Health Reform Implementation

Recording of NACo webinar on February 21, 2013

PowerPoint presentations by Jennifer Tolbert of the Kaiser Family Foundation, Laura Hanen of the National Association of County and City Health Officials, and Ron Manderscheid of the National Association of County Behavioral Health and Developmental Disability Directors

PowerPoint presentations by Sarah Somers of the National Health Law Program, Meg Sheldon of the County Welfare Directors Association of California and Pat Fleming of Salt Lake County for NACo webinar on February 23, 2012 (recording available upon request)

PowerPoint presentations by Dara Alpert Lieberman of the Trust for America's Health and Eli Briggs of the National Association of County and City Health Officials for NACo webinar on April 21, 2011 (recording available upon request)

PowerPoint presentations from Gerald Doeksen and Val Schott from the National Center for Rural Health Works from NACo webinar on March 24, 2011 (recording available upon request)

PowerPoint presentations by Paul Beddoe, Associate Legislative Director for Health at NACo, Kathleen Nolan of the National Governors Association and Joy Johnson Wilson of the National Conference of State Legislatures for NACo's February 24, 2011 webinar (recording available upon request)

PowerPoint presentations by Dr. Timothy McBride and Dr. Keith Mueller of the Rural Policy Research Institute's Health Panel for NACo's October 19, 2010 webinar (recording available upon request)

PowerPoint presentations by James Slade from HHS' Office of Consumer Information and Insurance Oversight on the Early Retiree Reinsurance Program and by Rick Johnson and Kaye Pestaina from The Segal Company for NACo's June 17, 2010 webinar (recording available upon request)

PowerPoint presentations by Paul Beddoe, Associate Legislative Director for Health at NACo and Andrea Maresca of the National Governors Association for NACo's May 14, 2010 webinar (recording available upon request)

Presentation at NACo's 2012 Legislative Conference by Katherine Hayes, Associate Research Professor at George Washington University on issues related to the ACA that the U.S. Supreme Court will be considering in March 2012

Presentation at NACo's 2011 Legislative Conference by Eli Briggs of the National Association of County and City Health Officials for the workshop "The Affordable Care Act: Prevention and Public Health Investments"

Presentations at NACo's 2010 Annual Conference by Steven Kreisberg of AFSCME and by Jon Hager of the Nevada Public Employees' Benefits Program for the workshop "How Will Health Reform Affect Your County Employees' Health Benefits?"

Presentations at NACo’s 2010 Western Interstate Region Conference by Matt Kazan from the Senate Finance Committee and by Beth Dillon, Health Resources and Services Administration, Denver office

The American College of Mental Health Administration (ACMHA) provided a series of free webinars throughout 2010 and 2011 focused on behavioral health and the health reform law

On 2/22 HHS published a final rule regarding insurance market rules and rate review standards under the ACA. The rule outlines five primary consumer protections that will be effective in 2014, which include: 1) Guaranteed availability of coverage; 2) Fair health insurance premiums, meaning health insurance companies offering coverage to individuals and small employers will only be allowed to vary premiums based on age, tobacco use, family size, and geography; 3) Guaranteed renewability of health coverage; 4) Single risk pool; each state will have a single state-wide risk pool for each of their individual and small group markets; and 5) Catastrophic plans: young adults and people for whom coverage would otherwise be unaffordable will have access to catastrophic plans in the individual market. The rule also requires insurance companies to report all rate increases.

On 2/21 HHS announced $300 million in State Innovation Model awards. These awards provided through the ACA provide support to state efforts to develop initiatives to improve care delivery and health system performance. Six states will receive Model Testing Awards to implement their State Health Care Innovation Plan and test multi-payer payment and service delivery models such as Accountable Care Organizations on a broad scale. Nineteen other states will receive funding awards to create and further develop State Health Care Innovationo Plans.

On 2/21 HHS released a report, Medicaid Moving Forward, which highlights efforts that states have implemented that are designed to improve care and lower costs in their Children’s Health Insurance Program (CHIP) and Medicaid programs. The report also describes options designed to improve care that are currently available for states to pursue.

