HHS issues final rule on insurance exchanges

March 12, 2012 | Mary Mosquera, Contributing Editor


WASHINGTON – The Department of Health and Human Services has released its final rule on the establishment of health insurance exchanges - online marketplaces. The rule also includes provisions for qualified health plans and exchange functions in the individual market.


The final rule, which combines what originally had been separate proposed rules published in July and August 2011, encompasses the key functions of exchanges related to eligibility, enrollment and plan participation and management. The department received more than 24,781 comments on the proposed rules.


HHS seeks further comments from the public on several sections, which are issued as interim final rules, related to options for conducting eligibility determinations, the ability of a state to permit agents and brokers to assist qualified individuals, and Medicaid and Children’s Health Insurance Program.


The 644-page rule appeared March 12 in a preview section of the Federal Register. HHS will officially publish the rule on March 27.


The policies incorporated in the rule give states more flexibility to design and create their exchanges - websites - where individuals and small businesses will be able to shop for and compare health coverage. Exchanges are scheduled to go live in 2014 under the health reform law. “Exchanges will offer Americans, competition, choice and clout,” the final rule said.


The rule offers guidance about the options on how to structure exchanges in setting standards for establishing exchanges, setting up a small business health options program (SHOP), performing the basic functions of an exchange, and certifying health plans for participation in the exchange.


The rule also provides guidance for establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.


Boosting competition


Insurers will have to compete for their customers’ business, said Health and Human Services Secretary Kathleen Sebelius. “More competition will drive down costs and exchanges will give individuals and small businesses the same purchasing power big businesses have today,” she said in a statement.


The final rule makes sure that exchanges will coordinate with Medicaid, CHIP, and the Basic Health Program so that an applicant experiences a seamless eligibility and enrollment process regardless of where he or she submits an application.


In response to comments, the final rule provides two ways for exchanges to interact with Medicaid agencies when making eligibility determinations. Exchanges can conduct eligibility determinations for Medicaid and for advance payment of premium tax credits, or the exchange will make a preliminary eligibility assessment and then turn it over to the state Medicaid agency for final determination.


Also, a state-based exchange may determine eligibility for advance payments of the premium tax credit and cost-sharing reductions, or it could be approved ifHHS makes determinations for these functions.


HHS previously provided a total of $50 million to all states except Alaska, which refused it, to begin to plan the exchanges. Recently, 33 States and the District of Columbia have received more than $667 million in establishment grants to begin building exchanges.


The federal government will put in place an exchange for states that choose not to establish one or will not have one operational by 2014.


The health reform law also provides for a premium tax credit for eligible individuals who enroll in a qualified health plan through an exchange to reduce the cost-sharing obligation of eligible individuals.


HHS said it has worked with states, small businesses, consumers, and health insurance plans and sought public comments to come up with the rule’s provisions.




http://www.healthcareitnews.com/news/hhs-issues-final-rule-insurance-exchanges 

Local schools join push for healthier eating

http://www.sbsun.com/ci_20097651

Will Bigham, Staff Writer First lady Michelle Obama's push to improve the quality of food served in U.S. schools appears to be bearing fruit locally. "Childhood obesity is a big buzz topic right now," said Cinde Stone, director of nutrition services at the Rialto Unified School District. "I think there's studies that show our nation as a whole is overweight. I think they're trying to help fix that problem." In keeping with the first lady's goal, the U.S. Department of Agriculture has been adjusting its school meal requirements so that districts must serve more fruits, vegetables and whole grains, and less salt. And for the first time, the government has set maximum calorie counts for meals served in schools. Previous regulations required only a minimum calorie count. The new regulations will be phased in beginning in the 2012-13 school year, and many local districts are already adjusting their menus. "It's been quite a transition because there are a lot of kids, particularly in this area, that grew up eating fast food," said Rose Fennell, nutrition specialist with the San Bernardino City Unified School District. "And so they like that profile of the food that they're used to getting," Fennell added. "They're used to fried food that's very salty. It's a transition for them to come to the schools and have things that are not fried, that are not really that high in sodium. So it's a challenge." Starting next school year, districts must serve each student up to a cup and a half of fruits and vegetables. Current regulations call for three-quarters of a cup of the foods, Fennell said. Next year the government will also require that more than half the grains served at schools be whole grain. Current laws encourage but don't require that whole grains be served, Fennell said. "There's been such a problem with childhood obesity, kids becoming diabetic at a very young age," Fennell said. In the Rialto district, Students eat healthy food during lunchtime Friday at Kordyak Elementary School in Rialto. (LaFonzo Carter/Staff Photographer) officials have instituted a program where students are served local produce. The practice is encouraged by the U.S. Department of Agriculture, Stone said. One hundred percent of the oranges served by the district are produced locally by the Mentone-based Inland Orange Conservancy. Stone said most of the fruit is from groves in Redlands and Highland. There's a grove in Rialto that Stone said she's approached about purchasing oranges. "I feel very confident that it won't be long until we're working with him," Stone said. To help it increase the amount of produce it serves, the Upland Unified School District has purchased a new six-food salad bar to replace a salad bar about half that size at Baldy View Elementary School. "If it goes well I'm going to go ahead and order nine more," said Food Service Director Sherry Conrad. The district has 10 elementary schools. Conrad has worked in the district's food service department for almost 25 years. She's seen soda removed from Upland schools, as well as french fries and other foods considered unhealthy. "We used to serve those kinds of foods as well, but we've gotten away from that," Conrad said. She said she understands the need for change in school menus. "There are so many children that are not eating properly right now," Conrad said. "Parents find it easy to go to McDonald's, I guess." The challenge for schools is finding healthy foods that children like enough to eat, Conrad said. "I'm going to gradually go in to make my changes, and maybe the kids will enjoy it," Conrad said. If students won't eat food served at school, they still have the option of bringing outside foods to school such as soda, candy and chips. "It's unbelievable," Conrad said of some students' lunches brought from home. "It's kind of sad."

