Morgan2011

Alan Morgan

Chief Executive Officer

National Rural Health Association

December 9th, 2011

NRHA Mission

The National Rural Health Association is

a national membership organization

with more than 21,000 members whose

mission is to provide leadership on

rural issues through advocacy,

communications, education and research.

Children (up to age 26) can remain on

their parents’ health plan.

Small businesses can qualify for tax

credit (up to 35%) of the cost of premiums.

Insurance plans are barred from setting

lifetime caps on coverage, and can no

longer cancel policies when patients

get sick.

People with pre-existing medical conditions are eligible for a new federally funded “High Risk” insurance program. Eligible residents of Virginia can apply for coverage through the Pre-Existing Condition Insurance Plan program run by the U.S. Department of Health and Human Services.

To qualify for coverage: You must be a citizen or national of the

United States or lawfully present in the United States.

You must have been uninsured for at least the last six months before you apply.

You must have a pre-existing condition or have been denied coverage because of your health condition.

To apply: https://www.pcip.gov/Apply.html

The Patient Protection & Affordable Care Act

(ACA)

Addressing Key Challenges

Improving Health Insurance Coverage

Expanding the Rural Workforce

Supporting the Rural Infrastructure

Improving Public Health

Improving Quality

Solutions in ACA that will improve coverage:

Immediate Consumer Protections

Coverage for adult dependant children

Changes to Medicare

Expansion of Medicaid and CHIP

The Affordable Care Act and Rural America

Access: Eliminates discrimination based on pre-existing medical conditions.

Exchanges: A competitive marketplace for easy-to-compare, one-stop shopping of health insurance plans.

Affordability: Premium tax credits for people less than 400% of poverty level ($88,200 income for a family of four today) when purchasing insurance through the exchange.

Immediate Consumer Protections: No lifetime and restricted annual limits, prohibition on rescissions, and temporary high risk pool program for people who are uninsured and have a pre-existing condition.

The Affordable Care Act

Key Patient “Protections”

A Focus on Increasing Insurance Coverage

Challenges

More dependant on Individual Market

Small Businesses as key employer

Around one quarter of all rural adults are uninsured.

High reliance on public insurance

One-fifth of rural residents under age 65 have health

insurance from a public source, primarily Medicaid or

CHIP, compared to 17% of urban residents.

40% of rural children have public coverage versus

30% of urban children.

The Affordable Care Act and Rural America

Section 1101 of The Affordable Care Act (ACA) requires that HHS establish a “temporary high risk health insurance pool program”

Provides immediate coverage for individuals with pre-existing conditions until the Health Insurance Exchanges are available in 2014

Law required establishment within 90 days of enactment

The Pre-Existing Condition Insurance Plan (PCIP)

The Patient Protection & Affordable Care Act (ACA)

Medicare Eliminates cost sharing for recommended preventive services

Part D donut hole closed by 2020

– $250 rebate in donut hole (only in 2010)

– 50% brand-name discount (beginning 2011)

Medicaid Expands the Medicaid program to more Americans. This expansion will

increase access to care for low-income adults including many people living with HIV/AIDS.

The Affordable Care Act


Hospitals & Clinics Can Help Refer At-Risk Individuals to High-Risk Plans

PCIP: Why This Matters in Rural America

Higher rates of Chronic Disease and Disease Burden

Lower Enrollment in Group Insurance Market


As in commercial coverage, PCIP enrollees pay monthly premiums and deductibles for coverage

2011 Plan Options & Out-of Pocket Costs

Beneficiary Responsibilities

Federal Plans State Plans

Standard Option

Extended Option

HSA-eligible Option

Monthly premium $116 - $626 $156 - $842 $121 - $650 $69 - $1,806

Medical deductible $2,000 $1,000 $2,500 $0 - $5,000

Drug deductible $500 $250 Incl. in medical $100 - $500 or incl.

Out-of-pocket limit $5,950 $5,950 $5,950 $5,950

Section 1311(b) and section 1321(b) of the Affordable Care Act provide that each State has the opportunity to establish an Exchange(s) that:

(1) Facilitates the purchase of insurance coverage by qualified individuals through qualified health plans (QHPs);

(2) assists qualified employers in the enrollment of their employees in QHPs; and

(3) meets other requirements specified in the Affordable Care Act.

Affordable Health Insurance Exchanges: Legislation


On July 11, 2011, HHS released two regulations relating to the establishment of Affordable Health Insurance Exchanges:

Establishment of Exchanges and Qualified Health Plans:

Standards Related to Reinsurance, Risk Corridors and Risk Adjustment:

The proposed rules offer states flexibility, choices, competition and clout for consumers and small businesses

Comments on the Proposed Rule were due September 28, 2011

Affordable Health Insurance Exchanges



On August 12, 2011, CMS and the Treasury Department proposed three regulations aimed at making it easier for consumers to buy private health insurance through the exchanges established in the ACA and reducing the administrative burden on states establishing those exchanges.

