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Health Chairs Meeting
June 8-10, 2006
Washington, D.C.

Winds of Change: Health Policy in Turbulent Times

This program is sponsored by the National Conference of State Legislatures and the Kaiser Family Foundation.

For questions, comments or more information about the Health Chairs meetings, e-mail the Forum at health.chairs@ncsl.org.

Thursday, June 8

• Welcome and Agenda
• Eye on the Prize: Changing State Policies and Improving Access
• A Time of Change
• Roundtable Discussion
• Changing Science, Changing Systems
  • Transformative Technology
  • Facilitated Discussion [NCSL Project HITCh]
• Legal Preparedness: New Partnerships in the Face of Fear
• Political Will and State Leadership

Friday, June 9

• A Change of Paradigm? Health Reform in Massachusetts
• Health Policy Changes: Federal Actions, State Options
  • Trends in Budgets and Mandates
  • Federal Health Policies
  • Medicaid Program Integrity: New Opportunities
• Roundtable Discussion
• A Change of Heart: The Ethics of Health Care
• State Leadership Informing Medicaid Policy Changes: Children and Families
  • Benefits and Cost-Sharing Flexibility in DRA
  • Making Informed Choices: Issues for States
  • State Action: The West Virginia Example
• Roundtable Discussion
• State Leadership Informing Medicaid Policy Changes: People with Disabilities and the Elderly
  • Long Term Care Services and Eligibility Reforms
  • Emerging Issues for Providers, Consumers, and States
• Roundtable Discussion

Saturday, June 10

• Prescription Drugs: What's Ahead
  • Medicaid Prescription Drug Payment Reform and States
  • Part D: Looking to the Future
• Changing Demographics
  • Going Gray
    • Changes in Retiree Health
    • Retirement Health Savings Approaches
  • Immigrants and Newcomers
• Closing Roundtable Discussion on Health Care Change

Additional Resources

Presentations are in PDF format.  To view PDF files, you must install Adobe Acrobat Reader.

