1. 1 Health Reform and the Kansas Health Policy Authority Marcia Nielsen, PhD, MPH Executive Director Kansas Health Policy Authority

2. 2 KANSAS TEAM Marcia Nielsen Marcia Nielsen Susan Allen Susan Allen Andy Allison Andy Allison Senator Jim Barnett Senator Jim Barnett Secretary Rod Bremby Secretary Rod Bremby Representative Jeff Coyler Representative Jeff Coyler Ned Holland Ned Holland Senator Laura Kelly Senator Laura Kelly Joe Tilghman Joe Tilghman Representative Valdenia Winn Representative Valdenia Winn

3. 3 Kansas Health Reform Overview 2005 and 2006: Creation of Authority (KHPA) 2005 and 2006: Creation of Authority (KHPA) Appointment of BoardAppointment of Board Creation of vision principles and frameworkCreation of vision principles and framework 2007: Creation of Health for All Kansans Steering Committee 2007: Creation of Health for All Kansans Steering Committee Passage of SB 11:Passage of SB 11: Creates premium assistance program Creates premium assistance program Outlines development of health reform options Outlines development of health reform options 2008: Debate Health Reform Options 2008: Debate Health Reform Options Legislative debateLegislative debate Passage contingent on community participationPassage contingent on community participation

4. 4 2005 – 2006: Laying the Framework for Health Reform

5. 5 KHPA created in 2005 Legislative Session KHPA created in 2005 Legislative Session Built on Governor Sebelius’ “Executive Reorganization Order” Built on Governor Sebelius’ “Executive Reorganization Order” Modified by State Legislature to: Modified by State Legislature to: Create a nine member Board to govern health policyCreate a nine member Board to govern health policy Executive Director reports to BoardExecutive Director reports to Board Added a specific focus on health promotion and data driven policy makingAdded a specific focus on health promotion and data driven policy making

6. 6 July 1, 2005 January 1, 2006 March 1, 2006 July 1, 2006 2007 Legislative Session 2008 Legislative Session Kansas Health Policy Authority Established. Transfer programs of programs to a Division first, then to a separate agency. Assume responsibilities of Health Care Data Governing Board and oversight of KS Business Health Partnership program. Authority plan for various program transfers submitted to Legislature. Transfer programs to Authority. Authority plan for additional program transfers submitted to 2007 and 2008 Legislatures.

7. 7 Programs Transferred to KHPA in 2006 Medicaid Medicaid (Regular Medicaid) (Regular Medicaid) MediKan MediKan State Children’s Health Insurance Program State Children’s Health Insurance Program Ticket to Work/Working Healthy Ticket to Work/Working Healthy Medicaid Management Information System Medicaid Management Information System Medicaid Drug Utilization Review & related programs Medicaid Drug Utilization Review & related programs State Employee Health Insurance State Employee Health Insurance State Workers Compensation State Workers Compensation Health Care Data Governing Board Health Care Data Governing Board Business Health Partnership Program Business Health Partnership Program

8. 8 KHPA Board Members Nine voting board members Nine voting board members Three members appointed by the GovernorThree members appointed by the Governor Six members appointed by legislative leaders.Six members appointed by legislative leaders. Seven nonvoting, ex officio members include: Seven nonvoting, ex officio members include: Secretaries of Health and Environment, Social and Rehabilitation Services, Administration, and Aging; the Director of Health in the Department of Health and Environment; the Commissioner of Insurance; and the Executive Director of the Authority.Secretaries of Health and Environment, Social and Rehabilitation Services, Administration, and Aging; the Director of Health in the Department of Health and Environment; the Commissioner of Insurance; and the Executive Director of the Authority.

9. 9 Vision Principles & Health Indicators Adopted by the Board in 2006 Adopted by the Board in 2006 Provides governance and operational direction to the Board Provides governance and operational direction to the Board Provides guiding framework to analyze health reform options Provides guiding framework to analyze health reform options Provides “yardstick” to measure over time improved health in Kansas Provides “yardstick” to measure over time improved health in Kansas

