Sellers Dorsey Press Room

Now What? Perspective on National Health Care Reform

admin@sellers-feinberg.com () — Fri, 26 Mar 2010 12:00:00 GMT

LGBT Health Town Hall Meeting

admin@sellers-feinberg.com () — Thu, 11 Mar 2010 12:00:00 GMT

Did You Know?

Gay men and lesbian women are at increased risk for certain cancers, due to a higher prevalence of smoking and inadequate risk assessment and screening by providers?
Elders in same-sex relationships are at high risk of economic devastation due to the fact that legal protections are not afforded to same-sex couples?
Even if your company offers domestic partnership health care benefits, those benefits are taxed differently than health care benefits for opposite sex spouses?
No federal health survey includes a question on sexual orientation or gender identity and this creates a hurdle for health agencies and policy makers to be able to address issues relevant to transgender communities?

In conjunction with LGBT Health Awareness Week, which is March 28th - April 3rd, Sellers Dorsey is proud to announce an LGBT Health Town Hall meeting in Philadelphia, PA. Sellers Dorsey will be convening this meeting with a host of cosponsors, including SD pro-bono client Mazzoni Center. Christopher Labonte, Principal at Sellers Dorsey, will be moderating.

For more details on this exciting event, please view the attached flyer or contact Blair Sirolli at bsirolli@sellersdorsey.com.

Also, please check out the article about the event published in the Philadelphia Gay News.

We hope to see you there!

We would like to thank all of our cosponsors for their support with this Town Hall:

United States Census Bureau

Merck

Philly Pharmacy

ActionAIDS

AIDS Fund

AIDS Law Project

ASIAC

Attic Youth Center

Blacks Educating Blacks about Sexual Health Initiatives

Bread & Roses Community Fund

Brothers Network

Calcutta House

COLOURS

Delaware Valley Legacy Fund

Drexel University's Program for LGBT Health (LOCATION)

Equality Forum

Equality Pennsylvania

GALAEI

Gay and Lesbian Medical Association

House of Blahnik

Human Rights Campaign - Philadelphia Region

Independence Business Alliance

Keystone Progress

Lutheran Children and Family Services (Bethel Community Center)

MANNA

Mazzoni Center

National Center for Transgender Equality

National Coalition for LGBT Health

National Gay and Lesbian Task Force

Office of LGBT Affairs, City of Philadelphia

People with Hope

Philadelphia Family Pride

Philadelphia FIGHT

Queer Philadelphia Asians

Renaissance Transgendered Association

SafeGuards

SAGE

San Francisco AIDS Foundation

Sapphire Fund

The Womyn's Village

University of Pennsylvania Health Systems- HIV/AIDS Prevention Research Division

William Way Community Center

Bill Summary - Potential Enanced FMAP Extension

admin@sellers-feinberg.com (Kip Piper) — Mon, 01 Mar 2010 12:00:00 GMT

As states continue to struggle with difficult budgets, Congress has been considering many options to extend the ARRA enhanced FMAP to assist state Medicaid programs. Sellers Dorsey drafted a summary of the bills currently containing provisions to extend the ARRA enhanced FMAP by six months. The attached summary details the various bills that include this provision as well as their origins, status and website to locate each bill.

Business of Medicare Advantage Presentation

admin@sellers-feinberg.com (Pat Brady and Jim Pezzuti) — Tue, 09 Feb 2010 12:00:00 GMT

Recently, Pat Brady and Jim Pezzuti presented at the Business of Medicare Advantage Conference. Their presentation, Collaborating with the States to Implement Integrated Products for Dual Eligibles, highlighted:

Challenges states face implementing integrated care programs
Strategies for overcoming these challenges
Analysis from a major integrated care initiatives in Pennsylvania

You can view the presentation in the attached link. If you have any questions regarding the presentation or Long Term Care strategies, please contact Pat at pbrady@sellersdorsey.com.

