Health, Medicine & Nutrition
Branstad submits letter of intent on PPACA on time PDF Print E-mail
News Releases - Health, Medicine & Nutrition
Written by Office of the Governor of Iowa   
Friday, 16 November 2012 11:21

Outlines significant, unanswered questions looming over implementation

(DES MOINES) – Gov. Terry Branstad this morning submitted the below letter of intent on the Patient Protection and Affordable Care Act (PPACA) to Sec. Sebelius, meeting the deadline previously set forth by the Health and Human Services director.

However, late yesterday, Sec. Sebelius pushed back the deadline to December 14. In response to the new, arbitrary deadline set forth by the federal government, despite all the work states like Iowa have already accomplished, Communications Director Tim Albrecht said the following:

“Make no mistake, this deadline was extended because the federal government does not have the answers or capability to administer the Obamacare program,” said Albrecht. “This deadline was not pushed back to give the governors more time, rather it was a lifeline to help save themselves.”

The text of Gov. Branstad’s letter is as follows, with 50 remaining questions the federal government has yet to answer that underscore the information the state needs to make an informed decision:

 

November 16, 2012

The Honorable Kathleen Sebelius

US Department of Health & Human Services

200 Independence Avenue Southwest

Washington, DC 20201

 

Dear Secretary Sebelius:

 

My top priorities as governor are to protect the health, safety and welfare of Iowans, promote our State’s fiscal well-being and ensure our State remains a leader in job creation and income growth. I write you today to inform you that Iowa will continue on its path to creating an Iowa-based exchange that is intended to protect the health of Iowans, ensure the integrity of our health insurance markets and safe-guard our State budget from unnecessary turbulence. I continue to have concerns that an intrusive Federal exchange would raise costs on individuals and businesses, making it harder for them to create jobs and raise family incomes in Iowa. In fact, I have even greater concern that the health benefit exchanges proposed in the Patient Protection and Affordable Care Act (PPACA) do nothing to address the quality of care or make our population healthier.

 

However, I cannot provide you with a set of timelines or complete details about the exchange until our State receives clear, binding rules from your Department. Forcing an exchange decision on states based on an arbitrary timetable, would be like forcing a consumer to buy a car without knowing the vehicle’s price tag or fuel economy. If forced to make a decision with incomplete information, then I have no choice but to default on some level to a Federal exchange. That is not my preferred path forward. Recently, I recommitted to my long-time pledge to work in a bipartisan fashion with Iowa legislative leaders and that pledge applies to our Federal partners as well. We have not abandoned our legal responsibility to create an exchange; however, the path towards consensus rests with you and Health and Human Services leadership. Our intention is not to default to a Federal exchange, but the road blocks and impediments in front of us may leave us no choice.

 

As a former governor, I trust you know the challenges states face when trying to navigate the murky waters of implementing a Federal mandate without clear guidance. In Iowa, formal rulemaking not only binds both the State and stakeholder to a clear set of expectations, it also allows for predictable and formal opportunities for stakeholder input that citizens deserve.

 

Iowa, like many states, has worked diligently, and met all deadlines for health benefit exchanges. We are updating vital systems and technology within our State, officials have met with critical stakeholders for input on exchanges and we have a solid framework for how an exchange could operate in Iowa. However, we continue to struggle with too many unanswered questions on topics critically important to the final development of an exchange that meets the needs of Iowans, including the cost of building and operating an exchange. Practical considerations will be guiding all states with the looming deadlines set by PPACA.

 

It is my hope that you will work with my State, and others, to address our questions and give us the flexibility and information we need to address the real challenges we face when trying to make decisions with incomplete guidance. Enclosed please find a list of issues and questions on which we seek specific guidance. Building a state-based exchange at all costs is not an option for any state. If Iowa must have an exchange, the exchange must provide solutions to the unique health care problems Iowa faces at an affordable and sustainable cost.

