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Concurrent Care for Children: Implementation Toolkit
Released by NHPCO and DCPPCC
(Alexandria, Va) – It has been just over a year since President Obama signed the Patient Protection and Affordable Care Act into law which enacted a new provision known as the “Concurrent Care for Children Requirement” (CCCR). A new publication to help with the implementation of CCCR, the Concurrent Care for Children: Implementation Toolkit, has been created by the National Hospice and Palliative Care Organization and the District of Columbia Pediatric Palliative Care Collaboration.
The CCCR provision (Section 2302 of the ACA) states that children under the age of 21 who have been diagnosed with a life-limiting illness—and are eligible for Medicaid or the Children’s Health Insurance Program—may receive all services that are related to the treatment of a child’s life-limiting illness. This would allow these young people to have palliative and hospice care services while they are receiving other disease-modifying treatments.
“The CCCR provision is a vital piece of legislation that the pediatric hospice and palliative care community has been championing for years. The Toolkit is a comprehensive resource to guide providers, legislators and families to implement the provision as well as to strategize options for all children with serious illness, and represents a tremendous step forward for children with life-threatening conditions,” said Sarah Friebert, MD, Director of the Haslinger Division of Pediatric Palliative Care at Akron Children's Hospital.
 Concurrent Care for Children: Implementation Toolkit provides information on the options available to states that are implementing Section 2302 or are considering expansion of pediatric palliative care services to children.
Inspired by the vision of the late Dr. Carlos Gomez, one of the founders of the District of Columbia Pediatric Palliative Care Collaboration, the Concurrent Care for Children: Implementation Toolkit is available online as a free resource on the NHPCO website.
NHPCO gratefully acknowledges the District of Columbia Pediatric Palliative Care Collaboration for their generous funding to make this valuable resource available to the entire pediatric palliative care field.
NHPCO’s Children’s Project on Palliative/Hospice Services (ChiPPS), a pediatric leadership council created in 1998, has been committed to making the best-known practices in pediatric palliative and hospice care more widely available to care providers and increasing the availability of state-of-the-art services to families.
To learn more about pediatric palliative and hospice care or to download the Toolkit, please visit nhpco.org/pediatrics.
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Contact:
Jon Radulovic
NHPCO, Vice President of Communications
703-837-3139
Thanks to the Indiana Cancer Consortium and their partnership with Washington University, we are adding three new fact sheets to our arsenal of information. Washington University developed two new ones (Immediate benefits and expanded Good For Business) and updated the Common Arguments document. The fact sheets were approved by the Steering Committee and are now ready for release. All of the ICSA fact sheets can be found on the website www.smokefreein.com.
Please click the links below to review the ICSA Fact Sheets:
posted: Friday, January 14, 2011
Thank you for your participation in the 2011 Health Reform: Opportunities for AAP Chapter Advocacy Webinar on Monday, December 13, 2010.
Click here to review the Q&A prepared in response to questions submitted prior to and during the webinar. An archived recording of the Webinar can be accessed on the State Government Affairs Web page (Member Center login required) or at this link (no login required). Please
If you have any questions or need assistance, please contact Kristin Schleiter at 847/434-7797 or kschleiter@aap.org or Jeff Hudson at 847/434-7799 or jhudson@aap.org.
An archived recording of an update on the Affordable Care Act and children, youth and pediatricians in Webinar form can be accessed on the State Government Affairs Web page (Member Center login required) or at this link: http://link.delvenetworks.com/media/?channelId=1ca3fee23e104417a18a9bc292db615e&width=480&height=411&playerForm=DelvePlayer&deepLink=true. In addition, the final presentation handout is available at (LINK TO INAAP WEBSITE HERE).
Please take a moment to complete the Webinar evaluation by clicking on this link: http://www.surveymonkey.com/s/SZLBPVL by December 27. The evaluation will take 5 minutes to complete. Your input is very valuable in planning future AAP Webinars.
