Adirondack Health Institute News

AHI Receives Grant Funding to Expand Diabetes Prevention Efforts

We are pleased to announce AHI is one of 25 organizations in the state to receive new grant funding from the New York State Health Foundation (NYSHealth) to expand diabetes prevention efforts. The funding will help AHI implement and expand the National Diabetes Prevention Program (NDPP), an initiative that focuses on lifestyle changes to improve healthy eating and physical activity.

In New York State, an estimated 4.5 million people have prediabetes, a condition which heightens a person’s risk for developing diabetes and its complications. While curbing the diabetes epidemic is a daunting task, strong evidence has emerged in support of strategies to prevent diabetes. Specifically, the NDPP was identified by the Centers for Disease Control and Prevention as an effective, evidence-based public health program. This lifestyle intervention has been shown to help participants lose 5–7% of their body weight and reduce their risk of developing diabetes by nearly 60%.

Through the “Laying the Groundwork to Scale Up the National Diabetes Prevention Program in New York State” initiative, NYSHealth have awarded grants to organizations to implement, expand, and secure the sustainability of the NDPP in community-based settings across the State. NYSHealth awarded AHI a grant to participate in this initiative.

With NYSHealth funding, grantees of this initiative will reach communities with high rates of diabetes and prediabetes, making this effective program available to New Yorkers in places where they live, work, and worship. The grant awards will support a range of activities to help organizations implement and grow the NDPP, including the expansion of existing programs; communication, outreach, and education activities to obtain a steady flow of participants; and development of business plans to ensure the sustainability of the program.

Specifically, AHI seeks to train up to seven lifestyle coaches to deliver the NDPP at worksite wellness programs in four organizations serving the Adirondack region. AHI will offer 10 NDPP cycles, enrolling a total of 150 participants. We will conduct communication, outreach, and education activities to obtain a steady flow of referrals.

How the Health Care Law is Making a Difference for the People of New York

Continuing with the theme of how the Health Care Law is making a difference:

Creating New Coverage Options for Individuals with Pre-existing Conditions -  as of August 2012, 4,134 previously uninsured residents of New York who were locked out of the coverage system because of a pre-existing condition are now insured through a new Pre-Existing Condition Insurance Plan that was created under the new health reform law.

Supporting New York’s work on Affordable Insurance Exchanges – New York has received $183,177,639 in grants for research, planning, information technology development, and implementation of the Affordable Insurance Exchanges.

*$1,000,000 in Planning Grants – This grant provides New York the resources needed to conduct the research and planning necessary to build a better health insurance marketplace and determine how its exchange will be operated and governed.

*$27,431,432 in Early Innovator Grants – These grants are being used to help a group of “Early Innovator” states design and implement the information technology (IT) infrastructure needed to operate Affordable Insurance Exchanges. Using these funds, the Early Innovator states will develop exchange IT models that can be adopted and tailored by other states.

*$154,746,207 in Exchange Establishment Grants – These grants are helping States continue their work to implement key provisions of the Affordable Care Act.

Preventing illness and promoting health - Since 2010, New York has received $62,000,000 in grants from the Prevention and Public Health Fund created by the Affordable Care Act. This new fund was created to support effective policies in New York, its communities, and nationwide so that all Americans can lead longer, more productive lives.

Watch for more info on Health reform.

Medicare Preventive Services

Under the Affordable Care Act, if you have Original Medicare, you may qualify for a yearly wellness visit and many preventive services for free.

Medicare provides preventive benefits to keep you healthy including a yearly wellness visit, tobacco use cessation counseling, and a range of no-cost screenings for cancer, diabetes, and other chronic diseases.

What This Means for You:  As of January 1, 2011, many preventive services are covered under Medicare if you get them from a doctor or other health care provider who accepts assignments.

Annual Wellness Visits:  If you are new to Medicare, your “Welcome to Medicare” preventive visit is now covered without cost sharing during your first 12 months of Part B coverage.  This exam is a one-time review of your health as well as education and counseling about preventive services and other care. If you’ve had Part B for longer than 12 months, you can get a yearly wellness visit to develop or update a personalized prevention plan based on your current health and risk factors.

Several preventive services that qualify are listed below:

Tobacco Use Cessation Counseling:  This benefit is now considered a covered preventive service, whether or not you have been diagnosed with an illness caused or complicated by tobacco use. While the counseling is a covered service, the co-insurance and deductible will apply if you have already been diagnosed with a tobacco related illness.

