This is the Health Chairs e-Bulletin for November 2005
Resources on Line
More Katrina
The National Center for Policy Analysis (NCPA) has issued a proposal for getting health care to Katrina and Rita evacuees using health savings accounts. http://www.ncpa.org/pub/ba/ba532/.
The Kaiser Commission on Medicaid and the Uninsured (KCMU) has released an overview of ten Katrina-related Medicaid waivers. http://www.kff.org/medicaid/7420.cfm.
It has also published a comparison of the Bipartisan Senate bill for Katrina medical aid, the Texas waiver, and the HHS Katrina relief waiver template http://www.kff.org/medicaid/upload/7417.pdf.
Access and Costs
Health Care Tax Credit
A health care tax credit (HCTC) to help people buy insurance coverage got its first test with the Trade Adjustment Act’s HCTC program. In 2004, GAO found problems with take-up and targeting http://www.gao.gov/new.items/d041029.pdf. Now a new evaluation by Stan Dorn looks at the program’s early experience. If this approach is to be successful, he concludes, it needs to incorporate four features: affordable premiums; coverage that beneficiaries value; effective outreach; and customer-friendly intake. http://www.esresearch.org/documents_1-05/HCTC_TakeUp.pdf.
Medicaid
The Kaiser Commission released three new surveys of the states that describe the condition of Medicaid programs across the country. A webcast of the release of the reports is available at http://cme.kff.org/Key=9401.D1k.K.C.yX9HQ.
The reports include the annual update on the state of state Medicaid programs produced by Vern Smith and colleagues and reports on prescription drug policies and coverage for children and families. The reports and where to find them:
Medicaid Budgets, Spending and Policy Initiatives in State Fiscal Years 2005 and 2006 http://www.kff.org/medicaid/7392.cfm.
State Medicaid Outpatient Prescription Drug Policies: Findings from a National Survey, 2005 Update http://www.kff.org/medicaid/7381.cfm.
In a Time of Growing Need: State Choices Influence Health Coverage Access for Children and Families http://www.kff.org/medicaid/7393.cfm.
Vermont has now taken extensive steps in converting its program to a block grant. The state’s “Global Commitment to Health” Section 1115 federal Medicaid waiver went into effect at the beginning of the federal fiscal year. The state has set up a web page with links to the waiver and related documents including a concept paper and PowerPoint presentation are available at http://www.ovha.state.vt.us/Globalhome.cfm. A risk analysis by Health Management Associates, (link below) was a factor in convincing the legislature to support the Governor’s plan. http://www.leg.state.vt.us/JFO/Global%20Commitment%20Update/HMA%20Global%20Commitment%20Analysis%209-30-05.pdf.
Florida has just received word from the federal government that it can proceed with its Medicaid reform under Section 1115 authority. AHCA’s web site leads to the proposal and correspondence about the plan. http://www.fdhc.state.fl.us/Medicaid/medicaid_reform/waiver/index.shtml.
Chuck Milligan, who will be speaking at the December meeting in Chicago, delivered a presentation to the federal Medicaid Commission at its meeting in Washington on October 26-27, 2005. His slides are posted at http://www.chpdm.org/News/centerNews.htm#medComPresent.
Massachusetts Audit on Fraud and Abuse
A report by the state auditor points to the lack of systems to detect and rectify Medicaid fraud and abuse. By comparing 2003 Government Accountability Office (GAO) estimates (http://www.gao.gov/pas/2003/d03119.pdf) against recoveries collected by the state, the report estimates that between $471 million and $1.57 billion were lost by Massachusetts to fraud and abuse in the period FY 2001-2003. The report proposes systems to improve oversight. http://www.mass.gov/sao/medicaid200413743s.pdf.
Children
Three resources for children are newly available.
The March of Dimes has issued a memo with state-by-state analysis of potential gaps if the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit requirement were eliminated. The memo shows which of 12 services that are particularly important to children with chronic physical and developmental conditions are now covered under policies that apply to medically needy adults. A 50-State Analysis of Medicaid Benefit Coverage for Children without EPSDT is available at http://www.mchpolicy.org/50-StateAnalysisofMedicaidBenefitCoverageforChildrenwithoutEPSDT.pdf.pdf.
The Data Resource Center for Child and Adolescent Health has made 100 standardized indicators from two state-based surveys easy to use, with click-through maps and the ability to look at indicators broken down by race, age, income and other factors. Click on “state profiles” in the left hand column for maps, or explore other options. The surveys are: The National Survey of Children's Health, at http://www.nschdata.org/DesktopDefault.aspx and The National Survey of Children with Special Health Care Needs at http://www.cshcndata.org/DesktopDefault.aspx. Indicators can be searched by the age, race/ethnicity, income, and health status of children and youth in a targeted state.
The State of the States in Developmental Disabilities, a research project administered by the University of Colorado, is available on line. You can link through the report to state-specific profiles on long term care services and supports for children and adults with developmental disabilities over several decades. You can order a report, or see state and U.S. profiles. http://www.cu.edu/ColemanInstitute/stateofthestates/aboutSOS.html.
Long Term Care
Those of you who attended our June meeting or the Chairs tea in Seattle learned about state innovations to keep people in their homes and out of nursing facilities as long as possible. Kaiser has just released a new publication with more information on this and descriptions from several of the states. Strategies to Keep Consumers Needing Long-Term Care in the Community and Out of Nursing Facilities, by Laura Summer from the Georgetown University Health Policy Institute, is available at http://www.kff.org/medicaid/upload/Strategies-to-Keep-Consumers-Needing-Long-Term-Care-in-the-Community-and-Out-of-Nursing-Facilities-Report.pdf.
Noting where the chart came from, I followed the link and recommend this site to anyone wanting to learn more about home- and community-based services. Among other things, this terrific tool includes state-by state listings of programs and services at http://www.hcbs.org/stateByState.php.