Medicaid Managed Care in Health Care Reform

admin@sellers-feinberg.com (Christopher Labonte, Principal) — Mon, 01 Feb 2010 12:00:00 GMT

Nobody knows how the health care debate will be resolved nor do we know what the final package will include when it reaches President Obama's desk. However, that hasn't stopped many health care reform watchers from both inside and outside the beltway from making well reasoned assumptions about what might be included in a final package. Aside from the question of how to pay for it, the expansion of Medicaid is one such idea that commentators and journalists mention frequently as something likely to be included in a final package. Among other factors, this could be attributed to an infrastructure already in place and the program's ability to enroll individuals quickly.

With each state and territory administering their own Medicaid program, it is dangerous to make sweeping statements regarding the impact of an expansion with any specificity. With that in mind as a caveat, we explore below on how this Medicaid expansion might impact a major method of health care delivery in this joint state-federal program, Medicaid health plans. This commentary highlights what this proposed expansion might mean for Medicaid health plans, a leading delivery system for Medicaid enrollees in many states.

Medicaid Health Plan Enrollment: Going Up

Depending on the eligibility levels included in any final legislation, the Congressional Budget Office estimates that 15 million new individuals will be newly enrolled in state Medicaid programs - a 25% hike between now and 2017. However, that would not be the case in every state. In Medicaid, all states are not equal. Given the different levels of eligibility in the states, the enrollment increases will be disproportionately distributed among the states. States in the south and west are likely to see the largest increase, while states with already relatively high eligibility levels, such as Massachusetts, Vermont, Minnesota and New York, will see little to no increase in their Medicaid enrollment.

Much has been said, written and blogged about how to finance this planned expansion. A great deal of this focus has been on a provision in the Senate-passed bill that ensures 100% of the cost of the Medicaid expansion is borne by the federal government in the State of Nebraska. If that provision was changed to allow all states to have this financing arrangement, the cost would be an additional $35 billion over the next 10 years.

Yet, financing is only one of the questions that remain. The delivery system has not been the focus of many conversations and it may be just as important to the overall success of health care reform, since the delivery of care will greatly impact the program's long term financial sustainability and impact the quality of care.

While it is both hard and dangerous to predict the future, this national expansion of Medicaid will likely increase the number of lives enrolled in Medicaid health plans. After all, the new enrollee population is already disproportionately enrolled in full risk plans and those states that will have the largest numbers of new enrollees currently largely depend on Medicaid managed care plans for the delivery of service - California, Florida and Texas to name a few.

Some states will continue to shy away from fully capitated managed care, either due to strong policy disagreements, scarcity of providers, or a political situation makes it untenable to create or expand managed care in a state. State budget woes will also play a part in determining what portion of the new enrollees will be cared for by Medicaid managed care plans and which ones in fee-for-service. Many states are experimenting with pilot programs and seeking waivers from CMS to place more of their Medicaid beneficiaries in fully capitated plans. Some are looking to better manage dually eligible individuals, those higher cost beneficiaries who are eligible for both Medicaid and Medicare. One can reasonably expect this trend to continue. Based on a number of factors, we estimate that as many as 6-8 million new individuals will be in Medicaid health plans once implementation is complete. One to two million lives will also likely shift from CHIP plans to Medicaid managed care plans.

However, an increase in the number of lives in health plans does not necessarily mean an increased bottom line in the board room.

Given state budget situations, states continue to squeeze savings from their Medicaid budgets, which nationally account for 21% of state budgets according to the National Association of State Budget Officers. To deal with this, states enacted and are proposing cost containment initiatives, the most common of which was reducing provider reimbursements. States are also facing potential federal restrictions on reducing or cutting eligibility if some provisions in the health care reform bill make it through to enactment.

With their experience in managing care for the Medicaid population, many Medicaid health plans have been creative in working with their state partners to developing and implementing a number of innovative programs to concurrently help improve quality and help the bottom line.

The navigation of all of these factors and more will be important for health plans to consider to take full advantage of the opportunities that exist during expansion and implementation.

To learn more or to discuss how Medicaid health plans may be impacted by health care reform, please contact Christopher Labonte at clabonte@sellersdorsey.com.