Screenings:  No more Medicare Part B deductible or co-payment for these screenings if certain coverage criteria apply:

  • Bone mass measurement
  • Cervical cancer screening, including Pap smear tests and pelvic exams
  • Cholesterol and other cardiovascular screenings
  • Colorectal cancer screening (except for barium enemas)
  • Diabetes screening
  • Flu shot, pneumonia shot, and the hepatitis B shot
  • HIV screening for people at increased risk or who ask for the test
  • Mammograms
  • Medical nutrition therapy to help people manage diabetes or kidney disease
  • Prostate cancer screening (except digital rectal examinations)

See the full list of preventive services at Medicare.gov.

Some Important Details

  • For some preventive services, you will pay nothing. You may have to pay co-insurance (a part of the cost) for the office visit when you get these services.
  • Your first yearly wellness visit can’t take place within 12 months of your “Welcome to Medicare” preventive visit.
  • If you’re in a Medicare Advantage Plan, check your plan to see if these benefits will also be free for you.

The Affordable Care Act and Wellness Programs – Ensuring Flexibility for Employers

The proposed rules also implement changes in the Affordable Care Act that increase the maximum permissible reward under a health-contingent wellness program from 20 percent to 30 percent of the cost of health coverage, and that further increases the maximum reward to as much as 50 percent for programs designed to prevent or reduce tobacco use.

Evidence shows that workplace health programs have the potential to promote healthy behaviors; improve employees’ health knowledge and skills; help employees get necessary health screenings, immunizations, and follow-up care; and reduce workplace exposure to substances and hazards that can cause diseases and injury. The proposed rules would not specify the types of wellness programs employers can offer, and invite comments on additional standards for wellness programs to protect consumers.

This information can be found at:  http://www.healthcare.gov/news/factsheets/2012/11/wellness11202012a.html

 

The Affordable Care Act and Wellness Programs

In order to protect consumers from unfair practices, the proposed regulations would require health-contingent wellness programs to follow certain rules, including:

-Programs must be reasonably designed to promote health or prevent disease. To be considered reasonably designed to promote health or prevent disease, a program would have to offer a different, reasonable means of qualifying for the reward to any individual who does not meet the standard based on the measurement, test or screening. Programs must have a reasonable chance of improving health or preventing disease and not be overly burdensome for individuals.

-Programs must be reasonably designed to be available to all similarly situated individuals. Reasonable alternative means of qualifying for the reward would have to be offered to individuals whose medical conditions make it unreasonably difficult, or for whom it is medically inadvisable, to meet the specified health-related standard.

-Individuals must be given notice of the opportunity to qualify for the same reward through other means. These proposed rules provide new sample language intended to be simpler for individuals to understand and to increase the likelihood that those who qualify for a different means of obtaining a reward will contact the plan or issuer to request it.

For more information, you can read the proposed rule on wellness programs at: http://www.regulations.gov/#!documentDetail;D=EBSA-2012-0031-0001.

 

 

The Affordable Care Act and Wellness Programs

Implementing and expanding employer wellness programs may offer our nation the opportunity to not only improve the health of Americans, but also help control health care spending.

The Affordable Care Act creates new incentives and builds on existing wellness program policies to promote employer wellness programs and encourage opportunities to support healthier workplaces.  The Departments of Health and Human Services (HHS), Labor and the Treasury are jointly releasing proposed rules on wellness programs to reflect the changes to existing wellness provisions made by the Affordable Care Act and to encourage appropriately designed, consumer-protective wellness programs in group health coverage. These proposed rules would be effective for plan years starting on or after January 1, 2014.

The proposed rules continue to support workplace wellness programs, including “participatory wellness programs” which generally are available without regard to an individual’s health status. These include, for example, programs that reimburse for the cost of membership in a fitness center; or that provides a reward    who complete a health risk assessment without requiring them to take further action.

The rules also outline amended standards for nondiscriminatory “health-contingent wellness programs,” which generally require individuals to meet a specific standard related to their health to obtain a reward. Examples of health-contingent wellness programs include programs that provide a reward to those who do not use, or decrease their use of, tobacco, or programs that provide a reward to those who achieve a specified cholesterol level or weight as well as those who fail to meet that biometric target but take certain additional required actions.

More info to follow….

Preventive Care Under the Affordable Care Act

The following are preventive services that are covered for children under the Affordable Care Act.