10. 10 KHPA: Coordinating health & health care for a thriving Kansas SRSKDHEKDOA Access to Care Quality and Efficiency Affordable, Sustainable Health Care Health and Wellness Stewardship Public Engagement Mental Health LTC for Disabled Substance Abuse Health Promotion Child, Youth & Families Consumer Health Health & Envir. Statistics Local & Rural Health Aged Institutional Care Community Care  Health Insurance Status  Health Professions Workforce  Safety Net Stability  Medicaid Eligibility  Health Disparities  Physical Fitness  Nutrition  Age appropriate screening  Tobacco control  Injury control  Use of HIT/HIE  Patient Safety  Evidence based care  Quality of Care  Transparency (Cost, Quality, etc.)  Health insurance premiums  Cost-sharing  Uncompensated Care  Medicaid/SCHIP Enrollment  Health and health care spending  Open Decision Making  Responsible Spending  Financial Reporting  Accessibility of Information  CMS Cooperation  Council Participation  Data Consortium  Public Communication  Community/Advocacy Partnership  Foundation Engagement KID Private Health Insurance Business Health Partnership

11. 11 2007: “First Steps” to Health Reform

12. 12 Building Consensus 50,000 Feet: 50,000 Feet: KHPA January Board Retreat – Meeting the Governor’s challenge to develop “Health for All Kansans” Steering Committee (HFAK)KHPA January Board Retreat – Meeting the Governor’s challenge to develop “Health for All Kansans” Steering Committee (HFAK) KHPA Board Members and four legislators, appointed by House and Senate leadershipKHPA Board Members and four legislators, appointed by House and Senate leadership 40,000 Feet: 40,000 Feet: HFAK Steering Committee embraces short term and long term health reform packageHFAK Steering Committee embraces short term and long term health reform package Passed by legislature – specific requirementsPassed by legislature – specific requirements 30,000 Feet: 30,000 Feet: KHPA Board, HFAK, and Advisory Councils narrowing health reform prioritiesKHPA Board, HFAK, and Advisory Councils narrowing health reform priorities

13. 13 Defining Health Reform Process Coordination of current reform initiatives Coordination of current reform initiatives Existing initiatives within the KHPA Existing initiatives within the KHPA In Partnership with other agencies In Partnership with other agencies Economic analyses required by SB 11 Economic analyses required by SB 11 Input from Advisory Councils Input from Advisory Councils Final health reform options developed by KHPA Board and Health for All Kansans Steering Committee Final health reform options developed by KHPA Board and Health for All Kansans Steering Committee

14. 14 Current reforms within the KHPA Medicaid Reform: Medicaid Reform: Premium AssistancePremium Assistance Fraud and Abuse: Inspector GeneralFraud and Abuse: Inspector General Enhanced Care Management PilotEnhanced Care Management Pilot Community Health Record PilotCommunity Health Record Pilot Disproportionate Share for Hospitals (DSH) ReformDisproportionate Share for Hospitals (DSH) Reform State Employee Health Plan (SEHBP) Reforms: State Employee Health Plan (SEHBP) Reforms: Health and Wellness IncentivesHealth and Wellness Incentives Self-InsuranceSelf-Insurance Actuarial AnalysesActuarial Analyses System Reforms System Reforms Health Information Technology/Exchange (HIT/HIE) in collaboration with HIE CommissionHealth Information Technology/Exchange (HIT/HIE) in collaboration with HIE Commission Transparency and quality information for consumersTransparency and quality information for consumers

15. 15 Concurrent Reform Priorities in Sister Agencies Kansas Department on Health and Environment (KDHE): Kansas Department on Health and Environment (KDHE): Obesity and tobacco control policyObesity and tobacco control policy Social and Rehabilitation Services (SRS): Social and Rehabilitation Services (SRS): Mental health, substance abuse, child welfare reformsMental health, substance abuse, child welfare reforms Kansas Department on Aging (KDOA): Kansas Department on Aging (KDOA): Long term care reformsLong term care reforms Kansas Department on Insurance (KID) Kansas Department on Insurance (KID) ReinsuranceReinsurance Long Term Care PartnershipLong Term Care Partnership

16. 16 Reforms agreed to in SB 11 Premium Assistance, other health policy provisions Premium Assistance, other health policy provisions Enabling legislation requires economic analysis of: Enabling legislation requires economic analysis of: health care insurance connector including a model for a voluntary insurance connector;health care insurance connector including a model for a voluntary insurance connector; Policies designed to increase portability, individual ownership of health care policies, utilize pre-tax dollars for health insurance, expand consumer responsibility for making health care decisions;Policies designed to increase portability, individual ownership of health care policies, utilize pre-tax dollars for health insurance, expand consumer responsibility for making health care decisions; Reinsurance; andReinsurance; and Financing methods (such as federal funding, etc).Financing methods (such as federal funding, etc).

