Adirondack Health Institute News

Adirondack Health earns Gold Seal for Quality and Patient Safety

The Adirondack Daily Enterprise announces that Adirondack Health earns a goal seal for quality and patient safety following an unannounced visit by the Joint Commission.  Read the story here.

Congratulations to all!

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

The health care law Increases support for community health centers - The Affordable Care Act increases the funding available to community health centers nationwide. In New York, 61 health centers operate 582 sites, providing preventive and primary health care services to 1,489,141 people. Health Center grantees in New York have received $195,635,138 under the new Affordable Care Act to support ongoing health center operations and to establish new health center sites, expand services, and/or support major capital improvement projects.

Strengthening partnerships with New York – The law gives states support for their work to build the health care workforce, crack down on fraud, and support public health. Examples of Affordable Care Act grants to New York not outlined above include:

  • $12,200,000 for health professions workforce demonstration projects, which will help low income individuals receive training and enter health care professions that face shortages.
  • $600,000 to support teaching health centers, creating new residency slots in community health centers.
  • $4,600,000 for the expansion of the Physician Assistant Training Program, a five-year initiative to increase the number of physician assistants in the primary care workforce.
  • $12,200,000 for school-based health centers to help clinics expand and provide more health care services such as screenings to students.
  • $1,700,000 to support outreach to eligible Medicare beneficiaries about their benefits.
  • $191,000 for Family-to-Family Health Information Centers, organizations run by and for families with children with special  health care needs.
  • $887,000 to support the Personal Responsibility Education Program, to educate youth on both abstinence and contraception for the prevention of pregnancy and sexually transmitted infections, including HIV/AIDS.
  • $2,000,000 for disease demonstration projects, to test approaches that may encourage behavior modifications among Medicaid beneficiaries and determine solutions.
  • $9,700,000 for Maternal, Infant, and Early Childhood Home Visiting Programs. These programs bring health professionals to meet with at-risk families in their homes and connect families to the kinds of help that can make a real difference in a child’s health, development, and ability to learn-such as health care, early education, parenting skills, child abuse prevention, and nutrition.

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.

How the Health Care Law is Making a Difference for the People of New York (Part 3)

Health reform is already making a difference by:

Providing better value for your premium dollar through the 80/20 Rule - Under the new health care law, insurance companies must provide consumers greater value by spending generally at least 80 percent of premium dollars on health care and quality improvements instead of overhead, executive salaries or marketing. If they don’t, they must provide consumers a rebate or reduce premiums. This means that 1,001,476 New York residents with private insurance coverage will benefit from $86,526,642 in rebates from insurance companies this year. These rebates will average $138 for the 627,000 families in New York covered by a policy.

Scrutinizing unreasonable premium increases – In every State and for the first time under Federal law, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. New York has received $5,469,996 under the new law to help fight unreasonable premium increases.

Removing lifetime limits on health benefits - The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits. Already, 6,432,000 residents, including 2,529,000 women and 1,609,000 children, are free from worrying about lifetime limits on coverage. The law also restricts the use of annual limits and bans them completely in 2014.

Watch for more info to come.

How the Health Care Law is Making a Difference for the People of New York (Part 2)

Health reform is already making a difference for the people of New York by:

Providing new coverage options for young adults - Health plans are now required to allow parents to keep their children under age 26 without job-based coverage on their family coverage, and, thanks to this provision, 3.1 million young people have gained coverage nationwide. As of December 2011, 160,000 young adults in New York gained insurance coverage as a result of the health care law.

Making prescription drugs affordable for seniors – The health care law includes benefits to make Medicare prescription drug coverage more affordable. In 2010, 254,934 people with Medicare in New York who hit the prescription drug donut hole, received a $250 rebate. In 2011, people with Medicare who hit the donut hole began receiving a 50 percent discount on covered brand-name drugs and a discount on generic drugs. Since the law was enacted, New York residents with Medicare have saved a total of $342,524,678 on their prescription drugs. In the first nine months of 2012, 151,994 people with Medicare received a 50 percent discount on their covered brand-name prescription drugs when they hit the donut hole. This discount has resulted in an average savings of $690 per person, and a total savings of $104,800,724 in New York in 2012. By 2020, the law will close the donut hole.

Covering preventive services with no deductible or co-pay - In 2011, 1,518,392 people with Medicare in New York received free preventive services such as mammograms and colonoscopies or a free annual wellness visit with their doctor. And in the first nine months of 2012, 1,238,801 people with Medicare received free preventive services.

Because of the law, 54 million Americans with private health insurance gained preventive service coverage with no cost-sharing in 2011, including 3,342,000 in New York. An for policies renewing on or after August 1, 2012, women can now get coverage (without cost sharing) of even more preventive services they need. Approximately 47 million women, including 3,092,653 in New York will now have guaranteed access to additional preventive services without cost-sharing.

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

For too long, too many hardworking Americans paid the price for policies that handed free rein to insurance companies and put barriers between patients and their doctors. The Affordable Care Act gives hardworking families in New York the security they deserve. The new health care law forces insurance companies to play by the rules, prohibiting them from dropping your coverage if you get sick, billing you into bankruptcy because of an annual or lifetime limit, or, soon, discriminating against anyone with a pre-existing condition.

All Americans will have the security of knowing that they don’t have to worry about losing coverage if they’re laid off or change jobs. And insurance companies now have to cover your preventive care like mammograms and other cancer screenings. The new law also makes a significant investment in State and community-based efforts that promote public health, prevent disease and protect against public health emergencies.

 

Information taken from  www.healthcare.gov/law/information-for-you/ny.html.

 

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….