 

 

Sincerely,

 

 

 

Terry E. Branstad

Governor

 


Exchange-Related Questions for US HHS

 

1)     Please provide a complete list of regulations that will have to be reviewed, revised and re-opened for public comment prior to implementation as a result of the Supreme Court ruling (e.g., the Medicaid eligibility regulations, exchange regulations related to interface with Medicaid). What is the schedule for re-issuing these regulations?

 

2)     When will final rules be issued on essential health benefits, actuarial value and rating areas?

 

3)     The federal government has already extended deadlines for applying for Level 1 and Level 2 Exchange Establishment funding into 2014. Can we expect extensions of the deadlines for other areas of implementation given the uncertainty caused by the Supreme Court ruling and the linkage between Medicaid expansion and exchange eligibility and enrollment functions? In addition, will the deadlines change for states implementing a partnership exchange? Will the deadlines be extended for states implementing a federal exchange? Can you confirm that states will be able to switch from a federal model to a partnership or state model until 2019 and that funding will be available to enable that transition?

 

4)     When will the details of the federal partnership options be available? These cannot be considered as an option without details including cost estimates and how state and federal systems are expected to link. How will the long term funding of the federally-facilitated healthcare exchanges be sustained?

 

5)     States considering a state-based exchange need to know whether there will be a charge to use the federal data hub, advance premium tax credit/cost-sharing reduction service, risk adjustment and transitional reinsurance programs. Will there be a charge? And, if so, how much will it be?

 

6)     When will states learn the details of the operational systems for a federal exchange? The procedural, technical, and architectural requirements for linking to the federal exchange have not been released. It is not feasible to know if a state-based exchange is better for our citizens until we know what the contents of a federal exchange will be.

 

7)     When will information from the establishment of a federal exchange be available for states to use if a state opts to build its own exchange? It is costly for each state to have to start from scratch and still not know how interfaces will work.

 

8)     If states choose to build a state-based exchange, what dollars will the federal government contribute now and in the future? For the federal exchange states, when will the regulations regarding the imposition of taxes on a state’s insurers be released?

 

9)     It has been widely reported that Congressional leaders who have to appropriate money will seek to defund exchanges. Can you explain how the enactment provisions of the law allow the Executive Branch to continue to fund exchanges without Congressional action to appropriate money?

 

10)  What happens to a state that has taken exchange planning and implementation grants if their exchange is not financially viable after 2015? Can a state refuse to increase taxes on either its residents or insurers, thus putting the financial underpinning of an exchange at risk? What penalties does the federal government envision in this case?

 

11)  What happens if a state accepts grant money now to begin to build a state exchange, and subsequently determines that a federal exchange may be better? Will the federal government claw back these grant dollars from the states?

 

12)  The Congressional Budget Office (CBO) has pointed out a provision in the law that reduces exchange subsidies after 2018, which means fewer and fewer people will qualify for subsidies, and the people who do qualify will get a smaller and smaller subsidy. Does the Administration support that change, and if so, how would you pay for it? If you do not, why do you think people should be forced to buy insurance if federal subsidies are shrinking?

 

13)  Alongside the considerable challenge of greatly expanding the Medicaid program, states are charged by the PPACA with creating a single, seamless point of entry for all of the insurance affordability programs affected by the Act--Medicaid, the Children’s Health Insurance Program (CHIP), the Basic Health Plan (where offered), advance tax credits for individual and Small Business Health Options Program (SHOP) exchange enrollees. This leaves another major question on the table. What about all of the other social service programs?

 

14)  In order to minimize disruptions to a state’s insurance market, The Office of Personnel Management (OPM) is required to certify multi-state plans that must be included in every exchange. When will the rules be released detailing the requirements and timeline for multi-state plans? How OPM structures these rules can be very disruptive to a state’s insurance market.

 

15)  Does the federal government intend to maintain high risk pools and how will they be financed? What actions will they take in a state that has opted not to operate a high risk pool or an exchange?

 

16)  How do states with a federal exchange ensure that Web Based Entities (WBE) are an option in their state?

 

17)  Will HHS and the United States Department of the Treasury offset the advance payments of premium assistance tax credits to issuers for an applicant’s outstanding tax, alimony, and/or child support debts?

