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Illinois Blockchain Initiative to Pilot Credentials Verification Program

Thu, 08/17/2017 - 19:12
On August 8th, 2017, the Illinois Blockchain Initiative announceda pilot program in partnership with Hashed Health to use blockchain technology to streamline the medical credentialing process in the state. By exploring opportunities through distributed ledger technologies, the program could be able to reduce the complexity of licensing and credentialing. The program will look to provide a new blockchain-based registry to act as a repository for credentialing data.
Eric Fish, senior vice president of legal services at the Federation of State Medical Boards, praised the initiative, remarking that, “If successful, this effort may prompt other state medical boards, as well as others within healthcare, to investigate potential benefits that can be derived from the use of distributed ledgers, and may ultimately result in a more efficient regulatory process without any sacrifice to patient safety.”
To read more on the pilot program, see the full story at Health IT Analytics.
Blockchain technology is a decentralized peer-to-peer system through which digital transactions are created, shared, verified, and stored. This technology consists of three main components: a distributed network, a shared ledger, and digital transactions. The network is the basic skeleton of the blockchain: individual network members generate, verify, and store data on the blockchain, instead of contributing to one central database. The ledger provides a mechanism to share and verify information in the network, protecting the data from tampering and ensuring quick and easy verification of the information within. Finally, a digital transaction is the actual act of generating or verifying data.
NAMSS is continuing to monitor the development of blockchain technology in healthcare, especially with regards to the credentialing process. In May, we hosted our 4th annual Government Relations Industry Roundtable, entitled Building Blocks for the Future. A panel of NAMSS staff, stakeholders and strategic partners discussed the impact of blockchain and its potential applications for the industry. Be on the lookout for further information from NAMSS on blockchain technology and its potential impacts on MSPs!

Obamacare Repeal and Replace Dead, For Now

Sat, 07/29/2017 - 01:12
In the early hours of the morning on July 28, 2017, the Senate held its final vote on Republican efforts to repeal and replace the Affordable Care Act (ACA). The Health Care Freedom Act, referred to by some as “skinny repeal,” fell 51-49, with Republican Senators John McCain (R-AZ), Lisa Murkowski (R-AK), and Susan Collins (R-ME) joining all Democrats in voting against the bill.
The path towards repeal in the Senate had been winding at best. After multiple delays, the Senate narrowly voted to proceed to debate on the House version of the bill, the American Health Care Act (H.R. 1628). Sens. Murkowski and Collins were opposed to the motion, requiring Vice President Mike Pence to provide the tiebreaking vote. The Senate then considered several different options on the repeal efforts, which were all defeated. Senate Republican’s own original plan, the Better Care Reconciliation Act, was soundly defeated, with 9 Republicans from the conservative and moderate wings voting against (57-43).

[Republicans voting against the BCRA were Susan Collins, Lisa Murkowski, Bob Corker (TN), Tom Cotton (AR), Lindsey Graham (SC), Dean Heller (NV), Mike Lee (UT), Jerry Moran (KS), and Rand Paul (KY)]
Next, Senate Majority Leader Mitch McConnell brought up a partial repeal bill, the Obamacare Repeal and Reconciliation Act, which would have repealed essential ACA provisions like the individual mandate, Medicaid expansion, and premium subsidies after a period of two years, during which the Senate hoped to draft a replacement plan. This was voted down 55-45, with Sens. Collins, Murkowski, Heller, McCain, Shelley Moore Capito (R-WV), Rob Portman (R-OH), and Lamar Alexander (R-TN) voting against.
The “skinny repeal” bill was brought up as a last-ditch effort to garner consensus from the Republican caucus on repeal efforts, with the intention of passing a bare-bones bill in order to come up with a fuller plan in conference with the House of Representatives. It would have repealed selected provisions of the ACA, including the individual mandate, delay the employer mandate until 2025, extend the moratorium on the medical device excise tax through December 31, 2020, and modify ACA State Innovation Waivers, among other provisions. For the moment, Republican efforts to repeal the ACA are dead, and Senate leadership has expressed a desire to move onto other business. However, some House Republicans, including Rep. Tom MacArthur (R-NJ), Greg Walden (R-OR) and Freedom Caucus Chairman Mark Meadows (R-NC) have stated they will continue in their efforts to take down the ACA. 

