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  • APTA Named 'Provider of the Month' by National MS Society

    APTA 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).

    The society promotes the Nationwide Service Provider of the Month in many ways across the organization:

    • A special bulletin is sent to the 35 information and referral specialists in the society's national call center to alert them of the provider and suggest they make appropriate referrals to the provider.
    • A special summary is sent to all programs staff at the society's 45 chapters to ensure they know of the provider and are referring applicable clients as appropriate.
    • The provider is featured as the Provider of the Month on the society's Facebook page, which has more than 136,000 followers. As of December 3, the post regarding APTA's selection as Provider of the Month garnered 112 likes, 5 shares, and 8 comments. 

    Proposed Rule Expands on Programs to Protect Consumers

    On 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 include:

    • 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 contributions.

    • 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 program.

    • 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 state-based Exchanges.

    Watch the Board of Directors Meeting Broadcast Until December 15

    APTA members can view archived video of the recent Board of Directors meeting livestream until December 15 at www.apta.org/Livestream.

    Also at 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.

    CMS Issues Pre-regulation Guidance Aligning EHB Proposed Rule and Medicaid ABPs for New Expansion Population

    The 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 Act) 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:

    • any ABP that will cover the optional Medicaid expansion population under the ACA must cover EHB  as described in ACA
    • the Mental Health Parity and Addiction Equity Act applies to Alternative Benefit

    CMS 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 … "

    For 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).

    In future regulations, CMS intends to propose the following provisions, among others:

    • The supplementation process for ensuring coverage of the 10 EHB categories is to be the same as proposed in ACA.
    • The following EHB definition/options are to be adapted to Medicaid: (1) Habilitative Services: States will define the benefit and will request comment on the parameters for this benefit. (2) Pediatrics: For children enrolled in Medicaid, all medically necessary services generally are covered under the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit. Therefore, EHB supplementation is not necessary. (Note that EPSDT covers children to age 21; whereas, pediatric services under the EHB proposed rule would cover children for services under age 19.)
    • Free choice of qualified providers continues.

    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.

    Researchers Call for Providers to 'Embrace' Social Media in Prevention, Management of Childhood Obesity

    Health 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. 

    The writing group evaluated research on Internet-based interventions to lose weight, increase physical activity, and improve eating habits.

    "The 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.  

    Variables 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.

    People 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.

    "Athletes 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.

    About 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.

    However, the downsides to social media include exposure to cyber bullying, privacy issues, "sexting," and Internet addiction that can cause sleep deprivation, Li adds.

    The 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.

    More 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.

    For 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.