[NYAPRS Enews] NY Identifies Work Groups to Examine, Give Input on Key Health Care Reform Elements

[Harvey Rosenthal]

NYAPRS Note: The following comes courtesy of NYSCCBH's Lauri Cole, who
writes that the following information was shared during Monday's meeting
of NY's Health Care Reform Advisory Committee "regarding the formation
and function of seven (7) unique workgroups the Governor's Office will
be coordinating to inform short and long-term decisions regarding
various aspects of health reform here in New York. Each Workgroup will
look at a particular area of healthcare reform, discuss the specific
elements and key issues associated with the topic and prepare
recommendations for the Advisory Panel and the Healthcare Cabinet."
Lauri goes on to note that "anyone can join a workgroup" and that
"specifics around how to sign-up will follow from the Governor's
Office." Look to for several possible public legislative hearings on
these issues in the future. 

NYAPRS is convening a Health Care Reform Group to be headed up by Steve
Coe to help generate recommendations and spur input from our community.
Look to for a simplified background piece from us soon that will try to
summarize and translate some of the decisions that have to be made and
what the impact could be for people with psychiatric disabilities and
community providers. 

 

Suggested Work Group Topics Presented to the Health Care Reform Advisory
Committee, 10-25-10

Note: These are not final lists of work group topics.

 

Health Care Reform Advisory Committee Work Groups: Draft for Discussion
Purposes

October 25, 2010

 

Health Insurance Exchange

Meeting 1: Impact on individual and small group health insurance markets
(jointly with Commercial Market Reforms Workgroup)

Meeting 2: Role of the Exchange: active purchaser, clearinghouse, or
selective contracting agent

Additional Topics:

1. Markets: (jointly with Commercial Market Reforms Workgroup)

a) size of small groups

b) inclusion of large groups

2. Establishment of a Basic Health Plan: pros and cons for New York
(jointly with Public Health Insurance Programs Work Group)

3. Certification of Qualified Health Plans

4. Navigators (jointly with Outreach and Enrollment Work Group)

a) role in the Exchange (including brokers)

b) role in the commercial market (including brokers)

5. Information technology (jointly with Public Health Insurance Programs
Work Group)

6. Structure of the Exchange: statewide or regional

7. Benefits: Essential Health Benefits Package, transparency through web
portal and uniformity, and limited medical benefits (jointly with
Outreach and Enrollment Work Group)

 

Commercial Market Reforms

Meeting 1: Six month insurance reforms under the Affordable Care Act

Meeting 2: Impact on the commercial market resulting from the decision
to separate or combine individual and SHOP Exchanges (jointly with the
Exchange work group)

Additional Topics:

1. Markets: (jointly with Exchange Workgroup)

a) size of small groups

b) inclusion of large groups

2. Benefits: (jointly with Exchange Workgroup)

a. transparency through web portal and uniformity

b. Essential Health Benefits Package

c. limited medical benefits

3. Quality measurements: health plan and provider measurements

4. Premiums: rate review, risk adjustment, coordination with Exchange to
manage risk flow

 

Public Health Insurance Programs

Meeting 1: Medicaid eligibility rules: streamlining categorical
eligibility and the path to MAGI

Meeting 2: Prevention and quality measures

Additional topics-non-eligibility:

1. Medicaid reimbursement alternatives

2. Medical homes, ACOs, and integrated care models (jointly with Cost
Containment/Delivery System Reforms Work Group)

3. DSH reductions: implications and strategies

Additional topics-eligibility:

1. ACA impact on Medicaid rules: coordination between Medicaid and the
Exchange (no wrong door) and other changes

2. Benchmark benefits: definitions and the enhanced match rate

3. Coverage for immigrants: provisions for lawfully present immigrants
and assess options for NY

4. The non-MAGI population: ensuring they are not left behind in the
promise of simplification

5. Eligibility systems: needs and options (jointly with Exchange Work
Group)

6. Pregnant women: impact on coverage and the Family Planning Benefit
Program

7. Presumptive eligibility and other mandates: impact on hospitals and
expansion of presumptive eligibility

8. Establishment of a Basic Health Plan: pros and cons for NY (jointly
with Exchange Work Group)

 

Outreach and Enrollment

Meeting 1: Effective enrollment and retention strategies for ACA target
populations: focus on low income childless adults

Meeting 2: Effective enrollment and retention strategies for ACA target
populations: focus on children and families

Additional Topics:

1. Effective enrollment and retention strategies for ACA target
populations:

a) Immigrants

b) Low-income seniors

2. Navigators (jointly with Exchange Work Group)

a) role in the Exchange (including brokers)

b) role in the commercial market (including brokers)

3. Exchange outreach, enrollment, and retention strategies

 

Cost Containment/Delivery System Reforms

Meeting 1: Primary care

Meeting 2: Medical homes, ACOs, and integrated care models (jointly with
Public Health Insurance Programs Work Group)

Additional topics:

1. Evidence-based medicine

2. Paying for value

3. Dual eligibles (jointly with Long Term Care Work Group)

4. Administrative Efficiencies

5. Standardization

Public Health

Meeting 1: Role of public health in federal health care reform

Meeting 2: Public health grants: received funding and uses, anticipated
future funding

Additional Topics:

1. Planning for the Future-the intersection of the Affordable Care Act
with:

a) the Surgeon General's Strategic Plan

b) the NYSDOH Prevention Agenda

c) Healthy People 2020

d) CDC's Winnable Battles Initiative

2. Federal, state, and local roles to promote the goals of health reform

 

Long Term Care

Meeting 1: Balancing Incentive, Community First Option, and Money

Follows the Person

Meeting 2: CLASS Act and nursing home transparency

Additional Topics:

1. Removal of barriers to providing home and community based services

2. Spousal provisions

3. Dually-eligible and Medicare

4. Elder Justice Act Provisions

5. CMS Center for Medicare and Medicaid Innovation

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