UCEDD Directors Meeting December 2, 2012 3:15 6:15 pm A U C D 1 - - PowerPoint PPT Presentation

A U C D

Association of University Centers on Disabilities

UCEDD Directors Meeting

December 2, 2012 3:15‐6:15 pm

1

A U C D

Association of University Centers on Disabilities

2

Welcome

A U C D

Association of University Centers on Disabilities

 Timm Vogelsberg, PhD (MT)  Judy Struck, MD (SD)

3

Recognition

A U C D

Association of University Centers on Disabilities

 Native American DD Needs Assessment  PCPID 2012 Report to the President  Involving People w/ Most Significant Disabilities  Capacity Building Tool‐kit  Minority Partnerships report  UCEDD Annual Report

4

UCEDD TA Updates

A U C D

Association of University Centers on Disabilities

 Allies in Self‐Advocacy

Final Summit Report Promotional video State team progress Listserv Organizational Development Mini‐grants Updated website www.AlliesInSelfAdvocacy.org

5

UCEDD TA Updates

A U C D

Association of University Centers on Disabilities

 UCEDD National Salary Survey ‐ elements

Director & associate director $, degree, longevity UCEDD admin. home, budget, FTE University Carnegie classification Salary source University support for UCEDD

 UCEDD Evaluation Plans

6

Upcoming Requests

A U C D

Association of University Centers on Disabilities

7

Self‐Advocacy Online

 Amy Hewitt, PhD  www.SelfAdvocacyOnline.org

A U C D

Association of University Centers on Disabilities

 3 major efforts

AIDD/AUCD Fellowship AUCD Policy Fellowship UCEDD Leadership Institute

 Wonderful opportunities for early‐mid career

network members and trainees

 Strongly encouraging applicants with

cultural, ethnic, linguistic diversity

8

Leadership Development

A U C D

Association of University Centers on Disabilities

 Sue Fox, Associate UCEDD Director, IOD, NH

9

UCEDD Leadership Institute

A U C D

Association of University Centers on Disabilities

 Mette Pedersen, PhD, 2012‐2013 Fellow  Applications due December 15 for 2013‐2014!

10

AIDD/AUCD Fellowship

A U C D

Association of University Centers on Disabilities

 Kristina Majewski, JD, 2012 Fellow  Applications for 2013 due now!

11

AUCD Disability Policy Fellow

A U C D

Association of University Centers on Disabilities

 Martha Roherty, Executive Director, NASUAD  www.nasuad.org

12

Partnership

A U C D

Association of University Centers on Disabilities

BREAK

10 minutes Don’t miss a minute of the ACA!

13

Kim Musheno AUCD Director of Legislative Affairs Rachel Patterson AUCD Policy Analyst

Health Care Reform Update

2012 AUCD Annual Meeting UCEDD Directors

Impact of election

Affordable Care Act will not be repealed ACA will continue to be implemented by HHS Secretary Kathleen Sebelius Medicaid will not be block granted Medicare will not be fundamentally altered House bills to consolidate and cut education and employment programs will not pass Bills to weaken the ADA will not pass Cuts to discretionary programs will not be as severe Still need bipartisan support to pass any bill

Public Law 111-14 Historic Legislation

Patient Protection and Affordable Health Care Act and the Health Care and Education Reconciliation Act Signed into LAW on March 23, 2010

16

Purpose

• Expands coverage and access
• Transforms focus from treating sickness to

preventing illness and promoting wellness

• Strengthens protections for people with

disabilities who have been discriminated based on pre-existing conditions or health status

• Goal to achieve health equity and reducing

health disparities

• Bending the Cost Curve over time

17

Insurance Market Reforms

18

“Guaranteed issue and renewability” – Insurance companies must not deny anyone “Medical loss ratio” means 80‐85% of premiums must be spent on medical care, not on advertising

• r CEO paychecks‐‐

Or you get money back! Regulations require insurers to justify any unreasonable rate increases

“Individual Mandate”

Everyone must share responsibility for lowering costs and covering more people

19

Expanding Coverage

Temporary high‐risk pools Small business tax credits to cover employees Premium subsidies (133‐400% FPL) Employer & individual responsibility Medicaid expansion – 133% of FPL covered Insurance Exchanges – more coverage, increased competition, lower costs

Expand Coverage: Medicaid

Expands Medicaid eligibility for everyone up to 133 % of Federal Poverty Level (2014)

• Up to $14,600/

individual

• $29,400 /family of four

Federal share of costs to states:

• Administration lower than

private insurance

• States will receive100% for

newly eligible first 3 years (2014 – 2016)

• Phases down to 90% for

2020 and subsequent years

Estimated to cover 17 million more in 2014

Efficient

more info: www.kff.org

Cost‐effective Humane

Health Insurance Exchanges

22

Exchange = = Market

If you can’t get Medicaid You can shop in the marketplace for insurance with government subsidies

Making Coverage Affordable

Subsidies for marketplace comes in form of Tax Credits provided for individuals/families between 133% ‐ 400% Federal Poverty

Approximately

Up to $43,000 individual Up to $88,000 family of 4

Paid by Government directly to Insurer

Limits out of pocket costs:

Deductibles, Coinsurance, Copayments

HOW?

