Public Policy & Advocacy

In Addition to MCQA Bill, ACAP Continues to Press for SNP Reauthorization in SGR Reform
While things may appear to be quiet in Washington, behind the scenes there is nothing but movement as the nation’s Capital enters the second session of the 113th Congress.  And when it comes to health policy, ACAP seems to be right at the center of it all.

First, as noted above, ACAP is very pleased to report that Senate Finance Committee Health Subcommittee Chairman Jay Rockefeller (D-WV) has introduced the “Medicaid and CHIP Continuous Quality Act of 2014.”  We are proud to work with Chairman Rockefeller on this important legislation and we will work with our member plans to solicit bipartisan cosponsors of the bill over the coming months.

In addition to the introduction of the bill, ACAP has been very actively involved in behind-the-scenes negotiations between the House and Senate to ensure the reauthorization of a number of expiring Medicaid, CHIP and Medicare provisions.  The most important for ACAP is the reauthorization of the Medicare Advantage Special Needs Plans program.  The Senate Finance package reauthorizes the Dual Eligibles SNP program through December 2020 and makes a number of excellent changes to the program itself.  In addition to SNPs, the package also reauthorizes a number of other Medicaid and CHIP programs including the Express Lane Eligibility program through September 2015, the Transitional Medical Assistance Program through December 2018, the Qualifying Individuals (QI) program permanently, and a number of low-income outreach and enrollment programs. 

Last week, ACAP learned of concerns that the SNP and Medicaid/CHIP extenders might not make it into the final package: unlike the Senate version, the House versions of SGR reform legislation did not include the extenders package.  In response, ACAP issued an action alert last week asking all ACAP member plans to contact their Senators and Representatives to ensure that the SNP authorization and Medicaid/CHIP extenders be included in any SGR reform package that emerges from negotiations. ACAP is concerned that failing to reauthorize the SNP programs could make them legislative “orphans” because without any major piece of legislation to which to attach them, their authorization could expire and they could go away permanently.  That is why we continue to urge all ACAP members to communicate with the Hill about your strong support for including the SNP reauthorization package in any SGR negotiations. While negotiators announced an agreement in principle on the SGR on Thursday, details are still being finalized, including those pertaining to SNP reauthorization.

Finally, it appears that Congressional Republicans will forego any efforts to attach extraneous provisions to legislation lifting the nation’s borrowing limit, also known as the debt ceiling.  We all recall efforts over the past several years where Republicans demanded policy concessions in exchange for increasing the debt ceiling -- President Obama’s willingness to negotiate in 2011 gave us the ill-fated and poorly-named “SuperCommittee” which eventually led to sequestration which we are still suffering under today.  After President Obama refused to negotiate with Republican’s last year, Congress still increased the debt ceiling with broad bipartisan majorities.  That still hasn’t prevented some conservatives, including House Budget Chair Paul Ryan, from openly suggesting that they would attach a repeal of the ACA’s risk-corridor provisions to the debt ceiling legislation.  While it was discussed aloud, it appears that Republican leaders are rejecting this approach and instead signaling smooth passage of the debt ceiling increase.

ACAP, Allied Orgs Suggest Improvements to Medicare Advantage Risk Adjustment
Last October, ACAP, the SNP Alliance, and the National PACE Association gathered a workgroup of several experts in payment and risk adjustment to discuss issues related to the Medicare Advantage risk adjustment system. Improvements to risk adjustment in Medicare Advantage will help assure that plans are reimbursed accurately based on the health status of their members—an area of special interest to ACAP plans operating Special Needs Plans, as many not only serve a disproportionate share of high-need beneficiaries but specialize in serving such members. 

The workgroup reviewed the current risk adjustment model, evaluated the accuracy of payments for high-need Medicare beneficiaries, suggested improvements in the existing model and the larger system.  

The group developed a wide range of proposals, distilled in this report. They included:

• Inclusion of dementia and chronic condition counts as risk factors in the CMS-HCC model;

• Expanding application of the current frailty adjuster to additional plans beyond PACE and certain FIDE-SNPs;

• Improvements to “new enrollee” risk adjustment, such as expanding the approach that CMS uses to pay for new enrollees in C-SNPs, considering concurrent risk adjustment, or adjusting new enrollee payments based on previous cohorts of a plan’s new enrollees;

• Considering risk adjustment models being used in Marketplaces and duals demonstrations for broader applicability to Medicare Advantage;

• Pursuing additional research into the CMS-HCC risk adjustment model, which the group believed to systematically under-predict costs for certain high-risk groups of Medicare beneficiaries, and use the results to correct systematic biases in payment; and

• Considering the consequences of distinguishing between partial- and full-benefit dual eligible status when adjusting for Medicaid status to avoid disadvantaging plans that serve more full-benefit dual eligibles.

ACAP has incorporated many of the group’s recommendations into its advocacy efforts when meeting with officials from CMS and lawmakers on Capitol Hill, and will continue to pursue strategies to improve risk adjustment for plans that serve the highest-need Medicare beneficiaries—including MedPAC’s recommendations to use two years of patient data and include additional conditions when calculating risk adjustment.

ACAP Comments on Basic Health Program Funding Methodology
On January 22, ACAP submitted comments on draft regulations that outlined funding methodologies for the Basic Health Program. ACAP urged the Administration to reconsider its choice to prohibit states from using BHP trust funds to administer the BHP, and asked that the Administration provide BHP funds to states based on 100 percent of cost-sharing reductions, rather than 95 percent. ACAP also requested that CMS: 

• Adjust the “reference premium” in a way sufficient to offset qualified health plan premiums in 2014, which are thought to be artificially low, and use real-time premium data for the BHP program year as soon as it becomes available;

• Allow states to choose whether to pool risk between the BHP and the individual Marketplace; and

• Describe explicitly that caps applied to enrollee repayments at reconciliation will be applied also to the BHP income reconciliation process.

The full comment letter is available on ACAP’s Web site.

Excellence and Accountability

Hudson Health Plan’s Janet Sullivan Named to NQF Committee on Diabetes Quality Standards
Recently, the National Quality Forum (NQF) named Hudson Health Plan Chief Medical Officer Janet “Jessie” Sullivan, M.D., to its Endocrine Steering Committee. 

NQF reviews and endorses measures of health care quality. Measures that earn the endorsement of NQF often have significant influence the in the way that health care is delivered to patients across the country on a daily basis.

The Endocrine Steering Committee most notably reviews measures around care for diabetes, a condition that has a significant effect on those who live with the condition. Diabetes is also a major driver of health care costs. As part of the committee, Dr. Sullivan will review measures aimed at assuring that patients with diabetes receive regular blood glucose and blood pressure monitoring, eye exams, and kidney disease screening. Appropriate diabetes care can reduce the risk of significant health complications, including stroke, blindness, kidney failure, and loss of limbs.

However, many diabetes measures were endorsed by the NQF more than a decade ago. To stay abreast of developing medical knowledge and treatment options, NQF launched the Endocrine Measure Endorsement/Maintenance project to improve related performance measures. Dr. Sullivan’s work will fall under the auspices of this program.

Dr. Sullivan has significant experience with quality measure workgroups, having served on groups sponsored by NQF, the American Medical Association, National Coalition of Quality Assurance, Center for Health Care Strategies, National Transitions of Care Coalition, American Academy of Dermatology, and the New York Quality Alliance. She is also a founding member of NQF.

More information is available on Hudson Health Plan’s Web site.

Safety Net Health Plan News

Passport Health Plan Aligns with Community Care of North Carolina
In mid-January, Passport Health Plan announced that it had formed a strategic alliance with Community Care of North Carolina (CCNC), a private-public partnership dedicated to improving care and reducing waste in North Carolina’s Medicaid program.

Under the terms of the partnership, the two organizations will identify and share best practices, develop new approaches to primary care case management, and pool the two organizations’ expertise to create greater value for stakeholders in both Kentucky and North Carolina.

The two organizations have already identified areas of complementary knowledge: Passport will help CCNC to manage financial risk, navigate the NCQA accreditation process, and develop new provider reimbursement models, while CCNC will help Passport with data analytics, population management technology, and developing a state-wide operational structure tailored to local market dynamics.

“As we expand our Kentucky operations statewide beginning in January 2014, we think lessons learned by CCNC in building its statewide provider infrastructure and programs can complement Passport’s expansion initiatives across the Commonwealth,” said Passport Chief Executive Officer Mark Carter in a statement.

Safety Net Health Plan People

CareSource Promotes Steve Ringel to President, Ohio Market; Introduces Darren Morgan as VP, Strategic Marketing 
On February 3, CareSource announced that it had promoted Steve Ringel to president of the plan’s Ohio market. Mr. Ringel has more than two decades’ experience in managed care; he joined the organization in 2011 as Vice President of Operations and was subsequently promoted to Senior Vice President, Market and Product Group. 

