From: Dean, Lori [mailto:[log in to unmask]]
Sent: Wednesday, March 14, 2012 3:39 PM
To: Whitehead, Shona R. (HSC)
Subject: FW: Week In Review - New HHS Exchange Rule, Public Input for 1115 Waivers, Funding for Community-Living, Millions benefit from ban on lifetime insurance limits, more


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From: Catalyst Center [mailto:[log in to unmask]]
Sent: Wednesday, March 14, 2012 3:06 PM
To: Dean, Lori
Subject: Week In Review - New HHS Exchange Rule, Public Input for 1115 Waivers, Funding for Community-Living, Millions benefit from ban on lifetime insurance limits, more


Catalyst Center Week in Review.



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NewsNews Items Newsroom

March 12, 2012

The U.S. Department of Health and Human Services (HHS) has published a final rule about the Affordable Health Insurance Exchanges. HHS also provided guidance about the standards each state must use for establishing and choosing qualified health plans for the Exchanges; determining eligibility and enrollment; and operating Small Business Health Options programs (SHOP). HHS's intent is to give states flexibility to design an Exchange that best meets the needs of its residents. States will decide if the Exchange will be part of an existing state agency, an independent agency, or a stand-alone nonprofit. The Kaiser website is tracking the status of each state's progress towards developing its Exchange. Every Exchange will have certain responsibilities, including:

  • Choosing plans to offer through the Exchange;
    • Qualified plans may not discriminate against individuals with pre-existing conditions
    • Qualified plans must ensure consumers have timely access to a wide range of providers
  •   Creating a website where consumers can compare and shop for health plans;
  • Facilitating outreach and enrollment by operating a toll-free consumer hotline and funding "Navigators" to provide additional assistance;
  • Determining eligibility for premium tax credits and public insurance options, such as Medicaid and the Children's Health Insurance Program (CHIP);
    • This will be done through the use of a single application that will "funnel" applicants to the correct program;
    • By use of electronic data sources to match information and verify eligibility, which will ensure timely processing of the application and reduce paperwork.

In 2014, SHOPs will be part of the Exchanges and will provide opportunities for small businesses to offer health insurance to their employees.   


By Katherine Howitt

Health Policy Hub: The Community Catalyst Blog

March 5, 2012

Section 1115 Medicaid and Children's Health Insurance Program (CHIP) waivers allow exemptions from certain Medicaid and CHIP regulations. Once approved by the Centers for Medicare and Medicaid Services (CMS), a waiver allows a state to continue to receive federal matching funds for providing, for example, specific services to certain populations, expanding eligibility, or even for limiting services and increasing cost-sharing. This blog, written by Katherine Howitt, a senior policy analyst at Community Catalyst, explains section 10201(i) of the Affordable Care Act (ACA). In this section, CMS and the U.S. Department of Health and Human Services (HHS) provide the final rules for obtaining public input into the review and approval process for Section 1115 waivers. Prior to the passage of the ACA, there were rules about soliciting public input for waivers. However, states and CMS, forgetting the "nothing about us, without us" lessons from disability activists in the 1990s, had been developing and approving waivers without input from the people affected by the changes. The final rule, effective on April 27, 2012, states:

  1. Prior to submitting a waiver application, states must have a public comment period and hold two public forums to gather input. In addition, they must summarize and submit these comments with the application and describe to CMS how the state considered them in its decision-making process.
  2. CMS must post the waiver application on its website and provide an additional 30-day public comment period.
  3. No later than 6 months after approval, the state must hold a public forum to gather input about how the waiver is working. Afterwards, they must hold a public forum once a year.

In addition, the final rules for the Review and Approval Process for Section 1115 Demonstrations specify regulatory requirements for eliciting input from Indian health care providers and urban Indian organizations.   


By Thomas D. Musco and Benjamin D. Sommers

Assistant Secretary for Planning and Evaluation (ASPE), Office of Health Policy

March 2012

Prior to the passage of the Affordable Care Act (ACA) in March 2010, the majority of employer-sponsored and individual health plans imposed lifetime maximum benefit limits for covered individuals. Section 1001 of the ACA, which went into effect on September 23, 2010, disallows lifetime maximum benefits, although plans can still impose annual limits of $1.25 million through September 23, 2012, rising to $2 million until January 1, 2014, when annual limits will be phased out. This ASPE issue brief estimates 105 million people, including 28 million children, will benefit from this change. In addition, individuals who lost coverage because they reached the lifetime maximum can re-enroll. While insurers can no longer limit the dollar amount of benefits, they can still limit the specific number of visits for certain services, such as physical therapy or mental health.