Thursday, June 8	View Webcasts and Transcripts  from Kaiser
Welcome and Agenda Donna Folkemer, Group Director, NCSL Barbara Lyons, Ph.D., Vice-President, The Henry J. Kaiser Family Foundation
Eye on the Prize: Changing State Policies and Improving Access Overview and change highlighting the ultimate beneficiaries of policies that will be discussed and new policy tools available.  By better understanding the different reasons different groups are uninsured or lack access to care and how they obtain care, states are able to target their access to care programs more accurately.  An introduction to new directions in Medicaid and federal-state policymaking related to access. Diane Rowland, Executive Director of the Kaiser Commission on Medicaid and the Uninsured	Rowland Presentation  Additional Resources
A Time of Change Many types of change are affecting health and the health system.  This session takes a look at new laws, wild card politics, demographic shifts, health system innovations, technological future shock, commercial innovation, viral mutation, globalization... and state initiatives that anticipate and respond to the changes. David Merritt, Project Director, Center for Health Transformation	Merritt Presentation  Additional Resources
Roundtable Discussion
Changing Science, Changing Systems How are science, technology, and organizational change transforming the health system, and what kinds of policy responses will states need to make?  Transformative Technology What are some potentially transformative technologies and state roles?  The session highlights how AHRQ is helping to "change the science of health" by developing the evidence base on waht works (Effective Health Care Program), and how state and local policymakers can access and use that information. Carolyn Clancy, Director, Agency for Healthcare Research and Quality  Facilitated Discussion What technological and system changes are affecting states now?  How are they preparing to respond to or encourage changes that create a break - "disruptive technologies"?  Some state examples include Maryland and California stem cell research legislation and various investments in HIT. NCSL Project HITCh (Health Information Technology Champions) members	Clancy Presentation  Additional Resources
Legal Preparedness: New Partnerships in the Face of Fear Concerns about emerging infections and bioterrorism provide an opportunity to build new partnerships between business and public health communities around preparedness.  What legislative/policy issues resonate with business and public health leaders?  Common sick leave policies during a public health emergency?  Liability for volunteer responses?  Discuss developing new alliances, strategies, and legislative agendas. Gene W. Matthews, J.D., Director, Institute of Public Health Law	Matthews Presentation  Additional Resources
Political Will and State Leadership Crisis and contradiction, a vision for system transformation and state opportunities to lead. John Kitzhaber, M.D., Former Governor, State of Oregon, President, Estes Park Institute	Kitzhaber Presentation  Additional Resources
Friday, June 9	View Webcasts and Transcripts  from Kaiser
A Change of Paradigm?  Health Reform in Massachusetts State health reform took a leap forward with the passage of legislation in Massachusetts that includes striking new features and showcases an unusual breadth of political support.  John McDonough and Ed Haislmaier will lay out policy features that attached bipartisan support.  Senator Richard Moore, Representative Patricia Walrath, and Representative Bob Hargraves will discuss various components of the new law, offering advice to other legislators looking to develop compromises that move their states toward wider access to health insurance. Moderator:  Diane Rowland, Executive Director, Kaiser Commission on Medicaid and the Uninsured Panelists: John McDonough, Executive Director, Health Care for All Massachusetts Edmund Haislmaier, Research Fellow, Center for Health Policy Studies, The Heritage Foundation Senator Richard Moore, Chair [via videoconference] Representative Patricia Walrath, Chair Representative Robert Hargraves [via videoconference]	Massachusetts Presentation  McDonough Presentation  Walrath Presentation  Supplemental Readings from Edmund Haislmaier  Additional Resources
Health Policy Changes:  Federal Actions, State Options The Deficit Reduction Act (DRA) seems to be part of continuing federal actions that push decisions, responsibilities and fiscal risk onto the states.  How is the relationship between states and the federal government changing and what are the up and down sides of these changes for health policy in the states?  Trends in Budgets and Mandates Overview of changing dynamics in budgets and mandates; how states will be affected and how legislatures can act. Molly Ramsdell, NCSL  Federal Health Policies Health policy trends and implications.  DRA overview and other federal policies to watch.  Keep an eye out for the Medicaid commission report; the continuing story of Medicare D; Federal insurance reform including Health Savings Accounts (HSAs) and Association Health Plans (AHPs); SCHIP reauthorization. Joy Wilson, NCSL  Medicaid Program Integrity:  New Opportunities DRA encourages the enactment of State False Claims Acts and strengthens Medicaid Integrity Programs at the federal and state levels.  What are the opportunities and challenges for states? Vikki Wachino, Wachino Health Policy Consulting	Ramsdell Presentation  Wilson Presentation  Wachino Presentation  Additional Resources from: Ramsdell Wachino
Roundtable Discussion
A Change of Heart:  The Ethics of Health Care Len Nichols, New America Foundation	Nichols Presentation  Additional Resources
State Leadership Informing Medicaid Policy Changes:  Children and Families The State Leadership sessions will focus on Medicaid policy questions to be considered by states over the next twelve months.  Driven by DRA, states will have a range of benefit design, coverage, cost-sharing, and reimbursement options to examine.  What should states know to inform their choices?  Benefits and Cost-Sharing Flexibility in DRA Elicia Herz, Specialist in Social Legislation, Congressional Research Service  Making Informed Choices:  Issues for States Jocelyn Guyer, Senior Researcher, Georgetown University Health Policy Institute  State Action:  The West Virginia Example Nancy Tyler, Finance Committee Counsel, West Virginia House of Delegates	Herz Presentation  Guyer Presentation  Tyler Presentation  Additional Resources
Roundtable Discussion
State Leadership Informing Medicaid Policy Changes:  People with Disabilities and the Elderly States have led the way in Cash and Counseling, Long Term Care Partnerships, and waivers to reform long term care service delivery.  Now DRA allows states to take another step forward using some of the tools pioneered at the state level.  How does federal law change the framework within which states will operate?  How can states build on past experience as they consider new long term care reform opportunities?  Long Term Care Services and Eligibility Reforms Jeffrey Crowley, Senior Research Scholar, Georgetown University  Emerging Issues for Providers, Consumers, and States Michael W. Cheek, Avalere Health	Crowley Presentation  Cheek Presentation  Additional Resources from: Crowley Cheek
Roundtable Discussion
Saturday, June 10
Prescription Drugs:  What's Ahead  Medicaid Prescription Drug Payment Reform and States John Coster, National Association of Chain Drug Stores  Part D:  Looking to the Future Cheryl Matheis, Director of Health Strategies, AARP	Coster Presentation  Additional Resources
Changing Demographics  Going Gray An end to private sector retiree health?  What do changes in employer coverage signal, and what are the implications for states?  What are some new approaches and what are the implications for state policies?  Changes in Retiree Health Coverage Melinda Silver, U.S. Department of Labor  Retirement Health Savings Approaches Kathy Harm, ICMA-RC  Immigrants and Newcomers How is health care changing to meet the needs of a growing immigrant population?  Some state actions to make sure immigrants receive appropriate care address cultural competency, Medicaid reimbursement for language services, and interpreter certification issues. Mara K. Youdelman, Staff Attorney, National Health Law Program Elena Rios, M.D., President and CEO, National Hispanic Medical Association	Silver Presentation  Harm Presentation   Rios Presentation  Additional Resources on: Retiree Health Immigrant Health
Closing Roundtable Discussion on Health Care Change	Read the Discussion

