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Children’s Dental Health Project | 1020 19 th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org Health Reform Implementation – Focus.

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Presentation on theme: "Children’s Dental Health Project | 1020 19 th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org Health Reform Implementation – Focus."— Presentation transcript:

1 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Health Reform Implementation – Focus on the States February 11, 2011 Marcy Frosh Meg Booth & Colin Reusch Children’s Dental Health Project

2 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Implementation of oral health provisions Example of a problem the ACA sought to address? Status of challenges to the law? What are the timelines and opportunities around the state exchanges and the pediatric dental benefit? What are some steps states can take to influence the exchange and benefit processes?

3 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | The “upside down” problem: Children with most need have least care Example of a problem that requires an innovative solution that:

4 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | The “fix” : Children with most need get most care As the Children’s Dental Health Project (CDHP) sees it: The challenge is to: 1.Reduce disease burden 2.Improved access to quality care

5 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | How federal Health Care Reform can innovate: Comprehensive systems approach, building on CHIPRA Health coverage bill – estimated by 2019, 92% non-elderly will have health insurance Provides dental coverage to nearly all children Coverage is supported by numerous additional provisions Unfortunately, many of these provisions still await funding Prevention & Health Promotion Quality Treatment Oral Health Infrastructure & Capacity Community Awareness/Education Effective Coverage Family-level Prevention Effective Workforce Child-level disease management Effective Delivery Systems Surveillance, Evaluation, CQI Systems Framework

6 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Prevention & Health Promotion Dental Caries Disease Management Establishes a national grant program to demonstrate the effectiveness of research-based dental caries disease management School-based Dental Sealant Programs Requires that states receive grants for school-based dental sealant programs Oral Health Public Education Campaign Requires HHS Secretary to establish a 5-year public education campaign to promote oral health Prevention and Public Health Trust Fund Establishes a fund to provide an expanded and sustained national investment in prevention and public health programs – may include oral health National Prevention, Health Promotion, and Public Health Council Charged with coordinating Federal prevention policy and developing a national prevention strategic plan Community Transformation Grants Establishes grants to state and local agencies and community organizations for prevention efforts outside the doctor’s office

7 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Workforce and Training Alternative Dental Health Care Providers Establishes a 15-site demonstration project to train or employ alternative dental health care professionals National Health Care Workforce Commission Establishes the Commission and makes the oral health care workforce a high priority for review Dental Training Programs Establishes a number of provisions to promote and encourage the training of dental professionals including loan repayment Primary Care Residency Programs Establishes three-year, $500,000 grants for new primary care residency programs, including oral health Graduate Medical Education Programs Provides funding for new and expanded graduate medical education, including dental education

8 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Delivery System Federally Qualified Community Health Centers Provides funding for construction, capital improvements and service expansions, including dental program expansions School-based Health Centers Provides Grants to SBHCs and includes oral health services in qualified services provided by SBHCs Center for Medicare and Medicaid Innovation (CMMI) Establishes and funds a CMS Center to explore new models of care delivery (coordinated care, medical homes, dual eligibles etc.) and care financing. Opportunities for state demonstration grants available.

9 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Infrastructure, Quality & Surveillance Oral Health Infrastructure Requires the CDC to provide cooperative agreements to states for improving oral health infrastructure (from 19 states  50 states, territories, & tribes) Pregnancy Risk Assessment and Monitoring System Requires that oral health measurements be included in PRAMS National Health and Nutrition Examination Survey Retains “tooth-level” surveillance in NHANES Medical Expenditure Panel Requires a “look-back” validation for dental - parity with medical National Oral Health Surveillance System Requires that NOHSS include measurement of early childhood caries and authorizes funding to expand the system to all 50 states

10 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Mandatory ACA Funding Oral Health Services for Children (Dental Benefit) Required Prevention and Public Health Trust Fund 2010 – $500 million, 2011 – $750 million, 2012 – $1 billiion, 2013 – $1.25 billion, 2014 – $1.5 billion, 2015 – $2 billion School-Based Health Centers Capital Program $200 million through 2013 for construction and improvements Community Health Center Expansion (operations, construction, and improvements) $11 billion through 2015 Health Insurance Exchanges Amounts necessary to award state planning and establishment grants Center for Medicare and Medicaid Innovation $15 billion through 2019,

