Docstoc

The Role of School-Based Health Care in the Health Care Reform

Document Sample
The Role of School-Based Health Care in the Health Care Reform Powered By Docstoc
					The Role of School-Based
Health Care in the Health
     Care Reform Debate


Nan Gaylord Ph.D., R.N., C.P.N.P.

Friday, April 16, 2010
3:30 p.m. – 4:45 p.m.



                     1
  Speaker Disclosure


I have no financial relationships
  to disclose.
               AND

I will not discuss off label use
  and/or investigational use in my
  presentation.

                   2
   Session Objectives

1. Describe the health care reform
   proposals presently being discussed as
   potential options for the American health
   care system.

2. Discuss the impact of each of the
  proposals on school-based health care.

3. Provide opportunities for participants to
  become involved in health care reform
  initiatives that impact school-based
  health care.
                        3
•  House of Representatives introduced
   HR 3200 bill on 7/19/09
History of Health Care Reform

  •  1913 American Association for Labor
     Legislation's Social Insurance Committee

  •  1916 American Medical Association Insurance
     Committee recommended

  •  1920 American Medical Association opposed

                         1920’s The Depression -
                         more private insurance
                         plans and prepayment
                         plans for hospital workers
                         (nurses), teachers, and
                         firefighters.
History of Health Care Reform

  •  1934 President Franklin D. Roosevelt’s
     Committee on Economic Security suggested
     National Health Insurance

  •  Hospital prepayment plans endured
     and grew: Blue Cross

  •  Model for employer-based group
     insurance

  •  After WWII
    •  Fringe benefits exempt from
       wage and price controls
History of Health Care Reform

             “In the past, the benefits of modern
            medical science have not been
            enjoyed boy our citizens with any
            degree of equality. Nor are they
            today. Nor will they be in the future
            – unless the government is bold
            enough to do something about it.
            We should resolve now that the
            health of this nation is a national
            concern, that financial barriers in the
            way of attaining health shall be
            remove; that the health of all its
            citizens deserve the help of the
            Nation.”

          President Harry S. Truman’s address
            to Congress (1945)
History of Health Care Reform


  •  1948: Truman re-elected and NHI bill
     reintroduced but was opposed by AMA
     and insurers.

  •  1950’s: 45% of Americans had health
     insurance

  •  By 1963: 77% of Americans had
     health insurance
History of Health Care Reform

  •  1960: Kerr-Mills Act

  •  1963: President J.F. Kennedy
     introduced the Medicare bill.

  •  1965: President L.B. Johnson’s State
     of the Union Address

  •  1965: Medicare and Medicaid passed

  •  1971: Senator Ted Kennedy
History of Health Care Reform

•  1972: President Nixon [National Health
   Insurance Partnership Act]
•  1974: President Ford [encouraged
   national health insurance bill]
•  1977: President Carter [rein in costs]
•  1993: President Clinton
•  2009: President Obama
•  House of Representatives introduced
   HR 3200 bill on 7/19/09

•  The President’s Congressional address
   on September 9th provided several
   goals for health care reform
•  Bill further developed jointly by three
   committees
       • Education and Labor
       • Energy and Commerce
       • Ways and Means

•  America’s Affordable Health Care
   Choices Act (H.R. 3962) was
   introduced on 10/29/09

•  Passed November 7, 2009
•  Senate
   •  Two Separate Bills from Two
      Committees
         • Health, Education, Labor, and
           Pensions (H.E.L.P.)
         • Finance

•  The Patient Protection and Affordable
   Care Act (HR 3590 )

•  Passed Dec 24, 2009
•  The House of Representatives passed
   he Patient Protection and Affordable
   Care Act (HR 3590) and the senate
   amendments to HR 3590 on March 21.

•  The Patient Protection and Affordable
   Care Act (HR 3590) was signed into
   law by President Obama on March 23,
   2010.
•  The Health Care and Education
   Reconciliation Act of 2010
  •  House of Representatives on March 21
  •  Senate on March 25 with two provisions
  •  House of Representatives on March 25 the
     amended bill

•  President Obama signed the Health
   Care Reconciliation bill into law on
   Tuesday, March 30, 2010.
 “Congressional Budget Office [CBO]
 and Joint Committee on Taxation [JCT]
 estimate that enacting both pieces of
 legislation—H.R. 3590 and the
 reconciliation proposal— would
 produce a net reduction in federal
 deficits of $138 billion over the 2010–
 2019 period as result of changes in
 direct spending and revenue.”

