Agenda - 10-12-2010 - Board of Health Meeting

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20 For Medicaid, are there any changes in terms of the drug rebate program? Yes-in 2010, the drug rebate is expanded to Medicaid managed care plans. Also, for brand name drugs the Medicaid drug rebate percentage is increased to 23.1 percent, and for non-innovator, multiple source drugs, the rebate is increased to 13 percent of average manufacturer price. For Medicare, what are some of the important changes included in the health reform law? In addition to the Center for Medicare and Medicaid Innovation and the Federal Coordinated Health Care Office, some other important changes include: • In 2010, the annual market basket updates for inpatient and outpatient hospital services, long-term care hospitals and inpatient rehabilitation facilities. and psychiatric hospitals and units will be reduced. In 2012, the annual market basket updates will be reduced for home health agencies, skilled nursing facilities, hospices and other Medicare providers. Subsequently these payments will be adjusted for productivity. • In 2011, there will be no coinsurance or deductibles charged in traditional Medicare for certain preventive services, and Medicare will offer a free comprehensive wellness visit annually as well as a personalized prevention plan • Providing additional Medicare payments to qualifying hospitals in counties with the lowest quartile of Medicare per enrollee spending for 2011 and 2012 • In 2011, the benchmarks (the maximum amount Medicare pays plans per county) will remain the same as in 2010, and in 2012, federal payments to Medicare Advantage plans will be restructured by aligning payments closer to the average costs of Medicare beneficiaries by county and reduced over time. In 2012 bonus payments will be provided to plans that receive high quality ratings. (Currently Medicare Advantage plans receive federal government payments that vary by county to provide benefits, and on average, Medicare payments to Medicare Advantage plans are higher than local fee-for-service costs.) • Implement a Medicare pilot program by January 1, 2013 that will test a bundled payment model for acute, inpatient hospital services, physician services, outpatient hospital services and post-acute care services to better coordinate care and payment practices for an episode of care • In 2014, a new Independent Payment Advisory Board will be created to provide Medicare spending reduction recommendations if the growth in Medicare per capita spending surpasses a certain rate Does the health reform law provide any relief for individuals affected by the Medicare Part D "doughnut hole"? Yes-below are some of the changes that the new law contains: • In 2010, Part D enrollees who are affected by the doughnut hole coverage gap will receive a $250 rebate check (qualifying enrollees do not need apply for the rebate; they will automatically receive them) • In 2011, if enrollees have spending within the coverage gap, they will be able to receive a 50 percent discount on brand-name drugs • The coverage gap will be gradually phased out so that by 2020, enrollees will only pay for 25 percent of the cost of both brand name and generic drugs in the coverage gap Other Delivery System, Access and Quality Improvement Measures What measures in the health reform law help coordinate care for low-income uninsured and underinsured individuals? In 2011, the Collaborative Care Network Program will be established to support consortiums of health care providers to coordinate and integrate health care services for low-income uninsured and underinsured individuals. 14