-Alcohol and Drug use assessments for adolescents

-Autism screening for children at 18 and 24 months

-Behavioral assessments for children of all ages

-Blood Pressure screening for children

-Cervical Dysplasia screening for sexually active females

-Congenital Hypothyroidism

-Depression screening for adolescents

-Developmental screening for children under age 3, and surveillance throughout childhood

-Dyslipidemia screening for children at higher risk of lipid disorders

-Fluoride Chemoprevention supplements for children without fluoride in their water source

-Gonorrhea preventive medication for the eyes of all newborns

-Hearing screening for all newborns

-Height, Weight and Body Mass Index measurements for children

-Hematocrit or Hemoglobin screening for children

-Hemoglobiniopathies or sickle cell screening for newborns

-HIV screening for adolescents at higher risk

-Immunization vaccines for children from birth to age 18 (doses, recommended ages, and recommended populations vary): Diphtheria, Tetanus, Pertussis; Haemophilus influenza type b; Hepatitis A; Hepatitis B; Human Papillomavirus; Inactivated Poliovirus; Influenza (Flu Shot); Measles, Mumps, Rubella; Meningococcal; Pneumococcal; Rotavirus; Varicella

-Iron supplements for children ages 6 to 12 months at risk for anemia

-Lead screening for children at risk of exposure

-Medical History for all children throughout development

-Obesity screening and counseling

-Oral Health risk assessment for young children

-Phenylketonuria (PKU) screening for this genetic disorder in newborns

-Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk

-Tuberculin testing for children at higher risk of tuberculosis

-Vision screening for all children

 

For more information, visit http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html.

Preventive Care Under the Affordable Care Act

Continuing on the topic of Preventive Care Under the Affordable Care Act, below are covered services for women and pregnant women.

For the new prevention-related health services marked with an asterisk (*) must be covered with no cost-sharing in plan years starting on or after August 1, 2012.

♥ Anemia – screening on a routine basis for pregnant women

♥ Bacteriuria – urinary tract or other infection screening for pregnant women

♥ BRCA counseling about genetic testing for women at higher risk

♥ Breast Cancer Mammography screenings for every 1 to 2 years for women over 40

♥ Breast Cancer Chemoprevention counseling for women at higher risk

♥ Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*

♥ Cervical Cancer screening for sexually active women

♥ Chlamydia Infection screening for younger women and other women at high risk

♥ Contraception – Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs*

♥ Domestic and interpersonal violence screening and counseling for all women*

♥ Folic Acid supplements for women who may become pregnant

♥ Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes*

♥ Gonorrhea screening for women at higher risk

♥ Hepatitis B screening for pregnant women at their first prenatal visit

♥ Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women*

♥ Human Papillomavirus (HPV) DNA test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older

♥ Osteoporosis screening for women over age 60 depending on risk factors

♥ Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk

♥ Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users

♥ Sexually Tranmitted Infections (STI) counseling for sexually active women*

♥ Syphilis screening for all pregnant women or other women at increased risk

♥ Well-woman visits to obtain recommended preventive services for women under 65*

For more information, visit http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.htm

Preventive Care Under the Affordable Care Act

Continuing on the subject of Preventive Care and the ACA, below you will find a clist of covered Preventive Services for Adults

  1. Abdominal Aortic Aneurysm – a one-time screening for men of specified ages who have never smoked
  2. Alcohol Misuse screening and counseling
  3. Aspirin use for men and women of certain ages
  4. Blood Pressure screening for all adults
  5. Cholesterol screening for adults of certain ages or at higher risk
  6. Colorectal Cancer screening for adults
  7. Depression screening for adults
  8. Type 2 Diabetes screening for adults with high blood pressure
  9. Diet Counseling for adults at higher risk for chronic disease
  10. HIV Screening for all adults at higher risk
  11. Immunization vaccines for adults (doses, recommended ages, and recommended populations vary);  Hepatitis A, Hepatitis B; Herpes Zoster; Human Papillomavirus; Influenza (Flu Shot); Measles; Mumps; Rubella; Meningococcal; Pneumococcal; Tetanus; Diphtheria; Pertussis; Varicella
  12. Obesity screening and counseling for all adults
  13. Sexually Transmitted Infection (STI) prevention and counseling for adults at higher risk
  14. Tobacco Use screening for all adults and cessation interventions for tobacco users
  15. Syphilis screening for adults at higher risk

For more information, visit:  http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html

 

Preventive Care Under the Affordable Care Act

Under the ACA, many people are now able to access preventive health services without any cost-sharing. This means that you can get these services without having to pay a co-payment, coinsurance, or a deductible (when you see an in-network provider).

If you receive preventive services as part of an office visit, the primary purpose of which is not the preventive service, you might still have to pay some of the cost of the office visit.  This is also true if your doctor bills the office visit and the preventive service separately.

Please note that this rule applies to non-grandfathered plans (“grandfathered” plans are plans that have existed since before March 23, 2010 without changing significantly).