A great man once said that nothing focuses the mind of a member of Congress like the prospect of losing a holiday recess. As it approaches, four key issues remained on the plate of Congress: appropriations for fiscal year 2012, the pending Medicare physician payment cut, extending the payroll tax “holiday,” and extending expiring tax provisions.

Here is what we know as of lunchtime Tuesday:

First, an appropriations bill, which will fund most of the government through the end of September 2012, was agreed to by leaders in Congress last week after many of the controversial policy riders that had been attached to the bill—including ones that would have defunded implementation of the health reform law—were dropped. Few in Congress had the appetite for raising the specter of another looming government shutdown.

The Republicans then rolled the other issues – the “doc fix,” extension of the payroll tax cut, and other tax extenders, including extension of unemployment insurance benefits set to expire – into an omnibus bill that included cuts unpopular with hospitals and forced a showdown with President Obama over the controversial inclusion of a provision that would force a decision to approve or disallow the Keystone XL pipeline, which would transport oil from Alberta, Canada to delivery points in Oklahoma and Texas.

Over this past weekend, it appeared that members of both parties had negotiated an agreement. The White House dropped its opposition to Republicans’ insistence on including a forced decision on the Keystone pipeline; in return, the bill would have extended the payroll tax cut, implemented a “doc fix” and extended unemployment benefits – all three measures would be in effect for two months. The measure passed the Senate, 89-10. While implementing tax policy in sixty-day increments is hardly ideal, it would appear that the Senate had a seasonal breakout of bipartisanship in order to keep the tax provisions afloat for the first two months of the new year.

Not so fast, said House Republicans on Sunday morning. In an appearance on Meet the Press, Speaker Boehner said that the agreement would not pass the House of Representatives and vowed to schedule an up-or-down vote on the legislation on Monday. In a reprise of the “grand bargain” negotiations between President Obama and Speaker Boehner, the right flank of the House Republican caucus forced the Speaker to reverse course, arguing for a bill that covers the full year, paid for with spending reductions that had been discussed in the context of the Super Committee negotiations. For his part, Senate Majority Leader Reid said that negotiations on the compromise were over, and the House should pass the two-month bill as it stands.

A vote on the bill was scheduled for Monday night, but was then delayed and cancelled altogether. Instead, the House voted on a procedural bill which would remand the payroll tax agreement to a conference committee for further negotiations, denying the regular-order up-or-down vote that the Speaker had promised.

Should the impasse stand, the Medicare physician payment fix would expire on January 1, but CMS has announced that it will delay payments on 2012 claims until January 17 to avoid having to reprice claims in the event that Congress comes to an agreement. Delays beyond that date could result in a cash-flow crunch for physicians’ offices as leaders attempt to cobble together a solution in late January.

The prospect of a middle-class tax increase, coupled with the prospect of a 27 percent reduction in physician reimbursement rates, would have appeared to serve as strong impetus for the House, Senate, and the Administration to come together on an agreement before Santa is done loading his sleigh on the 24th. However, the Senate is now out of session, and few believe that the Senate will reconvene to open negotiations in conference with the House until after the Christmas holiday. ACAP will continue to monitor developments and keep you updated accordingly.

ACAP Tracking Supreme Court Health Reform Case Online
As you are no doubt aware, the U.S. Supreme Court has decided to hear oral arguments regarding the constitutionality of the Patient Protection and Affordable Care Act – the health reform law. The members of the court will hear the case decided in the 11th Circuit Court of Appeals, which struck down the individual mandate provisions of the ACA as unconstitutional, and which “severed” the Individual Mandate from the rest of the law, finding that the rest of the law could be implemented. In addition, the 11th Circuit dismissed claims that the Medicaid expansion was unconstitutional.

To keep members of the ACAP community apprised of key documents and other developments in the case, ACAP has initiated a thread specific to the Supreme Court case on its Federal and State Policy Issues bulletin board.

Visit the board by logging in with your ACAP user ID and password; check with Tim Murphy if you run into issues logging on. Sign up for e-mail updates by “subscribing” at the top of the page. ACAP will continue to monitor developments relative to the case.