Douglas W. Elmendorf
Director [CBO]
Health Care Reform and School
       Based Health Care

     •  The Patient Protection and
        Affordable Care Act [Senate Bill
        3590]

     •  Health Care and Education
        Reconciliation Act of 2010
    Senate Bill 3590

•  TITLE I—Quality, Affordable Health
   Care for All Americans

•  TITLE II—Role of Public Programs
  •  Subtitle A—Improved Access to Medicaid
  •  Subtitle B—Enhanced Support for the
     Children’s Health Insurance Program
  •  Subtitle C—Medicaid and CHIP Enrollment
     Simplification
  •  Subtitle L—Maternal and Child Health
     Services
     •  Sec. 2951. Maternal, infant, and early childhood
        home visiting programs.
    Senate Bill 3590

•  TITLE III—Improving the Quality and
   Efficiency of Health Care
  •  Subtitle F—Health Care Quality
     Improvements
      • Sec. 3501. Health care delivery system
        research; Quality improvement technical
        assistance.
      • Sec. 3502. Establishing community health
        teams to support the patient-centered
        medical home.
    Senate Bill 3590

•  TITLE IV—Prevention of Chronic
   Disease and Improving Public Health
  •  Subtitle A—Modernizing Disease
     Prevention and Public Health Systems
     •  Sec. 4003. Clinical and community preventive
        services.
  •  Subtitle B—Increasing Access to Clinical
     Preventive Services
     •  Sec. 4101. School-based health centers.
  •  Subtitle C—Creating Healthier
     Communities
     •  Sec. 4201. Community transformation grants.
Grants for the Establishments of
  School-Based Health Centers

   •  The Secretary of Health and Human
      Services shall establish a program to
      award grants to eligible entities to support
      the operation of school-based health
      centers.

   •  Preference given to those SBHC that serve
      a large population of children eligible for
      the State Medicaid plan.
Grants for the Establishments of
  School-Based Health Centers


   •  Funds are provided for either facility
      expenditures or operating.

   •  The facility expenditures are
      appropriated for each of fiscal years
      2010 through 2013 at $50,000,000.
Grants for the Establishments of
  School-Based Health Centers

   •  Operating Expenses Criteria
     •  Comprehensive Primary Health
          •  (A) PHYSICAL.—Comprehensive health
             assessments, diagnosis, and treatment of minor,
             acute, and chronic medical conditions, and
             referrals to, and follow-up for, specialty care and
             oral health services.
          •  (B) MENTAL HEALTH.—Mental health and
             substance use disorder assessments, crisis
             intervention, counseling, treatment, and referral
             to a continuum of services including emergency
             psychiatric care, community support programs,
             inpatient care, and outpatient programs.
Grants for the Establishments of
  School-Based Health Centers

   •  Operating Expenses Criteria (continued)
      •  Medically Underserved Children and
         Adolescents
        • area designated as a medically underserved
          area
        • a health professional shortage area
        • may include factors indicative of the health
          status
        • the ability of the residents of such area to
          pay for health services
        • the accessibility of such services
        • the availability of health professionals to
          such children and adolescents.
Grants for the Establishments of
  School-Based Health Centers
 •  Criteria necessary to be designated an SBHC
    •  local need;
    •  parental or guardian consent has been obtained;
    •  effort to establish and maintain collaborative
       relationships with other health care providers in
       the catchment area of the SBHC;
    •  provide access during the academic day when
       school is in session and 24-hour coverage
       through an on-call system and through its backup
       health providers to ensure access to services on a
       year-round basis when the school or the SBHC is
       closed;
Grants for the Establishments of
  School-Based Health Centers

