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SCI keeps the Federal Reform Resources Web page up-to-date with the most recent information from the states, the federal government, and health policy organizations in an effort to guide our readers through the health reform implementation process. We know there are several places to go for the latest health reform resources, and we thank you for using SCI as one of your trusted sources. Here are some of the most recent resources that can be found on our Federal Reform page:

Insurance Market Reforms

 

In this FAQ on states’ involvement in plan management activities, HHS establishes that states can evaluate whether health plans and issuers meet certification standards and conduct other specified plan management activities without submitting a Blueprint.

 

 

Maryland Health Benefit Exchange has issued an RFP to procure a contact or call center, called the Consolidated Service Center (CSC) to support Maryland consumer inquiries for exchange services. The CSC will need to be easily accessible via toll free number and website with live agent support; utilize culturally and linguistically appropriate communication channels; provide safeguards to ensure customer privacy and data security; provide clear, accurate, responsive information tailored to meet Maryland consumer needs; and be fully compliant with American Disabilities Act requirements.

 

This analysis was prepared to assist in planning for the design, implementation, and operation of a successful SHOP Exchange in New York State. It provides an overview of state and federal laws and regulations relating to the design and implementation of the SHOP; identifies potential options and decision points related to the design of the SHOP; summarizes other states' approaches to developing a SHOP; and provides a SHOP concept of operations, including the identification of key SHOP business processes.

 

Robert Wood Johnson Foundation and Health Affairs

With the passing of the partnership deadline on February 15, 26 states have defaulted to the Federally Facilitated Exchange (FFE), and it will now be the responsibility of the U.S. Department of Health and Human Services to get the exchanges up and running in these states. This brief provides an overview of the requirements necessary to establishing a FFE and the challenges that the federal government may face in implementing them in 26 different states. 

 

 

Under the Affordable Care Act (ACA), there will be several changes to the Medicaid enrollment process in efforts to simplify it, including a single streamlined application. This report examines the proposed paper-based application and 85 current printable Medicaid and CHIP applications, focusing on availability of application assistance, language accessibility, verification of income, verification of citizenship and immigration status and other messages for immigrant families, medical support requirements, and disability screening questions.

 

This bulletin released by the Center for Medicaid and CHIP Services provides further information to state Medicaid and CHIP agencies on the verification plans required for both Medicaid and Children’s Health Insurance Program (CHIP) eligibility, the MAGI-based (Modified Adjusted Gross Income) Eligibility Verification Plan Template, and a review of the final verification regulations.

 

This brief explains various considerations for states deciding between Survey of Income and Program Participation (SIPP) and state administrative data, how to use the eligibility templates provided by CMS for the MAGI-based eligibility conversion process, and the steps that states wishing to perform the conversions using state Medicaid and CHIP data will need to follow.

 

 

State Refor(u)m has created a chart tracking states’ selection of vendors for their Exchange and/or Medicaid Eligibility and Enrollment IT systems and  the vendors’ roles in building these new systems. This chart also provides information on the software components that these vendors are using and whether states have brought on additional resources, such as developers, program management, and Independent Verification and Validation (IV&V) or Quality Assurance (QA) vendors. 

 

Deloitte Center for Health Solutions

With new efforts underway to reform health insurance and improve quality, efficiency, and effectiveness of the U.S. health care system, assessing and planning for an adequate health care workforce is critical to meeting this evolving demands of the system. In this report, Deloitte Center for Health Solutions examines the health care worker demand projections and makes recommendations for modernizing the health care workforce planning framework.

 

 

This report analyzes the early experiences of the State Action on Avoidable Rehospitalizations (STAAR) initiative, which is a program implemented in Massachusetts, Michigan, and Washington focused on reducing preventable hospital readmissions. Three key barriers to success were identified: 1) forming productive, collaborative relationships across care settings; 2) identifying effective interventions, especially across settings; and 3) addressing a lack of quality improvement capabilities among some health care providers. 

 

There are several different approaches to promoting patient-centered care: creating medical homes, helping patients to become partners in treatment decisions, and instituting payment reforms that enable doctors to be reimbursed for time spent counseling patients about healthy behaviors, for e-mail consultations, and for coordinating care with other providers. Little is known, however, about how health care organizations choose their approach and set goals. In this Commonwealth Fund–supported study, researchers interviewed health plan leaders and providers in Washington State, a leader in patient-centered innovation.