Now that I'm done with a month of frequent travel (and have partially caught up with the work I couldn't do while on the road,) I hope to return to frequent posts in the ongoing analysis of the health care reform law. The last few posts have looked at the health insurance exchanges and how they will certify health plans as "qualified." Now let's look at how exchanges will work with health plans to improve quality.
Starting in 2015, a qualified health plan may contract with a hospital that has 51 or more beds only if the hospital uses a patient safety evaluation system and if it ensures that each patient receives a comprehensive hospital discharge program. This program must include patient-centered education and counseling, comprehensive discharge planning, and post-discharge follow up from a health care professional. The plan may contract with other types of health care providers that implement health care quality improvement measures as may be required by the federal Department of Health and Human Services. HHS has the ability to make exceptions to these requirements, including adjusting the threshold number of hospital beds.
The exchanges must create programs to award grants (funded by the exchanges, not the federal government) to entities to act as "navigators." These navigators will:
- Conduct public education activities to raise awareness that qualified health plans are available
- Distribute "fair and impartial" information about plan enrollment and the availability of tax credits and cost-sharing reductions to lower the cost of health coverage
- Facilitate enrollment in plans
- Provide referrals to the appropriate public authorities for consumers with grievances, complaints, or questions regarding their plans, coverages, or claim handling
- Provide this information in a manner "culturally and linguistically appropriate" for the populations the exchanges are serving.
The navigators will be entities such as:
- Trade, industry and professional associations
- Commercial fishing industry organizations
- Ranching and farming organizations
- Community and consumer-focused non-profit groups
- Chambers of commerce
- Unions
- Resource partners of the U.S. Small Business Administration
- Licensed insurance agents and brokers (emphasis added)
- Other entities that are capable of performing navigators' duties and that meet other standards (I'll get to them below.)
To be eligible for a navigator grant, the entity must demonstrate to the exchange that it has existing relationships or could readily establish relationships with employers, employees, consumers or self-insured individuals who are likely qualified to enroll in an exchange plan. HHS must set standards for navigators to ensure that they are qualified and licensed (if appropriate) to perform the duties and to avoid conflicts of interest. A navigator cannot:
- Be a health insurance carrier
- Receive any consideration directly or indirectly from a health insurance carrier in connection with the enrollment of qualified individuals or employees in an exchange plan.
HHS must work with the states to set standards to ensure that the information navigators provide is fair, accurate and impartial.
Lastly, exchange plans must abide by the same mental health coverage parity rules that apply to other plans and health insurance policies. Exchanges may not create rules that conflict with other provisions of the health care reform law or regulations that HHS issues under the law.
That brings us to the end of Section 1311. Next time, we'll get into Section 1312, Consumer Choice.
The exchanges must create programs to award grants to entities to act as navigators.
Posted by: zovirax online | July 01, 2011 at 07:09 AM