MHA Federalist

Daschle nervous about possible defunding of health reform

Defunding poses what former Senate Majority Leader Tom Daschle calls a "very serious threat" to the healthcare reform, according to an interview with Kaiser Health News. Daschle also is worried about implementation.

Because much of what happens will occur at the state level, governors could affect the level of support and the implementation's success. Just how much support the reform will get is up in the air, because 37 governor seats are up for grabs in this election cycle, he noted.

Read more here.

Federal group asks for public comment on NHIN governance

A Health IT Policy Committee work group is seeking public input as it develops rules of governance that will guide providers in sharing patient data via the nationwide health information network. The panel, which plans to issue a proposal on NHIN governance early next year, has set Nov. 3 as the deadline for the feedback.

Learn more here.

Politicians Tap Sophisticated Online Tracking Tools

The battle over health care is shifting to the states, and Massachusetts and Utah offer radically different models for the design of insurance exchanges across the country. Read more from Robert Pear in The New York Times here.

Empowering the public with health care facts

If you’re not familiar with the Patient Centered Outcomes Research Institute’s board, you’re not alone. Created by the healthcare overhaul law, it’s one of the newest and least known panels in government. But the work of its 21 members, if successful, could increase the public’s knowledge of medical treatments for everything from attention deficit and hyperactivity disorder to cancer. And it could dramatically change how you discuss treatments with your doctor when the law is fully implemented in 2014.

Read more from The Washington Post here.

NCQA releases proposed ACO standards

The National Committee for Quality Assurance released for public comment proposed standards and measures for identifying accountable care organizations that meet the definition of an ACO, as well as the ability to achieve the simultaneous ACO goals of improving health, improving patient experience and reducing per capita costs.

“While there is room for much innovation and experimentation, there is sufficient evidence and emerging consensus that ACOs must include a group of physicians with a strong primary-care base and sufficient other specialties that support the care needs of a defined population of patients,” according to the program introduction. “A well-run ACO should align the clinical and financial incentives of its providers. … ACOs will also need the administrative infrastructure to manage budgets, collect data, report performance, make payments related to performance and organize providers around shared goals.”

Organizations and individuals interested in providing comment on the draft standards must do so by 5 p.m. ET on Nov. 19. The ACO criteria were developed by a task force convened in April and led by former NCQA Chairman Robert Margolis, chairman and CEO of HealthCare Partners, a 400-physician medical group based in Torrance, Calif. Final criteria are scheduled to be released in mid-2011.

[ via Andis Robezniek, Modern Healthcare's Daily Dose ]
 

Florida judge allows health reform lawsuit to proceed

A federal judge in Florida on Oct. 14 allowed a lawsuit challenging the constitutionality of the individual coverage mandate of the Patient Protection and Affordable Care Act to continue to trial. Judge Roger Vinson of the U.S. District Court for the Northern District of Florida also allowed the lawsuit's claim that states are coerced to participate in the reform law's Medicaid expansion to proceed, but dismissed all other claims in the lawsuit, filed in March by attorneys general in Florida and 19 other states.

"I have not attempted to determine whether the line between Constitutional and extraconstitutional government has been crossed. That will be decided on the basis of the parties' expected motions for summary judgment, when I will have the benefit of additional argument and all evidence in the record that may bear on the outstanding issues," Judge Vinson's order states. "I am only saying that …with respect to [these two particular causes of action] the plaintiffs have at least stated a plausible claim that the line has been crossed."

[ via AHA News Now ]

Model MLR rebate rule advances to final vote

The National Association of Insurance Commissioners' health insurance and managed care committee on Oct. 14 approved a draft model regulation for calculating medical loss ratio rebates under the Patient Protection and Affordable Care Act. The committee sent the proposal to NAIC's executive committee for a final vote.

The ACA requires health plans to provide rebates to enrollees if their MLR, the percentage of premiums spent on clinical services and health care quality improvement activities, is less than 85% for large group health plan markets or 80% for small group and individual markets. The executive committee is expected to reconsider two decisions made by the NAIC subcommittee regarding whether health insurers should be able to calculate the MLR on an aggregated basis (state or national level) and reserve requirements known as "credibility," which affect the amount available for rebate payments.

NAIC is expected to send its final model regulation recommendations to Health and Human Services Secretary Kathleen Sebelius next week. The American Hospital Association recently submitted comments on the model regulations to NAIC.

Massachusetts State Rep. Ruth Balser speaks with David Harlow about health reform, the Massachusetts experience, and potential implications for the federal effort

The Massachusetts health reform experience is often cited as a model for key aspects of the federal health reform law - the Affordable Care Act. To gain some insight into the origins of the Massachusetts health reform law, and to explore current experience with implementation, David Harlow of HealthBlawg spoke with Rep. Ruth Balser, a legislative leader and supporter of the health reform laws in Massachusetts.

CSC: Start planning ACOs now

Though the Patient Protection and Affordable Care Act doesn't take full effect until 2014, right now is the perfect time for providers to start developing Accountable Care Organization plans, according to a white paper from Computer Sciences Corp. "The availability of the [Medicare] incentives and the start-up programs make it an ideal time for healthcare providers to get in on the ground floor of ACO development--the time for innovation will never be better, and the financial risks will never be lower," the CSC report says.

The international consulting firm has identified six "critical success factors" and accompanying health IT solutions to help assure that providers meet ACO operational goals.

Explaining Health Reform: Building Enrollment Systems That Meet the Expectations of the Affordable Care Act

This new issue brief from the Foundation's Kaiser Commission on Medicaid and the Uninsured explains the key enrollment–related provisions of the new health reform law; discusses the elements of an enrollment system that would comply with the law's requirements; and, offers strategies and examples of how to achieve such a system that addresses the different populations served by Medicaid, CHIP and the new Exchanges.