What: An afternoon to learn about current community issues in pediatrics and visit with legislators, and a chance to meet national leader in obesity advocacy, Dr. Sandra Hassink
Who: Any Indiana pediatrician interested in speaking to state legislators on behalf on Indiana children
When: February 1st 2011 starting at 1pm
Where: Downtown Indianapolis
Marriott Hotel
350 W Maryland St · Indianapolis, IN
(317) 822-3500
Dinner is included and the program is free to Indiana pediatricians. Please RSVP to the Indiana Chapter via Carolyn Downing, cdowning@ismanet.org, 317/261-2060 or 1-800-257-4762. Reservations are first come, first served, so don’t delay!
Dear Indiana Health Advocate,
President Obama has asked the U.S. House of Representatives to make passing child nutrition legislation a top priority after the midterm elections. The child nutrition bill currently before Congress would make the most significant improvements to the programs in decades and offers a historic opportunity to achieve a major public health priority; finally removing junk food and sugary drinks from all schools. I write to ask for your help, once more, in passing this bill.
Can you contact your district office in support of passage of this historic child nutrition bill? Contact information and a model email are below and additional background information and talking points are attached. Please let me know if you are able to reach out. (Even if you have reached out before, we need your help again in this final push to pass the bill.)
This child nutrition bill would not have been possible without the years of tireless effort and support from advocates like you. Thank you again for your help.
Sincerely,
Lindsay Vickroy
Child Nutrition Talking Points and Background For Democrats
· The House plans to vote on the Healthy Hunger-Free Kids Act during the lame duck session.
o House leaders and the White House are working out a solution to address Members concerns about the ARRA SNAP offset and a strategy to expand access to the child nutrition programs. We are confident this will be resolved to allow for the vote.
· This child nutrition bill would make the most significant improvements to the programs in decades; the increase in resources in this bill is ten times more than in the last reauthorization ($4.5 billion over 10 years in this child nutrition reauthorization v. $487 million from the 2004 reauthorization)
· The bill would expand access to nutritious food both in and out of school.
o 120,000 more low-income children will receive free school meals each year from improvements to direct certification.
o 2,500 schools will be able to use new methods of offering universal free lunches and breakfasts to children through improvements to community eligibility.
o After 10 years of work to remove unhealthy food from vending machines and a la carte lines, this bill would finally allow USDA to update nutrition standards for all food sold outside of school meals.
o USDA is working on updated school meal standards, which should be released this year. Increased reimbursement rates are essential to help schools meet the updated standards and serve more fruits, vegetables, and whole grains. The bill also will help improve meal quality and increase resources by providing more technical assistance, strengthening accountability, and reforming meal payments.
o Upon full implementation, 29 million more afterschool suppers will be provided to at-risk children each year. This translates to an average of $14,000 in additional revenue for each afterschool feeding site, each fiscal year.
o The bill will strengthen school wellness policies, supporting schools efforts to improve nutrition and physical activity for children.
o The bill will support local famers and bring more healthy foods into schools by providing $40 million for farm to school programs.
o The bill will increase participation in Child and Adult Care Food program by simplifying area eligibility determinations.
o It will increase participation in the WIC program by streamlining certification periods.
· Support for the bill is strong.
o The bill is a top priority for the President, First Lady and USDA Secretary Vilsack.
o 83% of Americans support expanding the Child Nutrition Act to "provide healthier food and cover more kids.”
o Over 1100 health, education, anti-hunger, and industry groups support the bill – including PTA, AHA, American Diabetes Assoc., National WIC Assoc., Feeding America, Share Our Strength, Alliance to End Hunger, Voices for America's Children, and more. Also, ABA, Nestle, IDFA, Mars, Coke, Pepsi, and supermarkets.
· This bill is essential for the health and well being of low-income children. The bill would not only expand access to child nutrition programs, but make sure that kids get the good nutrition they need from the programs.
o There is a new face of childhood hunger. Kids don't just need calories. They need access to good nutrition, to avoid diabetes, heart disease, and obesity. Obesity rates are highest among low-income kids.
o It is essential that child nutrition programs are an excellent source of good nutrition for low-income kids; otherwise programs do not fulfill their mandate. Likewise, healthy food does not do children any good unless they have access to it.
o No child should be hungry in America today. But they also shouldn't be fed meals that put them at risk of heart disease and diabetes.
