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Critical Health Areas Project (CHAP) Newsletter

Volume 2, Issue 2

February 28, 2007

In This Issue

Announcement:

Chronic Care and Quality: 

Healthcare Access:

Addiction Prevention and Treatment:

Providers and Workforce:

Announcements

Audioconference Series: State Access 2007

March 14, March 21

Please see below or visit http://www.ncsl.org/programs/health/webcast2.htm for conference details and registration.

Many legislative leaders and governors have signaled plans to take on access to health care this year.  We’re putting together a series of web-assisted audioconferences to keep you connected with the latest developments and give you an opportunity to share concerns and insights.  Three have been scheduled and we will add topics as interest and state and national policy developments warrant.

March 14--Healing the system:
3 P.M. EST (2 P.M. Central, 1 P.M. Mountain, Noon Pacific time)

Quality improvement, safety and effectiveness strategies to contain costs.  Vermont and Pennsylvania have both placed system reform at the heart of access reform.  Vermont has focused on providing more rational and effective care to people with chronic conditions—the group most likely to use health care.  Pennsylvania’s Rendell has focused in on making care more affordable by improving hospital safety and quality, an area where the state leads, as well as expanding the use of nurse practitioners.   How are these and other state incorporating a changed approach to delivering care into their reform efforts?

Register now at http://www.ncsl.org/public/registration/mtg_reg.htm?mtg=wc031407.  For more information on program content please contact Kala Ladenheim.  For registration questions please contact lisa.castro@ncsl.org.

March 21-- Making plans affordable:
12 P.M. EST (11 A.M. CST, 10 A.M. MST, 9 A.M. PST)

Connector and other pooling and reinsurance arrangements.  Mandates and expanded offers only work if people can afford them  What are states doing to make care affordable and what is working?  We will look at subsidies and multi-sharing plans, risk pools and reinsurance as well as experiments with low-benefit and limited plans that get new groups into insurance. 

Registration will soon be available. Watch your inboxes for the notice.  Please contact Kala Ladenheim at Kala.Ladenheim@ncsl.org or Laura Tobler at Laura.Tobler@ncsl.org with any questions about the programs. 

Archives of Previous Web-Assisted Audioconferences Now Available

The archives page can be found here http://www.ncsl.org/programs/health/webcastfeb07.htm.  Events recordings and supporting documents are usually added a week after the event.  Recently added audioconferences:


Save the Date! CHAP Meeting October 3-5, Saint Louis, MO

Save the date! Emerging Health Leaders (CHAP) meeting October 3-5, Saint Louis, MO.  We heard you loud and clear:  You want your own stand-alone meeting, and you want more than a day.  We've chosen a date and a hotel but other plans won't be made for quite a while. Mark your calendar now, stay tuned for more, and send any requests for program topics or activities to Kory Mertz at health.chaps@ncsl.org.



Chronic Care and Quality

Federal Grants to Improve Medicaid Quality

The Centers for Medicare and Medicaid Services (CMS) has awarded $103 million in grants to 27 states to improve efficiency and quality of care in Medicaid.   The funds can be used for technology to reduce medical errors, implementing strategies to reduce rates of waste and fraud, increasing the use of generic drugs, improving access to primary and specialty care by using integrated systems, and the implementing a medication risk management program.

These "transformation grants" were approved as a part of the Deficit Reduction Act of 2005 and will distributed in 2007 and 2008.  No matching state funds were required for these grants.    

For a list of grantees:
http://www.cms.hhs.gov/MedicaidTransGrants/02_012507awards.asp#TopOfPage

CMS grant information page:
http://www.cms.hhs.gov/MedicaidTransGrants/

NCSL information on Health Information Technology:
http://www.ncsl.org/programs/health/forum/hitch/  



Healthcare Access

State Approaches to Expanding Access  

Continuing last month’s series highlighting state access reforms, this month we look at what’s brewing in Maryland, Connecticut and Oregon.  Most plans would create a health insurance purchasing pool and provide subsidies to the poor. Notably, Maryland Delegate Peter A. Hammen’s plan would increase the state’s cigarette tax by $1, and Connecticut Governor Jodi Rell’s plan would require no new legislation.

  • Maryland – Governor Martin O’Malley’s plan, House Bill 132, would establish a Maryland Health Insurance Exchange, similar to the Massachusetts model, where small businesses could obtain health coverage for their employees using pre-tax dollars.  This proposal would expand the State Children’s Health Insurance Program to children in families with income up to 400 percent FPL, and would require insurance companies to cover dependent children up to age 25 on their parents health insurance plans.  This plan would also create a task force to look into other possible avenues to expand health coverage to the uninsured, including Medicaid expansion.

