Affordable Care Act in Your State: Utah

The Affordable Care Act is being implemented with partners across the country and, since the enactment of the Affordable Care Act, the Department of Health and Human Services has awarded $12.8 million in new grant funding in Utah.

Specifically, the Affordable Care Act is already helping the people of Utah by:

Providing New Benefits and Lowering Costs for Medicare Beneficiaries 
Nearly all of the 290,000 Medicare beneficiaries in Utah can now receive certain preventive services – like mammograms and colonoscopies – as well as an annual wellness visit with their doctor without paying coinsurance or deductibles. In fact, 4,476 residents of Utah have already received an annual wellness visit this year.  In addition, more than 22,353 Utah residents who hit the Medicare prescription drug coverage gap known as the “donut hole” received $250 tax-free rebates in 2010.  This year, seniors are receiving a 50% discount on covered brand name prescription drugs in the donut hole, and by 2020 the donut hole will be closed.

Bringing Insurance Reforms to Utah Residents
People across Utah are benefiting from key insurance reforms that went into effect in 2010:

• 1.9 million residents with private insurance are free from worrying about lifetime limits on coverage.
• The 216,000 residents of Utah who buy coverage on the individual market can now trust that their coverage will not be rescinded due to a mistake on an application.
• Because of the Affordable Care Act, most young adults can stay on their parents’ plan until their 26th birthday.  An estimated 10,500 young adults in Utah will gain coverage this year because of this provision.
• Insurance companies are prohibited from denying coverage to the 206,000 children in Utah with pre-existing conditions.

$1 Million to Scrutinize Unreasonable Rate Increases 

New rules require insurers to publicly justify unreasonable premium rate increases, and strengthen States’ abilities to crack down on rate hikes. Utah is receiving $1 million to crack down on unreasonable insurance rate increases.

Supporting Utah’s Work on Affordable Insurance Exchanges with $1 Million in Planning Grants
These grants will give States the resources they need to conduct the research and planning necessary to build a better health insurance marketplace and determine how their Exchanges will be operated and governed. Learn how the funds are being used in Utah here.

Lowering Early Retiree Coverage Costs 
48 employers in Utah have enrolled in the Early Retiree Reinsurance Program, and Utah employers have already received $6.9 million in reimbursement. The Early Retiree Reinsurance Program provides much-needed financial relief to businesses, schools and other educational institutions, unions, State and local governments, and non-profits, in order to help retirees and their families continue to have quality, affordable health coverage.  Find a list of organizations accepted into this program here.

Preventing Illness and Promoting Health
In 2010, Utah received $3.4 million in grants from the Prevention and Public Health Fund created by the Affordable Care Act. This new fund was created to prevent illness and promote health, so that all Americans can lead longer, more productive lives.

•  $670,000 for community and clinical prevention activities, which will help Utah and its partners prevent and manage costly conditions.
• $550,000 to support public health infrastructure.  These grants strengthen State and local capacity to meet 21st century public health challenges.
• $2.1 million invested in primary care training, which will expand and support Utah’s health workforce.

In 2011, the Prevention and Public Health Fund has already provided $1.6 million to Utah to support the critical work of State and local health departments.

$3.6 Million Investment in Community Health Centers
The Affordable Care Act has invested $3.6 million in new and existing community health centers in Utah. Currently there are more than 1,100 health centers operating over 8,100 service delivery sites across the country. 

$12.7 Million in Therapeutic Discovery Project Program Tax Credits and Grants
This program was created by the Affordable Care Act to support groundbreaking biomedical research to produce new therapies, address unmet medical needs, reduce the long-term growth of health care costs and advance the goal of curing cancer within the next 30 years.  In Utah, this program will support projects that show significant potential to produce new and cost-saving therapies, support good jobs, and increase U.S. competitiveness.  This program is operated by the Department of the Treasury, and a full list of small businesses participating in this program is available here.