11 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Future of Health Care Reform Law Congress: Attempts to repeal & to modify U.S. Supreme Court: Does Congress have the power to require people to buy health insurance? Arguments: -- Yes – within power to regulate interstate commerce, to impose taxes and to pass laws that are necessary and proper to carry out its intentions. -- No (and whole law is potentially unconstitutional) - exceeds Commerce Clause power to reform and regulate the market

12 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Timeline for Federal Appropriations: September 2010: Congress passed a continuing resolution (CR) for FY11 until December 3. Senate Appropriations Committee and House Labor HHS Appropriations Subcommittee proposals included oral health, but fell short of full funding December 2010: Congress passed 2 nd CR for FY11 until December 21. December 2010: Congress passed 3 rd CR for FY11 until March 3, Despite lack of funding, Federal government is moving forward with implementation through regulations & rulemaking, ARRA funding, and shifting money between agencies (e.g. Title VII)

13 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | MN not a party to the health reform challenge... Governor Mark Dayton is on record with: Support for most of the federal health care reform law, including requirements on allowing individuals with pre- existing conditions to purchase insurance, and is in favor of asking for and accepting most grants and other incentives A proposal to create a “health care helpline” to advocate for patients regarding insurers, providing a public option, reducing paperwork, e-prescribing, telehealth, and home- based care

14 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Current State Action: Insurance Exchanges Key Players: 1.National Association of Insurance Commissioners (NAIC) 2.Office of Consumer Information and Insurance Oversight (OCIIO) at HHS 3.State Insurance Commissioners & Departments of Insurance 4.Governors’ Offices & State Health Agencies

15 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | State Insurance Exchanges: Timeline Fall: Initial guidance released Exchange planning grants awarded NAIC Model Legislation released January: Second round of state planning and establishment grants now available. January: Exchanges must be certified by HHS January: States indicate whether they will operate an exchange Winter/Spring: Finals rules on Exchanges issued Fall: Exchange rules for public comment January: State and/or Federal Exchanges up and running State Exchange Planning Process 2011 & 2012: Stakeholder engagement, exchange governance decisions, plan selection, rates review, etc.

16 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | State Insurance Exchange Planning Grants: MN is one of 2 states with no award but is reportedly pursuing an expedited application Alabama Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Award details available at:

17 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Oral health on the radar screen Approaches to consider: 1) Advocate to include oral health in exchange planning application (indication that the establishment grants should be adequate to accomplish well-developed proposals) 2) Ensure capacity to address oral health in new benefit structure 3) Emphasis state capacity needs to integrate oral health into a plan for seamless interface among Medicaid, CHIP, and the new ACA provisions

18 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Connect with State Insurance Authorities Defining stakeholder input with or without a planning grant: 1.Who are interested stakeholders both within oral health and beyond? How can you partner? 2. What are the opportunities for stakeholder input (e.g., consumer protections, ensuring viable provider networks, plan options, etc?)

19 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Benefit Design: Timeline Fall: DOL begins review of employer benefits January: IOM public meeting on determination of essential benefits study January: State and/or Federal Exchanges up and running with Essential Benefits Packages and Qualified Health Plans March-Sept: IOM study recommendations on essential benefits published March: DOL report on employer plans released Fall: Determination of Essential Benefits by HHS IOM Ongoing Review of Essential Benefits

20 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | At the national level, CDHP is working on: 1. Ensuring Medicaid & CHIP access and stability 2. Getting the lay of the land (e.g., timelines, champions for individual provisions), etc.) 3.Stakeholder input: 70 organizations signed on to a May 2010 letter requesting funding for the ACA oral health provisions 4.Engaging in determination of benefit design (e.g., that the law’s “essential benefit” for oral pediatric services is defined by medical necessity) 5.Awareness & influence consumer protections

21 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Quick Recap! Health Care Reform at the moment: State insurance Commissioners have power w/ consumer protections, networks, & plan options! Messages on Medicaid/CHIP dental benefit need to be reinforced! Federal funding for the ACA oral health provisions is key!

22 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Resources ACA Summary and Talking Points, CDHP Healthcare Reform Center: Sample correspondence concerning ACA rules & regulations: Comment on Rules and Regs, Office of Consumer Information & Insurance Oversight NAIC Model Exchange Legislation: pdf pdf IOM Essential Health Benefits Survey Results: mmentsIOM1210.pdf mmentsIOM1210.pdf Visit the CDHP website at:

23 Children’s Dental Health Project | th Street NW, Suite 400 Washington, DC | | Thank You! Visit the Children’s Dental Health Project at:


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