On 2/20 HHS released a final rule outlining standards for essential health benefits, a set of core benefits that the ACA requires all non-grandfathered health insurance plans in the individual and small group markets, both inside and outside of the health insurance exchanges/marketplaces, to provide. The rule also finalizes a benchmark-based approach for defining essential health benefits, which allowed states to select an existing plan in their state to serve as the benchmark plan or for states that did not select a benchmark plan the small group plan that is the largest in the state will serve as the benchmark. The rule also outlines plan actuarial value levels which are designed to help consumers compare plans that offer different coverage levels. Additionally, the rule offers further information about accreditation standards for qualified health plans (QHPs) that will be offered through the health insurance exchanges/marketplaces.

On 2/6, the Centers for Medicare and Medicaid Services issued a set of frequently asked questions related to Medicaid and the Children’s Health Insurance Program (CHIP) ACA implementation. The FAQs address a wide range of issues

On 2/6, the National Health Service Corps’ Students to Service Loan Repayment Program through the ACA awarded over $10 million in funding for loan repayment to 87 medical students who will serve as primary care physicians in communities in need of health providers. Currently close to 10,000 National Health Service Corps providers are providing primary care at nearly 14,000 health care sites in urban, rural, and frontier areas.

On 1/30, the Centers for Medicare & Medicaid Services and the Internal Revenue Service issued proposed rules related to the ACA’s provision on individual shared responsibility for health insurance coverage. Beginning in 2014, the ACA’s individual shared responsibility provision requires each individual to have basic health insurance coverage, referred to as “minimum essential coverage” unless the individual qualifies for an exemption. If the individual does not qualify for an exemption and does not have qualifying health insurance coverage, the individual must make a shared responsibility payment when filing a federal income tax return. The proposed rules specify which individuals are exempt from some or all of the requirements of the provision.

On 1/28, the Centers for Medicare and Medicaid Services issued a draft of the application that individuals will use when applying for coverage through the health insurance exchanges/marketplaces as well as the draft Small Business Health Options Program (SHOP) application that will be used for small businesses. Enrollment is scheduled to begin through the exchanges/marketplaces on October 1, 2013.

On 12/28/12 the Department of the Treasury and the Internal Revenue Service issued proposed regulations as well as an FAQ document on the ACA’s Employer Shared Responsibility provisions, which are effective in 2014. Under these provisions large employers may face a penalty if they do not provide affordable and minimum essential health coverage to their full-time employees and one or more of their full-time employees receives a premium tax credit to purchase coverage on an exchange.

On 12/10/12 HHS released a new FAQ document on the exchanges, market reforms and Medicaid. The guidance clarifies that states will not be able to receive the enhanced federal match rate for a partial expansion of the Medicaid program. As originally outlined in the ACA, Medicaid would be expanded in 2014 to cover all individuals up to 133 percent of the federal poverty level (FPL), and for the first three years the federal government would provide 100 percent of the funding to cover this expansion population, phasing down to 90 percent in 2020 and all subsequent years.

On 11/30/12 HHS provided information about the federally-facilitated exchanges that will operate in states that choose not to run their own exchange

On 11/19/12 CMS issued additional information in an FAQ document about operational details related to eligibility determination and enrollment for Medicaid and the exchanges

The Alliance for Health Reform is a nonpartisan, nonprofit group that offers a full array of resources and viewpoints regarding health care system changes in a number of formats to elected officials and their staffs, journalists, policy analysts and advocates. Since 1991 the Alliance has organized more than 400 forums in Washington, D.C. and around the nation, each presenting a balance of expert views. They held a July 9, 2012 briefing, Health Care After the Supreme Court Decision: What’s Next?

On 1/26/12 the Center for Medicare and Medicaid Innovation (CMMI) released a report on the first year of work of the CMMI

On 10/31/11, the Negotiated Rulemaking Committee on the Designation of Medically Underserved Populations and Health Professional Shortage Areas issued its final report to the HHS Secretary.

On 6/16/11 U.S. Surgeon General Regina Benjamin and members of the National Prevention, Health Promotion and Public Health Council released the National Prevention Strategy called for through the ACA

Information from the Internal Revenue Service regarding ACA tax provisions

Information from the Department of Labor's Employee Benefits Security Administration about the ACA

Information about the Early Retiree Reinsurance Program

A NACo June 2010 survey of county human resource directors and how they are preparing for changes required by the health reform law

Information about the enrollment workgroup and their recommendations on standards for enrollment in federal and state health and human services programs

This brief highlights some of the key issues related to the integration of health information technology (HIT) into local health care and public health delivery systems