   •  Criteria necessary to be designated an
      SBHC
     •  integrated into the school environment and
        will coordinate health services with school
        personnel
     •  the SBHC sponsoring facility assumes all
        responsibility for the SBHC administration,
        operations, and oversight;
     •  HIPPA compliant
      Senate Bill 3590
•  TITLE V—Healthcare Workforce
  •  Subtitle B—Innovations in the Health Care
     Workforce
    •  Sec. 5202. Nursing student loan program.
    •  Sec. 5208. Nurse-managed health clinics.
    •  Sec. 5308. Advanced nursing education grants.
    •  Sec. 5309. Nurse education, practice, and
       retention grants.
    •  Sec. 5310. Loan repayment and scholarship
       program.
    •  Sec. 5311. Nurse faculty loan program.
  •  Subtitle F—Strengthening Primary Care and
     Other Workforce Improvements
    •  Sec. 5509. Graduate nurse education
       demonstration.
    Senate Bill 3590

•  TITLE VI—Transparency and Program
   Integrity

•  TITLE VII—Improving Access to
   Innovative Medical Therapies

•  TITLE VIII—CLASS Act

•  TITLE IX—Revenue Provisions

•  TITLE X—Strengthening Quality,
   Affordable Health Care for All
   Americans (amendments)
Health Care and Education
Reconciliation Act of 2010


•  Three Subdivisions
   • A. Affordable Health Choices
   • B. Medicare and Medicaid
     • Title VII: Medicaid and CHIP
Health Care and Education
Reconciliation Act of 2010

 •  C. Public Health and Workforce
    Development
   • Title I: Community Health Centers
   • Title II: Work Force
      •  Subtitle A: Primary Care Workforce
      •  Subtitle B: Nursing Workforce
   • Title V: Other Provisions
      •  Subtitle B: School-Based Health Clinics
      •  Subtitle D: Grants for comprehensive programs to
         provide education to nurse and create a pipeline to
         nursing
    Title V. Subtitle B:
School-Based Health Clinics


 •  Grant to the SBHC if agrees to provide,
    from non-Federal sources, an amount
    equal to 20 percent of the amount of
    the grant (which may be provided in
    cash or in kind).
    Title V. Subtitle B:
School-Based Health Clinics

 •  Grant to an SBHC if the SBHC
    demonstrates that funds received
    through the grant will not be expended
    for any activity to the extent that
    payment has been made, or can
    reasonably be expected to be made—
    under any insurance policy or health
    benefits program or by an entity which
    provides health services on a prepaid
    basis.
    Title V. Subtitle B:
School-Based Health Clinics


 •  Regulations regarding the
    reimbursement for health services
    provided by SBHCs to individuals
    eligible to receive such services
    through the program under this
    section, including reimbursement
    under any insurance policy or any
    Federal or State health benefits
    program.
    Title V. Subtitle B:
School-Based Health Clinics

•  Provide (either directly or by grant or
   contract) technical and other
   assistance to SBHCs to meet the
   requirements of this section. Such
   assistance may include fiscal and
   program management assistance,
   training in fiscal and program
   management, operational and
   administrative support, and the
   provision of information to the SBHCs
   of the variety of resources available
   under this title and how those
   resources can be best used to meet
   the health needs of the communities
   served by the SBHCs.
    Title V. Subtitle B:
School-Based Health Clinics


 •  The HHS Secretary shall develop and
    implement a plan for evaluating SBHCs
    and monitoring quality performances
    under the awards made under this
    section.
       Timeline 2010
•  Covering Preventive Health Services.

•  Strengthening Community Health Centers and
   the Primary Care Workforce.

•  Increasing Access to Home and Community
   Based Services.

•  Improving Public Health Prevention Efforts.

•  Extending Payment Protections for Rural
   Providers.

•  Establishing a Patient-Centered Outcomes
   Research Institute.