· If Congress passes an extension, kids lose.
o The child nutrition bill already passed the Senate. The bill is bipartisan, fully paid for, and passed unanimously. This bill is the only remaining option to pass a child nutrition reauthorization this year.
o Deferring to the next Congress is not an option. An extension is the worst possible outcome because kids would lose out on the strong reforms and $4.5 billion in additional resources already passed by the Senate. Renewal of the child nutrition programs has been delayed for more than a year. Children shouldn’t have to wait any longer.
Will Representative XX vote in support of the Healthy, Hunger-Free Kids Act in the lame duck session?
For more information, contact Arianne Corbett at the Center for Science in the Public Interest
at 202.777.8358 or acorbett@cspinet.org.
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The Patient Protection and Affordable Care Act (ACA) requires states to establish programs to contract with Recovery Audit Contractors (RACs) to audit payments to Medicaid providers by the end of 2010. This document provides education on the history of RACs, the effect of the ACA on RACs and state Medicaid programs, recent guidance from Centers for Medicare and Medicaid Services (CMS) on RACs, and guidance for AAP chapters on how to be involved with planning and implementation of Medicaid RAC programs.
Recovery Audit Contractors
Recovery Audit Contractors (RACs) are independent contractors who work with the CMS (for Medicare RAC programs) and the states (for Medicaid RAC programs) to identify overpayments and underpayments and recoup improper overpayments and underpayments made to providers of federal health program business. RACs are paid on a contingency fee basis for collecting overpayments and in amounts specified by the state for identifying underpayments. RAC programs are designed to supplement existing claims review processes by requiring the review of claims previously paid by existing Medicare and Medicaid claims administration contractors.
RACs began in 2005 as a 3-year Medicare demonstration project through the Medicare Modernization Act of 2003. The demonstration program began in the states with the highest Medicare expenditures: California, Florida, and New York. In 2007 the RAC Medicare demonstration program expanded to include Massachusetts, South Carolina, and Arizona. Over the course of the demonstration, RACs identified and collected more than $1.03 billion in improper payments. According to CMS, the RAC Medicare program returned $693.6 million to the Medicare Trust Funds, and cost approximately 20 cents for each dollar returned to the funds.
Due to the success of the demonstration project, the RAC Medicare program was expanded to a permanent, nationwide program. As a result of the Tax Relief and Health Care Act of 2006, the RAC Medicare program became operational in all 50 states on January 1, 2010. Section 6411 of the ACA, Expansion of the Recovery Audit Contractor (RAC) Program, took RAC programs a step further by requiring states to expand their RAC programs to Medicaid.
RAC Expansion to State Medicaid Programs
Pursuant to mandates set forth in the ACA, states must implement RAC programs in Medicaid by December 31, 2010. States must have contracted with at least 1 Medicaid RAC by this date. The mission of Medicaid RAC programs will be the same as that of the Medicare RAC program--to identify overpayments and underpayments, and to recoup Medicaid overpayments or return underpayments. CMS expects states to fully implement their RAC programs by April 1, 2011.
On October 1, 2010, CMS issued a State Medicaid Director Letter that provides preliminary guidance on expansion of RAC programs. In this guidance, CMS outlined the parameters for establishing RAC programs, and included templates for state use. CMS also delineated certain exceptions, appeals, reporting, and coordination requirements for state RAC programs for Medicaid, and provided guidance on contingency fees and other payment matters. CMS also expressed its intent to allow states to maintain flexibility in their design of Medicaid RAC program requirements.
CMS is required by statute to issue regulations on expansion of RAC programs in the near future. The regulations will provide additional guidance to states on coordination and implementation of RAC programs. Until that time, CMS has established a Web site dedicated to RACs, which can be found online at www.cms.gov/RAC. The AAP Division of State Government Affairs will track the progress of guidance on Medicaid RAC implementation, and will notify chapters when relevant regulations are made available.
AAP Chapter Guidance
AAP chapters have an opportunity to be involved at the outset of state Medicaid RAC program planning, as states will be working to implement the ACA's mandate by the end of this year. AAP chapters can provide invaluable input as to how state Medicaid RAC programs should be implemented.
