Medicare Part D

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Medicare Part D Powered By Docstoc
					The ABC’s of
 Advocacy
 South Carolina Cancer Alliance
                 &
South Carolina Oncology Society
        Annual Meeting
                                                           Nancy Davenport-Ennis, CEO
       Friday, May 5, 2006                             National Patient Advocate Foundation
          Columbia, SC                                           725 15th St. NW
                                                                     10th Floor
                                                              Washington, DC 20005
                                                                 1-202-347-8009



National Patient Advocate Foundation                                        Columbia, SC
Established in 1996                    South Carolina Cancer Alliance
                                                                             May 5, 2006
 Actions for Effective Advocacy

Advocacy is a process of communication
different from the mere dissemination of
information and education.
         It seeks support, commitment and recognition
         from policy makers and the general public.

         It provides solutions and support on specific
         issues.

         It relies on the collection of accurate information to
         inform activities.
 National Patient Advocate Foundation                                    Columbia, SC
 Established in 1996                    South Carolina Cancer Alliance
                                                                          May 5, 2006
                        Advocacy Basics

Creates Awareness of the Magnitude of the Problem.

Seeks to Diminish and Remove Public Policy Barriers
to Clear Solutions.

Campaigns for Effective and Sustainable Action.

Aims to Influence decision makers at every level.

Can Call on a Broad Network of Participants.

Can be Activated Quickly.


National Patient Advocate Foundation                                    Columbia, SC
Established in 1996                    South Carolina Cancer Alliance
                                                                         May 5, 2006
              Clarifying the Message

Know your message
      Clearly identifies the issue/issues.

Know your audience
      Focuses on Target Audiences such as government
      officials, policy makers, employers, health
      professionals, the media.

Know your strategic process for the effective
delivery of your message
      Has Clear Expectations of Results (More funding,
      More research, Less Discrimination).


National Patient Advocate Foundation                                    Columbia, SC
Established in 1996                    South Carolina Cancer Alliance
                                                                         May 5, 2006
  NPAF 2006 Federal Statements of
      Principles and Policies

Assisting Uninsured                               Drug Safety and Efficacy
Americans                                         Standards

Health Information                                Appropriations Priorities
Technology
                                                  Prescription Drug
Association Health Plans                          Reimportation

Pay for Performance                               Stem Cell Research
(P4P)

Physician Payment

National Patient Advocate Foundation                                    Columbia, SC
Established in 1996                    South Carolina Cancer Alliance
                                                                         May 5, 2006
                                     Pending Bills
Pay for Performance
H. R. 3617 – Medicare Value-Based Purchasing for Physician’s
   Services Act of 2005
  Would establish physician payment incentives based on meeting quality and
  efficiency standards; would replace Sustainable Growth Rate (SGR) feature
  of physician reimbursement schedule with payment update based on
  Medicare Economic Index (MEI).
  Sponsor: Rep. Nancy L. Johnson (R-CT) (introduced 7/29/2005).
  Status: 8/5/2005 Referred to House Subcommittee on Health. (46
  cosponsors)

S. 1356 – Medicare Value Purchasing Act of 2005
  Would provide value-based payments (ranging from 1% in 2007 to 2% in
  2011 of Medicare payments) to hospitals, physicians and practitioners,
  health plans, end stage renal disease (ESRD) providers and facilities, and
  home health agencies.
  Sponsor: Sen. Charles Grassley (R-IA) (introduced 6/30/2005).
  Status: 6/30/2005 Referred to Senate Committee on Finance. (5
  cosponsors)
    National Patient Advocate Foundation                                    Columbia, SC
    Established in 1996                    South Carolina Cancer Alliance
                                                                             May 5, 2006
                                      Pending Bills
Health IT
H.R. 4157 – Health Information Technology Promotion Act of 2005
  Would create statutory safe harbor to allow hospitals/providers to provide
  health IT and training, and require development of national strategic plan.
  Sponsor: Rep. Nancy L. Johnson (R-CT) (introduced 10/27/2005).
  Status: 11/4/2005 Referred to House Subcommittee on Health. (45
  cosponsors)