Sellers Dorsey Webinar on Medical Homes and Implications for Medicaid Managed Care Organizations

admin@sellers-feinberg.com () — Tue, 19 Jan 2010 12:00:00 GMT

As a supporting member of Medicaid Health Plans of America (MHPA), Sellers Dorsey is proud to sponsor a series of webinars on Medicaid managed care topics. Last month, Sellers Dorsey's Director of Health Care Reform, Pris Boroniec, presented the attached Webinar "Medical Homes: Implications for Medicaid Managed Care Organizations."

Over the past several years states have increasingly pursued Medicaid Medical Home initiatives by implementing new program requirements and payment reforms. In addition, the federal government has designed a Medical Home demonstration pilot for Medicare. With a growing focus on promoting effective care coordination and chronic care management, ensuring use of evidence-based protocols, integrating primary, preventive and behavioral health care, incenting consumer involvement and responsibility, and leveraging E-health infrastructure, it is likely that Medical Home initiatives will become even more widespread in the future. Pilots that would further develop and test Medical Homes are included in proposed national health reform legislation, and structural components that support the framework for medical homes, such as HIT and quality initiatives, have been enacted in the Children's Health Insurance Program Reauthorization (CHIPRA) and in economic stimulus (ARRA).

The Medical Home Webinar highlighted the goals, issues and decisions in building a medical home, reviewed state and federal initiatives for Medical Homes, and explored opportunities and challenges to Medicaid managed care plans of Medical Homes.

If you have any questions about the Webinar or would like to discuss it further, please feel free to contact Pris at pboroniec@sellersdorsey.com or 608.203.2685.

Fall 2009 Fiscal Survey of the States

admin@sellers-feinberg.com () — Thu, 10 Dec 2009 12:00:00 GMT

The National Association of State Budget Directors (NASBO), in conjunction with the National Governor's Association (NGA), recently released the Fall 2009 Fiscal Survey of the States Report. The attached report provides an informative overview of where state budgets stand at this time of the year.

The sections on Medicaid and health care expansions offer some valuable information and data on state Medicaid programs, efforts by states to contain costs, changes to state CHIP programs and efforts to expand coverage to the uninsured.

Over the past year, Sellers Dorsey has played a role in various states, increasing access to care, assisting with strategies around cost containment and financing, as well as advising states on various aspects of their Medicaid programs. Many of these initiatives can be seen throughout this survey.

Global Payments: Concepts and Considerations for Medicaid

admin@sellers-feinberg.com () — Thu, 19 Nov 2009 12:00:00 GMT

New Report

Payment reform is an integral part of national and state-based health reform efforts. Massachusetts, a leader in reform, is exploring global payment concepts in an effort to rein in costs and improve care coordination and quality. The Massachusetts Medicaid Policy Institute (MMPI) has released a new report on global payment in the Medicaid context.

The report, prepared by Mark Heit and Kip Piper of the Sellers Dorsey team, assesses global payment options while addressing the concerns of applying these payment mechanisms to the vulnerable Medicaid population.

Click here to read the report (also attached).

The MMPI report was funded through a grant from Blue Cross Blue Shield of Massachusetts (BCBSMA). BCBSMA is implementing global payments with select providers through its contracts.

The Massachusetts Medicaid Policy Institute is an independent and non-partisan source of information about the Massachusetts Medicaid program.

Sellers Dorsey November 2009 Newsletter

admin@sellers-feinberg.com () — Thu, 05 Nov 2009 12:00:00 GMT

Sellers Dorsey welcomes former PA Official, Jim Pezzuti!

Sellers Dorsey welcomes Jim Pezzuti, the latest addition to our long term care team. With over 35 years of experience working for Pennsylvania's Department of Public Welfare and most recently serving as the Director of the Bureau of Community Development in the Office of Long Term Living, he led the Commonwealth's efforts to rebalance their long term care system and led a team to expand the state's Programs of All-Inclusive Care for the Elderly (PACE) program. Jim brings a wealth of experience to our long term care clients. To learn more about how Jim and our long term care team can help you in Pennsylvania or another state, visit our website.

