Encouraging news about enrollment in Medicaid and CHIP

By Cindy Mann, Deputy Administrator and Director, Center for Medicaid & CHIP Services, Center for Medicare & Medicaid Services (CMS)

When it comes to getting children the health coverage they need, our nation is moving in the right direction.  According to a new analysis by the Urban Institute, the participation rate in Medicaid and the Children’s Health Insurance Program (CHIP) has increased to 87.2 percent in 2011, up 5.5 percentage points from 81.7 percent in 2008. Over that same time period, the number of eligible uninsured children has declined from 4.9 million to 4.0 million.  At CMS, we are greatly encouraged by this progress, because we know a bump in participation means that more children are getting access to the comprehensive health benefits – including preventive services – that all children need.

In addition to the work states have done over the past decade or more to simplify and streamline enrollment procedures, outreach efforts that include providing application assistance directly to families have played a key role in improving enrollment.  Secretary of Health and Human Services, Kathleen Sebelius helped galvanize these efforts in 2010, when she launched the Connecting Kids to Coverage Challenge, calling upon leaders at all levels of government, community-based organizations, health centers, school districts, faith-based groups, Indian tribes and others to find and enroll all uninsured children eligible for Medicaid and CHIP eligible children.  We are proud that, working together, our national Connecting Kids to Coverage Campaign, our outreach and enrollment grantees and many other partners have helped to achieve the progress described in the Urban Institute report.

But, there is still more to be done.  Too many uninsured children who could be eligible for Medicaid and CHIP today remain uninsured.  As the Connecting Kids to Coverage Campaign continues to reach out to families across the country, we know that new opportunities to boost enrollment are just around the corner.  Beginning October 1, as a result of the Affordable Care Act, many more parents will be eligible for Medicaid or other coverage available through the Health Insurance Marketplace.  And we know that when eligible parents enroll, they are also likely to enroll their children and take advantage of the preventive services that help them stay healthy.

To find the children’s Medicaid/CHIP participation rate in your state check out this map: http://www.insurekidsnow.gov/professionals/reports/index.html

To find out about health insurance opportunities for the whole family:

https://www.healthcare.gov/

For recent children’s health coverage outreach materials and ideas for how best to use them:

http://www.insurekidsnow.gov/professionals/back_to_school.html

Watch the Insure Kids Now television public service announcement here: http://www.insurekidsnow.gov/professionals/outreach/strategies/tv_and_radio_psas.html

Find out more about the grants we’ve awarded to groups across the country: http://www.insurekidsnow.gov/professionals/index.html

 

A guide for new and first-time physicians participating in federal healthcare programs

By Shantanu Agrawal, MD

With a new class of medical residents beginning their training, and residents and Fellows graduating from their programs every July, it’s important that our critical partners in the delivery of healthcare have the tools they need to understand federal program requirements.  At the Centers for Medicare & Medicaid Services (CMS) we have a comprehensive strategy to reduce fraud, waste and abuse that is designed to target risk – that means as we make it harder for bad actors to enroll or bill in our systems, we are always evaluating how to make it easier for legitimate physicians and other providers to participate in Medicare and care for beneficiaries.

CMS demonstrates this commitment with several initiatives:

  • Providers enrolling in Medicare for the first time now have a much easier experience enrolling than in years past. Since 2012, paper is no longer required to complete an application.  Everything can be submitted online, using web-based “PECOS” (the Provider Enrollment, Chain and Ownership System – the official record of every provider in Medicare). That includes required signatures and attachments, such as medical licensure. If an application fee is required – typically owed by organizations – it can also be paid online. The conveniences of the web-based PECOS system allow for faster application processing times over paper-based applications.
  • We recently launched two free mobile applications for Apple iOS and Android devices to help various stakeholders comply with the new requirements of the Open Payments program (commonly known as the Physician Payments Sunshine Act). This program tracks financial relationships between covered physicians and the health care industry – such as pharmaceutical and medical device companies – and will make the data available to the public annually on a website currently being designed. Physicians are not required to report any data, but the mobile applications will help them to track financial relationships and assess reported data for accuracy.
  • CMS is also modernizing how we communicate with physicians. We are now using Facebook / Facebook4 and Twitter / Twitter10 to keep tech-savvy providers up-to-date on the latest CMS news and progress being made.  Use these resources to engage and share your comments on our program efforts via Email and Google.
  • At CMS we also know the risks and challenges that many new physicians face in today’s healthcare landscape. We are dedicated to helping new physicians stay on track with important updates in our Medicare and Medicaid operations. That’s why the Center for Program Integrity is making it easier for physicians to resolve issues of identity theft. We’re providing information on how to protect your medical identity, numerous educational toolkits and Continuing Medical Education (CME) on CMS program integrity activities.