H.R. 747 – National Health Information Incentive Act of 2005
  Would provide loans, grants and tax subsidies, including refundable tax
  credit to small health care providers to support IT acquisition.
  Sponsor: Rep. Charles A. Gonzalez (D-TX) (introduced 2/10/2005).
  Status: 2/25/2005 Referred to House Subcommittee on Health. (51
  cosponsors)

H.R. 4142 – Medicaid Transformation Grant Act of 2005
  Would provide grants to state Medicaid programs for IT.
  Sponsor: Rep. Tim Murphy (R-PA) (introduced 10/25/2005).
  Status: 11/4/2005 Referred to House Subcommittee on Health. (No
  cosponsors).
     National Patient Advocate Foundation                                    Columbia, SC
     Established in 1996                    South Carolina Cancer Alliance
                                                                              May 5, 2006
                                  Pending Bills

Health IT
S. 1418 – Wired for Health Care Quality Act
  Would establish quality measurement system, require
  development/adoption of standards/criteria for national interoperable
  system, and provide grants.
  Sponsor: Sen. Michael B. Enzi (R-WY) (introduced 7/18/2005); Related
  Bills: H.R. 4642, S. 1355.
  Status: 12/16/2005 Referred to House Subcommittee on Health.
  Senate Reports: 109-111. (38 cosponsors)

S. 1227 – Health Information Technology Act of 2005
  Would provide grants and tax incentives to health care entities for IT.
  Medicare payment amounts would be adjusted for providers who use IT
  with applications that improve quality/accuracy.
  Sponsor: Sen. Debbie Stabenow (D-MI) (introduced 6/13/2005).
  Status: 6/13/2005 Referred to Senate Committee on Finance. (4
  cosponsors)


 National Patient Advocate Foundation                                    Columbia, SC
 Established in 1996                    South Carolina Cancer Alliance
                                                                          May 5, 2006
                                   Pending Bills

S. 2340 – Community Cancer Care Preservation Act –
   Would require drug price updates as changes occur;
   remove the prompt pay discount from the average
   sales price (ASP); extend 2005 quality cancer care
   demonstration project through 2006; provide 2%
   increase payments for drug handling/storage; and
   requires the Secretary to report on cancer care and
   plans to increase clinical trial participation.
   Sponsor: Sen. Arlen Specter (R-PA) (introduced
   2/28/2006).
   Status: 2/28/2006 Referred to Senate Committee on
   Finance. (4 cosponsors)

  National Patient Advocate Foundation                                    Columbia, SC
  Established in 1996                    South Carolina Cancer Alliance
                                                                           May 5, 2006
                                   Collaboration

A Key Ingredient to Legislative & Policy Success

  Local Access Projects
  Health Information Technology Working Group
  Consumer Empowerment Working Group
  One Voice Against Cancer
  Cancer Leadership Council
  Advocates Alliance for Action

Patient Congress VII ~ June 26-28 ~ Washington, D.C.
www.pc.patientadvocate.org


  National Patient Advocate Foundation                                    Columbia, SC
  Established in 1996                    South Carolina Cancer Alliance
                                                                           May 5, 2006
American Health Information Community
                (AHIC)
                  The Consumer Empowerment Workgroup
Co-Chairs:
   Nancy Davenport-Ennis, NPAF
   Linda Springer, Director, Office of Personnel Management
   Karen Bell and Kelly Cronin from the Office of the National Coordinator, DHHS, will
   serve as coordinators for the workgroup.
Members:
  Jodi Daniel, ONC/DHHS
  Lorraine Doo, CMS
  Kevin Hutchinson, Surescripts
  Robert Kolodner, Veterans Health Administration
  David Lansky, Markle Foundation
  Ross Martin, Pfizer
  Susan McAndrew, Dept. Health and Human Services
  David McLean, RxHub
  Davette Murray, Tri-Service Infrastructure Management Program Office
  Nancy Nielsen, American Medical Association
  Lynne Rosenthal, National Institute of Standards and Technology
  Scott Serota, BCBS Assoc.
  Steve Shihadeh, Microsoft
  Myrl Weinberg, National Health Council
     National Patient Advocate Foundation                                       Columbia, SC
     Established in 1996                    South Carolina Cancer Alliance
                                                                                 May 5, 2006
American Health Information Community
                (AHIC)

 The AHIC and the Consumer Empowerment Workgroup
 recognize that the following universal components of Health IT
 must be addressed:

    Portability                                    Certification
    Affordability                                  Privacy
    Interoperability
                                                   Security

 The Consumer Empowerment Workgroup:

 The Workgroup will conduct a series of ten four-hour conference
 calls/meetings to be held throughout 2006. These calls/meetings will
 comply with Federal Advisory Committee requirements.