Other Grants Awarded in Utah:

• $1.6 million for Maternal, Infant, and Early Childhood Home Visiting Programs.  These programs bring health professionals to meet with at-risk families in their homes and connect families to the kinds of help that can make a real difference in a child’s health, development, and ability to learn - such as health care, developmental services for children, early education, parenting skills, child abuse prevention, and nutrition.
• $60,000 to support outreach to eligible Medicare beneficiaries about their benefits.
• $530,000 for the Personal Responsibility Education Program, which will educate young adults on the prevention of pregnancy and sexually transmitted infections.
• $95,700 for Family-to-Family Health Information Centers, organizations run by and for families with children with special health care needs.

For more information, go to healthcare.gov

Uninsured Parents Urged to Apply for PCN

Primary Care Network opening enrollment Dec 10th

What: Utah’s Primary Care Network (PCN) will open enrollment for parents Saturday, December 10 through Friday, December 23. PCN is a primary preventive health coverage plan for uninsured adults. Benefits include physician services, prescriptions, dental services, eye exams, emergency room visits, birth control, and general preventive services.

Why:  Since November 2010, PCN has been closed for enrollment and has not accepted new applications. Beginning Saturday, December 10 through Friday, December 23, Utah parents may apply online, by mail, or in person to receive primary health care.

Who:  Parents who meet the following requirements may apply:

- Age 19 through 64

- Have dependent child(ren) under age 19 living at home

- U.S. citizens or legal residents

- Not covered by other health insurance

- Meet income guidelines (e.g., a family of 4 with a maximum  income of $33,525 per year)

- Not qualified for Medicaid

- Have no access to student health insurance, Medicare, or Veterans benefits

When: Friday, December 10 through Friday, December 23 at 5:00 p.m.

Where:  Apply online at www.health.utah.gov/pcn  or call the PCN hotline at 1-888-222-2542.

Job Opening: Developmental Screening Coordinator

The Bureau of Child Development in the Utah Department of Health has an opening for our full-time Developmental Screening Coordinator.  If you are interested or know anyone who may be interested, the job posting can be found at:

https://statejobs.utah.gov/JobAnnouncement.jsp?rid=25330

This opening closes on December 18th.

CDC Data to Action

The Centers for Disease Control and Prevention have added new features to their website that allow you to compare data across states.  These tools have been added to the OHD website at http://health.utah.gov/disparities/data.html#otherutah

Sortable Stats

See how Utah compares to other states in several health indicators. Click on a health indicator at the top of the screen to view states in order of rank at that measure.
http://wwwn.cdc.gov/sortablestats/
Policy Implementation Analyses
Compare state laws affecting health.
http://www.cdc.gov/program/data/policyanalyses/index.htm

Americans urged to put flu shots on holiday to-do lists

This year's flu season is off to a mild start, but confirmed cases have been seen in 30 states so far — and January and Feburary are often the peak.

Which is why health officials on Monday urged Americans to get their flu shots or flu nasal sprays now, so "you're protected before the holiday season begins, when you get on that plane, train or bus to go see loved ones," says Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases.

A total of 36.3% of Americans older than 6 months of age had been vaccinated for influenza by early November, say officials at the Centers for Disease Control and Prevention (CDC). This year's rate is a little better than last year's, which in early November stood at 32.8.8%. And for children it's even better, 36.7% compared with last year's 30.6%.

"But the season's not over, and we can still do better," says Schuchat, who reminded Americans that this is National Influenza Vaccination Week.

The flu is a serious disease. Each year between 5% and 20% of the U.S. population gets influenza, says Howard Koh, assistant secretary for health with the Department of Health and Human Services. On average, 200,000 people a year are hospitalized during flu season, he says. Death totals vary tremendously depending on the strains circulating, ranging from 3,000 to 49,000 a year, he says.

For the past two years, the CDC has recommended that everyone six months or older be vaccinated against influenza. It's especially important for young children, pregnant women, older people and those with chronic conditions such as asthma, diabetes and heart or lung disease, Schuchat says. All of these groups are at particular risk for complications.

