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Besio, Ph.D. Director of Health Care Reform Implementation Vermont Agency of AdministrationeZe3333)Vermont Context(Population: 623,000 19 U.S. cities are larger than Vermont Ranked 11th for proportion of population insured 1 1 US Census 2005 revised : www!www' www!www3 www!www!www!www ' 1      _UVermont Context(fRanked the 2nd healthiest state overall in 2005 and 2006 1 Highest percentage (86.4%) of women enter prenatal care in 1st trimester Lowest percentage (7.4%) of children living in poverty 4th lowest re: prevalence of obesity (20.2%) Decrease in prevalence of smoking from 30.7% to 19.3% since 1990 Lowest rate of motor vehicle deaths Lowest premature death rate (years of potential life lost before age 75) Vermont is considered an  aging state, where the older population is growing faster than the younger population Vermont has approximately 78,000 (12.6%) residents age 65 or older. By the year 2030, 25% of Vermont s population will be age 65 and older 1 United Health Foundation R; www]q www www!www9H q   FVermont Context  Health Care Costs$$$Growing cost of health care is unsustainable Annual expenditures of $3.5 billion 15.2% of Vermont s gross state product Vermont s per capita costs still less than national average, but spending growth rates have been higher than national average for last 6 years Health Care Expenditures(2005) Vermont U.S. Total (billions) $3.5 $2,016 Per capita $5,636 $6,682 Annual Change (2004-2005) 7.2% 7.4% Average Annual Change (1995 -2005) 7.9% 7.0% Share of Gross State/Domestic Product 15.2% 16.2% Over 60,000 Vermonters are uninsured, and the number is growing An estimated 50% of Vermonters with chronic conditions account for 70% of health care spending, but only 55% get the right care at the right time&- ___Z$ ___Z!___Z' ___Z!___Z ___Z50___Z ___Z___Z@ ___Z!___Z ___Z-$ '                  l-5@4+:Vermont Context  The Insured$Private Health Insurance 59.4% (370,000) have private insurance as primary coverage 91% receive employer-sponsored insurance 5% purchase their own coverage in the individual market Remaining covered by higher education, COBRA, etc. Medicaid: 14.5% (90,350) have Medicaid as primary coverage Traditional Medicaid  up to 125% FPL Dr. Dynasaur  Children in households up to 300% FPL (34% of Vermont s children) Vermont Health Access Plan (VHAP)  Adults up to 150% FPL and caretakers of dependent children up to 185% FPL Largest Insurer in Vermont (9,000 Enrolled Providers) Medicare: 14.5% (90,100) Military Insurance: 1.7% (10,500) wwwZ;" wwwZ wwwZ!wwwZ wwwZ1 0wwwZ  0wwwZ 6" wwwZ" wwwZ; wwwZ ;    06   TJVermont Data (2005)  The Insured 91.2% of Vermonters, 95.1% of Vermont childrenR#$/HPrivate Insurance 61.5% (382,239) of insured have private insurance A decline of 2.1% since 2000 (63.6%) 90.9% (347,435) have employer-sponsored insurance 4.9 % (18,658) purchase their own coverage in the individual market Enrollees decreased by 47% from 2002 to 2005 Another 4.2% covered by higher education, COBRA, etc. www2www%-www-www2-wwwwwwEwww- www!www6www www2%2  E-6  $$((UKVermont Data (2005)  The Insured 91.2% of Vermonters, 95.1% of Vermont childrenR#$/Medicaid / VHAP / Dr. Dynasaur 19.1% (118,388) of insured are enrolled in Medicaid programs An increase of 0.6% since 2000 (18.5%) 22% (26,442) are employed adults 14.5% (90,352) are enrolled in a Medicaid program as primary coverage 41% (58,000) of Vermont children under age 18 are enrolled in Dr. Dynasaur 86% of these (50,000) rely exclusively on Medicaid Largest Insurer in Vermont (9,000 Enrolled Providers)  !wwwP=wwwP'-wwwP-wwwP!-wwwP-wwwPF-wwwPwwwPKwwwP3-wwwP-wwwP70wwwP P='!F  K35      $$i_Vermont Context  The Uninsured 9.8% of Vermonters, 4.9% of Vermont childrenN!