New Sellers Dorsey Podcast on Family Planning - Coming Soon

Later this month, Sellers Dorsey will be releasing a new podcast of an interview with our Senior Vice President and head of our Family Planning practice, Nancy Hardy. The podcast will focus on the potential impact of National Health Care Reform on Family Planning programs in Medicaid. If you have any questions or would like to learn more about our Family Planning line of business, contact Nancy at nhardy@sellersdorsey.com or 215.279.9745.

SD Expert Testifies Before Kansas Legislature

Sellers Dorsey's Director of Long Term Care, Pat Brady testified in front of the Kansas House of Representatives Appropriations Committee on October 12th. She joined state officials in discussing the benefits and challenges to enacting a health care provider assessment. Health care provider assessments are permitted under federal law and can be used to increase federal financial participation in state Medicaid programs and more than 40 states have one or more forms of a provider assessment in place. For a copy of Pat's presentation or for more information about nursing home assessments, other provider assessments and other Medicaid financing initiatives, please contact her at pbrady@sellersdorsey.com or 717.514.2427.

Sellers Dorsey Webinar on Revenue Maximization in the World of Managed Care

Sellers Dorsey's Director of Revenue Maximization, Brian McGuckin, along with our Director of Long Term Care, Pat Brady, recently presented a Webinar to the members of the Medicaid Health Plans of America (MHPA). The presentation focused on state efforts to maximize federal Medicaid revenues related to Medicaid managed care. The discussion focused on managed care provider assessments, detailing how they have been used in the past and how states are responding to the changes in federal law regarding these assessments that take effect on October 1, 2009. The presentation can be found in our press room. Along with many of our clients and strategic partners, Sellers Dorsey is a supporting member of the MHPA. For more information about our work in Medicaid managed care, contact Chris at clabonte@sellersdorsey.com or 215.279.9746.

November 2009

In This Issue

Sellers Dorsey Welcomes Jim Pezzuti

New Podcast - Coming Soon!

SD LTC Director Testifies Before Kansas Legislature

Managed Care Revenue Maximization Webinar

Events Pris Boroniec, Pat Brady, Mark Heit, Russell Pederson and Chris Labonte will be attending the NASMD Fall Meeting on November 9-11.

Nancy Hardy and Chris Labonte will be attending the MHPA Annual Conference, November 16-17.

Do you know everything you need to know about what's going on in the world of healthcare? Call us at 215-564-3014.

Next Steps in National Health Care Reform

The wheels continue to move in National health care reform. With all of the recent developments in Congress, we have pulled together a summary of next steps in the legislative process, detailing what comes next with the House and Senate bills, as well as options for what could happen if they do or do not pass. We hope this will provide you with insight into the latest developments and future potential of reform. If you have any questions around National health care reform and what it means for states or your business, please contact us at 215.279.9746.

Curious About Something? Ask Sellers Dorsey Sellers Dorsey often receives questions in response to our newsletter, webpage or concerning other hot topics in health care. If you have any questions, please email us at info@sellersdorsey.com and our staff would be happy to answer them. We can provide you with insight from consultants who are in the field on a daily basis and offer up-to-date information on the latest breaking news.

Sellers Dorsey is a national health care consulting firm providing strategic consulting services to state governments, private sector companies, and advocacy organizations. Our newsletter is intended to keep you informed about current happenings in the healthcare arena as well as news about our firm.

Please contact us with your topic ideas for future newsletters at mailto:info@sellersdorsey.com

Sellers Dorsey 230 South Broad Street Suite 1802 Philadelphia, PA 19102

HCR Legislative Process

admin@sellers-feinberg.com () — Wed, 28 Oct 2009 12:00:00 GMT

Below you will find a chart listing all of the recent developments and next steps detailing the legislative process of Health Care Reform. You will find a printable version of the chart attached.