Excellence and Accountability

ACAP Leaders Provide Input on CHCS Report on Quality Metrics for Complex Beneficiaries
Mary Kennedy, ACAP’s Vice President for Medicare and Managed Long Term Care, and Deborah Kilstein, ACAP’s Vice President for Quality Management and Operational Support, were interviewed for a publication recently released by the Center for Health Care Strategies entitled Measuring Quality for Complex Medicaid Beneficiaries in New York State.

The report focuses on quality measures for individuals with multiple chronic conditions, behavioral health conditions, and long-term care, and how they can be used for quality improvement, accountability, and evaluation; for stratification to identify those at risk; or for demonstrating the effectiveness of the health home model.

Know Someone Who’d Be a Good Fit at ACAP?
ACAP currently seeks an Administrative Assistant for full-time work at its Washington, D.C. office. Details here.

You can see other opportunities at ACAP-member plans in the Job Postings section of our Web site; contact Jeff Van Ness to add yours to the list.

ACAP Scholarship Essay Contest Dates Announced for 2012
In an effort to build upon the success of the 2011 Scholarship Essay Contest, ACAP has worked to enhance the program with an eye towards expanding participation among ACAP-member plans. More time has been built into the program for 2012 so that plans wishing to participate that must secure approvals for member communications from state regulators can do so; the award will also be announced in May, which provides an option to the scholarship winner to apply the award to a summer term.

A kickoff call will be held on Wednesday, January 4 for all interested parties at 2 p.m. Eastern. The deadline for applications is April 10, 2012. The essay contest winner and sponsoring plan will be notified the week of May 14.

Contact Jeff Van Ness with any questions about the program.

EPA Issues Call for Nominations for National Environmental Leadership Award in Asthma Management
Last week, the Environmental Protection Agency opened nominations for the 2012 National Environmental Leadership Award in Asthma Management. The award recognizes health plans, health care providers and communities for their efforts in delivering excellent environmental asthma management as part of their comprehensive asthma care services. Several ACAP member plans and their parent organizations are past winners of this award, including the Monroe Plan for Medical Care, Neighborhood Health Plan, Boston Medical Center and Children’s Mercy Hospital.

A set of health-plan-specific criteria is available here. In addition to national recognition during Asthma Awareness Month (May), winners receive a place in the EPA’s Hall of Fame, press materials for promotion in winners’ communities, and the opportunity to share your experiences with other programs, funders and decision-makers. For more information, visit the EPA’s Web site.

The deadline for applications is February 21, 2012.
 

 
Safety Net Health Plan News

Maine PCA Receives CO-OP Grant
The Maine Health Access Foundation recently awarded the Maine Primary Care Association a grant of $200,000 to help develop a Consumer Operated and Oriented Plan (CO-OP) to be offered as a qualified health plan through the State’s insurance exchange. The plan will be up and running by the end of 2013 in an effort to help Maine’s small group and individual market to control the health care costs that inhibit business growth and increase access to coverage.

Maine PCA joins CareOregon as ACAP members moving definitively towards sponsoring CO-OP plans. For more information about the grants, click here.

L.A. Care Declines to Pass Medi-Cal Rate Cut on to Providers
In a recent announcement, ACAP member plan L.A. Care declared that it had opted to absorb the state’s Medi-Cal rate cut, a 3 percent reduction retroactive to this past July 1, rather than pass the cut on to its directly-contracted providers.

“L.A. Care recognizes the challenge that doctors and providers experience in serving the Medi-Cal population under existing rates,” said CEO Howard Kahn. “We feel strongly that we must maintain the integrity of the safety net to ensure access to quality care for L.A. County’s vulnerable populations. Helping doctors and providers in this way ensures there will be no interruption of service for our Medi-Cal beneficiaries.”

For the full announcement, visit L.A. Care’s Web site.

Amida Care Featured in AIDS United Video Campaign
ACAP member plan Amida Care was highlighted in a new video recently released by AIDS United, a group dedicated to ending the AIDS epidemic in the United States. The video highlights the efforts of Amida Care to increase access to care for people living with HIV and AIDS.

Amida Care, a Medicaid special needs HMO, was selected by AIDS United along with nine other programs across the country with the goal of funding local initiatives that will link people to and keep them in care, as part of AIDS United’s “Make It Grow” campaign.