In particular, AAP chapters can express to state Medicaid directors that any Medicaid RAC programs should address some of the issues Medicare RAC programs have been dealing with for years, such as by:
- Suggesting an appropriate look-back period for claim review
- Advocating for a requirement that Medicaid RACs employ a physician medical director
- Attempting to ensure that Medicaid RAC contrators are obligated to repay their contingency fee in the event a physician wins an appeal over the overpayment determination
In this way, AAP chapters can ensure that the interests of pediatricians and their patients are kept in consideration as states continue to establish Medicaid RAC programs.
Resources
AAP chapters can also help members prepare for increased Medicaid auditing activity as states begin to implement Medicaid RAC programs by utilizing the following resources:
The AAP Division of State Government Affairs will continue to apprise AAP chapters of guidance on Medicaid RAC programs and related health reform matters.
The Division of State Government Affairs sends this update to the Academy's Executive Committee, Board of Directors, District Vice Chairs, Chapter Presidents, Chapter Vice Presidents, Chapter Legislative Contacts, Committee on State Government Affairs, Committee on Federal Government Affairs, Chapter Executive Directors, and other interested AAP members and staff.
For additional state legislative information, strategy suggestions, in-depth resources on issues of pediatric interest, and past editions of this update, log onto the AAP Member Center and see the State Government Affairs area at www.aap.org/moc/stgovaffairs.
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For more information on the issues contained in this e-mail update, please contact Kristin Schleiter at 800/433-9016, ext 7797 or at kschleiter@aap.org or Dan Walter at 800/433-9016, ext 4086 or at dwalter@aap.org.
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ACA Update: Child-Only Policy CMS Guidance, State ACA Lawsuits, and State Implementation of Health Reform
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Child-Only Policy CMS Guidance
As reported in a September 24 Advocacy FLASH e-update, insurance carriers in a number of states have indicated that they are no longer offering new child-only insurance plans in the individual market, in reaction to the September 23 implementation of the Affordable Care Act (ACA) preexisting exclusion provision for children. The AAP has continued to raise this issue at every opportunity in meetings with federal officials.
On October 13, US Department of Health and Human Services (HHS) Secretary Kathleen Sebelius issued a letter to the National Association of Insurance Commissioners (NAIC), renewing the HHS commitment to allowing families to buy insurance in the individual market, and outlining that HHS will work with states to provide options to ensure that child-only coverage can continue. The AAP issued a press statement the same day, supporting HHS efforts in working with states to find coverage for children with preexisting conditions.
In the HHS letter, Secretary Sebelius indicated that insurers would not be allowed, as they requested, to offer healthy children year-round enrollment in child-only coverage but to restrict such coverage to children with preexisting conditions to time-limited periods of open-enrollment. Further, HHS outlined a range of practices related to child-only plans that are allowed if consistent with state law, including:
. Allowing for open enrollment periods for all children regardless of health status
. Adjusting rates by health status (which the ACA disallows as of 2014)
. Imposing a surcharge for enrollee dropping of coverage and then reapplying
. Implementing rules to help prevent employers from encouraging employees to enroll in child-only plans instead of employer-sponsored insurance
. Allowing the sale of child-only plans that are self-sustaining and separate from closed child-only books of business
HHS further highlights that several states require "guaranteed issue" of all insurance in the individual market, and that several states have established uniform open enrollment periods to address this issue. The letter also discusses coverage via state CHIP buy-in programs and the availability of the Pre-Existing Condition Insurance Plan (PCIP) for children with preexisting conditions. The letter also highlights the recently enacted California legislation that requires plans to sell child-only policies or be banned from the state's entire individual market for 5 years. HHS encourages all states to take whatever steps they can to preserve options for children in the individual market.
AAP Chapter Guidance
AAP chapters are encouraged to reach out to state insurance commissioners, to determine the status of child-only policies in the individual market in your state. Chapters are further encouraged to work with insurance commissioners, state legislators, and other state officials to determine which policy options may be used to address any loss of child-only coverage in the individual market in your state.
