recently was chosen from more than 250 nationwide provider organizations to be
the National Multiple Sclerosis Society's Nationwide Service Provider of the Month for
November 2012. This award was developed in 2011 to show appreciation toward
provider organizations and to ensure that they receive the attention they
deserve for serving clients affected by multiple sclerosis (MS).
society promotes the Nationwide Service Provider of the Month in many ways
across the organization:
Friday, the Department of Health and Human Services (HHS) released a proposed rule expanding on the standards set forth in 2 final
rules published in March
related to reinsurance, risk adjustment, and risk corridors programs and the
establishment of Exchanges and qualified health plans. These programs aim to
ensure that insurance plans compete on the basis of quality and service and not
on attracting the healthiest individuals.
Key proposals in the draft Notice of Benefit and Payment Parameters for 2014
• Reducing disincentives for health insurance issuers to enroll people
with preexisting conditions by using a risk adjustment methodology that assists
health plans that cover individuals with higher health care costs and helps
ensure that those who are sick have access to the coverage that they need. CMS
also outlines the agency's proposed approach to validating risk adjustment data
to instill confidence in the program. States that are running an Exchange and
their own risk adjustment program can propose a different methodology.
• Stabilizing premiums in the individual market for health insurance by
adopting uniform reinsurance payment parameters for the transitional
reinsurance program, which is a 3-year program designed to reduce medical risk
for issuers and thereby reduce premiums for enrollees. CMS proposes that a
state may supplement the HHS reinsurance payment parameters, but must pay for
those supplementary parameters with additional state reinsurance collections or
state funds (instead of funds collected by HHS under the national contribution
rate). CMS also proposes a per-capita rate under which contributions would be
collected annually by HHS from all applicable health insurance issuers and
group health plans, exclusion of certain types of plans from the reinsurance
contribution requirement, and standards governing the calculation of
• Protecting health insurance issuers against uncertainty in setting
premium rates by accounting for profits and taxes in the temporary risk
corridors program and aligning this program with the medical loss ratio
• Helping low- and moderate-income Americans afford health insurance in
Exchanges by making advance payments of premium tax credit to issuers on behalf
of certain individuals. CMS is proposing that issuers provide cost-sharing
reductions at the point of service for eligible individuals and that CMS
directly reimburse issuers for these payments.
• Charging health insurances issuers participating in a federally
facilitated Exchange a user fee that would be commensurate with fees charged by
members can view archived video of the recent Board of Directors meeting
livestream until December 15 at www.apta.org/Livestream.
that page, members can provide feedback on the content of the meeting or the
livestream itself, which was APTA's first broadcast of that kind.
Based on viewer interest and feedback, APTA will determine whether and how
often to livestream future meetings.
Centers for Medicare and Medicaid Services (CMS) recently released guidance to help
states align Alternative Benefit Plans (ABPs) under Medicaid programs with the
Essential Health Benefit (EHB) requirements. Prior federal Medicaid law (Deficit Reduction Act of 2005, §1937 of the Social Security
has allowed states to design Medicaid
benefit packages under their state plans. The Affordable Care Act (ACA)
made changes to §1937 that become effective on January 1, 2014, which are:
intends for the provisions of the recent EHB proposed rule, released on November 20, generally to apply to
Medicaid. However, modifications will be provided in future rulemaking
that will apply when furnishing EHB services to Medicaid beneficiaries. CMS' State Medicaid Director letter says, "[s]ection 1937
coverage options are a starting point for states to establish their [ABPs], and
the process for ensuring coverage of and, as necessary, adding EHBs will mirror
steps taken by issuers in the individual and small group markets … "
states to develop a benefit plan that meets the ACA provisions, CMS proposes
that (1) states initially choose a coverage option from the choices in §1937
and (2) then determine whether the §1937 option is one of the options that is
available for defining EHBs in the individual and small group market (there is
overlap between these options).
