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3 posts from November 2015


Expectations for 2016 ACA Marketplace Enrollment: A Conversation with Sabrina Corlette (December 21st)

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January 1st will mark the Affordable Care Act's (ACA) third health insurance expansion year.  Under the ACA individuals with income below 400% of poverty are eligible for insurance subsidies and individuals with incomes below 138% of the federal poverty level are eligible for state Medicaid coverage (or in the 31 states that have to date chosen to expand Medicaid coverage).  As of 2015 the ACA has expanded coverage to approximately 12 million Americans.   Medicaid expansion has added another 14 million lives.   Despite significant gains in the number of insured approximately 25 million non-elderly adults or about 11% remain without coverage.  Roughly half of these are undocumented immigrants whom are ineligible for coverage under the ACA.   Despite subsidies the cost of insurance remains the reason individuals go without coverage that frequently results in individuals going without needed care.      

During this 24 minute conversation, Ms. Corlette discusses expected 2016 enrollment numbers, premium prices, the impact pharmaceutical cost growth has had on premium costs, to what extent individuals comparative shop for plans, the number of and reasons for the un-enrolled, insurer participation and the issue of risk corridor funding (recently a presidential campaign issue). 

Sabrina Corlette is a Senior Research Fellow and Project Director at the Center on Health Insurance Reforms (CHIR) at SearchGeorgetown University's Health Policy Institute.  Prior to joining the Georgetown faculty, Ms. Corlette was Director of Health Policy Programs at the National Partnership for Women and Families.  From 1997 to 2001, Ms. Corlette worked as a professional staff member for the Senate Health, Education, Labor and Pensions (HELP) Committee.   After leaving the Hill Ms. Corlette also served as an attorney at Hogan Lovells.  She received her JD with high honors from the University of Texas and earned her undergrad degree also with honors from Harvard. 

For more on CHIR go to: http://chir.georgetown.edu/.  


Will Medicare Ever Cover Telehealth & Remote Monitoring? A Conversation with Krista Drobac (November 18th)

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Telehealth and remote monitoring services generally enable physicians to treat patients and monitor their health status remotely.  Because of advances in wireless communication and biosensor technology these services are increasingly being used in the commercial health care market and as well in the Medicaid program and the VA because research shows these services can reduce acute care visits and lengths of stay, iatrogenic harm and improve patient adherence to care.  Nevertheless, the Medicare program restricts reimbursement for these services largely because CMS (the Congress and the CBO) see them moreover as duplicative (v. substitutive) services.   For example, in 2014 Medicare spent just $14 million on telehealth service reimbursement.  (Total Medicare spending in 2014 was well north of $500 billion).    

During this 18 minute conversation Ms. Drobac discusses in part how and why reimbursement for telehealth and remote monitoring services are limited under Medicare, how other payers and providers are using telehealth and remote monitoring, what the research literature suggests regarding clinical effectiveness and cost efficiency, proposed Congressional legislation and related regulatory action to broaden Medicare coverage and chances for legislative and regulatory success. 

Krista Drobac leads the Alliance for Connected Care, a 501(c)(6) coalition formed to create a statutory and regulatory Drobacenvironment in which providers are able to deliver and be adequately compensated for providing telehealth and remote monitoring services regardless of delivery location or technological modality.   Ms. Drobac was previously Director of the Health Division at the National Governors Association's Center for Best Practices.  Prior to that she was senior adviser at CMS, Deputy Director of the Illinois Department of Healthcare and Family Services and spent five years on Capital Hill where she was a Health Adviser to the Senate Majority Whip Senator Richard Durbin and served as a John Heinz Senate Fellow for Senator Debbie Stabenow.  Ms. Drobac earned her BA from the University of Michigan and her MPP from the Kennedy School of Government at Harvard. 

For information on the Alliance for Connected Care go to: http://www.connectwithcare.org/ 


The Jimmo Settlement: Its Importance and Implementation to Date: A Conversation With Margaret Murphy (November 10th)

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In 2011 a 78 year old blind, amputated Vermont woman, Ms. Glenda Jimmo, was denied physical therapy services under Medicare because her condition was determined to not likely improve. Because Medicare therapy services via skilled nursing, home health and outpatient care never required the patient "improve" in order to receive services and because thousands of other Medicare beneficiaries along with Ms. Jimmo had been denied therapy the Center for Medicare Advocacy and Vermont Legal Aid filed a class action suit against the federal government, i.e., Jimmo vs. Katheleen Sebelius.  After 11 months of negotiations, a settlement agreement was reached in late 2012 that affirmed there is no "improvement standard" required to be met for beneficiaries to receive therapy services.  That is care would no longer be denied due to a Medicare beneficiary's lack of restoration potential. 

During this 18 minute discussion Ms. Murphy explains the impetus for the case, speculates why DHHS did not act on its own in resolving the problem, how well or effectively CMS has implemented the terms of the settlement agreement (not very well) and why the decision has received so little attention over the past three years.   

Margaret Murphy is the Associate Director of the Center for Medicare Advocacy where she works to develop the Center's legal policy and litigation strategies.  Ms. Murphy has been counsel or co- Murphycounsel in several of the Center's federal class action suites.  She serves on the Steering Committee of the Complex Care Committee of the Connecticut Medicaid Medical Assistance Program Oversight Council.  She has also been appointed by the Connecticut probate courts to represent incapacitated adults. She has also taught as an adjunct professor at Quinnipiac University Law School.   Prior to joining the Center Ms. Murphy worked for more than 20 years a a trust and estate attorney.   She is a member of the Connecticut Bar Association, serves as the Secretary of the Executive Committee of the Elder Law Section and is a member of Swift's Inn in Hartford.  Ms. Murphy earned her JD degree from the University of Connecticut School of Law and her BA from Mt. Holyoke College.