By Bridget M. Kuehn

March 6, 2012

The provision of the Affordable Care Act (ACA) that allows parents to keep their young adult children on their private health insurance plans to age 26 went into effect in September 2010. Data from the Centers for Disease Control and Prevention's National Health Interview Survey show an estimated 2.5 million previously uninsured 19 to 25 year olds gained health insurance coverage between September 2010 and June 2011. Researchers at the U.S. Department of Health and Human Services (HHS), using data from the U.S. Census Bureau's Current Population Survey, investigated this increase and determined it was a direct result of this provision of the ACA. They found a 2.9% increase in insurance coverage for all 19 to 26 year olds. When the researchers examined the data by race and ethnicity, they found a more significant increase in private health insurance coverage (3.5%) for black and Native American young adults. See a table of the estimated number of young adults, ages 19 - 25, who have acquired health insurance due to the ACA, by race and ethnicity in the March 2012 Assistant Secretary for Planning and Evaluation (ASPE) issue brief, New Report Shows Affordable Care Act Has Expanded Insurance Coverage Among Young Adults of All Races and Ethnicities.

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius states in Health Care Reform Law Helps 1.3 Million Minority Young Adults Obtain Health Insurance, a press release from HHS, "As a result of the Affordable Care Act, we are making strides in giving every American regardless of race or ethnicity a fair shot at quality, affordable health coverage."

Article5Billions Unleashed To Expand Community Living
By Michelle Diament
Disability Scoop
March 6, 2012
The Balancing Incentive Program is an initiative of the Affordable Care Act (ACA). States that currently spend more than half of their Medicaid funds on long-term care for individuals with disabilities, which they must fund, can apply for grants to expand services that will allow individuals with disabilities to have more choice for community living options. New Hampshire, the first state to receive a Balancing Incentives Grant, will get $26.5 million of the $3 billion allocated for this program.





Young Invincibles

Young Invincibles is a national organization dedicated to representing the interests of 18 - 34 year olds. They have created an online toolkit where young adults, parents, and employers can find state-specific information about health insurance options for young adults, how to join a parent's plan, student health plans, pre-existing conditions, insurance terms, updates about the Affordable Care Act (ACA), and more.






Date: March 28, 2012

Time: 3:00 - 3:30 PM EDT
Got Transition? National Health Care Transition Center

Health Care Transition and School Radio Episode Part One discussed the use of a student's Individual Education Plan (IEP) to address health goals and transition. Part two will focus on identifying both the additional people to involve and the educational system resources that are available to help develop and support these goals and incorporate them into a student's IEP.
Register for this event. Listen to past broadcasts.


On October 17, 2012, the Health Care Transition Research Consortium (HCTRC) and Got Transition? the National Health Care Transition Center, in collaboration with the Chronic Illness & Disease Conference, Transition from Pediatric to Adult Care will host the 4th Annual HCTRC Research Symposium at Baylor College of Medicine in Houston, Texas. The goals of this international conference are to share experience and expertise about health care transition; advance the development of health care transition as a field of science and specialty practice; and provide a networking opportunity for colleagues and consumers. Researchers, clinicians, consumers, and families raising young people with chronic conditions are invited to submit abstracts for proposed presentations about the young adult and/or parent experience; quality improvement and program design; education; research and outcomes; service models; and other topics. Submit abstracts by May 31, 2012, online, or e-mail Maria Ferris, or call May Doan at 919-966-2561, extension 266.




PastIssuesIn case you missed is the most popular news item from our last issue of the Week In Review

Disability Scoop

March 1, 2012

The National Conference of State Legislators reports that at least 29 states have autism mandates, which require health insurers to cover specific services for individuals with autism. An additional five states have laws that require insurers to cover a limited number of autism services as part of their plan's mental health benefits. This article reports the results of a survey conducted by Autism Speaks and MedClaims Liaison, a private, for-profit patient advocacy company. More than 25% of the 900+ families that participated in the survey - all with family members with autism and all living in states that require insurers to cover autism services - said they did not know about their states' requirements for coverage. Half of the families said the providers their family member needed did not accept their insurance. Disability Scoop reports Peter Bell, executive vice president of programs and services at Autism Speaks, as stating that autism legislation is not enough to ensure individuals receive needed services, and that there must be a focus on "implementation and enforcement."


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To view more articles from past issues of the Week In Review, visit the Catalyst Center website. If you have suggestions for news items related to coverage and financing of care for CYSHCN please email Week In Review editor and Catalyst Center Assistant Director Beth Dworetzky by 12 pm EST on Friday at [log in to unmask].


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The Catalyst Center is a national center dedicated to improving health care insurance and financing for Children and Youth with Special Health Care Needs (CYSHCN). For more information please visit us at or contact Meg Comeau, Program Director at [log in to unmask].


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