   National Patient Advocate Foundation                                    Columbia, SC
   Established in 1996                    South Carolina Cancer Alliance
                                                                            May 5, 2006
      Global Access Project Mission

The purpose of this initiative, in part, is to develop a
comprehensive information resource to assist key
policymakers in Congress and at the Centers for
Medicare and Medicaid Services (CMS) as they examine
reimbursement corrections and consider recommended
steps of implementation of the new Medicare law.


As changes may need to be made in the law and
policymakers have requested assistance in monitoring
the impact of this implementation, it is hoped that this
effort will help inform this process and work to ensure
access to quality cancer care.

  National Patient Advocate Foundation                                    Columbia, SC
  Established in 1996                    South Carolina Cancer Alliance
                                                                           May 5, 2006
                       Global Access Project
                       Member Organizations
ALCASE                                               International Oncology Network (ION)
American Cancer Society                              *Institute of Health, Georgia State
*Amgen                                               *Leukemia & Lymphoma Society
*Assoc. of Community Cancer Centers (ACCC)           Medimmune
*Assoc. of Oncology Social Workers (AOSW)            Men’s Health Network
Assoc. of Pediatric Oncology Nurses (APON)           Millennium Pharmaceuticals
*Assoc. of Pediatric Oncology Social Work            National Prostate Cancer Coalition
(APOSW)                                              Novartis
AstraZeneca                                          NurseWorks
Aventis                                              *Office of Native Cancer Survivorship (ONCS)
Cancer Research and Prevention Foundation            *Oncology Nursing Society
*Coalition of National Cancer Cooperative            Ovarian Cancer National Alliance
Groups                                               Pfizer
Community Oncology Alliance (COA)                    *SCOOPS!
Eli Lilly                                            The Lance Armstrong Foundation
Friends of Cancer Research                           The Unbroken Circle
Genentech                                            *US Oncology
GlaxoSmithKline                                      US TOO International Prostate Cancer
*Intercultural Cancer Council (ICC)                  Education & Support Network
International Myeloma Foundation                     Y-ME!

                                                    *Indicates participation as a member of the
                                                    Gap Steering Committee

    National Patient Advocate Foundation                                                   Columbia, SC
    Established in 1996                    South Carolina Cancer Alliance
                                                                                            May 5, 2006
             Global Access Project Studies
2004 & 2005 Studies
   Practice Expense Reimbursement for Cancer Care Services: Methodology
   Evaluation & Assessment of Alternative Policies, Donald W. Moran, The Moran
   Company

   Geographic Proximity of Cancer Care, Kathleen Dalton, PhD, University of North
   Carolina

   Changes in Oncology Practices in the First Quarter of 2005, Survey of Oncology
   Nursing Society Members, Donald Moran, The Moran Company

   Documentation of Pharmacy Cost in the Preparation of Chemotherapy Infusions in
   Academic and Community-Based Oncology Practices, University of Utah

2006 Studies
   Patient Access to Cancer Clinical Trails: An Assessment and Validation of the Role
   of Community Oncology Practice, Robert Comis, MD, Coalition of Cancer
   Cooperative Groups

   Medicare Modernization Act and Changes In Reimbursement for Outpatient
   Chemotherapy: Do Patients Perceive Changes in Access to Care?, Kevin Schulman,
   M.D., Duke University
      National Patient Advocate Foundation                                    Columbia, SC
      Established in 1996                    South Carolina Cancer Alliance
                                                                               May 5, 2006
      Global Access Project Outreach


Prior release of completed studies, NPAF and
  GAP representatives, brief the following:

       MedPAC
       Centers for Medicare and Medicaid Services (CMS)
       The White House
       Congressional Committees of Jurisdiction
              House Ways & Means
              House Energy & Commerce Committee
              Senate Finance Committee

 National Patient Advocate Foundation                                    Columbia, SC
 Established in 1996                    South Carolina Cancer Alliance
                                                                          May 5, 2006
National Patient Advocate Foundation



