December 9th, 2011Alan MorganChief Executive OfficerNational Rural Health Association
NRHA MissionThe National Rural Health Association is a national membership organizationwith more than 21,000 members whosemission is to provide leadership onrural issues through advocacy,communications, education and research.
Children (up to age 26) can remain ontheir parents’ health plan.
Small businesses can qualify for taxcredit (up to 35%) of the cost of premiums.
Insurance plans are barred from settinglifetime caps on coverage, and can nolonger cancel policies when patientsget sick.
People with pre-existing medical conditionsare eligible for a new federally funded“High Risk” insurance program. Eligibleresidents of Virginia can apply for coveragethrough the Pre-Existing ConditionInsurance Plan program run by theU.S. Department of Health andHuman Services.
To qualify for coverage: You must be a citizen or national of the United States or lawfully present in the United States. You must have been uninsured for at least the last six months before you apply. You must have a pre-existing condition or have been denied coverage because of your health condition.To apply: https://www.pcip.gov/Apply.html
The Patient Protection & Affordable Care Act(ACA) Addressing Key Challenges Improving Health Insurance Coverage Expanding the Rural Workforce Supporting the Rural Infrastructure Improving Public Health Improving Quality
The Affordable Care Act and Rural AmericaSolutions in ACA that will improve coverage: Immediate Consumer Protections Coverage for adult dependant children Changes to Medicare Expansion of Medicaid and CHIP
The Affordable Care ActKey Patient “Protections” Access: Eliminates discrimination based on pre-existing medical conditions. Exchanges: A competitive marketplace for easy-to-compare, one-stop shopping of health insurance plans. Affordability: Premium tax credits for people less than 400% of poverty level ($88,200 income for a family of four today) when purchasing insurance through the exchange. Immediate Consumer Protections: No lifetime and restricted annual limits, prohibition on rescissions, and temporary high risk pool program for people who are uninsured and have a pre- existing condition.
The Affordable Care Act and Rural America A Focus on Increasing Insurance Coverage Challenges More dependant on Individual Market Small Businesses as key employer Around one quarter of all rural adults are uninsured. High reliance on public insurance One-fifth of rural residents under age 65 have health insurance from a public source, primarily Medicaid or CHIP, compared to 17% of urban residents. 40% of rural children have public coverage versus 30% of urban children.
The Patient Protection & Affordable Care Act (ACA)The Pre-Existing Condition Insurance Plan (PCIP) Section 1101 of The Affordable Care Act (ACA) requires that HHS establish a “temporary high risk health insurance pool program” Provides immediate coverage for individuals with pre- existing conditions until the Health Insurance Exchanges are available in 2014 Law required establishment within 90 days of enactment
The Affordable Care ActMedicare Eliminates cost sharing for recommended preventive services Part D donut hole closed by 2020 – $250 rebate in donut hole (only in 2010) – 50% brand-name discount (beginning 2011)Medicaid Expands the Medicaid program to more Americans. This expansion will increase access to care for low-income adults including many people living with HIV/AIDS.
The Patient Protection & Affordable Care Act (ACA)PCIP: Why This Matters in Rural America Higher rates of Chronic Disease and Disease Burden Lower Enrollment in Group Insurance Market Hospitals & Clinics Can Help Refer At-Risk Individuals to High-Risk Plans
The Patient Protection & Affordable Care Act (ACA)2011 Plan Options & Out-of Pocket Costs As in commercial coverage, PCIP enrollees pay monthly premiums and deductibles for coverage Federal Plans State Plans Beneficiary Responsibilities Standard Extended HSA-eligible Option Option Option Monthly premium $116 - $626 $156 - $842 $121 - $650 $69 - $1,806 Medical deductible $2,000 $1,000 $2,500 $0 - $5,000 Drug deductible $500 $250 Incl. in medical $100 - $500 or incl. Out-of-pocket limit $5,950 $5,950 $5,950 $5,950
The Patient Protection & Affordable Care Act (ACA)Affordable Health Insurance Exchanges: Legislation Section 1311(b) and section 1321(b) of the Affordable Care Act provide that each State has the opportunity to establish an Exchange(s) that: (1) Facilitates the purchase of insurance coverage by qualified individuals through qualified health plans (QHPs); (2) assists qualified employers in the enrollment of their employees in QHPs; and (3) meets other requirements specified in the Affordable Care Act.