Further information about this plan is available at  http://www.gov.state.md.us/pressreleases/070122b.html

House Bill 754, sponsored by Delegate Hammen, would include subsidies to low-income workers and small businesses.  Under this proposal, Medicaid eligibility would be increased from 40 percent FPL to 116 percent FPL for low-income adults.  Small businesses also would be encouraged to establish plans where employees could obtain health insurance using pre-tax dollars.  In addition, this proposal would require insurance companies to cover dependent children up to age 25 on their parents health insurance plans.  Higher income residents would be required to purchase health insurance, or face penalties.  This plan includes a $1 cigarette tax increase to fund the reform and is projected to provide coverage for about half of the state’s uninsured.

Further information about this plan is available at  

     http://www.washingtonpost.com/wp-dyn/content/article/2007/01/30/AR2007013001862.html

     http://money.aol.com/news/articles/_a/maryland-lawmakers-have-ambitions-big/n20070205002809990001

     http://www.childrenshospitals.net/AM/Template.cfm?Section=Home&CONTENTID=24504&TEMPLATE=/CM/ContentDisplay.cfm

  • Connecticut – Governor Jodi Rell is working with managed care organizations to offer low cost plans to uninsured residents for $250 or less, through a single purchasing pool called Charter Oak Health Plan. The plan would be community rated, assuming that benefits and price can be balanced so as to attract enough healthy participants.  The basic plan would include prescription drug benefits, laboratory services, and pre- and post-natal care, and a $1 million lifetime cap on benefits.  It could be offered without any legislative action.  There would be a mandate  requiring all parents to show that their school-aged children are covered. The state would promote the plan, which would be offered by the private sector.  The legislature is expected to offer proposals including HuskyHealth 2007, which would cover all 75,000 uninsured children. 

Further information about this plan is available at
     http://www.medicalnewstoday.com/medicalnews.php?newsid=60387

     http://www.ct.gov/governorrell/cwp/view.asp?A=2791&Q=332004

  • Oregon – SB 329, sponsored by state Senators Alan C. Bates and Ben Westlund, would establish the Oregon Health Fund. This proposal requires uninsured individuals with income greater than 250 percent of federal poverty guidelines to pay a premium and denies the state income tax exemption credit for individuals who do not pay that premium.  The state’s poorest residents would have coverage provided for free through the program, and residents with income slightly above them would receive subsidies.

Further information about this plan is available at  

     http://www.oregoncatalyst.com/index.php?/archives/349-Oregon-Health-Care-Reform-Begins.html

     http://www.progressivestates.org/blog/465/or-the-beginnings-of-a-universal-health-care-bill

NEW!! NCSL Resources


The NCSL’s Access to Health Care and the Uninsured Website

http://www.ncsl.org/programs/health/h-primary.htm

Building Blocks SCHIP FAQ Recently Updated

  • Building Blocks is part of an orientation package for state legislators on the fundamentals of state health policy.  This package is geared mainly toward the information needs of newly elected legislators who serve on a standing health committee or for veteran legislators who are newly appointed to a health committee.  Each paper provides basic, introductory information on the most common policy and program areas addressed by state health committees.  The SCHIP FAQ section has just been updated and can be viewed here  http://www.ncsl.org/programs/health/forum/faqpreface.htm#schip.  The whole document is currently being updated and should be completed sometime this summer.

New Immigrant Health Documents

  • Health Care for Children of Immigrants Annotated Bibliography: 
    NCSL has compiled a bibliography of literature written over the past five years (2002-2006) on the policies and trends that affect the health of immigrant children and their families in the United States.  Key issues covered are health status and access to health care; federal, state, county and city programs; cost estimates; U.S.-Mexico health insurance; and U.S.-Mexico border health.  http://www.ncsl.org/programs/immig/immigbib07.htm
  • Immigrant Eligibility for Health Benefits: Federal Action and State Laws in 2005-2006:
    Documents States’ responses to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), enacted in 1996, which restricted eligibility for Medicaid, and later SCHIP, for many legal immigrants.
    http://www.ncsl.org/programs/immig/immigranthealth0506.htm

Addiction Prevention and Treatment

New Federal Study Shows Methamphetamine Use Has Dropped 

Data from the National Survey on Drug Use and Health (NSDUH) shows that past-year use of methamphetamine, a highly addictive stimulant, declined between 2002 and 2005 among persons age 12 and older. Those living in the western part of the U.S. were more likely to have used methamphetamine in the past year, compared to those living in any other part of the country, according to the report. 

The study also shows that the number of persons who used methamphetamine for the first time in the 12 months before the survey remained stable between 2002 and 2004, but decreased between 2004 and 2005.

