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November/December 2012 St@teside

Health Reform Resources

SCI keeps the Federal Reform Resources Web page up-to-date with the most recent information from the states, the federal government, and health policy organizations in an effort to guide our readers through the health reform implementation process. We know there are several places to go for the latest health reform resources, and we thank you for using SCI as one of your trusted sources. Here are some of the most recent resources that can be found on our Federal Reform page:
Insurance Market Reforms:
Commonwealth Fund
The Affordable Care Act changes the small-group insurance market substantially beginning in 2014, but most changes do not apply to self-insured plans. This brief analyzes this exemption and the coverage decisions small-employers can make, finding that low-risk stop-loss policies lead to higher premiums in the fully insured small-group market.
Insurance Exchanges:
Illinois Department of Healthcare and Family Services
Illinois Department of Healthcare and Family Services has released a Request for Proposal (RFP) in order to secure the services of a vendor to provide Independent Verification and Validation (IV&V) services associated with two separate implementation projects: the Integrated Eligibility System (IES) and Health Insurance Exchange (HIX). Both projects serve to satisfy the requirements of the ACA; the IES project also supports the implementation of a new Eligibility system aside from the ACA requirements.
Center for Health Care Strategies
This Policy Update provides a summary of the final regulation released by the Centers for Medicare & Medicaid Services governing the implementation of the Medicaid primary care rate increase to Medicare levels for 2013 and 2014. It highlights select provisions for states to consider when planning implementation.
Manatt Health Solutions
This template, prepared by Manatt Health Solutions, is intended to assist states in evaluating the options with respect to transitioning certain Medicaid and state-funded populations and programs into a post-ACA coverage environment with Medicaid eligibility for non-disabled adults under age 65 (potentially) expanded to 133% of the FPL and tax credits and cost sharing reductions available to individuals between 133% and 400% of the FPL (or between 100% and 400% in a non-expansion state).
State Health Access Data Assistance Center and the Hilltop Institute at the University of Maryland Baltimore County
SHARE (State Health Access Reform Evaluation) grantee David Idala, Director of Medicaid Policy Studies at The Hilltop Institute at the University of Maryland, Baltimore County, released a final report from his SHARE-funded evaluation of Maryland’s effort to identify and enroll eligible children in Medicaid and CHIP using information from state tax forms.  The report highlights key findings from the study and explores the factors that facilitated the outreach effort as well as the key challenges that Maryland faced as it implemented the initiative. 
Center for Medicaid and CHIP Services
The Center for Medicaid and CHIP Services sent out a letter to State Medicaid Directors providing guidance on Medicaid benchmark benefit coverage options, which will now be referred to as “Alternative Benefit Plans.”
Urban Institute and the Kaiser Family Foundation
This analysis uses the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM) to provide national as well as state-by-state estimates of the impact of ACA on federal and state Medicaid costs, Medicaid enrollment, and the number of uninsured. The analysis shows that the impact of the ACA Medicaid expansion will vary across states based on current coverage levels and the number of uninsured.  This analysis shows that by implementing the Medicaid expansion with other provisions of the ACA, states could significantly reduce the number of uninsured.  Overall state costs of implementing the Medicaid expansion would be modest compared to increases in federal funds, and some states are likely to see small net budget savings.  
Center for Health Care Strategies
On November 1, 2012, the Centers for Medicare & Medicaid Services (CMS) released final regulations regarding a Medicaid primary care rate increase to Medicare levels for 2013 and 2014 – a provision that is intended to encourage greater provider participation in Medicaid. This technical assistance brief reviews the final regulatory language and identifies key questions and operational steps states should consider in implementing this provision.
Strategic Planning:
Health Affairs and the Robert Wood Johnson Foundation
The ACA provides for additional means of expanding coverage beyond expanding Medicaid and establishing exchanges, including allowing states to run a so-called Basic Health Program beginning in 2014. This policy brief explores the issues surrounding the Basic Health Program and outlines options for states.
Delivery System Redesign:
Commonwealth Fund
Half of state Medicaid programs are taking new approaches to provider payment—focusing on chronically ill populations, using shared teams, aligning payments with national quality standards, and implementing shared-savings programs—to help primary care practices become patient-centered medical homes for their low-income patients. This article focuses on trends in Medicaid patient-centered medical home payment that can inform public and private payment strategies more broadly.
Center for Health Care Strategies
Leading-edge states across the country are exploring the potential of accountable care organizations (ACOs) to drive improvements in quality, delivery, and cost-effectiveness for Medicaid populations. This brief outlines 10 core considerations to help guide the development and implementation of Medicaid ACO approaches.
Center for Improving Value in Health Care
The Center for Improving Value in Health Care has officially launched the Colorado APCD.  The database, created under legislative authority in 2010, includes claims data from commercial health plans, Medicare, and Medicaid.  APCD users can view data of interest from a geographic perspective on an interactive map and/or as a report with more detailed health care information.  Customized reports and high-level summary data sets will be available beginning in early 2013.