$-An 1.4% increase in the rate of uninsured since 2000 (8.4%) 51% are eligible for Medicaid programs but not enrolled 79% of uninsured children; 49% of uninsured adults (18  64) 87% are interested in enrolling; 57% believe they are not eligible 27% have household income between 150-185% and 300% FPL and are not eligible for a Medicaid program but cannot afford private insurance <" www" www8" www= wwwC www" www<8<C   j`Vermont Data 2005  The Uninsured 9.8% of Vermonters, 4.9% of Vermont childrenO"$-69% have been without insurance for more than a year 77% reported cost as the main reason for being uninsured 30% of uninsured children and 40% of uninsured adults did not see a health care professional in past year 45% of uninsured children did not see a physician for routine care (compared to 7% of insured children) Much more likely to go to ER or urgent care (8.6% vs .7%) 25% of uninsured adults reported not seeking needed medical care due to cost 5 wwwwww9 wwwwwwj www!wwwh www:www!wwwM www59jB&:-uU`V>Vermont Context  The Uninsured $H9.8% - A 1.4% increase in the rate of uninsured since 2000 (8.4%) Uninsured Adults (18 to 64)  13.4% of adults (N = 53,708) Young: 38% are between ages18 -24; over 25% between 25 - 34 Male: 60% are male Educated: 50% have high school /GED; 21% have up to college degree; 18% have college degree or more Employed: 81% are employed 60% work full-time 30% work for employers that provide health insurance benefits Uninsured Children (0 to17)  4.9% of all children (N = 6,942) Adolescents: 60% of uninsured children are between ages 11 - 17 Male: Over 60% of uninsured children ages 0 to 17 are male Uninsured Families: 70% of adults with uninsured children are also uninsured }www" wwwQ www" www?www" www> :6 [ Q?   4    6    ;  aW>Vermont Context  The Uninsured $*51% are eligible for Medicaid programs but not enrolled 79% of uninsured children; 49% of uninsured adults (18  64) 87% are interested in enrolling; 57% believe they are not eligible 27% have household income between 150-185% and 300% FPL and are not eligible for a Medicaid program but would be eligible for new Premium Assistance 1 person: $15,315 - $30,630 2 person: $20,535 - $41,070 4 person: $30,975 - $61,950 69% have been without insurance for more than a year 77% reported cost as the main reason for being uninsured 45% of uninsured children did not see a physician for routine care (compared to 7% of insured children) Much more likely to go to ER or urgent care for medical care (8.6% vs .7%) 25% of uninsured adults reported not seeking needed medical care due to cost p8 wwwP= wwwPCPP wwwPT wwwPwwwP5 wwwP!wwwP9 wwwP!wwwPh wwwPKwwwP!wwwPM wwwPPP8<C T   5 9 B&K -VbXWhat the Data Tell Us $Many of the uninsured are people who cannot afford coverage We have very specific demographic data about the uninsured 51% of uninsured are eligible for Medicaid programs; 87% are interested; over half think they are not eligible pv?;o Catamount Health must be affordable We need to provide premium assistance to people to enroll in Catamount Health or ESI Outreach will be designed for and targeted to specific groups We will re-tool our outreach and enrollment processes to enroll more people Zy$Vermont s Response$2006 Legislation Health Care Affordability Acts (Acts 190, 191) Common Sense Initiatives (Appropriations Bill) Sorry Works! (Act 142) Safe Staffing and Quality Patient Care (Act 153) 2007 Legislation Corrections and Clarifications to the Health Care Affordability Acts of 2006 (Act 70) An Act relating to Ensuring Success in Health Care Reform (Act 71) Joint Legislative Commission on Health Care Reform Administration Director of Health Care Reform Implementation T ___ ___!___ ___ ___!___4 ___!___= ___v    2 =Health Care Reform GoalsJ@8Goal: Increase Access to Affordable Health Care Coverage99$KAGoal: Improve Quality of Care$LBGoal: Contain Costs$F<Insurance CoverageSIWhy is Coverage Important?$xUn-reimbursed care increases private insurance premiums Makes insurance less affordable Fewer people are covered Benefits are decreased and/or people choose non-comprehensive plans to make plans affordable People with comprehensive insurance coverage are more likely to participate in preventive care Increases quality of life Decreases cost of health care overall 68Z"Zw" ZZZ`ZDZZZ8 w    _BCatamount Health $(A non-group insurance product for uninsured Vermont residents Offered as a preferred provider organization plan by two private insurers, beginning October 1, 2007 Is required to be a comprehensive insurance package covering: Primary care Preventative care Acute episodic care Chronic care Hospital services Pharmaceutical coverage Individuals may choose which insurer they would like to use.  > ___P!___Pe ___P!___P> ___Pk" ___P!