Senate Republicans Release Draft Healthcare Bill

Mon, 06/26/2017 - 21:07
On June 22, 2017, Senate Republicans released the Better Care Reconciliation Act (BCRA), their much-anticipated version of the House’s American Health Care Act (AHCA), which repeals and replaces the Affordable Care Act (ACA).  Here’s a breakdown of how the Senate and the House versions align and how they break away from the ACA.

The Senate and House Similarities:

  • Eliminate the ACA’s controversial individual mandate, which required all Americans to have health insurance.
  • Eliminate the ACA’s unpopular employee mandate, which required most employers to offer employees health insurance.
  • Enable payers to implement age-based pricing determinations for health insurance.
  • End the ACA’s Medicaid state-expansion and reduces overall Medicaid funding (although the Senate version proposes a deeper rate than the House version). 
  • Enable states to waive the ACA’s requirement that payers cover the following 10 essential health benefits: 1) ambulatory patient services; 2) emergency services; 3) hospitalization; 4) maternity and newborn care; 5) mental health and substance abuse; 6) prescription drugs; 7) rehabilitative and habilitative  services; 8) laboratory services; 9) preventive and wellness services and chronic disease management; 10) some pediatric services.
  • Defund Planned Parenthood for one year. 
  • Repeal most of the ACA’s taxes. 
  • Continues the ACA’s policy that enabled children to remain beneficiaries of their parents’ health plans until age 26.
The Senate and House Differences:

  • Tax Credits: The Senate version lowers the income eligibility level for tax credits.  The House version fixed tax credit eligibility to age.
  • Pre-Existing Conditions: The Senate version maintains the ACA’s requirement that payers cover individuals with pre-existing conditions without charging these individuals higher rates.  The House version would enable states to allow payers to opt out of mandating coverage for preexisting conditions.  In lieu of this requirement, the House version would provide states funding to establish high-risk pools to cover individuals with pre-existing conditions.
Key Medicaid Points

Medicaid Expansion

The BCRA would overhaul the current Medicaid expansion system by phasing out the Federal Medical Assistance Percentages (FMAP) to states by 15 percentage points between 2020 and 2023 (90-percent funding in 2020 to 75-percent funding in 2023).  In 2024, FMAP reductions would continue until they matched the state rate for other benficiaries, which is, on average, 57 percent.

Traditional Medicaid Funding

While both the Senate and House versions would reduce federal funding to the Medicaid program, the Senate version replaces the program’s current open-ended entitlement with individual beneficiary caps. Beginning in 2020, states would be eligible to receive federal block grants instead of the proposed funding cap if they meet specific requirements and agree to cover 14 essential services.  States may also begin to implement optional work requirements for non-disabled, non-elderly, and non-pregnant beneficiaries.

Looking Back—and Ahead

The ACA’s collapsing state exchanges shows just how difficult and costly it is to expand and ensure coverage.  Theoretically, the ACA’s individual and employer mandates would alleviate the burden to payers by requiring young and healthy Americans to buy health insurance.  The ensuing support from these mandates did not come through as expected, causing payers to leave state exchanges—and leaving many Americans with little or no insurance options.  Coverage and care are two critical—but distinct—components to healthcare.  Policymakers’ efforts to provide insurance to all Americans is misguided if that coverage does not equate to quality care.

The Congressional Budget Office, which provides price estimates to legislation, is currently assessing BCRA.  This cost assessment will shed more light on who would pay more or less for premiums and how the bill would affect the market stability of insurance companies.

Healthcare reform is a complex and complicated process that will impact the way we provide and receive healthcare.  A lot needs to happen before we see these changes—including enough support among Senate Republican to pass BCRA.  The process continues to be partisan and Republicans are finding that repealing and replacing the ACA is not easy.  Stay tuned.