Data from SAMHSA’s Treatment Episode Data Set (TEDS) showed that in 2004, 8 percent of treatment admissions had stimulants as the primary substance of abuse. Methamphetamine/amphetamine accounted for 99 percent of those seeking treatment for abuse of stimulants.

Forty-five percent of treatment admissions in 2004 for methamphetamine/amphetamine use were for women;26 percent of treatment admissions of women were for alcohol abuse or marijuana use.

According to the study, in 2005, approximately 1.3 million persons age 12 and older (0.5 percent) had used methamphetamine in the past year; 741,000 were male and 556,000 were female.

Combined data from 2002 to 2005 show that methamphetamine use in the past year was higher among persons in the West (1.2 percent) than among those who lived in the Northeast (0.1 percent), South (0.5 percent) or Midwest (0.5) regions. The findings were consistent for both females and males.

These results are based on survey questions about use of methamphetamine ("crank," "crystal," "ice" or "speed"), Desoxyn, or Methedrine that was not prescribed for the respondent or that he or she took only for the experience or feeling it caused.

The complete version of the NSDUH Report, Methamphetamine Use; is available online at http://oas.samhsa.gov/.

South Dakota to Expand Smoking Cessation Programs

Flush with cash from a November ballot initiative, South Dakota will develop and expand programs to encourage smokers to quit. The initiative, Initiated Measure 2, raised cigarette taxes by $1 per pack, and is expected to generate an additional $41 million in revenue. Of this, $5 million will fund anti-tobacco initiatives such as QuitLine, a state-run counseling service. The state will also pay for anti-smoking aides such as nicotine patches, and will fund further marketing and community campaigns against smoking. “This will give us a solid program, sustainable over the years,” Senator Donald Van Etten told the Sioux Falls Argus Leader. However, Sen. Van Etten also noted that the $5 million, combined with current anti-smoking expenditures of $700,000, still falls short of the $8.9 million that the Centers for Disease Control and Prevention recommends to properly fund anti-tobacco programs.

Colorado to Increase Spending on Treatment for Prisoners

Colorado Governor Bill Ritter submitted an amended budget plan this week that calls for more treatment for offenders with substance abuse and mental health problems. The plan would increase spending by $8 million, mostly on alcohol and drug treatment centers and beds for mental health patients and residential centers. The governor estimates his plan will save the state $14 million over the long term.

To see the whole story click here
http://www.ncsl.org/programs/health/snapshotfeb1507.htm#Colorado

New Study Finds American Indians and Alaska Natives Continue to Use Alcohol and Illicit Drugs at Higher Rates

American Indians and Alaska Natives age 12 and older were less likely to have used alcohol in the past year than were members of other racial groups, but they were more likely than members of other racial groups to have a past-year alcohol use disorder and to have a past-year illicit drug use disorder, according to new report from the Substance Abuse and Mental Health Services Administration (SAMHSA).

To see the whole story click here
http://www.ncsl.org/programs/health/snapshotfeb1507.htm#American_Indian_Studies

New Report Provides Snapshot of Substance Use Within 15 Largest U.S. Metropolitan Areas

The NSDUH Report: Substance Use in the 15 Largest Metropolitan Statistical Areas: 2002-2005 compares estimates for illicit drug use, binge alcohol use, and cigarette use for the nation as a whole with the same behaviors in the 15 largest metropolitan statistical areas (MSAs).

To see the whole story click here
http://www.ncsl.org/programs/health/snapshotfeb1507.htm#Substance_Abuse


Providers and Workforce

Connecticut aims to boost nursing faculty

In January, Connecticut introduced S 799, which addresses the shortage of nursing faculty in the state by establishing a nursing faculty student loan program.  The program would provide loans and loan forgiveness to state residents enrolled in local post-baccalaureate nursing programs, who agree to provide nursing instruction in the state.  To help fund the program, the bill also establishes a cash account, to consist of grants and private donations, and seeks to charge an additional one dollar fee to those requesting a nurse license renewal. 

Another Connecticut bill addresses provider shortages among allied health professionals.  The bill proposes to adopt the recommendations of the state’s allied health workforce policy board by establishing an allied health faculty scholarship; appropriating $1,500,000 to fund the scholarship program; and charging the Department of Higher Education, in collaboration with the Office of Workforce Competitiveness and the Labor Department, with conducting a state-wide marketing campaign to raise public awareness of various allied health programs and careers in the state.

Other bills tackling the nursing shortage:

New Mexico is considering H 1067, which creates a task force to craft an on-line nursing curriculum for military hospital corps members and medics.

New York is seeking to establish a professional nursing scholarship program. Under SB 1525, eligible nursing students would be required to practice in a region of the state experiencing a shortage, or teach nursing students


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