DBHIDS Health Care Reform Steering Committee 16 December 2011

State and Local Health Care Reform Efforts

Benefits of ACA in Pennsylvania (August 2011)Medicare

2.3 million Medicare beneficiaries receiving primary care services with no copay

247,686 Medicare prescription drug beneficiaries received $250 tax-free rebates in 2010

Currently, Medicare beneficiaries receiving 50% discount on brand name drugs in donut hole

By 2020 donut hole will be closed

Insurance Reform7.7 million residents are

without lifetime limits on coverage

32,100 young adults received coverage through parent’s plans

657,000 children can not be denied coverage due to pre-existing conditions

Financial Benefits to PA

Recent Happenings

PA Insurance Dept. Announcement re: state-based exchange

Joan King’s Report, Bringing Together Physical and Behavioral Health Care: An Exploration of Current Practice and Future Directions in Pennsylvania

CMS Innovation Challenge

Legislative Updates

PA Health Insurance Exchange UpdateOn November 21 the PA Insurance Dept.

announced it would be establishing a state-based Exchange

Released a report by KPMG

Yet, still few details

www.pahealthoptions.com

Report Findings

Summary of KPMG ReportExchange Requirements

AccessibilityEligibility and MonitoringSupport and AssistanceCommunications and Notifications

Demand Estimate that 2-2.2 million individuals would

participate in Exchange

KPMG AnalysisActive purchaser v.

Market Organizer Models

OrganizationQuasi-governmentNon-profitExisting AgencyMulti-state

Governance

Program Integration

Technology

Financial Management

Certification and Quality Rating

Eligibility and Enrollment

Bringing Together Physical and Behavioral Heath Care by Joan King

Overcoming Geography as a Barrier to Integration Community Services Group- central Pennsylvania

Overcoming Financing Barriers through an Entrepreneurial Approach Delaware County Professional Services Group- Philadelphia

Development Across the Continuum Abbottsford Falls Health Center- Philadelphia

Co-located Integrated Family Services of Western Pennsylvania- Greater Pittsburgh

http://www.dvg.org/resource/resmgr/research_reports/integratedcarereport-final_2.pdf

Legislative Update

SB 1336 Passed in General Assembly Pro: Large commercial plans will be subject to

some type of reviewCons: Allows insurers to file rate hikes up to

10% with no reviewRate hikes can take place without pre

approval Information does not need to be made

publicNo protections for small businesses (e.g.

businesses do not have a right to a hearing; reserved for insurance companies only)

CMS Innovation ChallengeDBHIDS Involvement

Received interest to participate with 12 organizations

Providing letters of support, descriptive data and limited advisory support

Providing up to $1 billion in grants to “innovative” projects

Criteria:

Engage partners to identify and test new delivery and payment models

Identify new workforce models

Support innovators who can rapidly deploy (6 months or less)

Goals: better health, improved care and lower costs to people enrolled in Medicare, Medicaid and CHIP

Happy Holidays!