future regulations, CMS intends to propose the following provisions, among
States that wish to establish a new §1937 ABP or to modify an existing ABP substantially are required to
publish public notice for public comment from stakeholders prior to submitting
their State Plan Amendment to CMS.
care providers should embrace social media's potential as a tool for promoting
healthy behavioral change in children who are overweight and obese, says a new
American Heart Association scientific statement published online in the
association's journal Circulation.
writing group evaluated research on Internet-based interventions to lose
weight, increase physical activity, and improve eating habits.
studies we looked at suggest that more parental involvement and more
interaction with counselors and peers was associated with greater success rates
for overweight children and teens who participated in an online
intervention," says Jennifer S. Li, MD, MHS, chair of the writing group,
in an AHA press release.
that influenced success were whether the rest of the family was involved in the
intervention, the degree of back-and-forth communication and feedback with a
counselor or support group, and the frequency with which kids and adolescents
logged on and used the programs.
who are overweight or obese tend to share a home or spend their leisure time
with others who are overweight or obese, according to research.
tend to hang out with athletes, and overweight kids hang out together, so they
reinforce each other's eating habits or preferences for recreational
activities," Li said.
95% of 12- to 17-year-old children have Internet access at home and/or in
school, so online social network health interventions should be explored as an
effective way to prevent or manage excessive weight, Li said.
the downsides to social media include exposure to cyber bullying, privacy
issues, "sexting," and Internet addiction that can cause sleep
deprivation, Li adds.
authors recommend clinicians, policy makers, and researchers ensure privacy
protection, monitor outcomes, and harness the strength of a health promotion
social network to devise interventions that initiate and sustain behavior
changes such self-monitoring, goal-setting, and problem-solving.
research is needed to provide data on overweight and obese adolescents to
determine whether differences in gender, ethnicity, geographic location, and
socioeconomic status affect the efficacy and level of engagement with social
media and technologically based weight management interventions, says AHA.
information on APTA's social media policy and resources that can help PTs and
PTAs stay informed, engage with peers on professional issues, and share the
benefits of physical therapy with consumers, go to APTA's Social Media Tips
& Best Practices webpage.
PTJ's December issue features the
Special Series on Rehabilitation for People With Critical Illness: Taking the
Next Steps. Editorials by Editor-in-Chief Rebecca Craik, PT,PhD, and guest coeditors Patricia Ohtake, PT, PhD, Dale Strasser, MD, and Dale Needham,
MD, PhD, introduce the special series.
special series will be published in 2 issues—December 2012 and February 2013.
The series presents recent advances in managing critical illness across the
continuum of care, from the intensive care unit (ICU) to the community setting.
The series also raises awareness of the essential role that physical therapists
and rehabilitation and critical care professionals play in this growing patient
population. The articles in the December issue showcase
important research conducted by established authors in the field, including
physical therapists from across the United States and from Australia. In
February 2013, articles will highlight innovative quality improvement
initiatives, discuss key considerations for the profession, illustrate
educational strategies, and describe novel cases.
In a new APTA podcast, MarySue Ingman, PT, DSc, describes the use of motivational
interviewing (MI) when talking to patients about making changes in their
lifestyle and presents the key concepts of MI—expressing empathy, supporting
self-efficacy, rolling with resistance, and developing discrepancy. She also
offers listeners specific MI techniques that they can use with patients, such as
asking open-ended questions and demonstrating reflective listening. Ingman
illustrates how the techniques can be used with an example in which a physical
therapist has to have a conversation with a patient about smoking or a sedentary
podcast is the third in a series on behavioral change. Look for a podcast later
this month that will provide an example of using MI with a student. The other
podcasts in this series can be found on APTA's Health Behavior Change webpage.
APTA podcasts are prerecorded
discussions and interviews, not live events. Members can listen to podcasts at
their convenience by clicking on the links provided in News Now articles, visiting www.apta.org/podcasts/, or subscribing to APTA podcasts on iTunes.