State ACA Lawsuits
On October 14, a judge in the US District Court in the Northern District of Florida ruled that the 20-state and National Federation of Independent Businesses (NFIB) lawsuit challenging the constitutionality of the ACA can proceed. This ruling does not decide the constitutionality question, but allows the case to continue to be litigated. While dismissing several counts, the judge also allowed the court to consider the states' claim that the ACA unlawfully forces states to expand Medicaid to new populations, and the constitutionality of the individual mandate. This ruling is similar to an August ruling in the US District Court in the Eastern District of Virginia that allows the Virginia lawsuit against the ACA to proceed. However, the Florida ruling contrasts an October 7 ruling in the US District Court in the Eastern District of Michigan, where the judge upheld the individual mandate requirement of the ACA in denying a preliminary injunction against its implementation in 2014.
State Implementation of Health Reform
An October 12 Politico article highlights the wide variation among states in the ACA implementation process and discusses the challenges in those states that are opposing implementation. Another Politico piece then discusses the importance of the November state elections, which are likely to significantly impact the implementation process at the state level.
AAP chapters will continue to receive StateHealth e-updates from the Division of State Government Affairs with information on these and other ACA-related issues. Please continue to visit the State Government Affairs Member Center page for more information and resources.
The Division of State Government Affairs sends this update to the Academy's Executive Committee, Board of Directors, District Vice Chairs, Chapter Presidents, Chapter Vice Presidents, Chapter Legislative Contacts, Committee on State Government Affairs, Committee on Federal Government Affairs, Chapter Executive Directors, and other interested AAP members and staff.
For additional state legislative information, strategy suggestions, in-depth resources on issues of pediatric interest, and past editions of this update, log onto the AAP Member Center and see the State Government Affairs area at www.aap.org/moc/stgovaffairs.
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For more information on the issues contained in this e-mail update, please contact Dan Walter at
800/433-9016, ext 4086 or at dwalter@aap.org or Kristin Schleiter at 800/433-9016, ext 7797 or at kschleiter@aap.org.
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While certain provisions of the ACA apply to all health plans, so-called “grandfathered” plans are not required to adopt all of the law’s provisions. Understanding the difference between provisions that apply to grandfathered plans and those that do not is essential to helping patients and families navigate the changes resulting from the ACA. The document, Grandfathered Health Plans Under the Patient Protection and Affordable Care Act (ACA), helps with this understanding. The document discusses the key differences between grandfathered and nongrandfathered health plans, and which provisions of the ACA apply to each. It will be updated regularly on the State Government Affairs Member Center page.
Please click here to read the Patient Protection and Affordable Care Act
Please click here to read Dan Walter’s at the Legislative Forum on 9/15/10 on State ACS Implementation
Washington – Senators Evan Bayh (D-IN), Tom Harkin (D-IA) and Kit Bond (R-MO) today introduced the bipartisan Medical-Legal Partnerships for Health Act, legislation aimed at improving public health and lowering health care costs through medical-legal partnerships (MLP). MLPs bring legal aid attorneys into the clinical health care setting to integrate law and preventive medicine.
Please click here to read more information on this Bill
posted: Friday, July 09, 2010
The Employers Forum, in conjunction with the Central Indiana Alliance for Health, is planning to start a community-wide discussion of payment reform on August 5. We’ve invited employers, health plans, hospitals, physicians, public health officials and representatives of a number of Indiana health-focused collaborations and coalitions to participate in this discussion.
The preliminary agenda is:
8:00 – 8:30 a.m. Continental Breakfast
8:30 – 8:40 a.m. Welcome and Introductions
8:40 – 9:10 a.m. National Program Office – Robert Wood John Foundation
Paving the Way to Accountability in Payment Reform
The speaker will provide a perspective on payment reform as it relates to national efforts and alignment with the program goals of the Aligning Forces programs.
9:10 – 9:35 a.m. Chris Schultz, Indiana Health Information Exchange
Alignments in Indiana
The speaker will briefly review related activities in central Indiana, including Quality Health First, Central Indiana Alliance for Health, the Medicare section 646 demonstration program and the new Beacon Collaborative
9:35 – 11:00 a.m. Keynote Speaker: Francois deBrantes, CEO, Bridges to Excellence
Pathway to Accountability – The Prometheus Payment Model
This session will include a presentation and then an open discussion.