New and practicing physicians should note that as CMS shifts its fraud-fighting strategy to become more proactive, people committing fraud are doing the same. In our long-running patient education programs, we have provided ways patients and their families can spot and prevent scams. And we are developing more fraud-focused materials for health care providers and suppliers.

New physicians are emerging as a new vulnerability because of their inexperience with federal programs, financial obligations resulting from medical school, and aggressive scammers skillfully crafting schemes that appear to be legitimate.

New doctors should be aware of job offers that appear “too good to be true.” As with any other professional offer received or found — in print, on the internet, or other reputable or often-used resources – please be wary of offers that pay large sums of money in exchange for reviewing medical records written by others. Most often these include night and weekend work offers for your professional services to assist home health and durable medical equipment operations, usually off-site.

For Medicare fraud scams, they will require that you enroll or be enrolled in Medicare or PECOS. Never accept money or gifts for work you did not perform. Scammers that are offering cash for your participation in fraud are quick to disappear and have no issue with leaving you out to dry. Convictions for certain health care fraud violations will result in exclusion from federal healthcare programs – and potentially preventing your participation in certain State Medicaid programs and private health plans. Remember, the penalties are much larger than any short-term benefit.

To help new physicians develop defenses against these scams, CMS urges you to:

And most importantly, all doctors and their patients should report fraud as soon as it is suspected to the HHS Office of Inspector General. Tips can be reported either online or by phone at 1-800-HHS-TIPS. It’s never too late to report information, and by doing so you will be joining the fight to protect federal healthcare programs for future generations.

Shantanu Agrawal, M.D., is the Medical Director for the Center for Program Integrity at the Centers for Medicare & Medicaid Services.

CMS Moves Toward Greater Transparency

Historically, information on charges and costs for health care services has not been available to the public. Receiving a bill at the end of a treatment was generally the only way a person could find out the cost of health care services. CMS is working to usher in a new era of transparency and is very pleased to announce its next steps to create a more transparent health care system.

Today, CMS is releasing a request for public comment regarding physician-specific payment information. On May 31, 2013, a Florida federal district court lifted a 1979 permanent injunction that prohibited CMS from disclosing annual Medicare reimbursement payments to individual physicians.  In light of this recent legal development and our ongoing commitment to greater transparency in the health care system, CMS seeks public input on the best way to move forward. We are seeking input in three specific areas:

  1. how to properly weigh the balance between any potential privacy interest a provider has and the public interest in disclosure of Medicare payment information;
  2. what specific policies CMS should consider with respect to disclosure of individual physician payment data, especially with to prevent the release of any health information on any Medicare beneficiary; and
  3. what form any potential data release might take (e.g., line item claim details, aggregated data at the individual physician level).

In addition to releasing this request for public comment, CMS is also announcing four new qualified entities (QE). Created as part of the Affordable Care Act, the Medicare Data Sharing for Performance Measurement Program allows organizations to combine Medicare claims data from CMS with claims data from other payers to evaluate the performance of providers, services, and suppliers. The four additional QEs named today are Minnesota Community Measurement (MNCM), Wisconsin Health Information Organization (WHIO), Minnesota Department of Health (MDH), and the Center for Improving Value in Health Care (CIVHC). They will join the seven existing QEs in helping CMS improve quality, reduce costs, provide important information to beneficiaries to help them make health care decisions, and increase transparency.

Today’s announcements are only the latest of several efforts that demonstrate this Administration’s and this agency’s commitment to making health care more transparent.  In May 2013, CMS released information on the average charges for the 100 most common inpatient services at more than 3,000 hospitals nationwide, followed in June with the release of average charges for 30 selected outpatient procedures. CMS has also prioritized the provision of Medicare data to Accountable Care Organizations partnering with Medicare to improve care.

It is important to note that none of these efforts will result in the public disclosure of any information that could directly or indirectly reveal patient-identifiable information.  CMS is committed to appropriately the privacy of its beneficiaries.

CMS recognizes the potential for transforming the health care system that our data provides. By making our charge information public, we can help promote initiatives that can reduce costs and improve quality. This is only the latest step CMS is taking to increase transparency, but it won’t be the last.