___P> ___P> e >k <Catamount Health$LEGISLATIVELY-MANDATED COST-SHARING Deductibles: In-Network: Out-of-Network: $250/individual $500/individual $500/family $1,000/family Co-Payment: $10/office visit Prescription Drugs: No deductible Co payments: $10 generic drugs $30 drugs on preferred drug list $50 non-preferred drugs Preventive Care & Chronic Care*: $0 Not subject to deductible, co-insurance, co-payments Out-of-Pocket Maximum: In-Network: Out-of-Network: (excluding Premium) $800/individual $1,500/individual $1,600/family $3,000/family * For people enrolled in Chronic Care Management Program$!___P!___PY!wwwP P!!wwwPPJ!wwwPDPd!wwwPP7!wwwP<P%P9P$ & !  d  $            7  !Catamount Health$ PROVIDER REIMBURSEMENT Health Care Professionals: Medicare +10% in 2006, increasing as per Medicare reimbursement methodology Hospitals: Cost +10%, increasing as per Medicare economic index OVERSIGHT Insurers go through the usual rate-setting process at the Department of Banking, Insurance, Securities and Health Care Administration (BISHCA) Emergency Board will suspend enrollment in Catamount Health premium assistance if there is not enough money Commission on Health Care Reform to review Catamount Health Plan by October 1, 2009 for cost effectiveness may trigger a self-insured plan if current structure is not cost effective v___ ___ ___!___ ___ ___333   gLCatamount Health Costs$The cost will depend on individual / household income Cost for Individual Coverage with Premium Assistance: Individual Income by federal poverty level Monthly premium cost * (1 person/annual in 2007) Below 200% FPL ($20,420) $60.00 200-225% ($20,421  22,973) $90.00 225-250% ($22,974  25,525) $110.00 250-275% ($25,526  28,077) $125.00 275-300% ($28,078  30,630) $135.00 * Cost for two-person coverage will be double these amounts Estimated Full Cost for Individuals/Households over 300% FPL: Single $ 390 / month Two Person $ 780 / month Family $1,750 / month7 ___<! ___0Ze02G0" Zr" ZZF" Z63333333333335333333333*                       ;    333=  333  333F  333Catamount Health Eligibility$rYou can purchase Catamount Health if you are an uninsured Vermont resident, are 18+, and are not eligible for an Employer-Sponsored Insurance (ESI) plan *. Uninsured means: You have insurance which only covers hospital care OR doctor s visits (but not both) You have not had private insurance for the past 12 months You had VHAP or Medicaid but became ineligible for those programs You had private insurance but lost it because you: Lost your job Got divorced No longer have COBRA coverage Had insurance through someone else who died Are no longer a dependent on your parent s insurance Graduated, took a leave of absence, or finished college or university and got your insurance through school ___!___" ______0 c   1(Catamount Health Eligibility$You can purchase Catamount Health even if you are eligible for an Employer-Sponsored Insurance (ESI) plan IF you have an income under 300% FPL, AND Your ESI plan is not approved by the state as comprehensive and affordable (with state assistance) OR It is more cost effective to the state to provide premium assistance for you to enroll in a Catamount Health plan than providing premium assistance for you to enroll in your ESI OR It is more cost effective to the state to provide premium assistance for you to enroll in your ESI than providing premium assistance for you to enroll in Catamount Health, but you must wait until the next open enrollment period for your ESI (at which point you must switch to your ESI to receive premium assistance)ZZe" ZZ" Z c=  Key DateszCATAMOUNT HEALTH September 8, 2006 Rules filed with Secretary of State October 7, 2006 Carriers submitted Letters of Intent (BCBS-VT, MVP, CDPHP) Mid-March, 2007 Carriers file forms and rates October 1, 2007 Catamount Health Insurance available to uninsured Vermonters October 1, 2009 Legislative review re: cost effectiveness; may trigger a self-insured plan  ___Pv___Piv___P&A CR*$Premium Assistance$ Catamount Health Vermonters who qualify for Catamount Health with income less than or equal to 300% of Federal Poverty Level (FPL) ($29,500 for one person) may receive premium assistance from the state Employer-Sponsored Insurance (ESI) Uninsured Vermonters with income less than or equal to 300% FPL may apply for ESI premium assistance ESI plans must offer comprehensive benefits and be affordable in order for the individual to