We have tentatively reserved room at the Montage at Allison Pointe, 8580 Allison Pointe Blvd., Indianapolis for this meeting. We will confirm this site when we know how many people plan to attend.
A favor of a reply is requested. You may do this by email. You may also bring guests if you let me know how many. If you have questions concerning this event, I would be pleased to answer them.
Dave Kelleher
HealthCare Options/Employers Forum
Office: 317-872-7900 (x800)
Cell: 317-509-2719
HHS Launches New Consumer-Friendly Website on Health Reform
On Thursday, the Department of Health and Human Services (HHS) launched a new website designed to help consumers understand the new health reform law, learn more about insurance options, learn about prevention, and compare health care quality. It is the first website to collect both public and private health insurance options across the nation in a single place. In addition to providing coverage scenarios based on individual circumstances, it also highlights the issues and benefits of the new law for providers. To see more, visit www.healthcare.gov.
It is a new day in America. Health reform has become law, and we can now join other developed nations that afford all citizens the right to health care. It is an especially good day for America's children and youth.....
To continue to read the following article published in the Indianapolis Star by Sarah Stelzner, Dawn Haut and Marilyn Bull, please click here!
The Academy has produced a series of new one-page fact sheets on health reform implementation and what it means for children and pediatricians. The fact sheets are now available on the main page of the AAP Member Center and on FederalAdvocacy.aap.org. Additional resources on health reform implementation will be added in the coming weeks.
The American Academy of Pediatrics supports the current health reform law. The AAP will continue to work with Congress and the Administration to ensure that the law is implemented to provide the best possible outcomes for children and the pediatricians who care for them.Please click here to read more
Good afternoon. I am Dr. Judy Palfrey, president of the American Academy of Pediatrics. I have practiced pediatrics at the Children's Hospital Boston for the past 35 years.
The American Academy Pediatrics is a non-profit professional organization of 60,000 pediatric doctors who work tirelessly for children's health and well-being. We are proud and honored to stand here today following last night’s historic vote on health reform!
The American Academy of Pediatrics highest priorities in health reform continue to be ACCESS to care, age appropriate BENEFITS in a medical home and COVERAGE for all children in the United States.
This reform greatly improves ACCESS to care based on workforce support and appropriate payment rates. The measure includes pediatric primary and subspecialty workforce improvements and for a first-time-ever federal commitment to bring Medicaid payment for Evaluation and Management codes to the floor of 100% of Medicare. This is a great step forward.
This reform provides age-appropriate BENEFITS in a Medical Home. All Bright Futures services—the definitive standard of pediatric well-child and preventive care-will be covered for children with private and public insurance as an immediate benefit for no co-pay. There is also a new commitment in Medicaid to help fund the medical home.
This reform ensures health care COVERAGE for children in the United States, including young people up to age 26.
Too many people have been hurting too much and waiting too long for this reform. We need only hear the story of the DeWitts in Indianapolis. Matt and Jax two-year-old twins were born prematurely and have had multiple health and developmental issues, including cerebral palsy. To care for the boys after their birth, Mrs. DeWitt had to leave her job... and lost her insurance. She has had to fight for nearly half a year to get on Hoosier Healthcare. Even with that, she still owes on her past medical bills and she has lost her house, her marriage and had to sell jewelry and other personal belongings just to keep the creditors from the door. No American family should have to suffer like this.
With health reform, we can make a difference for the DeWitts-and countless other hard-working Americans.
The House of Representatives' important vote yesterday places us as a nation at the closest point we have ever been to passing health reform legislation. I am from Boston and follow the Marathon every year. When the runners come in sight of the Prudential Building, they know they need one last burst of energy to finish the race. The American Academy of Pediatrics urges the Senate to take a deep breath, sip a little water and then run as if the lives of children and families depended on it... to the finish line... the passage of Health Reform for Americans.
Thank You
The American Academy of Pediatrics (AAP), which represents 60,000 pediatricians, pediatric medical subspecialists, and surgical specialists, endorses the United States House of Representatives modified health reform package introduced Thursday. The AAP applauds Congress for its steadfast commitment to passing significant health reform legislation this year.
click here to read the full press release
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