Many Returning Home from Prison, War: More Services Needed

By Carla María Guerrero

After leaving prison, Stacy Johnson (left) and Lori Hogg found the services they needed at A New Way of Life to stay off the streets and reintegrate into the community. (Photo by Joshua H. Busch)

Stacy Johnson had no idea what to expect when she was dropped off last August in front of a well-kept home in a quiet neighborhood in South Los Angeles. The 45-year-old had just been released early from serving her third prison sentence. She arrived at A New Way of Life Reentry Project hoping to make a fresh beginning after what had been a tumultuous twenty years.

Every year thousands of men and women like Johnson leave California prisons and return to South L.A. in need of jobs, housing and other supportive services. Their numbers could grow even higher under the state’s new prison “realignment” law, which transfers responsibility for “nonviolent, nonsexual, nonserious” felony offenders from state to county authorities.

According to Los Angeles County’s Criminal Justice Committee, an estimated 9,000 men and women who have served their prison sentences will be released to the county’s supervision by midyear and nearly 15,000 by mid-2013.

At the same time, the end of the Iraq War means the return of a significant number of veterans to the community. They share many of the same critical needs for jobs, housing and health services as those exiting prison. For both populations, locating these services in a community affected by deep budget cuts and the economic recession can be difficult.
But once found, these services can make a huge difference in whether an individual coming back from war or prison successfully reintegrates into the community.

Crucial Help
For Johnson, connecting with A New Way of Life and its founder, Susan Burton, has already changed her life immeasurably. She is in school full time and has been sober for almost three years. Eventually she would like to find a full time job and get her own place.
“I owe [Burton] everything. I came out of prison with nothing. I would’ve been back on the streets, probably using [drugs] again and staying in motels,” said Johnson, who knows firsthand how easy it is to fall prey to addiction.

At 22, Johnson started using crack cocaine and her life started unraveling. That same year, she was convicted of voluntary manslaughter after she picked up a knife to protect herself from being raped. Her assailant died and Johnson got twelve years in prison. After leaving prison she tried to rebuild her life around a new job and a new boyfriend. But he was abusive. She turned to drugs again, lost her job and her freedom, and gained one strike.
After serving two years, she lived in motels or on the streets and took drugs to numb the desolation. “When you are on drugs, you are weak. You are so vulnerable,” Johnson said. She went to jail a third time after being arrested for crack cocaine possession.

According to the California Department of Corrections and Rehabilitation, the state has one of the highest recidivism rates in the country. Nearly seven in ten former inmates will return to prison within three years.

Realign Priorities
For Cpl. Lauren Johnson, a 28-year-old African-American veteran of the Iraq War, knowing about the services and support available is key to successfully reintegrating back into communities.

“My experience was different from most veterans returning home because I was knowledgeable about the resources and services available to me,” she said. Originally from a Texas community with a strong military presence and culture, Lauren Johnson knew what benefits to tap into to help pay for school after her tour in Iraq.

Now working for Congresswoman Karen Bass, Lauren Johnson connects veterans with resources and services in South L.A., including referrals to Veterans Affairs and local organizations that provide housing, employment training and other services.

“It is imperative for us to mobilize for veterans once they come home. They’re used to unit cohesion and sometimes it can be a bit scary when you no longer have that camaraderie and that network you’ve been used to,” she said.

Social service advocates fear additional budget cuts will further erode the safety net in South L.A. at one of the most crucial moments.

“There needs to be an investment in housing, prevention, intervention and education … instead of systems of supervision and further incarceration,” A New Way of Life founder Burton said. “There needs to be a realignment of investment into people and communities so that crime won’t rise but opportunities for jobs and training programs will.”

Carla María Guerrero is the communications assistant at Community Coalition