Three proposed rules released by HHS and Treasury

Affordable Health Insurance Exchanges:

Additional Regulations

The Patient Protection & Affordable Care Act (ACA) Affordable Health Insurance Exchanges: State Legislation


Health Professions Education and Training

Reauthorizes the National Health Service Corps

Teaching Health Centers

Redistribution of Unused Residency Slots

Expanding the Rural Workforce

National Health Service Corps

The Affordable Care Act Builds on:

Significant Program Expansion

• $300 million in expansion funds for the NHSC from the Recovery Act

• More than 6,700 clinicians presently serving

• 7,358 Primary Care Providers estimated in 2010 vs. 4,760 in 2009

• Over 8,600 NHSC-Approved sites; 46% Community Health Centers

Recent Program Improvements

• Simplifying the NHSC site application and approval process.

• Examining NHSC disciplines to ensure the primary care workforce needs are supported.

• Assessing NHSC program implementation with the goal of driving more people into primary health care careers to meet public needs.

National Health Service Corps and

the Affordable Care Act

Over 2,800 new Loan Repayment awards and over 200 scholarships are expected in FY 2011.

Authorizes and appropriates $1.5 billion for the NHSC through 2015.

FY2011: $290 million






Public Health and Prevention Fund

Community Prevention Initiatives

Building the Public Health Infrastructure

Expanding Public Health Research and Training

Improving Public Health

Prevention and Public Health Fund

Primary Care, Prevention, and Wellness Workforce and Public Health Training Public Health Training Centers Program Advanced Nursing Education Expansion Program Expansion of Physician Assistant Training Program Primary Care Residency Expansion Nurse Managed Health Clinics State Health Care Workforce Planning Grants State Health Care Workforce Implementation Grants

Obesity Prevention and Fitness Healthy Weight Collaborative Nutrition, Physical Activity and Screen Time in Child Care Settings


Center for Medicare & Medicaid Innovation (CMMI)

Medicare Shared Savings Program: Accountable Care Organizations (ACOs)

Improving Quality

Health Reform Initiatives

Reduce harm caused to patients in hospitals.

We will accelerate the reduction of preventable harms to inpatients starting now, so that by the

end of 2013 we will observe a 40% reduction in preventable harm compared to 2010. Based on our calculations, this would mean almost two million fewer injuries to patients and more than 60,000 lives saved.

Reduce preventable hospital readmissions.

We will advance efforts to decrease preventable hospital readmissions within 30 days of

discharge, so that by 2013 all readmissions would be reduced by 20% compared to 2010. This would mean prevention of more than 1,600,000 hospital readmissions.

Achieving these two goals will not only save lives and greatly reduce injuries to millions of

Americans, it will also result in savings of billions of dollars that help put the nation on

the path to having a more sustainable health care system.

Partnership for Patients

Health Reform Initiatives

The goal of the Initiative is a 40% reduction of preventable HACs in three years.

Hospital-Acquired Conditions: Opportunities for Improvement

Condition/Adverse Event (examples) Total Cases (2010) Preventable Cases (2010)

Central Line-Associated Blood Stream Infection 41,000 20,500

Pressure Ulcer 250,000 125,000

Surgical Site Infection 290,000 101,500

Adverse Drug Event 1,900,000 950,000

Injury from Fall 200,000 50,000

Ventilator-Associated Pneumonia 40,000 20,000

All Other Hospital Acquired Conditions For example: - Delay in administration of aspirin leads to hemorrhage - Misplacement of feeding tube leads to choking - Failure to manage diabetic symptoms leads to coma

2,240,589 985,859

Total - ALL Hospital Acquired Conditions 5,982,768 2,623,150

Rural Programs and the Affordable Care Act

Supporting the Rural Infrastructure

Payment Extensions

340B Changes

Value-Based Purchasing Demonstration for Critical Access Hospitals

Low-Reimbursed Rural Hospital Payments

Frontier Wage Index & Practice Expense Floor

Low-Volume Adjustment Changes

Medicare-Dependent Hospital Extension

Expansion of the Regional Extension Assistance Center for HIT (REACH) Demonstration

Rural Programs and the Affordable Care Act

Rural Payment Extensions

Low-Reimbursed Rural Hospital Payments

Frontier Wage Index

Low-Volume Adjustment Changes

Medicare-Dependent Hospital Extension

Increase Payments for Rural Physicians

Bonus Payments for Primary Care and General Surgery

The Affordable Care Act Supporting and Expanding the Rural Infrastructure

www.ruralhealthweb.org

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Join NRHA Today!

Alan Morgan

Chief Executive Officer

National Rural Health Association

T H A N K Y O U

Morgan2011

Health & Medicine