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39 Organizations Voice Support for 12-Month Continuous Enrollment in Medicaid, CHIP

Thirty-nine allied health organizations recently submitted a letter to leaders in the House and Senate urging them to pass legislation that would provide for 12 months’ continuous eligibility for Americans in the Medicaid and Children’s Health Insurance Programs (CHIP). 

The legislation – H.R. 700 in the House, introduced by Reps. Gene Green (D-Texas) and Joe Barton (R-Texas), and S. 428, introduced by Sen. Sherrod Brown (D-Ohio) – addresses “churn,” a phenomenon where people with Medicaid and CHIP coverage lose their eligibility because of bureaucratic paperwork issues or short-term changes in income. Read the letter > | Press release > 

Medicaid Managed Care Is Accountable Care:
Reporting Prevalence by Program Type

Source: CMS Medicaid Managed Care Enrollment Reports, 2013 | see more >

Charles King of Housing Works Wins 2016 ACAP Leadership in Advocacy Award

The Association for Community Affiliated Plans (ACAP) today named Charles King, President and Chief Executive Officer of Housing Works, Inc., the winner of its Leadership in Advocacy Award. Housing Works is an organization dedicated to ending the dual crises of homelessness and AIDS through relentless advocacy, the provision of lifesaving services, and entrepreneurial businesses that sustain its efforts. Mr. King co-founded Housing Works in 1990 to serve the thousands of homeless people in New York City who were living with HIV/AIDS at the time. Since it was founded, Housing Works has served more than 20,000 homeless and low-income New Yorkers living with HIV/AIDS and currently serves over 5,000 people each year. Read more >

ACAP Lauds Introduction of S. 2438, The Medicaid and CHIP Quality Improvement Act of 2016

In a recent statement, ACAP CEO Margaret A. Murray applauded the recent introduction of S. 2438, the Medicaid and CHIP Quality Improvement Act of 2016:

“Safety Net Health Plans are strongly supportive of Senator Brown’s introduction of legislation that will establish a nationwide system of quality measurement, reporting, and improvement across all Medicaid program delivery systems, including managed care, fee-for-service, and primary care case management.  

“The benefits of this legislation are readily apparent: greater visibility into the quality of the Medicaid program will help us to get the most benefit out of the federalized nature of the program – because Medicaid is different in all 50 states, a richer set of quality data will give us a better idea of what’s working well, and what needs improvement... We are grateful to Senator Brown for his considerable leadership in introducing this bill, and urge his fellow Senators to support it as well." Full statement >

New Report Looks at Safety Net Plan Efforts to Promote Program Integrity in Medicaid

A new ACAP report examines ways in which Safety Net Health Plans work to promote program integrity in Medicaid. The report, which was written with support from Verisk Health, an ACAP Preferred Vendor, highlights strategies employed by plans to prevent, detect and resolve fraudulent or wasteful activities. 

The profiled activities include data analysis and claims review to identify aberrant claims patterns; the targeted use of Explanation of Benefit documents to alert members to help assure that billed services were actually delivered; partnership with regulators, law enforcement agencies and other health plans; employee training; and efforts to reduce avoidable adverse events such as hospital-acquired infections.

Press release > | Read the report >

Outdated Privacy Regulations Impede Care Coordination for People with Substance Use Disorder

A new ACAP report examines how Federal regulations interact with health plan efforts to coordinate care for their members with substance use disorder, or SUD. Among the Federal regulations relevant to health plans seeking to deliver coordinated care to their members are those found in Title 42, Part 2 of the Code of Federal Regulations—42 CFR Part 2, or “Part 2”. These regulations are intended to safeguard the confidentiality of patient records concerning alcohol and substance abuse treatment records. 

The report finds that owing in part to these regulations, SUD treatment programs operate in silos; the integration of SUD services with mental and physical health care is impeded owing to the restrictions on the disclosure of SUD information, which interfere with care coordination between a provider and a health plan. In contrast, the patient privacy provisions of the Health Insurance Portability and Accountability Act (HIPAA) allow information sharing for the purposes of care coordination while maintaining strong privacy safeguards.

Read the report > 

Related: Strategies to Reduce Prescription Drug Abuse > 

Community Catalyst, ACAP Issue Findings on Survey of Plans Participating in Financial Alignment Demonstrations

A new report jointly issued by ACAP and Community Catalyst examines the results of a survey of fifteen ACAP plans participating in demonstration programs for dual eligibles underway across the country. The survey results, which highlighted plan innovations and challenges in the demonstrations, led the organizations to issue a set of fifteen policy and operational changes that could lead to concrete improvements in the demonstration.

“This report offers policymakers and health plan leaders insights into the challenges of system change,” said Robert Restuccia, executive director of Community Catalyst, “and also concrete strategies and recommendations on how to improve care in the areas that are of top importance to enrollees.”

Read the report and recommendations > Press release >

ACAP Praises Proposed Changes to Risk Adjustment for Dual Eligibles

ACAP submitted a comment letter to CMS that details the support of Safety Net Health Plans for proposed changes to the risk adjustment system for health plans serving people who are dually eligible for Medicare and Medicaid.  In an October 28 memo, CMS came to the conclusion that the Medicare Advantage (MA) risk-adjustment system under-predicts the costs of full-benefit dual eligibles, or people who qualify for full Medicaid benefits due to their low incomes and their health status.

Press Release | Full Letter

Related: ACAP Applauds Steps to Consider Full-Benefit, Partial Benefit Duals Separately
Related: Fact Sheet on Progress in Duals Demonstration Programs