 

18)  Will state-based exchanges have the flexibility to retroactively adjust past due premium amounts for interim changes in income?

 

19)  How will the Center for Consumer Information and Insurance Oversight (CCIO) handle Qualifed Health Plans (QHP) to Medicare transitions to prevent enrollee confusion and the potential for unpaid QHP premiums due to the enrollee not terminating the QHP timely?

 

20)  How will CCIIO minimize the adverse impact of its overly-broad employer notice requirement?

 

21)  What is the process/timeline for the approval of a state-specific single streamlined application (SSA)?

 

22)  Must Iowa have a Medicaid Portal or can it use the federal portal? If the answer is that it has to use a federal portal, how does it incorporate state-specific programs (SNAP, TANF, etc.?)

 

23)  What is the role/scope of a verification plan in a state partnership exchange? Does it require federal approval? How and when should a verification plan be submitted for federal review?

 

24)  What will the federal government require of all the states in terms of specifications for account information/record layout/package of data elements?

 

25)  When and how should the implementation review be submitted?

 

26)  What are the HBE reporting requirements (HHS format? ACA 1313A?)

 

27)  Has the Plan Management Forum been rescheduled?

 

28)  Iowa would like to verify that the ACA will only allow “Indian status” for members of federally recognized tribes.

 

29)  Does this flow account for the possibility that some individuals may not be eligible for the exchange (because the individual has employer sponsored insurance), but person’s income could still qualify them to be eligible for Medicaid?

 

30)  With individuals coming into the system through the FFE, what implications are there for Iowa’s existing online application for SNAP and TANF?

 

31)  As an individual begins the application through the federal portal, what data elements will the FFE use to identify that the applicant lives in Iowa (attestation, zip code of mailing address, zip phone of residence, etc.)?

 

32)  At the "Transmit Account to State" point in the diagram, what are the gaps between the information that the federal hub gives Iowa and the information that Iowa needs to determine Medicaid MAGI eligibility?

 

33)  What data will be included in the account at the "Transmit Account to State" point? If this data set has not yet been determined, when will it be determined?

 

34)  Will the single streamlined application ask about health status (pregnancy, etc.)?

 

35)  In the Medicaid Agency swim lane, should CHIP Eligibility be moved before "Assess for Other IAP Eligibility" step? If so, this may be useful information for CCIIO to share with other states.

 

36)  What exactly happens at the "Assess for Other IAP Eligibility" point in the diagram?

 

37)  What is the communication back to consumers if it appears they are not eligible for anything (insurance affordability in addition to Medicaid and CHIP)?

38)  Can Iowa receive the application electronically (and thus meet the regulation that requires states to do so) through the FFE (instead of having a separate state-supported Medicaid portal)? Would using the FFE that meets the intent of the law which says that the states’ Medicaid must have the capability to accept Medicaid applications electronically?

 

39)  Will the paper application have to reflect the data elements in the single streamlined application and then have a number of supplemental data elements that are required by Iowa, or can the state continue using the current Iowa paper joint application?

 

40)  Iowa would like to verify that the entry point for the select group of people who are categorically eligible for Medicaid (babies born to Medicaid mothers, SSI, etc.) will remain subject to current business rules.

 

41)  How will the business rules for Medicaid presumptive eligibility change?

 

42)  From an education and outreach perspective, how will hospital staff get trained on the presumptive eligibility process?

 

43)  The Blueprint roadmap lists “Navigator” under 2.6, but does not indicate it is something that could be in a state partnership model (the partnership columns are not checked). In the same roadmap, 13.3 mentions Consumer assistance and indicates it can be part of a partnership model.  The draft “Design Review Modules – State Partnership Exchanges” under consumer assistance partnership shows Navigator as part of the module.  It seems like there is a conflict that may need to be clarified.

 

44)  Provide an overview of the federal Navigator program – are these actual people who will be stationed in the SPE/FFE states?  Will Iowa have Navigators physically in our state?