Additional Resources:

Diane Rowland recommends the following resources:

• The Kaiser Family Foundation at http://www.kff.org/about/kcmu.cfm
• Medicaid Enrollment and Spending Trends at http://www.kff.org/medicaid/7523.cfm
• Medicaid At a Glance at http://www.kff.org/medicaid/7235.cfm
• Deficit Reduction Act of 2005: Implications for Medicaid at http://www.kff.org/medicaid/7465.cfm
• Covering the Uninsured: Growing Need, Strained Resources at http://www.kff.org/uninsured/7429.cfm
• “Medicaid: Facing the Facts” in the January 2006 edition of Healthcare Financial Management 

David Merritt recommends the following resources:

• CHT Medicaid Solutions Handbook at http://www.healthtransformation.net/content/Files/Solution%20Workbook%203%2D14%2D06%20FINAL%2D2.pdf
• Center for Health Transformation at http://www.healthtransformation.net/ 
• Medicaid project at http://www.healthtransformation.net/projects/Medicaid__Transformation/
• Health Information Technology project at http://www.healthtransformation.net/projects/Health_Information_Technology/ 
• Consumerism at http://www.healthtransformation.net/projects/Consumerism/
• Avian flu/Homeland Security at http://www.healthtransformation.net/projects/Avian_Flu/
• Health information technology and preparedness at http://www.healthtransformation.net/news/cht_articles_and_op_eds/1974.cfm
• Paper on efforts to modernize healthcare at the state and local level at http://www.healthtransformation.net/content/Files/CHT%20Connectivity%20Conference%20Report%20%2D%2011%2028%2005%20%284%29.pdf

Carolyn Clancy recommends the following resources:

• Agency for Healthcare Research and Quality at www.ahrq.gov
• Quality and safety at http://ahrq.gov/qual/
• State snapshots web tool at http://ahrq.gov/news/press/pr2006/stsnappr.htm and http://www.qualitytools.ahrq.gov/qualityreport/2005/state/summary/map.aspx

Gene Matthews recommends the following resources:

• The Private/Public Response to Sudden Disease Outbreak at http://cdcfoundation.org/sitefiles/TorontoReport.pdf
• The Institute of Public Health Law at http://cdcfoundation.org/programs/iphl/index.aspx

John Kitzhaber recommends the following resources:

• JoinAM at http://www.joinam.org/
• The Archimedes Movement at http://www.archimedesmovement.org/

Edmund Haislmaier recommends the following resources:

• Doing it Right: The District of Columbia Health Insurance Market Reform at http://www.heritage.org/Research/HealthCare/hl936.cfm
• The Significance of the Massachusetts Health Reform at http://www.heritage.org/Research/HealthCare/wm1035.cfm

Additional Resources for the Massachusetts Health Reform

• Massachusetts Health Care Reform Plan at http://www.kff.org/uninsured/7494.cfm
• Massachusetts Health Care Reform: Building a Healthier, Better Future, Chapter 58 of the Acts of 2006
• Health Care Access Law: Frequently Asked Questions

From Molly Ramsdell:

• Turn to this page for information on federal issues that are important to state legislators.  From this page, you can link to NCSL's Mandate Monitor and NCSL's Preemption Monitor. You can also link to the "Health Policy-Federal Issues" page.
  http://www.ncsl.org/statefed/statefed.htm

Vikki Wachino recommends the following resources:

• Model State False Claims Act at http://www.taf.org/modelstatefca.pdf
• Why the False Claims Act Works and Why is It Important
• How A State Qualifies for Additional Federal Funds Under the Deficit Reduction Act
• How A State False Claims Act Benefits a State