receive premium assistance Affordable = maximum individual in-network deductible of $500 Comprehensive = covers physician, inpatient care, outpatient, prescription drugs, emergency room, ambulance, mental health, substance abuse, medical equipment/supplies, and maternity care Employers do not have to contribute to the plan for it to qualify#<  #z ;   4     /&+Premium Assistance Cost Effectiveness Test<,$(  ;VHAP Applicants (under 150 -185% FPL) If providing premium assistance to the individual to enroll in their ESI plan is more cost-effective to the state than enrollment in VHAP, the applicant will be required to enroll in their ESI plan to get state assistance. Catamount Health Applicants (at or under 300% FPL) If providing premium assistance to the individual to enroll in their ESI plan is more cost-effective to the state than providing premium assistance for the Catamount Health Plan, the applicant will only receive state assistance to enroll in their ESI plan. & www www3 www www&3+!$How will Premium Assistance be Paid?%%$Catamount Health Premium Assistance Beneficiary will pay his or her share to state State will pay total premium to carrier ESI Premium Assistance Employee will pay total premium to employer through payroll deduction State will pay employee prospectively for premium assistance Employers will not have to modify payroll or accounting systems Employers may have to provide information on the plan s cost to the employee to assist with enrollment in the premium assistance program$ wwwW" www!www wwwM" www$WM 2Key Dates: PREMIUM ASSISTANCE FOR ESI / CATAMOUNT3 ((  September, 2006 Waiver Amendment Request submitted to CMS for approval of premium assistance programs November, 2006 Report to Legislative Committees on fiscal implications (estimated costs and savings) April, 2007 Draft Rules for Premium Assistance Eligibility Determination July, 2007 Finalize Rules for Premium Assistance Eligibility Determination October 1, 2007 Premium Assistance enrollment for ESI and Catamount to eligible Vermonters!___PPZ[ A CNXO?OVERVIEW OF VERMONT EDUCATION, OUTREACH AND ENROLLMENT STRATEGY@@  Goal: To develop and implement a comprehensive, integrated and aggressive education, outreach and enrollment strategy: across a continuum of solutions for the uninsured, including Medicaid, VHAP, Dr Dynasaur and Catamount Health Plans using a unified multi-stakeholder campaign, with specialized interventions for specific uninsured populations, and targeted at multiple stakeholders (health care providers, community-based providers, grass-roots organizations, advocate organizations, state employees, employers) $zt,Hs3A,H  YNOutreach and Enrollment$+Integrated Medicaid, Catamount Outreach and Enrollment Strategies Aggressive Marketing and Education Campaign in Late Summer, Fall 2007 Using state and local staff, partners and volunteers 1-800 number New web-site Possible Re-branding Re-tooling of Existing Application and Enrollment Processes B=B     =  ZP Key Elements $Broad-based Outreach and Enrollment Steering Committee: to guide and inform outreach and enrollment efforts (see attached membership list) Health Care Marketing Firm to Develop: A broad-based, compelling message that conveys to all Vermonters why it is important to have health insurance coverage; Promotion of all available insurance products and subsidies, including private market options. Coordination of the broad message with education, outreach and enrollment activities that are nuanced to address targeted populations, including 1) specific uninsured sub-populations (using the 2005 Vermont Family Health Insurance Survey data), and 2) partners who can assist with the coverage efforts (e.g., employers, health care providers, human services providers and other community organizations, schools, the faith community). Use of health literacy research, such as that produced by the Harvard School of Public Health, to inform our effort PP'PjP$PtPPP8S &j$t  [QKey Elements, continued* $( Revisions to Current Enrollment Tools: The above must be coupled with the tools needed for effective screening and enrollment, including shifting FROM Current relatively passive approach: Examples: using brochures, 1-800 number, paper applications and office-based staff TO Pro-active and consumer-friendly approach: Examples: all of above, plus one-to-one and community-based outreach, user-friendly web-based screening tools, simplified application forms, ability to track application status and change in eligibility over time to prevent program drop-out, etc. Outreach and Enrollment Coordinator to facilitate the implementation and interface between all of the above activities. P P&P PLPP,PPPzP%m # K      *    #U\RRRevisions for Medicaid/VHAP/Dr. Dynasaur Eligibility Determination and EnrollmentSS  Explore streamlining Medicaid/VHAP/Dr Dynasaur application form Pro-actively assist with eligibility screening and applications (complete forms for people at key junctures) Actively engage AHS employees and partners (providers, regional partnerships, clergy, accountants, others to help people complete eligibility screening tool and / or application Add a contract/grant provision to state contracts/grants that have natural connections to the target populations Change VHAP coverage date to be the date of application receipt Move from 6 month to 12 month VHAP renewals Solicit feedback from individuals about the enrollment and renewal processes to inform additional refinements Z@ZZmZZZZqZZ@ZZ,ZZoZ @ ?.   28 '  M  ]SRRevisions for Medicaid/VHAP/Dr. Dynasaur Eligibility Determination and EnrollmentSS oCreate the Vermont Health Care Portal - an on-line system to access information and enrollment processes for all Vermont health care programs, designed to: streamline the application and eligibility process, and reduce the burden of program rules; interface in real time with other systems to verify information needed to grant eligibility and to disseminate notification of coverage; utilize the health information exchange being created by VITL in a way that improves the sharing of health care data; quickly incorporate changes in eligibility rules; reduce the need for paper by managing applications, notifications and billing electronically whenever possible; and enable caseworkers to be more focused on personally serving Vermonters because they need less time for data entry, managing paperwork, and getting accurate, timely results from the enrollment system. tPP\PPPPwPP3PPtPPPP\w3 t       n^T%Vermont Health Care Portal, continued &$  (This proposal is still under discussion and may be altered as more detailed information evolves about implementation issues  e.g., technical challenges, timelines, cost) Phase 1 (by August 2007): Web-based simple screening tool Links to information about Vermont s healthcare programs and application processes Down-loadable pdf version of the application form that can be completed and mailed or faxed Automated contact form that the individual can submit to request a follow-up phone call Phase 2 (by October 2008): Phase 1 plus: On-line application that can be submitted electronically Expanded links to educational health-related materials and sites Phase 3 (by June 2010): On-line application and renewal processes linked to back-end eligibility/enrollment/renewal system From any place with internet access, an individual will be able to: read and download current information about health care programs; complete an anonymous self-screening to determine if they may be eligible for assistance; fill out and submit an automated application or recertification that connects with the processing system; chat immediately with a caseworker to get answers to questions, help completing the application and an explanation of remaining requirements; submit verification, and receive notification letters and reminders, electronically; check the status of their case and gather the details of their benefit package; pay their premiums and select their providers; and, review information about the services and costs paid by Vermont health care programs for their household. This project will be a component of the vision for the  Medicaid enterprise which also entails replacement of the Medicaid Management Information System (MMIS)PPP(PPPPPPPPP(             IG=7Other Initiatives to Enhance Private Insurance Coverage87(w Non-Group Market Reform Promotion of Employer-Sponsored Insurance Local Health Care Coverage Planning Grant  !, !, !333333 , , =5CHRONIC CARE MANAGEMENT(Blueprint for Health $(State s Plan for Better Management and Prevention of Chronic Illnesses across All Payers and Providers Vision: Vermont will have a standardized statewide system of care that improves the lives of individuals with and at risk for chronic conditions. To achieve this vision, the Blueprint is: Statewide system reform based on the Chronic Care Model A public-private collaborative Recognizes the central role of the patient and community Designed around  Core System Competencies rather than disease programs Is the state s mandated standard for chronic care management across all payers and providersg ___Z!