The “Make It Grow” video shows Amida Care staff, providers and members discussing the positive impact that these grant dollars have had in breaking down barriers to care. “Some people delay getting into care because of high levels of fear, stigma, depression, substance abuse, or they’re homeless,” said Amida Care President and CEO Doug Wirth. “So you can’t wait for these people to come to us. Our Teams go out into the streets, bodegas, meal programs, neighborhood hang-outs, and parks to find and help people deal with these issues so they can get into life-saving medical and mental health care.”

Click here to see the very affecting eight-minute video, or here for Amida Care’s release.

Hudson’s Georganne Chapin Responds to NYT Op-Ed
In today’s New York Times, ACAP board member Georganne Chapin of Hudson Health Plan responded to a New York Times op-ed by detailing her plan’s Westchester Cares Action Program.

She writes, “We agree that investing in social safety-net services will reduce medical costs of the poor, and that the best approach is to integrate social services along with medical care. Our Westchester Cares Action Program… assigns a team of three — a nurse case manager, a behavioral health specialist and a social worker — to work with the most costly patients in the Medicaid system, the ones who repeatedly return to hospital emergency rooms for treatment. Guess what? It works. Not only are we saving Medicaid money, but we’re also putting people back on their feet.”

See the full letter to the editor here.



ACAP Meetings

Registration Open for ACAP’s February Legislative Fly-In
ACAP’s Exchange Meeting, Policy Face-to-Face and Legislative Fly-In, scheduled for February 7 and 8, is now open for registration. A meeting agenda and other details are available on the registration page.

ACAP February Fly-In
February 7-8 | register
The Renaissance Hotel
999 Ninth Street NW
Washington, DC 20001

Hotel and Lodging: ACAP has reserved a block of rooms for the discounted rate of $249 at the Renaissance Hotel. Click here to reserve under the block; you may also call 1-202-898-9000 and mention “Association for Community Affiliated Plans” to make your reservation. The discount will be available until January 9, 2012 – with the usual disclaimer that ACAP cannot guarantee hotel and group rate availability.

Mark Your Calendars for ACAP’s Spring Meetings in Seattle

ACAP will hold three meetings in Seattle during the week of March 12:

ACAP Chief Information Officers Meeting
March 12-13

ACAP Spring Board of Directors Meeting
March 13-14

ACAP Spring Medicare Meeting
March 15-16

All three events will be held at:

The Hotel Monaco Seattle
1104 4th Avenue
Seattle, WA 98101
(206) 621-1770

ACAP has reserved a block of rooms for the discounted rate of $159; to reserve under the block, call the hotel at (206) 621-1770 and ask for the ACAP group rate. The discount will be available until February 13, 2012 – again, ACAP cannot guarantee hotel and group rate availability.

More details about the spring meetings will come in a future edition of ACAP Community News. 

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Actuarial and Data Services: Cirdan Health Systems
Analytics, Business Intelligence and Performance Management: MedeAnalytics
Behavioral Health: Comprehensive Behavioral Care, Beacon Health Strategies
Business Process and IT Services: Dell Services, TriZetto
Business Strategy and Development: Arpegio Health, OptumInsight, Optimetra
Business Process Outsourcing: TMG Health
Care For High Risk Members: INSPIRIS
Care Management Technology: Warm Health
Compliance Software: Compliance 360
Group Purchasing: CommonWealth Purchasing Group, LLC
Health Management Solutions: Health Integrated
Health Technology Assessments: ECRI Institute
Member Assessments: INSPIRIS
Non-Emergency Medical Transportation Management: Coordinated Transportation Solutions
Patient Communication Services: CommonWealth Purchasing Group, LLC
Pay For Performance: 3M Health Information Systems
PBM Solutions: Excelsior Solutions, The Pharmacy Group 
Pharmacy Benefit Managers: MedImpact, Medmetrics Health Partners, Navitus Health Solutions
Radiology Benefits Management: Care to Care
Reinsurance Services: RBS Re, Summit Re, U.S. Advisors, Inc.
Risk Adjustment: DCA, PopHealthMan 
Strategic Consultants: DeltaSigma, LLC
Strategic Government Business Solutions: ClearStone Solutions
Subrogation: First Recovery Group
TPL Subcontractors: HMS
Web Portals/SaaS: Health X