Len Nichols recommends the following resources:

• Outline of the New America Vision for a 21st Century Health Care System at http://www.newamerica.net/Download_Docs/pdfs/Doc_File_2855_1.pdf
• Health Reform Massachusetts Style: Ink Blot Text And Example For Us All at http://www.newamerica.net/Download_Docs/pdfs/Doc_File_3030_1.pdf

Jocelyn Guyer recommends the following resource:

• The Deficit Reduction Act: A Review of Key Medicaid Provisions Affecting Children and Families at http://jonesd.ihcrp.georgetown.edu/~jonesd3/reconbrief013006.pdf

Jeffrey Crowley recommends the following resource:

• Medicaid Long Term Services Reforms in the Deficit Reduction Act at http://www.kff.org/medicaid/upload/7486.pdf

Michael Cheek recommends the following resources:

• Avalere Health LLC at http://www.avalerehealth.net/
• Information on Mike Cheek at Avalere Health at http://www.avalerehealth.net/staff/index.html  
• Evolution of State Health Information Exchange:  A Study of Vision, Strategy, and Progress at http://www.avalerehealth.net/research/docs/State_based_Health_Information_Exchange_Final_Report.pdf
• The Medicare Drug Benefit:  How Good Are the Options? at http://www.chcf.org/documents/policy/TheMedicareDrugBenefitHowGoodAreTheOptions.pdf
• The Medicare Drug Benefit: Implications for Chronic Disease Care at http://www.chcf.org/documents/insurance/MedicareDrugBenefitChronicDiseaseCare.pdf
• The Medicare Drug Benefit: Impact on Nursing Facilities at http://www.chcf.org/documents/insurance/MedicareDrugBenefitNursingFacilities.pdf
  Kaiser Family Foundation
• Frontline Perspectives on Long-Term Care Financing Decisions and Medicaid Assets Transfer Practices at http://www.avalerehealth.net/research/docs/AssettransferpaperFINAL.pdf 
• West Virginia Bureau for Medical Services at http://www.wvdhhr.org/bms/

John Coster recommends the following resources:

• Implications of Federal Medicaid Generic Drug Payment, Reductions for State Policymakers at http://www.nacds.org/user-assets/pdfs/gov_affairs/issuebriefs/ImplicationsFederalMedicaidGenericDrugPaymentReductionsFebruary2006.pdf
• Letter to Senator Charles Grassley
• CMS Letter on Co-pays

Additional Resources on Retiree Health

• Health Benefits in Retirement: Set for Extinction? at http://www.nhpf.org/pdfs_bp/BP_RetireeHealth_02-08-06.pdf
• Current Trends and Future Outlook for Retiree Health Benefits: Findings from the Kaiser/Hewitt 2004 Survey on Retiree Health Benefits at http://www.kff.org/medicare/med121404pkg.cfm

Additional Resources on Immigrant Health

• National Hispanic Medical Association at http://www.nhmamd.org/
• National Health Law Program at http://www.healthlaw.org/
• From KFF, a 2-page overview of Medicaid and SCHIP policy at
  http://www.kff.org/medicaid/upload/7492.pdf, coverage for immigrants at http://www.kff.org/uninsured/upload/Health-Coverage-for-Immigrants-Fact-Sheet.pdf and additional resources at http://www.kff.org/uninsured/immigranthealth.cfm 
• This 4-page backgrounder on coverage and immigrants from 2004 at http://www.kff.org/uninsured/upload/Immigrants-and-Health-Coverage-A-Primer.pdf
  summarizes a study by the Center for Budget and Policy Priorities.  Note the map on P. 6 showing which states supplement with state only dollars at http://www.kff.org/medicaid/upload/Covering-New-Americans-A-Review-of-Federal-and-State-Policies-Related-to-Immigrants-Eligibility-and-Access-to-Publicly-Funded-Health-Insurance-Report.pdf 
• Broad statistics from California Healthcare Foundation at http://www.californiahealthline.org/index.cfm?Action=dspItem&itemID=112092 
• The Employee Benefits Research Institute reported in 2005 on coverage and immigrants at http://www.ebri.org/pdf/notespdf/EBRI_Notes_06-2005.pdf 
• NCSL publications on immigrant policy and health at http://www.ncsl.org/programs/immig/immighealth.htm

 The Health Chairs Project