___Z ___Z!___Z* Z5 Zg333*5) cY Examples of Blueprint Components!!$@6?Other Chronic Care Strategies To Be Aligned with the Blueprint@@$ Medicaid Chronic Care Management Program State Employee Health Benefit Programs State-approved Employer-Sponsored Insurance (ESI) Plans for Premium Assistance Catamount Health Plans _________ )'O A7/Medicaid Chronic Care Management Program (CCMP)00$Establish a Chronic Care Management Program (CCMP) for the Medicaid and VHAP populations Contract with external vendors for two components: Program intervention Monitoring, evaluation and payment [ !3 8H P![38  333C9CCMP Interventions$Identify Medicaid enrollees with one or more chronic conditions (using claims data) Conduct health risk assessments (HRAs) for all beneficiaries identified Stratify the population into high, middle, low risk groups Conduct evidence-based care management interventions for each risk group (intensity varies by group) Coordinate CCMP activities with: Care coordination program (coordinating the care needs of the 1-2% most complex Medicaid enrollees) Blueprint for Health Choices for Care 1115 Waiver (Long-term Care Waiver)<T P!PK P!P; P!Pe P!P" P PT K ; e "v'7Blueprint Alignment Topics Across Chronic Care Programs88$Coordination of care across the multiple programs working with the same providers and patients Agreement on best practices for all chronic diseases Use of a consistent health risk assessment Referrals to patient self-management resources Coordination of IT initiatives to improve access and support clinical decision making Use of consistent metrics for provider feedback, profiling and measurement Changing and aligning payer fee structures to provide incentive to reward quality (e.g., pay-for performance, payment reforms)_ !6 !, !/ !V !K ! _6,/VKh^%Blueprint Impact on Health Care Costs&&$bIt will not SAVE money  but it will reduce the rise in cost of care We do expect to reduce the cost per case for chronic illness by: reducing hospitalizations reducing complications reducing specialist visits So why doesn t that save money? Because when we take better care of chronic illness we prolong productive life Because more people are developing chronic illness, especially with the obesity epidemic That means more people in Vermont with chronic illness More cases at less cost per case still means more total health care cost for the population EZZAZLZZ Z;ZZ0 AL    I?Health Information Technology$ VITL = Statewide Regional Health Information Organization (RHIO) State Health Information Technology Plan Medication History Pilot Project Implemented at 2 Hospital Emergency Rooms in April, 2007 Chronic Care Information System (Disease Registry) First community site (Mt. Ascutney) for diabetes will be implemented in December, 2007 Electronic Health Records supported statewide Master Provider Index, Multi-payer DatabaseZA Z!ZK Z9 Z!Z3 ZW Z!Z. ZZ, Z 9 (    "  9   3W . ,>3JCHAMPPS (Coordinated Healthy Activity, Motivation and Prevention Programs),K$C qCompetitive multi-year grants to communities starting July 1, 2007 Projects must be: Comprehensive approaches to promote healthy behavior and disease prevention Across the community Across the lifespan Consistent with the Blueprint and community goals Goal and outcome driven Based on effective strategies Able to provide data for evaluating and monitoring progress C ! L" )" ! C L)   &Healthy Lifestyles Insurance Discounts''$Permits BISHCA regulations to allow carriers to establish rewards, premium discounts, rebates, or waive/modify cost-sharing in return for member s adherence to programs of health promotion and disease Allows discounts of up to 15% of premium for compliance with health promotion program Limits total deviation from community rate to 30% (including these discounts) in the individual and small group insurance markets Rules developed in Fall, 2007 Also allowed in Catamount Health plans  ___Z!