Medicaid at Forty-eight

Cindy Mann, Deputy Administrator of the Centers for Medicare & Medicaid services and Director of the Centers for Medicaid and CHIP Services

Since 1965, Medicaid and Medicare have provided comprehensive and affordable health insurance to millions of Americans. Now, 48 years later, Medicaid continues to make strides towards connecting more eligible individuals with coverage and providing quality, affordable care. Now, as of 2013, 56.9 million people are covered by Medicaid, including 27.8 million children, 13.1 million adults and 15 million aged or blind/disabled persons.

 Key Medicaid Coverage Milestones

Children & Babies

                   •    Medicaid plays a key role in child and maternal health, financing approximately 40 percent of all births in the United States.

                   •    According to the Centers for Disease Control and Prevention, the rate of uninsured children dropped from 8.9 percent in 2000 to 6.6 percent in 2012, with millions gaining coverage – mainly through Medicaid and CHIP.

Elderly & Disabled           

•     Medicaid provides health coverage to more than 4.6 million low-income seniors, nearly all of whom are also enrolled in Medicare. Medicaid also provides coverage to 3.7 million people with disabilities who are enrolled in Medicare.

·                   •    Medicaid provides health coverage to over 8.8 million non-elderly individuals with disabilities, including people who are working or who want to work.

 Medicaid Moving Forward

As Medicaid turns 48, the program is evolving and there have been many important improvements to the program to help states across the country prepare for changes under the Affordable Care Act.  The Centers for Medicare & Medicaid Services (CMS) and states are partnering to implement streamlined eligibility rules and systems that will help ensure that eligible beneficiaries can enroll in the program that is right for them, whether Medicaid or coverage through the Health Insurance Marketplace.  And CMS continues to partner with states to improve the way care is delivered to help ensure Medicaid beneficiaries receive high quality health care services.  For example, over the last year, Medicaid has:

                 –  Issued guidance on a new state option for implementing integrated care models without a waiver that help states coordinate care in a fee for service delivery system;

-                                 –   Launched a new website to help states better implement long-term services and supports delivered through a managed care system;

-                                 –  Helped states and consumers to design new person-centered care programs and demonstrations and enhance current programs to improve coordination of care for Medicare-Medicaid enrollees;

-                                 –  Released major new funding opportunities for states and health providers and plans to design and test new delivery system models focused on multi-payer initiatives, new primary care initiatives, and improvements in birth outcomes; and

-                                -  Approved various initiatives to provide additional federal financial support to promote cost effective integrated care for individuals with chronic conditions and to help states improve access to home and community based long term services and supports. 

Medicaid also stands ready to serve more adults as states across the country take up the Medicaid coverage expansion as a result of the Affordable Care Act.  In 2014, states that expand Medicaid coverage to all adults with incomes at or below 133 percent of the federal poverty level can take advantage of 100 percent federal funding for the first three years and never less than 90 percent thereafter, thus extending Medicaid coverage to individuals who have historically been left out of the health insurance market.

CMS Releases App To Streamline Open Payment Program

by Peter Budetti, MD, JD

I’m excited to announce that we have released two apps to help physicians, manufacturers, and Group Purchasing Organizations (GPOs) track data for the Open Payments program, which was created through the “Sunshine” provision of the Affordable Care Act.  Use of the apps is entirely voluntary. Importantly, these apps are for information collection and storage only.  Having this mobile tool at your fingertips will make data much simpler to track and report.

The mobile apps are available to help physicians and others track payments and other information they receive throughout the year. This is intended to make annual reporting easier and ensure greater data accuracy.  CMS’ foray into mobile technology is about providing user-friendly tools for doctors, manufacturers and others in the health care industry to use in working with us to implement the law.  These two apps are an innovation option for doctors and industry to accurately and securely track their financial ties and other transfers of values as required under this transparency program created by the Affordable Care Act.

New Open Payments Apps available for download

The Open Payments law is designed to improve transparency to sustain patient care and trust as the highest priority by allowing the public to be informed about financial relationships that could influence the drugs, devices, biological, or medical supplies used in health care delivery.

To facilitate transparency and to keep patient care and trust as the highest priority, CMS has developed these apps to help physicians and others managed their oversight of information about their financial relationships that companies will report to Open Payments. We developed these apps to reduce the reporting burden by providing tools to simplify the tracking process and help improve data accuracy reporting for the industry (manufacturers and GPOs).

