AcademyHealth Stateside - 07/26/2006  (Plain Text Version)

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In this issue:
 Judge Finds “Wal-Mart” Bill Invalid
 Administration Eases Medicaid Citizenship Documentation Requirement
 Two New Invitational Programs Available from SCI
 Issue Brief on Medicaid Consumer-Directed Health Purchasing Now Available
 New State Coverage Reforms Enacted
 Coverage Implementations and Updates: Massachusetts, Florida & Maryland
 San Francisco Approves Universal Access Bill
 Register Now for AcademyHealth’s Health Policy Orientation
 Reports of Interest


New State Coverage Reforms Enacted


Tennessee: In March 2006, Tennessee Governor Phil Bredesen (D) proposed several coverage expansions to the legislature. On June 5, the Governor signed into law Senate Bill 3895. The legislation contains several coverage components.

Cover Kids: The Cover Kids Act creates a separate, stand-alone health care program for all children age 18 and under in Tennessee. This will be a State Children’s Health Insurance Program (SCHIP). Due to its prior TennCare expansion, Tennessee did not operate a separate SCHIP program. The program uses $7 million in state funds for Fiscal Year 2007 (six months) and Title XXI funds (SCHIP) from the federal government to cover children and pregnant women up to 250 percent of the federal poverty level (FPL). Eligibility is layered over current TennCare levels. For children who do not qualify for the subsidized product, the state offers a buy-in program.

Cover Tennessee: This program aims to provide a new, portable, and affordable product for the working uninsured in Tennessee who earn less than 250 percent FPL, as well as for small firms who do not currently offer insurance. Under the Cover Tennessee program, workers would be able to take this product with them when they change jobs. During the first three years of the program, premium amounts charged to employers, employees, and individuals may not increase more than 10 percent per year to maintain affordability.

Cover Tennessee is based on the three share concept where participating employers pay $50 per member per month (pmpm), the State of Tennessee pays $50 pmpm, and the individual contributes the final portion of the premium. The state will contract with at least two statewide carriers to offer a product ($150 pmpm medical loss) with low or zero dollar deductibles for preventative health services. Currently, the procurement process to contract with those health plans is under development.

Access Tennessee: The new legislation also creates a high-risk pool called Access Tennessee. Tennessee, prior to TennCare, operated a high-risk pool but chose to insure medically uninsurable individuals under its TennCare waiver, which was ultimately disbanded as a result of TennCare reform efforts. Eligibility for the new pool includes:

  • Residents of Tennessee who are uninsured for six months or longer, and who do not have access to other forms of public or private insurance due to a medical condition.
  • Tennessee residents who qualify under federal law (HIPAA, COBRA).

The legislation also allows board leadership to elect to enroll:

  • Any TennCare Standard recipient who lost coverage after August 1, 2005.
  • Others as determined eligibile by the leadership of the pool.

The legislation authorizes the administrators of the pool to develop two benefit packages: one modeled after the state employees PPO product, and a second option that is a high-deductible health plan coupled with a health savings account.

Access Tennessee will be funded by a combination of premiums, assessments on carriers and third party administrators, state appropriations, and possible federal funds pending grant release from the Centers for Medicare and Medicaid Services (CMS).

Premiums charged to pool enrollees will be capped between 150 percent and 200 percent of a commercial benchmark plan after moderate medical underwriting. The state also authorized a premium assistance program to assist those who cannot afford the premiums.

Other Programs: The appropriation bill associated with the program also continues funding for Tennessee’s safety net program for affordable prescription drugs, with a focus on high priority populations who have chronic diseases that require medication for daily functioning. The drug program will be available for adults who earn less than 250 percent FPL. In addition, the bill includes the Project Diabetes program, which funds endowment grants to high schools and health care entities to combat the epidemic of diabetes and obesity in the state. 
 
Rhode Island: Governor Donald Carcieri (R) signed into law a number of new health initiatives including several coverage expansions. The main focus of the coverage expansion is to provide premium relief for small businesses. The bill empowers the Insurance Commissioner to work with business, insurance, and other stakeholders to develop a new, affordable health plan, called “Select Care.” The plan is expected to reduce premiums for all small businesses by approximately 25 percent below market rate through a combination of state mandated benefit flexibility, premium rating restrictions, and consumer cost sharing.  In addition, eligible low wage small businesses (those with average wages in the bottom quartile) will save an additional 10 percent of premium through a state sponsored reinsurance program.  This reinsurance program passed into law during the 2006 legislative session; however, it is contingent upon the identification of a new funding source during the coming year.  Finally, the Insurance Commissioner is authorized to seek federal funds for the creation of a high-risk pool in the individual market.

The coverage expansions are part of a larger health care reform package that also includes:

  • Massachusetts Reform Review Task Force: This panel will explore the potential transferability of the Massachusetts reforms to the State of Rhode Island. 
  • Wellness: The legislation restricts the sale of sweetened beverages in school vending machines, creates an adult flu vaccination program, and encourages insurance coverage of tobacco cessation products.
  • Transparency: The legislation expands quality and cost data reporting to all licensed health facilities in the state to enable patients with deductibles and co-insurance to make informed decisions.

Virginia: On July 1, 2006, small businesses that employ 50 or fewer will be able to join together to form purchasing cooperatives.  These cooperatives will be able to purchase or facilitate providing insurance to employees (and dependents of employees) who work more than 30 hours per week.  The legislation authorizes the cooperatives to negotiate premiums for their members.  Regulatory guidance will be issued by the state Insurance Commission.  Full text of the legislation is available online for H.B. 761.