Quality
The National Committee for Quality Assurance (NCQA) has released its annual report on how well health plans are performing. This long-standing project scores plan performance against objective standards and uses these to compare plans. The report names names, listing the top plans nationally, by program (Medicare and Medicaid) and by region. The 2005 State of Health Care Quality Report is at http://www.ncqa.org/Docs/SOHCQ_2005.pdf or search for specific plans to see how they scored http://www.usnews.com/usnews/health/best-health-insurance/topplans.htm.
State-level hospital information continues to go on line—see “From the States”, below.
Health Information Technology
The Agency for Healthcare Research and Quality (AHRQ) announced its latest round of grants to further health information sharing. At state and local levels, the agency funded more than $22.3 million to 16 grantees to implement health information technology (health IT) systems to improve the safety and quality of health care. For a list of the new projects, by state, and the grant amounts go to http://www.ahrq.gov/news/press/pr2005/hitimppr.htm#hitgrants.
Molly Coye, who gave a memorable talk on technology to the Chairs via teleconference a few years back, can be heard in a webcast on the subject of California’s regional health information organization (RHIO) at http://www.ihealthbeat.org/index.cfm?action=mMediaD&itemid=115134.
The TeleHealth Connections Project for Children and Youth at the University of Florida's Institute for Child Health Policy is pleased to announce the release of a recently completed report, "Telemedicine for CSHCN: A State-by-State Comparison of Medicaid Reimbursement Policies and Title V Activities." This technical report provides data on a nationwide survey with Medicaid and Title V programs in each of the 50 states regarding telemedicine services, with a specific target of identifying common strategies related to Medicaid reimbursement and the types of telemedicine services specifically available for CSHCN served by Title V. This report can be accessed at http://telehealthconnections.ichp.ufl.edu/documents/Telemedicine_in_Medicaid_and_Title_V_Report.pdf.
I know it isn’t states, but there was some really neat stuff at this meeting on personal health records, webcast at http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1533.
Substance Abuse
State policy levers are the subject of Identifying State Purchasing Levers for Promoting the Use of Evidence-Based Practice (EBP) in Substance Abuse Treatment. The authors note that there are five types of incentives: financial payments (pay-for-performance), relief from regulatory requirements, competitive bidding process advantage, infrastructure support (including free training in EBPs), and recognition for providing evidence-based care. The new report from the Center for Health Care Strategies (CHCS) includes profiles of programs in Delaware, Iowa, Massachusetts, and Oregon. http://www.chcs.org/usr_doc/PurchasingLeversFinal.pdf.
Public Health
Now for something truly scary: an interactive map showing the readiness of each state for a flu pandemic. Based on a report from the Trust for America. Go to http://www.rwjf.org/newsroom/interactiveslist.jsp and select Are We Ready for a Killer Flu? The page also takes you to interactive maps on topics such as racial disparities and nursing shortages.
Providers
The AHA has released a report on the State of America’s Hospitals citing strains on community hospitals due to financial shortfalls, shortages of providers, and increasing use.
Conventional Wisdom?
Challenging conventional wisdom on medical malpractice, an article in the Cato Institute’s fall issue of Regulation looks at “Defensive medicine and disappearing doctors.” The verdict from this libertarian (and anti-regulatory) think tank? Don’t blame med mal for anything except increasing the use of imaging tests like MRIs. http://www.cato.org/pubs/regulation/regv28n3/v28n3-4.pdf.
The UCLA Center for Health Policy Research found that immigrants from Mexico use far fewer health services than their US-born counterparts, and suffer the consequences in diminished health status after entering the U.S. According to their study, Mexico-United States Migration: Health Issues, counter to conventional wisdom that care for immigrants drains hospital resources, uninsured immigrants are the group least likely to receive care in emergency rooms. http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=155.
From the States
Maine’s Insurance Commission has ruled on cost savings claimed under the state’s Dirigo Health program. Some insurers have disputed the finding that there are savings to offset. Dirigo’s filings and related documents will be of interest to anyone who has been following the state’s program. http://www.state.me.us/pfr/ins/dirigo_health_filing.htm. The Insurance Bureau’s final findings are at http://www.state.me.us/pfr/ins/ins05700Dirigo.htm.
Massachusetts has joined the rank of states with websites that allow consumers to compare hospital on cost and quality. The Kentucky Hospital Association allows buyers to compare prices on some procedures but this is the first state program with cost information. http://www.mass.gov/portal/site/massgovportal/menuitem.404daff1c71731c14db4a11030468a0c/?pageID=eohhs2agencylanding&L=4&L0=Home&L1=Government&L2=Special+Commissions+and+Initiatives&L3=Health+Care+Quality+and+Cost+Information&sid=Eeohhs2
The Oregon Hospital Association has also just mounted a site with comparable quality information from most of its members. http://www.orhospitalquality.org/.
Several months worth of past Chairs e-bulletins are archived at http://www.ncsl.org/programs/health/forum/chairs/ebull/index.htm.
Tell us about your favorite on-line resources, and what issues you want to see us cover with an e-mail to Kala.ladenheim@ncsl.org
Have any questions you'd like answered? A topic for which you’d like us to gather resources?
Do you have a report of your own you'd like to share with your peers? Drop us a line…
Donna Folkemer, Group Director
Forum for State Health Policy Leadership
National Conference of State Legislatures
ph: 202-624-8171 fx: 202-737-1069
Donna.Folkemer@ncsl.org
Kala Ladenheim, Ph. D. Program Director
Forum for State Health Policy Leadership
National Conference of State Legislatures
ph: 202-624-3557 fx: 202-737-1069
kala.ladenheim@ncsl.org
 NCSL Home Page
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