Essential Benefits Package for Exchanges and Medicaid

Services Everyone Expects to be Covered by their Insurance

24

Hospitalization, emergency services, ambulance Prescription drugs and laboratory services Rehabilitative and habilitative services and devices Mental health and substance use disorder services including behavioral health treatment Preventative and wellness services and chronic disease management Pediatric services including dental and vision care Maternity and newborn care

HUGE Focus on Prevention and Wellness

Requires new plans to cover certain preventive and immunization services without deductible or co‐insurance (applies to Medicaid and Medicare) One percent federal Medicaid share increase for States if it covers clinical preventive services Grants to provide state incentives to Medicaid beneficiaries who successfully participate in a wellness program $11 billion increase FY 2011 for Community Health Centers

25

Prevention and Wellness

26

• Coordination and goals

National Prevention Council

• $7 billion (FY 2010‐2015); $2

billion/yr (FY2015+)

• Sen. Coburn “prevention and

public health slush fund” Prevention and public Health Fund for transformational sustained investments

• Community Transformation Grants
• Comprehensive workplace wellness programs
• Education and Outreach Campaign
• Oral health prevention

Numerous Prevention and wellness programs such as:

Increasing and Improving the Workforce

National Health Care Workforce Commission established Oral Health: Grants for dental and dental hygiene schools, residency programs, public health programs Increases Medicaid reimbursement for primary care physicians and pediatricians to Medicare rates (2013 and 2014) Primary Care Training Grants for Medical Schools

• training on treating

individuals with disabilities priority population

Accessibility

Access Board (under the Rehab Act) establish standards for accessibility of medical diagnostic equipment Includes

• examination tables

and chairs

• mammography

equipment

• x‐ray machines

Understanding Health Disparities: Data Collection

29

Requires government to collect health survey data from people with disabilities to enable better understanding of the health of people with disabilities compared to other minority groups. Requires HHS to survey health providers to asses access to care and treatment for people with disabilities. Requires development of recommendations for quality measures to improve the quality of health care for individuals with disabilities.

New State Incentives for Community Living

30

Community First Choice State Option

• new Medicaid state plan option (beginning Oct. 2011) to provide

comprehensive home and community‐based attendant services and supports for individuals who are eligible for an institutional level of care Reforms 1915(i) State Option

• Allows states to provide HCBS services without a waiver

Grants to assist states to balance their Medicaid systems in favor of community Extends Money Follows the Person grants CLASS Act – Community Living Assistance, Services and Supports Act

Legal Challenge Won (mostly) Congressional Challenges continue

31

Challenges to Health Reform

Supreme Court Decision

Court upheld the individual mandate as constitutional exercise

• f Congress’ power

to levy taxes Medicaid expansion is unconstitutionally coercive of states

• Power of Secretary

to withhold all existing funds for state non‐ compliance Bottom line – Medicaid expansion in ACA is now an option

Medicaid expansion

4 Republican governors do not plan to join in the expansion 16 yes No deadline for states to decide

• n joining the

expansion and they can drop out at any time Partial expansion?

• E.g. limit

enrollment to people with income up to 100 percent of the FPL rather than 133 %

Will Congress slash Medicaid budget?

Cutting Medicaid

Block grants off the table, but Per Capita Caps still under discussion Limitations on Medicaid provider taxes Blended match rate Limit federal reimbursement for certain expenses

Election Impact - Exchanges

States must have Exchanges ready by Jan. 2013 States took “wait and see approach” – now not ready Secretary extended deadline for application from Nov. 16 to

• Dec. 14 (if partnership Feb. 15)

Two new Rules on Exchanges to come out soon Election Impact

Managed Long-Term Services and Supports

Source: AARP, On the Verge: The Transformation of LTSS

As of February 2012

MLTSS – Power Tools

Benefits Concerns Rebalancing Fast implementation Primary and Coordinated Care Limited experience from states or MCOs Cost containment Mandatory or passive enrollment Consumer protection Lack of quality measures

MLTSS – Where UCEDDs are Needed

Quality measures focused on long term quality‐of‐life outcomes

Duals Demos

Duals Demos

Benefits Concerns Medicare‐Medicaid coordination Demonstration overreach Care coordination Passive enrollment Cost containment Consumer protection Rebalancing Need for evaluation Lack of experience from states

• r MCOs

Duals Demos – Where UCEDDs are Needed

Public Engagement Monitoring and Evaluation

What you can do

Speak up and advocate for the Affordable Care Act Volunteer your expertise to help plan Coordinate with state partners

• National Academy for

State Health Policy

• National Association of

Insurance Commissioners

• National Association of

State Medicaid Directors

Resources

AUCD Health Reform HUB:

http://www.aucd.org/h ealthreformhub

• Text of the law
• Detailed summaries and

analyses

• Implementation resources
• Archived webinars on 4 topics

US Dept. of Health and Human Services:

http://www.healthcare .gov/

Kaiser Family Foundation:

http://www.kff.org/

45

46

Questions?

Thank You

A U C D

Association of University Centers on Disabilities

 Is your state considering any of the following:

 Managed Long Term Services & Supports (MLTSS)  Dual eligibility demonstrations  Expanding Medicaid  Setting up healthcare exchanges

 How are these issues being addressed in your state (task force, etc.)?  How are experts being chosen to advise the process?  How did you, or can you, get involved?  Do you use AUCD’s Health Care Hub?

 What else would be helpful to include?

 How else can AUCD assist through TA?

47

Table Discussions

A U C D

Association of University Centers on Disabilities

48

Implications for TA

A U C D

Association of University Centers on Disabilities

49