SENATE

1. Status as of October 27, 2009

The Senate Finance Committee and Senate Health, Education, Labor, and Pensions (HELP) Committees have each passed health reform bills.

The Senate Majority Leader, Sen. Harry Reid (D-NV) is developing a single bill to bring to the Senate floor.

This bill will blend provisions of the Senate Finance Committee bill and the Senate HELP Committee bills. It will likely include significant changes based on behind-the-scenes negotiations with Senators, including Sen. Max Baucus (D-MT), chairman of SFC; Sen. Chris Dodd (D-CT), lead negotiator for Senate HELP Committee; and swing votes.

2. Next Steps for the Senate Bill

Senate Majority Leader completes drafting of health reform bill.

Congressional Budget Office scores the federal budget impact of the bill.

Senate Majority Leader introduces health reform bill and schedules floor debate.

During the floor debate, Senators introduce, debate, and vote on amendments. Floor debate will likely take two weeks.

At some point, the Majority Leader will move to limit time for debate. A Cloture Motion is the only way to place a time limit on consideration of a bill on the Senate floor. With 60 votes (three-fifths vote), the Senate may limit consideration to 30 additional hours of floor time. Without Cloture, any Senator may filibuster a bill and delay a final vote indefinitely.

If the Cloture Motion passes, the Senate will end debate at the expiration of the time and vote on the amended bill. 51 votes required for passage, with Vice President Biden voting in case of a 50-50 tie.

If the Cloture Motion fails, Senators may negotiate changes to the bill to overcome the filibuster and secure the necessary 60 votes to close debate.

Alternatively, Senate Democrats may attempt to pass select portions of the health reform bill through the budget reconciliation process. Budget reconciliation bills may not be filibustered.

*Note: Should the budget reconciliation process be chosen, Sellers Dorsey will brief readers on this option in a future release.

HOUSE

1. Status as of October 27, 2009

Health reform legislation has been passed in the three House committees with jurisdiction: Ways and Means Committee, Energy and Commerce Committee, and Education and Labor Committee.

The Speaker of the House, Nancy Pelosi (D-CA) and other Democratic Party leaders in the House are finalizing the legislative language. It will likely include significant changes based on behind-the-scenes negotiations with House members, particularly swing votes.

The Congressional Budget Office is scoring the fiscal impact of different options.

2. Next Steps for the House Bill

The Speaker will schedule the bill for floor debate.

The House Rules Committee will adopt a rule governing the time for floor debate. The rule will likely limit the number and type of amendments the full House may consider. The full House will likely adopt this rule on a party-line vote.

The full House will then debate the bill and vote on amendments. Each side will have a "floor manager," who will allocate time for speeches by their supporters.

The House will then vote on the amended bill. A majority vote - 218 of the 435 voting members - is required.

HOUSE-SENATE CONFERENCE COMMITTEE

If the House and Senate successfully pass their own versions of a health reform bill, the House and Senate majority and minority leadership will appoint a Conference Committee.

The Conference Committee will have an equal number of House and Senate members but the majority will be Democrats given Democrat majorities in both chambers.

The House and Senate conferees will work to reconcile differences in the legislation. Their objective will be to develop a single bill. The process will include considerable behind-the-scenes negotiations between the House, Senate, and White House.

The Conference Committee process could take days or weeks, depending on how well the negotiations proceed.

The Congressional Budget Office will advise conferees on the fiscal impact of legislative provisions.

Consideration of Conference Committee Bill:

If a majority of the conferees are able to agree, the Conference Committee produces a "Conference Report", with is the reconciled bill language and details on how the House and Senate health reform bills were reconciled into the new, single bill.

The House and Senate will then vote on the Conference Report. They must vote up or down, with no amendments.

If both the House and Senate adopt the Conference Report, the final bill is presented to the President for his action.

If Congress is in session, the President has 10 days to either sign the bill into law or veto it. Otherwise, the bill becomes law without his signature. If Congress is not in session, the President has 10 days to sign the bill into law or formally veto it. If he takes no action, this is a "pocket veto" and the legislation dies.