17. 17 Premium Assistance What is it and who is it for? A phased-in plan to assist eligible low income uninsured Kansas families with the purchase of private insurance, leveraging state, federal and employer funding. What kind of assistance will it provide? Low income families will choose between their employer plan (if offered and sufficient) or be offered private health plan choices that are actuarially equivalent to the Kansas state employee health plan, which will be procured through the state.

18. 18 Goals of Premium Assistance Ensures access to affordable healthcare for families living in poverty Ensures access to affordable healthcare for families living in poverty Protects benefits currently offered to those children Protects benefits currently offered to those children Brings parents and children into the same private health plans Brings parents and children into the same private health plans Increases participation by eligible children Increases participation by eligible children Increases health plan choices available to low- income families Increases health plan choices available to low- income families Prepares the way for further reforms Prepares the way for further reforms Draws in Federal funds and takes advantage of DRA flexibilities Draws in Federal funds and takes advantage of DRA flexibilities

19. 19 Premium Assistance: Design Phase Who can participate? Who can participate? The plan extends private coverage to parents (“caretakers”) living in poverty.The plan extends private coverage to parents (“caretakers”) living in poverty. Currently, only parents below 25-36% of the Federal poverty level are eligible.Currently, only parents below 25-36% of the Federal poverty level are eligible. Children’s eligibility for Medicaid and HealthWave would not be affected.Children’s eligibility for Medicaid and HealthWave would not be affected. Children in poverty are already eligible for Medicaid.Children in poverty are already eligible for Medicaid. How will it work? How will it work? Design will use best practices and lessons learned from other statesDesign will use best practices and lessons learned from other states

20. 20 KHPA Legislative Report Card Significant support this year by the legislature: Significant support this year by the legislature: To fund operations – 31 new positionsTo fund operations – 31 new positions To fund Eligibility Clearinghouse and resolve backlog created by federal requirementsTo fund Eligibility Clearinghouse and resolve backlog created by federal requirements To support payment reforms required by CMSTo support payment reforms required by CMS To support SB 11: Premium Assistance and analysis of health insurance reformsTo support SB 11: Premium Assistance and analysis of health insurance reforms

21. 21 2008: Considering Comprehensive Health Reform in Kansas

22. 22 Need for Stakeholder Input Advisory Council Participation Advisory Council Participation Role: To advise KHPA Board and HFAK Steering CommitteeRole: To advise KHPA Board and HFAK Steering Committee Membership – 140 Kansans participatingMembership – 140 Kansans participating Consumer, Provider, Purchaser and At-Large Councils Consumer, Provider, Purchaser and At-Large Councils State Outreach Efforts State Outreach Efforts “Listening Tour” by Board members and other interested policymakers“Listening Tour” by Board members and other interested policymakers Utilizing Technology: Updating our website and creating list-serve Utilizing Technology: Updating our website and creating list-serve

23. 23 KHPA Board Priority Discussion June meeting to narrow draft priorities: June meeting to narrow draft priorities: Providing and protecting affordable health insuranceProviding and protecting affordable health insurance Focus on small business and portability Focus on small business and portability Prevention and primary carePrevention and primary care Focus on obesity, tobacco control, incentives for primary care Focus on obesity, tobacco control, incentives for primary care Promoting personal responsibilityPromoting personal responsibility For responsible health behaviors For responsible health behaviors Contributing to the cost of health insurance, based on sliding scale Contributing to the cost of health insurance, based on sliding scale

24. 24 KHPA Health Reform Timeline Summer and Fall 2007 Summer and Fall 2007 Advisory Councils meeting to offer recommendationsAdvisory Councils meeting to offer recommendations Listening TourListening Tour KHPA Board & HFAK Steering Committee to develop reform optionsKHPA Board & HFAK Steering Committee to develop reform options November 1, 2007 November 1, 2007 Reform options presented to Governor and legislatureReform options presented to Governor and legislature January 2008 January 2008 Consideration of health reform optionsConsideration of health reform options

25. 25 http://www.khpa.ks.gov/