 

45)  Describe the role/responsibility for the federal Navigators (who are the Navigators and what will their responsibilities be).

 

46)  How will the federal Navigators integrate with state specific in-person consumer assistors?

 

47)  What is CMS’s/CCIIO’s vision/description of what the state must do to fulfill their obligations regarding in-person assistance?

 

48)  In the blueprint section 4.0 (Plan Management), there are sub-sections identified as 4.5 and 4.6. However, in the guidance on what states need to prepare for in the design review for SPE, these two sub-sections are not listed. Can you clarify what the state’s responsibilities are for these two sub-sections?

 

49)  Is there a CMS’s/CCIIO’s plan for integration between the HBE implementation and the BIP implementation?

 

50)  Describe the role federal call centers play with regard to helping a caller obtain Medicaid (will the caller be switched to the Iowa Medicaid call center based on the area code of their call?) Describe the federal plan for education and outreach? Will marketing materials be tailored to the state? Will the state have input to the marketing materials?

 

 

 

# # #

 
Governor Quinn and Leader Tom Cross Mark Diabetes Awareness Day in Illinois PDF Print E-mail
News Releases - Health, Medicine & Nutrition
Written by Ryan C. Woods   
Friday, 16 November 2012 09:37

Free Diabetes Screenings Available Across Illinois

 

CHICAGO – November 14, 2012. Governor Pat Quinn and House Minority Leader Tom Cross today joined advocates from the Illinois Diabetes Policy Coalition (IDPC) to mark the first Diabetes Awareness Day in Illinois. Illinois residents can take advantage of free diabetes screenings available across the state today, and a list of locations can be viewed at www.ildpc.org. Diabetes Awareness Day in Illinois is the result of a new law signed this summer by the governor to increase public awareness of diabetes.

 

“Knowledge is power and being proactive about diabetes can save lives and help so many people who don’t know about all the treatment options they have,” Governor Quinn said. “By working together to raise awareness and strengthen our healthcare system, we can improve the health of the people of Illinois.”

 

“You or someone you know may have diabetes and not even be aware of it,” said Leader Cross. “While Type 1 Diabetes cannot be prevented, Type 2 Diabetes is a metabolic disorder than can be prevented or delayed with a healthy lifestyle.  Early detection and treatment are key to preventing the side effects of diabetes such as blindness, kidney failure, heart disease and stroke, which is why we are using Diabetes Day to raise awareness about the disease and to encourage everyone to get their blood sugar screened.”

 

In July, Governor Quinn signed House Bill 5003, sponsored by House Minority Leader Tom Cross (R-Oswego) and Sen. Mattie Hunter (D-Chicago) to officially designate November 14th as Diabetes Awareness Day in Illinois. November is American Diabetes Month, and more than 800,000 Illinois residents are living with the disease, double the number 20 years ago. In partnership with the IDPC, almost two dozen locations throughout Illinois will offer free diabetes screenings. The screenings were set up by the Illinois Hospital Association, Novo Nordisk and the Illinois Legislative Diabetes Caucus.

 

“The members of the IDPC are thrilled to be partnering with Governor Quinn, Leader Cross and the members of the Illinois Diabetes Legislative Caucus to mark an annual day dedicated to the awareness, education and prevention of diabetes. With nearly 900,000 people in Illinois living with diabetes and many more at-risk, this disease remains an important and critical public health issue that requires collaboration between public and private entities to provide on-going support and education,” said Kate O’Connor, co-chair of the Illinois Diabetes Policy Coalition.

 

In Illinois, diabetes remains the leading cause of chronic kidney disease, non-traumatic lower-limb amputations, heart disease, stroke and new cases of blindness among adults in the U.S. According to the Illinois Department of Public Health, the number of Illinois residents who have diabetes has more than doubled over the past 20 years, reaching approximately 800,000 in 2011. The department also estimates that an additional 500,000 people are unaware they have the disease. Of Illinois adults with diabetes, 18.6 percent are 65 years of age or older. Diabetes-related care in Illinois costs around $7.3 billion each year.