___ZV ___Z!___Z ___Z!___Z ___Z!___Z' ___ZV'E;Other Prevention Initiatives$(Agency of Human Services inventory of state wellness initiatives and funding Clinically recommended immunizations provided to all Vermonters at no cost January 15, 2007 - Report on Methods to Ensure Universal Access to Immunizations Catamount Health Plan: waiver of cost-sharing for prevention M !K wwwQ" ___" ___= www___MKQ  =    H>Quality Improvement Initiatives $Consumer Health Care Price & Quality System Hospital Adverse Events Monitoring System Hospital-acquired Infections Data Hospital Safe Staffing Reporting SorryWorks! Advanced Directives Registry, Forms and Stickers @,ZZ*ZZ"ZZ!ZZ ZZ1ZZ, * " !  2OEAdministrative Simplification$Common Claims and Procedures Maximization of the electronic claims process to support accurate and timely payment of claims Standardizing ID cards Simplification of Explanation of Benefits and patient bills Pre-authorization comparisons for commonality and variation Improving the efficiency of claims adjudication through common policies that determine how a claim may be adjudicated Simplification of Workers Compensation claims processing Credentialing standardization for provider application and billing eligibility Uniform Provider Credentialing Form Council for Affordable Quality Healthcare (CAQH) form will be used by hospitals and insurers for provider credentialing 0wwwZ(_ 0wwwZ( 0wwwZ(v 0wwwZ(!0wwwZ($ 0wwwZ(x 0wwwZ(_v$w ND Strategies to Address Cost Shift ! $$Medicaid Rate Increases for Primary Care Providers, Hospitals and Dentists (January 1, 2007) Cost Shift Task Force Hospital Cost Shift Reporting Reforms Standardized Policy for Hospital Uncompensated Care and Bad Debt] ___!___&A]  & @ Financing of Reforms$Based on the principle that everybody is covered and everybody pays: Catamount Health Plan: individuals pay sliding scale premiums based on income Employers pay an assessment based on number of uncovered employees Increases in tobacco taxes VHAP savings due to Employer-Sponsored Insurance (ESI) enrollment Cost avoidance due to better chronic care management Matching federal dollars via Global Commitment 1115 waiver E ___O ___!___D ___!___ ___!___B ___!___5 ___!___; ___!___EODB5;  -#Employer Contribution$Assessment for  uncovered FTEs Employers without a plan that pays some part of the cost of insurance of its workers must pay the health care assessment on all employees. Employers who offer coverage* must pay the assessment on: Workers who are ineligible to participate in the plan New amendment: If the employer offers insurance to all full time employees, they do not have to pay the assessment on seasonal or part-time employees who have coverage from another source (unless it is Medicaid or VHAP). Workers who refuse the employer s coverage and do not have coverage from some other source. Assessment does NOT enroll employees in Catamount Health! * Employers plan must include hospital and physician coverage to qualify |! www(! www( www!www: www! www 6 www " www" www\wwwwww: www(! www(Jwww" www!r  5\  :$$$$((G((,,.%Employer Contribution$Employee = any individual 18 years or older on employer s unemployment insurance filing Based on the unemployment insurance definition of employee; excludes the following: Workers on small farms Full time college students working at the college in a program designed to provide financial assistance Elected officials Emergency volunteers such as volunteer fire fighters Licensed insurance and real estate sales Foreigners temporarily in Vermont on cultural exchange (J-1) visas Foreigners in Vermont on temporary foreign agricultural (H-2A) visa $365 / year Fee per Uninsured FTE (2007) Assessed quarterly - $91.25 / FTE / Qtr FTE = number of employee hours worked during a calendar quarter divided by 520 (based on 40 hour work week maximum) Exempts 8 FTEs in 2007 & 2008; 6 FTEs in 2009; 4 FTEs thereafter Annual Fee indexed to Catamount Health premium increases *X 0wwwP(Uv!0wwwP() 0wwwP(0" wwwP(!0wwwP(9 0wwwP(!0wwwP(!wwwPXSv  (9333333 333  Key Dates (EMPLOYER CONTRIBUTION September, 2006 Draft Rules Distributed for Public Comment December 13, 2006 Final Rules Approved January 15, 2007 Report on Inclusion