a policy without proving fraud • Deny claims without a chance for appeal • New protections, particularly for CYSHCN

10. I. Private insurance (2 of 2) Health Care Reform 201: November 2010 • 2011: Health plans must report medical loss ratios • 80-85% of premiums must spent on clinical services • 2014: Preexisting conditions must be covered for all • 2018: Excise tax on high-cost insurance plans

11. II. Investments in prevention Health Care Reform 201: November 2010 • Prevention and Public Health Fund • $5B for 2010 through 2014; then $2B/year • New Prevention Council/National Prevention Strategy • Coverage of Preventative Benefits • Rated A or B by USPSTF, recommended by AAP’s Bright Futures guidelines • Copayments eliminated for new plans now • Eliminates Medicaid cost-sharing in 2011 • Extends EPSDT to all children covered by Medicaid

12. II. Investments in primary care Health Care Reform 201: November 2010 • Workforce investments • $1.5 billion mandatory funding for the National Health Service Corps • Support 15,000 primary care providers in shortage areas • $250 million from Prevention Trust Fund • Other appropriations: • $168 million for 500 new primary care physicians by 2015 • $32 million for more than 600 new physician assistants • $30 million to train 600 nurse practitioners • $15 million for 10 nurse-managed health clinics • $5 million for states to plan and implement innovative strategies to expand their primary care workforce

13. III. Access tocoverage (1 of 3) Health Care Reform 201: November 2010 • 32M more Americans will be insured • Including 9 million kids by 2014 • 2009’s CHIP reauthorization covered 6.5M kids (4.1M uninsured) • Young adults can stay on parents’ plans • Subsidies for private insurance • Expanded eligibility for public insurance

14. III. Access to coverage (2 of 3) Health Care Reform 201: November 2010 • Expands Medicaid coverage to all under 133% of FPL • States will receive 23% increase in CHIP match rate (by 2015) • Community Transformation Grants • Planning grants to address disparities • Not appropriated

15. III. Access to coverage (3 of 3) Health Care Reform 201: November 2010 • Creation of state-level health insurance exchanges; funding to states starts in 2011, must be established by 2014 • Available those over 400% FPL • List of essential health benefits is in ACA • NASBHC has submitted comments to HHS to urge SBHCs be eligible as an as “essential community provider”

16. IV. Cost Containment (1 of 2) Health Care Reform 201: November 2010 • Use of EMR • Federal review of premium increases • Tax on high-cost plans • Comparative effectiveness research • National quality improvement strategy • Data collection on disparities • Medical home (discussed earlier today)

17. IV. Cost Containment (2 of 2) Health Care Reform 201: November 2010 • Accountable Care Organizations • Movement away from fee-for-service • Toward prevention and wellness, and away from episodic care • $25M in planning grants from CMS to states for demonstration models allow state to recognize pediatric ACOs (starting in Jan. 2012)

18. Accountable Care Organizations Health Care Reform 201: November 2010 • Local health care organization plus a set of providers • Health care org.: often a hospital? • Providers accountable for • Cost of care • Quality of care (comparative results) • Providers would get cost savings under private or public insurance

19. Accountable Care Organizations Health Care Reform 201: November 2010 • Assumes providers, not insurers, know what’s best • Hospitals thought to part of most ACOs: • Requires managers, not just providers • Requires a continuum of care, needs to plan budget and resource needs, and be able to comprehensively measure performance,

20. IV. Accountable Care Organizations Health Care Reform 201: November 2010 • New concept. Many issues evolving • Design: Physician led? Hospital led? • Will provider participation be mandatory? • How will patients be brought in? • Payment methods? • How to measure quality

21. Key opportunities and other provisions (1 of 2) Health Care Reform 201: November 2010 • $200M for SBHC equipment and construction • $375M for teen pregnancy prevention • $125M for [Teen] Pregnancy Assistance Fund • $11B for Community Health Centers • Plus $1.5B for CHC construction and renovation

22. Key opportunities and other provisions (2 of 2) Health Care Reform 201: November 2010 $25M for childhood obesity demonstration programs through 2014 $40M for CHIP outreach & enrollment Authorizes oral healthcare prevention and education

23. Challenges we are facing Health Care Reform 201: November 2010 Implementation in the hands of the states Many funds are authorized but not appropriated What SBHCs will be eligible for with “Meaningful Use” Where SBHCs might fit in the Exchanges, Medical home, ACOs

24. Main Sources Health Care Reform 201: November 2010 Kaiser Family Foundation AMCHP New England Journal of Medicine Health Affairs/RWJF CRS Reports (www.crsdocuments.com)