 

For more information please visit: www.idph.state.il.us or www.ildpc.org.

 

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How to Carve Carbs at Thanksgiving PDF Print E-mail
News Releases - Health, Medicine & Nutrition
Written by dLife   
Friday, 16 November 2012 09:21
http://www.dlife.com/dlife_media/diabetes_slideshows/carve-carbs-at-thanksgiving?index=0&utm_source=Foodstuff-20121113&utm_medium=eNewsletter&utm_content=Foodstuff-newsletter&utm_term=Focused&utm_campaign=dLife-eNewsletter

 
Governor Quinn Announces New Health Clinic PDF Print E-mail
News Releases - Health, Medicine & Nutrition
Written by Leslie Wertheimer   
Tuesday, 13 November 2012 16:08

Illinois Jobs Now! Project Supported 200 Jobs; Will Strengthen Healthcare for Vulnerable, Low-Income and Medicaid Patients at Mount Sinai

CHICAGO - November 13, 2012. Governor Pat Quinn today joined with community and healthcare leaders to announce the newly renovated Mount Sinai Hospital Health Clinic. This $7 million Illinois Jobs Now! capital construction project created or supported almost 200 jobs and will allow Mount Sinai Hospital to relocate its specialty clinics into one space.

"As a result of this project, more people will get the medical care they need and we will strengthen the local community," Governor Quinn said. "Building this new clinic at Mount Sinai creates jobs, paves the way for more economic growth and improves healthcare services that will help tens of thousands of people every year."

The $7 million Illinois Jobs Now! project was used to move all of Mount Sinai Hospital’s specialty clinics out of a 60-year facility that was once used as a dormitory and into a newly-renovated space. These clinics include cardiology, gastroenterology, infectious disease, nephrology, general surgery, vascular surgery and several pediatric subspecialties. Construction on the first phase of this project will be completed in the next four to six months.

These clinics served more than 65,000 patient visits last year. The new space was designed to accommodate more patients that will be covered by the Medicaid expansion as part of the federal Affordable Care Act. Medicaid covers 60% of Sinai Health System’s patients and 15% are uninsured. The efficiencies created by bringing these clinics under one roof will mean increased care for vulnerable populations that have limited options in receiving specialty medical treatment.

The new clinics will be located on the third floor of the Sinai Community Institute Building, which serves as a central location where those in need can go for help. The first floor of the building houses many of the programs of Sinai Community Institute which offers a wide range of programs to serve the community. Programs include one of the largest Women, Infant and Children (WIC) programs in Illinois, parenting education, elder abuse services, workforce development, case management, youth programming, case management for the Juvenile Intervention Support Center, after school education programs and a community computer lab.

Governor Quinn’s $31 billion Illinois Jobs Now! capital construction program is the largest in Illinois history, supporting an estimated 439,000 construction jobs over six years. The program, which aims to modernize Illinois’ infrastructure, began in 2009.

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Jordan Catholic School partners with Trinity Smoke Free That's Me program PDF Print E-mail
News Releases - Health, Medicine & Nutrition
Written by Janine Parr   
Tuesday, 13 November 2012 11:37
Jordan Catholic School 4th grade teacher Karen Lavell reached out to Trinity to participate in their “Smoke Free That’s Me” program. Mrs. Lavell explained that this is a perfect time to teach students about the dangers of smoking as the Great American Smoke-out is this Thursday November 15th. Trinity will work with Mrs. Lavell’s 4th grade class from 1-2pm today.

Trinity Cancer Center reaches out to area elementary students to educate them in visual and interactive ways about the long-term dangers of smoking.  Smoke Free That’s Me is a program presented to 2nd and 4th graders by oncology-certified nurses.  Each presentation lasts about 50 minutes and includes an age-appropriate video, handout, and numerous interactive activities.  Educators are encouraged to call the Cancer Canter at (309) 779-5090 ext. 1 (nursing) or ext. 3 (Carolene) to schedule a visit.


 
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