“CareSource has always provided innovative programs for meeting the complex and changing needs of our members. Ringel’s extensive background and health care experience are well-aligned with our plans to help CareSource be a change agent in shaping the future of health care,” said CareSource President and CEO Pam Morris in a statement.

Mr. Ringel’s promotion comes as CareSource realigns its business, spurred in part by health reform. Mr. Ringel will lead eight of the company’s business components, including Community Education, Provider Relations, Member Care, Consumer Advocacy and Governmental Relations for the CareSource Medicaid, Marketplace and MyCare members.

More is available in this Dayton Business Journal story.

CareSource also introduced Darren Morgan as the plan’s new Vice President for Strategic Marketing. He will be charged with enhancing the strategic marketing of products and driving growth as CareSource expands to new product lines. Morgan will lead CareSource’s Marketing Management, Consumer Experience, Product Management and Community Marketing areas and comes with significant executive-level experience in marketing and strategic corporate imaging.

“Morgan has a wealth of senior level leadership experience in marketing, sales and operational management. He will be a valued addition to our team,” said Steve Ringel, CareSource President, Ohio Market, in a statement.



ACAP Meetings

Have You Made Your Plans for ACAP’s Fly-in and Spring Meetings?
You can now register for ACAP’s February Fly-In and Spring Meetings—and the Fly-In is just around the corner. Registration information is available on ACAP’s Web site (logon required); and hotel blocks are now available for both meetings. A little more on both meetings follows.

As a reminder – attendance at these meetings is limited to ACAP Board members and plan staff.

February 19 - 20: February Fly-In and Policy Face-to-Face
Washington Court Hotel, Washington, D.C.
More information, including agenda (ACAP logon required)

March 17 - 18: CFO Meeting
March 18 - 19: Spring Board Meeting
March 20 - 21: Medicare Meeting
Loews Santa Monica Beach Hotel, Santa Monica, Calif.
More information (ACAP logon required)

ACAP Roundtable Round-Up
And now we saddle up for the summaries of recent ACAP conference calls. More details are available on ACAP’s Roundtable page, and a list of upcoming calls is available on ACAP’s Member Calendar.

Some links include “a recording.” This generally means that you’ll see a phone number and passcode to access a recording of the call; most recordings are available for 30 days after the date of the original call.

You need an ACAP logon see these summaries, the Roundtable page, or the Member Calendar. ACAP plan staff encountering logon difficulty should contact Tanara Blanchard. 

Note: These listings do not include a variety of calls hosted by CCIIO on Exchange implementation. (There are many, many, many such calls.)You can get more information from Jenny Babcock, or go here and find instructions for getting notes on said calls that stretch back to 2012 – you may find them to be useful.

January 9: Networking Call on Dual Integration/MLTC Initiatives
This was part of ACAP's regular networking call series to discuss development in integration for dual eligibles and managed long-term care; it discussed a SNP performance measurement tool and discussed a recent readiness review. The link includes slides and a recording.

January 10: Networking Call for ACAP Plans Active in Marketplaces
This call provided an opportunity for ACAP plans participating in Marketplaces to discuss challenges and best practices as coverage became effective on January 1.

January 17: Biweekly Medicaid Expansion Networking Call
This networking call allowed plans to talk to each other about issues, concerns and successes related to participation in Medicaid expansion. 

January 23: Networking Call on Dual Integration/MLTC Initiatives
This was part of ACAP's regular networking call series to discuss development in integration for dual eligibles and managed long-term care. It focused on the proposed rule regarding Medicare Advantage and Part D changes for CY 2015, and also touched on rules issued for home- and community-based services (HCBS). The link includes slides and a recording.

January 24: Networking Call for ACAP Plans Active in Marketplaces
This call provided an opportunity for ACAP plans participating in Marketplaces to discuss challenges and best practices as coverage became effective on January 1. 

January 29: Medicare Part D Networking Call
This networking call, which focused on Medicare Part D, discussed proposed Medicare Advantage Part C and Part D changes for calendar year 2015. The call also pointed out a CMS fact sheet aimed at combating Part Dfraud and abuse, provided the findings of a research review on the impact of competition from generics and benefit management on prescription drug spending, and shared best practices from 2012 program audits. The link includes slides and links to several resources highlighted on the call.

January 30: Call to Discuss LPI Indicator Language in MA Proposed Rule
This call discussed the Low Performing Icon (LPI) language in the recent Contract Year 2015 Policy and Technical Changes to Medicare Advantage proposed rule promulgated by CMS. The call discussed potential comments, which are due to CMS on March 7. The link includes slides.