•  Strengthening the Health Care Workforce.
Kaiser Family Foundation
    Timeline for 2011


 Improve access to care by increasing
 funding by $11 billion for community
 health centers and the National Health
 Service Corps over five years;
 establish new programs to support
 school-based health centers and
 nurse-managed health clinics.
  Grant Applications

•  Be ready with a proposal to HHS
   (HRSA or NIH)
•  Complete Public Health Form 398
   today!
•  Support other SBHCs to apply
•  Form coalitions for a stronger
   grant
•  State Children’s Health Insurance
   Program
•  Quality of Care Measures
•  Childhood Obesity
•  Nursing Education
•  Medicare-Medicaid Advanced Primary
   Care Demonstration Initiative
•  Nurse Managed Clinics
•  Community Health Centers
•  Home Visitation
Education Monies:	
  
•  Title I Schools
•  Reauthorization of ESEA/NCLB
•  Community Schools Legislation
•  Special Populations (CSHCN, Learning
   disabilities)
•  “School Readiness”
•  Emergency preparedness
•  Write letters, make phone calls,
   contribute to local media in support of
   health care reform in general and how
   the SBHC contributes to the health of
   school children
•  Get your Representatives to visit a SBHC
•  Communicate with LEAs and principals
   about SBHCs and where they can fit in
   education policy
•  Join NAPNAP, NAPNAP SBHC-SIG,
   NASBHC and get involved
“Today, after almost a century of trying;
today, after over a year of debate; today,
after all the votes have been tallied –- health
insurance reform becomes law in the United
States of America. . . I’m signing this bill for
all the leaders who took up this cause
through the generations -- from Teddy
Roosevelt to Franklin Roosevelt, from Harry
Truman, to Lyndon Johnson, from Bill and
Hillary Clinton, to one of the deans who’s
                             been fighting this so
                             long, John
Dingell. To
     Senator Ted Kennedy.”
                       3/21/10
 “. . . I can't think of a day in the 37
 years that I've been a United States
 senator and the short time I've been
 Vice President that it is more
 appropriately stated. This is a historic
 day.”

Vice-President J. Biden
3/21/10
      Summary


1. Health care reform may provide
  multiple opportunities for SBHCs.
2. Stay informed of the reform
  process and how to contribute
  your expertise.
3. Be alert for the Requests for
  Proposals to support your
  professional work.
                   4
                   5
Questions




       ?
            4
            7
             References

•  Daschle, T. (2008).Critical: What can we do about the health
   care crisis. New York: St Martin Press.

•  Emanuel. E. J. (2008). Healthcare Guaranteed: A simple
   solution for America. New York: Public Affairs.

•  Kaiser Family Foundation. (2009). Health Care Reform
   Timeline
   http://www.kff.org/healthreform/upload/80601.pdf

•  National Assembly of School Based Health. (2010).
   http://www.nasbhc.org/

•  Reid, T.R. (2009). The healing of America: A global quest for
   better cheaper, and fairer health care. New York: Penquin
   Press.                             4
                                     8
Available Bills/ Government
        Documents

•  America’s Affordable Health Care Choices Act (H.R. 3962) on
   10/29/09
    •  http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?
       dbname=111_cong_bills&docid=f:h3962eh.txt.pdf [full text]
    •  http://energycommerce.house.gov/Press_111/health_care/
       hr3962_SUMMARY.pdf [summary]

•  List of the major policy changes between H.R.3200 and the
   Affordable Health Care for America Act (H.R. 3962)
  http://energycommerce.house.gov/Press_111/health_care/
  hr3962_SUMMARY.pdf[summary]

•  Patient Protection and Affordable Care Act (HR 3590 )
   http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?
   dbname=111_cong_bills&docid=f:h3590enr.txt.pdf
Available Bills/ Government
         Documents

 •  Patient Protection and Affordable Care Act and the Health Care
    and Education Reconciliation Act
    http://dpc.senate.gov/healthreformbill/healthbill62.pdf
    (summary)

 •  Health Care and Education Reconciliation Act of 2010.
    http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?
    dbname=111_cong_bills&docid=f:h4872enr.txt.pdf
 •  Financial Report from the Congressional Budget Office
    http://www.cbo.gov/ftpdocs/113xx/doc11379/
    Manager'sAmendmenttoReconciliationProposal.pdf

 •  Medicare-Medicaid Advanced Primary Care Demonstration
    Initiative
    http://healthreform.gov/newsroom/factsheet/
    medicalhomes.html

 •  Top Fourteen Provisions That Will Take Effect Immediately.
    http://energycommerce.house.gov/index.php?
    option=com_content&view=article&id=1687&catid=156&Itemid
    =55

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:3
posted:2/2/2012
language:
pages:50
jianghongl jianghongl http://
About