Using the Apps

Physician and industry users can track events and payments together using these apps for individual tracking purposes by either just the physician or just the industry user.  If they want to use the apps collaboratively, they can exchange many types of information, in real-time, to help ensure that physician information that the industry must supply to CMS in formal reporting such as  name, business address, and National Provider Identifier (NPI), is collected accurately. They can also collaborate on the interaction and payment that occurred to ensure everyone is on the same page.

Here is an example of how a physician could use the app to track payments received:

A physician receives a consulting fee from a drug manufacturer. The physician doesn’t have a reporting requirement under the Open Payments program, since all reporting is done by manufacturers and other companies, but she wants to be sure that the drug manufacturer accurately reports the consulting fee to CMS. Using the physician app, she can record a detailed summary of the transaction for her own records – by manually entering the data.

And here’s an example of how a doctor collaborates with the health care industry using the app:

The physician can use the “Read Quick Response (QR) Code” functionality that allows the manufacturer to create a record of the interaction and transfer it to the physician for her review.

Additionally, to help ensure the drug manufacturer correctly attributes the consulting fee to her, she can share her profile information with the drug company using the “Create QR Code” function. Months later, when she is reviewing the data the drug manufacturer reported to CMS, and before the data is made public, she can retrieve her original record from her mobile device and do a comparison to confirm that the information is correct.  If she believes the information that the manufacturer submitted to CMS about a particular interaction is not accurate, she can work with the manufacturer on correcting the information prior to publication.

Note that CMS will not validate the accuracy of data stored in the apps, nor will it be responsible for protecting data stored in the apps.  Reporting entities have sole responsibility for the accuracy and completeness of the data submitted to CMS under Open Payments.  

To download the mobile apps free of charge, for both Android and Apple platforms, users should visit the Google Play Store™ or iOS Apple™ Store and search for “Open Payments.” Once the chosen app has been installed, the user will be prompted to establish a password to ensure data security and privacy. That’s all it takes to get started.

Questions

This is an exciting time for CMS, as we’re able to harness the power of mobile technology to enable successful program implementation. Frequently Asked Questions about the apps and how they can be accessed and used are available on the Open Payments website. For any questions relating to Open Payments, contact the Help Desk at OpenPayments@cms.hhs.gov.

Connecting Kids to Coverage Outreach and Enrollment Grants

By Cindy Mann, Deputy Administrator and Director, Center for Medicaid and CHIP Services

Today, I’m thrilled that we are awarding nearly $32 million to support Connecting Kids to Coverage Outreach and Enrollment Grants.

Our ongoing partnerships with states and communities to connect eligible children to health coverage have taught us valuable lessons about how to conduct effective outreach – outreach that not only raises awareness of health coverage opportunities, but also gets eligible people enrolled.  We are applying these lessons to our work going forward so that Americans can get the health coverage they need.

These successes have also prepared the Centers for Medicaid & Medicaid Services for the historic expansion of coverage set to begin this fall, made possible by the Affordable Care Act.  Working closely with our colleagues in the states and at the federal level, these outreach and enrollment strategies will help us enroll millions of Americans in the Health Insurance Marketplaces and state Medicaid and Children’s Health Insurance Programs.

Today’s grants will build on this progress. Some of our outstanding grantees include:

  • The California Coverage & Health Initiatives will mobilize, coordinate and provide training and will work closely with the Spanish language community to increase health insurance enrollment for kids.
  • The Pima Community Access Program – As a past grantee, this group responded when Arizona reopened enrollment in its KidsCare program by setting up a call center and helped enroll 26,000 children whose families had been waiting to get coverage. This new grant will support their efforts to train over 600 organizations in four counties to help families with the new enrollment process.

Since 2008 children’s health coverage rates have improved dramatically, with millions gaining coverage mainly through Medicaid and CHIP — despite the economic downturn.

For the past four years we have worked tirelessly to reduce the number of insured children in our country. And thanks to these community groups that we partner with, we can see real results.

To view blogs by The California Coverage & Health Initiatives, and The Pima Community Access Program, please visit:

http://blog.cms.gov/

A new opportunity to connect kids to coverage in California

Suzie Shupe, Executive Director, California Coverage & Health Initiatives,

CCII 1

Edgar Aguilar, Program Manager, Children’s Health Initiative of Kern County

CCII 2

California is the most populous state in the union and home to more than 13 percent of the nation’s uninsured children. Since coverage is essential for making sure children reach their full potential, California Coverage & Health Initiatives (CCHI) is honored to receive a $750,900 Connecting Kids to Coverage Outreach and Enrollment Grant that will help us bring more low-income, eligible California children into health coverage.