of Seasonal Employees April 1, 2007 Assessment Implemented (to be paid at end of 4th Quarter  June 30, 2007) ___v___ --O Reform Oversight $$MJoint Legislative Commission on Health Care Reform Monthly meetings Reports on Reform Progress Five-year plan for Health Care Reform Implementation, including recommendations for administration or legislation (December 1, 2006) Annual Administration Reports on Reform Progress (January 15) Multiple Reports on Enrollment, Costs Universal Coverage/Individual Mandate - 2011 If Vermont has less than 96% of the population insured in 2010, the Health Care Reform Commission must submit a plan to increase health care coverage to ensure universal access, including individual mandates 3 ___P ___P!___P ___Pv___P ___Pv___Pe ___P" ___P- ___P ___P ___P3   >    &   -7-!Opportunities for Transferability""$Make health care affordable and accessible to uninsured Manage and coordinate chronic care for all Health Information Technology infrastructure Administration Simplification Build on Employer-Sponsored Insurance (ESI) Outreach to Medicaid eligible uninsured Reduce cost shift by: Insuring the currently uninsured and reimbursing at 110% of cost Providing better chronic care Increasing Medicaid reimbursement Finding common ground: building broad based coalitions8 wwwZ!wwwZ+ wwwZ!wwwZ- wwwZ!wwwZ wwwZ!wwwZ, wwwZ!wwwZ( wwwZ!wwwZ wwwZ wwwZwwwZ7 wwwZ8#-,(  6PFf\/(  0` 3L:̪3fܗ` =XL=xt=x̙` 3fL3[[E)̙` ff` 3F433` f3ϫ̙` ff̙f` @K=3NLGwt` geff>?" dd@,?d333d@)))"  @ `"  n?" dd@   @@``PR    @ ` `6p> >   (  l  6A \?"  6, "` `0  T Click to edit Master title style! !$  0̩ "` `p  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     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CArial Wingdings Courier New Mountain TopVermont Health Care ReformVermont ContextVermont Context$Vermont Context Health Care CostsVermont Context The InsuredRVermont Data (2005) The Insured 91.2% of Vermonters, 95.1% of Vermont childrenRVermont Data (2005) The Insured 91.2% of Vermonters, 95.1% of Vermont childrenNVermont Context The Uninsured 9.8% of Vermonters, 4.9% of Vermont childrenOVermont Data 2005 The Uninsured 9.8% of Vermonters, 4.9% of Vermont children Vermont Context The Uninsured Vermont Context The UninsuredWhat the Data Tell Us Vermonts ResponseHealth Care Reform Goals9Goal: Increase Access to Affordable Health Care CoverageGoal: Improve Quality of CareGoal: Contain CostsInsurance CoverageWhy is Coverage Important?Catamount Health Catamount HealthCatamount HealthCatamount Health CostsCatamount Health EligibilityCatamount Health Eligibility Key DatesPremium Assistance,Premium Assistance Cost Effectiveness Test%How will Premium Assistance be Paid?3Key Dates: PREMIUM ASSISTANCE FOR ESI / CATAMOUNT@OVERVIEW OF VERMONT EDUCATION, OUTREACH AND ENROLLMENT STRATEGYOutreach and Enrollment Key ElementsKey Elements, continuedSRevisions for Medicaid/VHAP/Dr. Dynasaur Eligibility Determination and EnrollmentSRevisions for Medicaid/VHAP/Dr. Dynasaur Eligibility Determination and Enrollment&Vermont Health Care Portal, continued8Other Initiatives to Enhance Private Insurance CoverageCHRONIC CARE MANAGEMENTBlueprint for Health Slide 41!Examples of Blueprint Components@Other Chronic Care Strategies To Be Aligned with the Blueprint0Medicaid Chronic Care Management Program (CCMP)CCMP Interventions8Blueprint Alignment Topics Across Chronic Care Programs&Blueprint Impact on Health Care CostsHealth Information Technology PREVENTIONKCHAMPPS (Coordinated Healthy Activity, Motivation and Prevention Programs)'Healthy Lifestyles Insurance DiscountsOther Prevention Initiatives Quality Improvement InitiativesAdministrative Simplification!Strategies to Address Cost ShiftFinancing of ReformsEmployer ContributionEmployer Contribution Key DatesReform Oversight"Opportunities for Transferability Slide 62I For more information about enrollment Member Services: 800-250-8427  Fonts UsedDesign Template Slide Titles?xH4Tl_AdHocReviewCycleID_NewReviewCycle_EmailSubject _AuthorEmail_AuthorEmailDisplayName_ReviewingToolsShownOncewBO$Web Postings - need by COB TuesdaySusan.Besio@state.vt.usBesio, Susan_R:hbellhbell  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstvwxyz{|}~Root EntrydO)PicturesCurrent UserSummaryInformation(uUPowerPoint Document(Wv:DocumentSummaryInformation8