                        State Initiatives
                                        Prepared by


                            Leslie Degnan
               Vice President, State Government Affairs




 National Patient Advocate Foundation                                       Columbia, SC
 Established in 1996                       South Carolina Cancer Alliance
                                                                             May 5, 2006
               State Government Affairs

Leslie Degnan, VP (Washington, DC)
Wendy Malcolmson, Regional Director (Seattle, WA)
Over 60 State Policy Liaisons
   Volunteers concerned about access issues at state level
   Physicians, nurses, social workers, PR professionals,
   healthcare system professionals, survivors, families of
   patients, professional advocates
   Full-time, part-time, retired, student
   Learn NPAF positions and priorities
   Learn State health policy climate and meet thought leaders
     (legislators, physicians, community stakeholders)
   Educate on issues in dialog and proposed for legislation
   Training, networking, recognition



National Patient Advocate Foundation                                    Columbia, SC
Established in 1996                    South Carolina Cancer Alliance
                                                                         May 5, 2006
               NPAF Presence in the CMS Regions

I. Boston (CT, ME, MA, NH, RI, VT) 2 SPLs, 59 AAA

II. New York (NY, NJ, U.S. Virgin Islands and Puerto Rico) 7 SPLs, 156 AAA

III. Philadelphia (DE, MD, PA, VA, WV, and DC)                    7 SPLs, 208 AAA

IV. Atlanta (AL, NC, SC, FL, GA, KY, MS, TN)                  14 SPLs, 511 AAA

V. Chicago (IL, IN, MI, MN, OH, WI)                7 SPLs, 158 AAA

VI. Dallas (AR, LA, NM, OK, TX)                4 SPLs, 561 AAA

VII Kansas City (IA, KS, MO, NE)                 7 SPLs, 109 AAA

VIII. Denver (CO, MT, ND, SD, UT, WY)                  6 SPLs, 44 AAA

IX. San Francisco (AZ, CA, HI, NE)                7 SPLs, 161 AAA

X. Seattle (AK, ID, OR, WA)                6 SPLs, 402 AAA

       TOTAL SPLs = 67                    (Advocates Alliance for Action) AAA= 2,369

   National Patient Advocate Foundation                                             Columbia, SC
   Established in 1996                           South Carolina Cancer Alliance
                                                                                     May 5, 2006
                                 CMS Regions




National Patient Advocate Foundation                                    Columbia, SC
Established in 1996                    South Carolina Cancer Alliance
                                                                         May 5, 2006
                Challenges in the States


Uninsured in America rose to 45.8 million- 15.7% of
the population

Employer-sponsored insurance continues to decline

16 million Americans are underinsured

Public program enrollment—Medicaid and the State
Children’s Health Insurance Programs (SCHIP)—is
increasing in most states


National Patient Advocate Foundation                                    Columbia, SC
Established in 1996                    South Carolina Cancer Alliance
                                                                         May 5, 2006
    States are Working on Solutions

Medicaid and State Children’s Health Insurance Program
(SCHIP) Section 1115 waivers, and the Health Insurance
Flexibility and Accountability Demonstration Initiative
(HIFA)

Creative financing and coverage demonstrations:
California, Florida, Iowa, Massachusetts, New Mexico,
Oklahoma, Vermont, Arkansas

Limited benefit plans, group purchasing arrangements,
premium assistance to small business.

Deficit Reduction Act 2005 reduces funds for public
programs while increasing states’ flexibility to innovate



National Patient Advocate Foundation                                    Columbia, SC
Established in 1996                    South Carolina Cancer Alliance
                                                                         May 5, 2006
                  Massachusetts H. 4850

                           “An Act Providing Access to Affordable,
                             Quality, Accountable Health Care”

      Signed into law April 12, 2006

      Individual and Employer Mandates
            Requires individuals to independently obtain and maintain a minimum level
            of health insurance by July 2007 (on 2008 tax form, coverage verified by
            database; minimum level by age and rate published each Dec 1) Penalty-
            50% of a minimum monthly premium; forfeiture of tax refund. (Exceptions:
            religion, hardship, no affordable coverage)
            Requires employers (with 11 or more employees) to make a ―fair and
            reasonable premium contribution‖ to a company health plan or an annual
            ―fair share employer contribution‖ of $295 per FTE
            Employers who do not provide health plans also face a 10-100% ―free rider‖
            surcharge for any employee who accesses the uncompensated care pool
            (after $50,000)