CCHI has been working for over a decade to ensure children and families have the security of coverage and access to quality care. Our member organizations reach Californians in over 90% of California counties, helping to promote a robust culture of coverage and expand coverage to all children and families in our state. This video highlights who we are and why we are committed to this work.

This new funding will help us focus more of our energy and efforts on counties in California’s Central Valley and Inland Empire regions, where high concentrations of uninsured Latino children and their families live, work and play. CCHI, together with our local member organizations, will work closely with leading Spanish-language media outlets, trusted sources of news and information for Latino communities, to publicize community education and enrollment events. Helping these families learn about their coverage options and how to enroll is crucial to the success of health care reform. We know we can see more children grow up healthy and succeed in life as a result of the opportunities in the Affordable Care Act.

CCHI will also mobilize, coordinate and provide training and “on-the-ground” technical assistance to application assistors in targeted regions with the goal of enrolling tens of thousands of children into Medi-Cal. Collectively we have already covered more than 165,000 previously uninsured children through locally-funded programs and we connect another 125,000 children each year to the Medi-Cal and Healthy Families programs. Our statewide network has firsthand experience enrolling children into public coverage programs and we know that coverage for all children in California is a worthy and achievable goal.

We look forward to leveraging this new opportunity to get Californians the coverage they need, and to new opportunities just over the horizon to connect kids to coverage as a result of the Affordable Care Act. This work promises to move our state toward a brighter and more productive future, and CCHI is proud to be a part of it.

En español

Una nueva oportunidad para vincular a los niños a una cobertura en California
Suzie Shupe, Directora Ejecutiva, Iniciativas de Cobertura y Salud en California
Edgar Aguilar, Gerente de Programas, La Iniciativa de Salud para Niños del Condado de Kern

California es el estado más poblado de la unión y el hogar de más del 13 por ciento de los niños sin seguro médico en la nación. Dado que la cobertura médica es esencial para asegurar que los niños alcancen su máximo potencial, Iniciativas de Cobertura y Salud en California (CCHI por sus siglas en inglés) tiene el honor de haber recibido un subsidio de $750,900 del programa “Conectando niños a una cobertura”.  Estos fondos nos ayudarán a inscribir a más niños de bajos recursos que califican a la cobertura médica en California.

CCHI ha trabajado durante más de una década para que los niños y las familias tengan la seguridad de una cobertura médica y acceso a una atención de salud de calidad. Nuestras organizaciones miembros alcanzan a los californianos en más del 90% de los condados de California, ayudando a promover una cultura sólida de los beneficios de la cobertura médica y expandir la cobertura a todos los niños y familias de nuestro estado.

Estos fondos nos ayudarán a concentrar más de nuestra energía y esfuerzos en los condados de Central Valley de California y las regiones de Inland Empire, donde viven y trabajan muchos niños y familias latinas que no tienen seguro médico. CCHI, junto con nuestras organizaciones miembros locales, trabajarán en estrecha colaboración con los medios de comunicación en español, fuentes confiables de noticias e información para las comunidades latinas, para dar a conocer y anunciar los eventos educativos y de inscripción locales. Ayudar a estas familias a conocer sus opciones de cobertura y cómo inscribirse es crucial para el éxito de la reforma de la salud. Sabemos que podremos ver a más niños crecer sanos y tener éxito en la vida como resultado de las oportunidades en la Ley del Cuidado de Salud a Bajo Precio.

CCHI también va a activar, coordinar y proporcionar capacitación y asistencia técnica personal a las personas entrenadas para ayudar a la gente con sus solicitudes en las regiones especificadas con el objetivo de inscribir a muchos más niños en Medi-Cal. Colectivamente hemos asegurado cobertura para más de 165,000 niños que previamente no tenían seguro médico a través de programas financiados localmente y también vinculamos a otros 125,000 niños cada año a los programas Healthy Families y Medi-Cal. Nuestra red estatal  tiene experiencia de primera mano en inscribir a niños a los programas de cobertura pública y sabemos que la cobertura para todos los niños de California es un objetivo valioso y posible.

Esperamos aprovechar esta nueva oportunidad para que más californianos obtengan la cobertura que necesitan, y para las nuevas oportunidades en el horizonte que vinculan a los niños a la cobertura gracias a la Ley del Cuidado de Salud a Bajo Precio. Este trabajo promete mover nuestro estado hacia un futuro más brillante y más productivo, y CCHI se enorgullece de ser parte de los esfuerzos.

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