The Patient Protection & Affordable Care Act (ACA)Affordable Health Insurance Exchanges On July 11, 2011, HHS released two regulations relating to the establishment of Affordable Health Insurance Exchanges: Establishment of Exchanges and Qualified Health Plans: Standards Related to Reinsurance, Risk Corridors and Risk Adjustment: The proposed rules offer states flexibility, choices, competition and clout for consumers and small businesses Comments on the Proposed Rule were due September 28, 2011
The Patient Protection & Affordable Care Act (ACA)Affordable Health Insurance Exchanges:Additional Regulations On August 12, 2011, CMS and the Treasury Department proposed three regulations aimed at making it easier for consumers to buy private health insurance through the exchanges established in the ACA and reducing the administrative burden on states establishing those exchanges. Three proposed rules released by HHS and Treasury
The Patient Protection & Affordable Care Act (ACA)Affordable Health Insurance Exchanges: State Legislation
The Patient Protection & Affordable Care Act (ACA)Expanding the Rural Workforce Health Professions Education and Training Reauthorizes the National Health Service Corps Teaching Health Centers Redistribution of Unused Residency Slots
National Health Service CorpsThe Affordable Care Act Builds on:Significant Program Expansion • $300 million in expansion funds for the NHSC from the Recovery Act • More than 6,700 clinicians presently serving • 7,358 Primary Care Providers estimated in 2010 vs. 4,760 in 2009 • Over 8,600 NHSC-Approved sites; 46% Community Health CentersRecent Program Improvements • Simplifying the NHSC site application and approval process. • Examining NHSC disciplines to ensure the primary care workforce needs are supported. • Assessing NHSC program implementation with the goal of driving more people into primary health care careers to meet public needs.
National Health Service Corps andthe Affordable Care Act Over 2,800 new Loan Repayment awards and over 200 scholarships are expected in FY 2011. Authorizes and appropriates $1.5 billion for the NHSC through 2015. FY2011: $290 million FY2012: $295 million FY2013: $300 million FY2014: $305 million FY2015: $310 million
The Patient Protection & Affordable Care Act (ACA)Improving Public Health Public Health and Prevention Fund Community Prevention Initiatives Building the Public Health Infrastructure Expanding Public Health Research and Training
Prevention and Public Health FundPrimary Care, Prevention, and Wellness Workforce and PublicHealth Training Public Health Training Centers Program Advanced Nursing Education Expansion Program Expansion of Physician Assistant Training Program Primary Care Residency Expansion Nurse Managed Health Clinics State Health Care Workforce Planning Grants State Health Care Workforce Implementation GrantsObesity Prevention and Fitness Healthy Weight Collaborative Nutrition, Physical Activity and Screen Time in Child Care Settings
The Patient Protection & Affordable Care Act (ACA)Improving Quality Center for Medicare & Medicaid Innovation (CMMI) Medicare Shared Savings Program: Accountable Care Organizations (ACOs)
Health Reform InitiativesPartnership for Patients Reduce harm caused to patients in hospitals. We will accelerate the reduction of preventable harms to inpatients starting now, so that by the end of 2013 we will observe a 40% reduction in preventable harm compared to 2010. Based on our calculations, this would mean almost two million fewer injuries to patients and more than 60,000 lives saved. Reduce preventable hospital readmissions. We will advance efforts to decrease preventable hospital readmissions within 30 days of discharge, so that by 2013 all readmissions would be reduced by 20% compared to 2010. This would mean prevention of more than 1,600,000 hospital readmissions. Achieving these two goals will not only save lives and greatly reduce injuries to millions of Americans, it will also result in savings of billions of dollars that help put the nation on the path to having a more sustainable health care system.
Health Reform InitiativesHospital-Acquired Conditions: Opportunities for Improvement The goal of the Initiative is a 40% reduction of preventable HACs in three years. Condition/Adverse Event (examples) Total Cases (2010) Preventable Cases (2010) Central Line-Associated Blood Stream Infection 41,000 20,500 Pressure Ulcer 250,000 125,000 Surgical Site Infection 290,000 101,500 Adverse Drug Event 1,900,000 950,000 Injury from Fall 200,000 50,000 Ventilator-Associated Pneumonia 40,000 20,000 All Other Hospital Acquired Conditions For example: - Delay in administration of aspirin leads to hemorrhage 2,240,589 985,859 - Misplacement of feeding tube leads to choking - Failure to manage diabetic symptoms leads to coma Total - ALL Hospital Acquired Conditions 5,982,768 2,623,150
Rural Programs and the Affordable Care ActSupporting the Rural Infrastructure Payment Extensions 340B Changes Value-Based Purchasing Demonstration for Critical Access Hospitals Low-Reimbursed Rural Hospital Payments Frontier Wage Index & Practice Expense Floor Low-Volume Adjustment Changes Medicare-Dependent Hospital Extension Expansion of the Regional Extension Assistance Center for HIT (REACH) Demonstration
The Affordable Care ActSupporting and Expanding the Rural InfrastructureRural Payment Extensions Low-Reimbursed Rural Hospital Payments Frontier Wage Index Low-Volume Adjustment Changes Medicare-Dependent Hospital ExtensionIncrease Payments for Rural Physicians Bonus Payments for Primary Care and General Surgery
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THANK YOUAlan MorganChief Executive OfficerNational Rural Health Association
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