January 31: PCP Rate Increase Networking Call
This call focused on how the PCP rate increase was being carried out in different states, the current status of implementation, and provided an opportunity for plans to share best practices and common challenges.

January 31: Biweekly Medicaid Expansion Networking Call
This networking call allowed plans to talk to each other about issues, concerns and successes related to participation in Medicaid expansion. 

ACAP STRATEGIC ALLY
Health Integrated | about the Strategic Alliance

ACAP PREFERRED VENDORS

340(b) Drug Pricing: PerformRx Actuarial and Data Services: Cirdan Health Systems and Consulting Analytics, Business Intelligence and Performance Management: CTG, MedeAnalytics, The Menges Group Behavioral Health: Beacon Health Strategies, PerformCare Business Process and IT Services: TriZetto Business Process Outsourcing: TMG Health Care For High Risk Members: Optum, The Menges Group Care Coordination/Management Technology Solutions: Altruista Health, CaseTrakker Compliance Software: Compliance 360 Dental: Avesis Disease Management: Accordant Health Services, a CVS Caremark company Exchange Integration: Softheon Executive Search and Recruitment: Morgan Consulting Resources Fraud, Waste and Abuse: Verisk Health Group Purchasing: CommonWealth Purchasing Group, LLC Health Management Solutions: Health Integrated Hearing: Avesis HEDIS Compliance and Reporting: Verisk Health HIPAA/HITECH Compliance Software & Consulting: Clearwater Compliance Individual and Group Private Exchange Portal: Softheon Individual and Group Enrollment and Premium Billing: Softheon Legal Services: Epstein Becker Green, Powers Pyles Sutter & Verville Management Consulting: HTMS, an Emdeon company Marketing: DeltaSigma, LLC Member Assessments: MedXM, Optum Member/Provider Communications Consulting and Software: Cody Consulting Services Network Development: Creative Health Concepts/WeiserMazars Non-Emergency Medical Transport Management: Coordinated Transportation Solutions Patient Communication Services: CommonWealth Purchasing Group, LLC PBM Solutions: Excelsior Solutions, The Pharmacy Group, Solid Benefit Guidance Pharmacy Benefit Managers: Catamaran, MedImpact, Navitus Health Solutions Radiology Benefits Management: Care to Care Reinsurance Services: RBS Re, Summit Re RFP Strategy and Response: DeltaSigma, LLC, The Menges Group Risk Adjustment: Altegra Health, PopHealthMan, Verisk Health Specialty Formulary Management: CDMI Specialty Pharmacy: Accordant Health Services, a CVS Caremark company; Amber Pharmacy, Welldyne, Inc. Strategic Consultants: DeltaSigma, LLC Strategic Government Business Solutions: ClearStone Solutions Subrogation: First Recovery Group Vision: Avesis, Block Vision Web Portals/SaaS: Health X
ACAP Member Plans: Affinity Health Plan | Alameda Alliance for Health | AlohaCare | AmeriHealth Mercy  Amida Care | Boston Medical Center HealthNet Plan | CareOregon | CareSource | CareSource Michigan | CenCal Health | Central California Alliance for Health  Children’s Community Health Plan | Colorado Access | Commonwealth Care Alliance | Community Health Choice | Community Health Group | Community Health Network of Connecticut | Community Health Plan of Washington | Contra Costa Health Plan | Cook Children's Health Plan | Denver Health | Driscoll Children's Health Plan | Elderplan & Homefirst | El Paso First Health Plans | Family Health Network | Gold Coast Health Plan | GuildNet | Health Plan of San Joaquin | Health Plan of San Mateo | Health Services for Children with Special Needs | Horizon NJ Health | Hudson Health Plan | L.A. Care Health Plan | Inland Empire Health Plan | Kern Family Health Care | Maryland Community Health System | MDwise | Metropolitan Health Plan | Monroe Plan for Medical Care, Inc. | Neighborhood Health Plan | Neighborhood Health Plan of Rhode Island | Network Health | Partnership HealthPlan of California | Passport Health Plan | Prestige Health Choice | Priority Partners | San Francisco Health Plan | Santa Clara Family Health Plan | Sendero Health Plan | Texas Children's Health Plan | Univera Community Health | University of Arizona Health Plans | UPMC for You | VillageCareMAX | Virginia Premier | VNSNY CHOICE Health Plans Produced by the Association for Community Affiliated Plans 1015 15th Street, N.W., Suite 950 | Washington, DC 20005 Tel. 202.204.7508 | Fax 202.204.7517 | http://www.communityplans.net/