National Patient Advocate Foundation                                             Columbia, SC
Established in 1996                       South Carolina Cancer Alliance
                                                                                  May 5, 2006
                  Massachusetts H. 4950


           Cafeteria Plan Mandate
           The Health Insurance Connector
           Insurance Market Reforms
           Health Insurance Subsidies
           Medicaid Funds Shift
           A new Health Safety Net
              Office and Fund


National Patient Advocate Foundation                                    Columbia, SC
Established in 1996                    South Carolina Cancer Alliance
                                                                         May 5, 2006
                 Legislation in the States

MISSOURI
      SB 1231 to make cancer a qualifying
      diagnosis for Medicaid—IN COMMITTEE
      HB 1089 to cover routine care costs for
      patients in Phase I or Phase II clinical trials—
      BACK TO SENATE


WYOMING
      SF0058 to expand SCHIP to parents of
      enrolled children—PASSED

National Patient Advocate Foundation                                    Columbia, SC
Established in 1996                    South Carolina Cancer Alliance
                                                                         May 5, 2006
          proposals we are examining

South Carolina legislation to raise cigarette taxes
and direct revenues to Medicaid and SCHIP
expansion- several different proposals with different
tax increase: we hope to see one support Medicaid
and SCHIP expansion

Minnesota SF 3380 to provide medical treatment
for breast or cervical cancer

New York A5003A to require insurance policies to
cover diagnosis and treatment of lymphedema


National Patient Advocate Foundation                                    Columbia, SC
Established in 1996                    South Carolina Cancer Alliance
                                                                         May 5, 2006
      Patient Advocate Day Proclamation

   Whereas: Access to healthcare is a basic human need and a shared societal
   responsibility; and

   Whereas: One patient who cannot access medical treatment or survive the financial
   hardship of illness is one patient too many; and

   Whereas: The experience of a serious diagnosis must open the patient’s door to
   relevant clinical information, empowerment within the medical care system, timely and
   sustained medical care and intervention, an ability to efficiently and effectively reach
   both well-informed, independent decisions, and the benefit of appropriate support which
   removes barriers to this care and empowerment; and

   Whereas: The challenging complexity of ensuring healthcare to those in need must not
   deter or distract us from the urgency of finding and creating solutions to this persistent
   problem which requires immediate relief now; and

   Whereas: We are certain that only the continuous, comprehensive, cooperative, and
   collaborative action of [Your State’s] government, private industry, healthcare
   providers, and citizens can and must surmount this challenge;

   And So: The State of ______ affirms its commitment to progressive, fiscally sound,
   fair, and effective healthcare for every [State Citizen], and stands in voice and action as
   an advocate for the patient now and in preparation for when the challenge is greatest.



National Patient Advocate Foundation                                                  Columbia, SC
Established in 1996                       South Carolina Cancer Alliance
                                                                                       May 5, 2006
                 The First Proclamations




National Patient Advocate Foundation                                    Columbia, SC
Established in 1996                    South Carolina Cancer Alliance
                                                                         May 5, 2006
                               South Carolina




National Patient Advocate Foundation                                    Columbia, SC
Established in 1996                    South Carolina Cancer Alliance
                                                                         May 5, 2006
                                              Contact Us




700 Thimble Shoals Blvd                       700 Thimble Shoals Blvd.            725 15th St. NW
Suite 200                                     Suite 201                           10th Floor
Newport News, VA 23606                        Newport News, VA 23606              Washington, DC 20005


Phone:       1-800-532-5274                   Phone: 1-866-512-3861               Phone: (202)-347-8009
Fax:         (757) 873-8999                   Fax:    (757) 282-7885              Fax:   (202) 347-5579
www.patientadvocate.org                       www.copays.org                      www.npaf.org
info@patientadvocate.org                      pap@patientadvocate.org             action@npaf.org


       National Patient Advocate Foundation                                                      Columbia, SC
       Established in 1996                             South Carolina Cancer Alliance
                                                                                                  May 5, 2006

				
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