One positive note, Schuchat says, is that the elderly are also getting vaccinated at higher rates; this year, 62.3% of people 65 and older have received flu vaccine.

The message also seems to be getting to pregnant women. Before 2009, the rate was less than 15%; this year, 43.2% of pregnant women had been vaccinated by early November, she says.

That's good news because there's still time to get vaccinated before the worst of the flu season hits.

Another shift that has increased vaccination rates is that flu shots are available many more places than previously. Rather than have to go see the doctor, flu shots and nasal sprays are available at supermarkets, pharmacies and in the workplace.

This year, 55% of adults got vaccinated at a clinic or the doctor's office; 21% at a supermarket or pharmacy; and 16% at work. Most children still get vaccinated at the doctor's office, though 5% were vaccinated at school this year.

Although there were no racial or ethnic disparities for children getting the flu vaccine, that's not the case with adults. Currently, coverage is 40% for whites, 28% for blacks and 26% for Hispanics, Schuchat says.

Read entire article at USA Today http://yourlife.usatoday.com/health/story/2011-12-05/Americans-urged-to-put-flu-shots-on-holiday-to-do-lists/51657678/1

Medicare Gives Employers, Consumers Information to Make Better Health Care Choices

Health care law will allow patients to compare options, find best value

Consumers and employers will have the health care information they need to make more informed choices about their care, thanks to the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) announced in a final rule today.

The rule gives qualified organizations, like employers and consumer groups, access to data that can help them identify high quality health care providers or create online tools to help consumers make educated health care choices.  Information that could identify specific patients, however, will not be publicly released and strong penalties will be in place for any misuse of data.

"This is a giant step forward in making our health care system more transparent and promoting increased competition, accountability, quality and lower costs," said Marilyn Tavenner, Acting CMS Administrator. "This provision of the health care law will ensure consumers have the access they deserve to information that will help them receive the highest quality care at the best value for their dollar."

For years, employers, consumers, and health care quality advocates have expressed frustration about the limited and piecemeal availability of Medicare data that could be used to help evaluate health care provider or supplier performance.  Although many health plans have created provider and supplier performance reports, these reports are based solely on the health plans' own claims, and do not reflect information from other health plans, including Medicare.

Providers, too, have expressed frustration at receiving performance reports that are piecemeal and produced without an opportunity for review and correction.  This final rule creates a framework for providers to receive a single, actionable performance report covering all or most of their practice.

The final rule makes a number of important changes from the original proposed rule. The final rule makes this data less costly for qualified entities, gives qualified organizations more flexibility in their use of Medicare data to create performance reports for consumers, and extends the time period for health care providers to confidentially review and appeal performance reports before they become public.  The rule also includes strict privacy and security requirements to protect patients, health care providers, and suppliers as well as stringent penalties for any misuse of Medicare data.

The final rule on Availability of Medicare Data for Performance Measurement is on display until Dec. 7, 2011 at the Office of the Federal Register at: http://www.ofr.gov/OFRUpload/OFRData/2011-31232_PI.pdf 

Make an educated healthcare treatment decision

Your quality of life depends on knowing your options, according to the U.S. Agency for Healthcare Research and Quality (AHRQ).  A website by AHRQ, Explore Your Treatment Options, explains what your options are.  From the website:

Just one food item on the menu? Only one dress in the store? You expect to have options everywhere else in life. Why not your health care?

You might not think to ask why your doctor recommends a certain treatment or if other options are available. But every patient is different. When it comes to medical tests and treatments, you deserve to know your options.

Whether you just got sick or you’ve been receiving care for a long time, ask your doctor about treatment options. The answers you get may help improve your health care and your quality of life.

This site has tips to help you talk with your doctor. Because knowing your options is the best option.

At the website, you can get information about treatment options for a variety of health conditions.  The Office of Health Disparities Reduction has linked to this website here: http://www.health.utah.gov/disparities/healthcareinutah.htm#informed