Affordable Care Act (ACA) Implementation in the Regional Collaboratives (RCs) Meredith Weaver, PhD, ScM, CGC May 22, 2014

Transcription

1 Affordable Care Act (ACA) Implementation in the Regional Collaboratives (RCs) Meredith Weaver, PhD, ScM, CGC May 22, 2014 The NCC is funded by U22MC24100, awarded as a cooperative agreement between the Maternal and Child Health Bureau/Health Resources and Services Administration, Genetic Services Branch, and the American College of Medical Genetics.

2 NCC/RC System

3 Charge to NCC/RCs HRSA (Health Resources & Services Admin) asked the NCC and RCs to address issues in access to genetics services through the ACA implementation (before, during, and after) Focus any work, as it relates to the RCs charge, on GENETICS Other national entities (Catalyst Center, Centers for Medicare & Medicaid Services, Kaiser Family Foundation) working on broader topics of education and population-based access to ACA

4 NCC/RC Activities National ACA Workgroup Convened (January 2013) Working with national organizations to identify opportunities for engagement around ensuring access and coverage for genetic services under ACA RCs are engaged in an assortment of activities at varying levels related to ACA implementation

5 RC Activities New England Genetics Collaborative (NEGC) Education: developing an educational policy brief Heartland Genetics Collaborative Education: Bringing states together to discuss ACA implementation (today!) Region 4 Midwest Education: Presentation at their annual meeting (May 1) about the impact of ACA on newborn screening Southeast Regional NBS & Genetics Collaborative (SERC) Needs Assessment: Consumer workgroup developing a consumer ACA survey to ascertain needs and issues related to ACA. New York Mid-Atlantic Regional Collaborative (NYMAC) Impact Analysis: Meeting to be held June 2014 to examine the ACA impact on services provided and funding (billing and reimbursement). Outcome will be steps to make implementation a smoother process. Education: Adult provider conference held May 2014; had a session dedicated to understanding the impact of ACA on young adults.

6 RC Activities (2) Western States Genetic Services Collaborative (WSGSC) Education/Public Information: A Comprehensive website was developed based on who you are to help make navigating the ACA easier. ( m)

7 ACA Implementation Supplement September 2013, NCC received a NCC/RC system-wide supplement to: Develop a cost element template for 3 model conditions PKU, Sickle Cell, and Fragile X MSGRC and NEGC in partnership State-by-state coverage analysis of the model conditions Collaborative project with Catalyst Center and NCC Considerations for a standardized genetics component in integrated care systems NYMAC Oversight provided by NCC ACA Implementation workgroup

8 Project 1 PKU Template

9 Project 2 State-by-State Analysis Use project 1 templates to do a 7-state analysis of varying benchmark, platinum, alternative expanded Medicaid, and Medicaid unmodified plans To develop an overview of what, and to what extent, genetics services are covered as a result of ACA Catalyst Center will develop the methodology and framework for this project A graduate student (located at ACMG) will perform the analysis using the Catalyst Center methodology and in consultation with the RCs and the NCC ACA Workgroup RCs will establish criteria for selecting which state from a RC will be selected for review

10 Project 3 Standardized Genetics Components within Integrated Care Systems NYMAC convened a small workgroup to outline what genetic components should be part of integrated care systems Initial literature review Preliminary meeting with stakeholders Accountable Care organization representatives Geneticists Genetic counselors Billing experts Summer 2014 meeting to finalize initial considerations Paper and publication of findings

11 Role in the Supplement: Provide oversight to the Supplement NCC ACA Workgroup NCC/RCs goal is to build evidence and data to support interactions with Title V programs, ASTHO, and others to get identified gaps in coverage addressed and improve access to care Foundational work and expected to continue beyond this supplemental funding period In-person meeting November 16, 2013 established the framework and priorities for the supplement Chairs: Sue Ginsburg (NYMAC Evaluation Consultant), and Meg Comeau (Catalyst Center, NEGC Project Lead)

12 ACA workgroup Activities Supplement oversight Resource for RCs Opportunity for inter-rc collaboration

13 NCC Activities ACA Matrices for each RC Heartlands Matrix completed in July, 2013 Pre-ACA implementation Is a snapshot in time: the numbers have changed different websites updated on different timeframes

14 Heartlands Matrix

15 Heartlands Matrix

16

17 Health Insurance Exchange

18 CCIIO info about benefits

19 Thank you! Contact us: NCC Project Director, Michael S. Watson, PhD, NCC Medical Director, David Flannery, MD, NCC Associate Project Manager, Meredith Weaver, PhD, NCC Project Manager, Alisha Keehn, NCC Evaluator, Debbie Maiese, Visit us: