HEALTHCARE UNPLUG

Taino Consultants Inc.Dr. Jose I. Delgado

TOPICS Affordable Care Act (ACA) Medicare Access and CHIP Reauthorization Act (MACRA)

AFFORDABLE CARE ACT (ACA) Section 1557

Summary Required Actions

Health Insurance Increases Expected Behavior Alternatives

MACRA Alternative Payment System

Categories Compliance

Security Risk Assessments Chronic Conditions

Diabetic Care Weight Loss

ICD 10

ACA SECTION 1557 Prohibits discrimination in health care

activities Race Color National origin Age Disability, and Sex

ACA SECTION 1557 - APPLICABILITY Covered Entities

“every health program or activity, any part of which receives Federal financial assistance or made available by”

Example: Health care providers, such as physicians’ practices, hospitals, community health centers, nursing facilities, home health agencies, clinical laboratories, residential or community-based treatment facilities, intermediate care facilities for people with intellectual/developmental disabilities, hospices, and organ procurement centers

ACA SECTION 1557 – DECISION TREEMedicaid Provider

Medicare Provider

Receive HHS $$

Receive HIT

FundsCoveredEntity

Doesn’t Apply

YES

YES

YES

YES

NO

NO

NO

ACA SECTION 1557 - ACTIONS Immediate

Develop and implement an effective written language access plan.

Provide free, accurate, and timely language assistance services for individuals with Limited English Proficiency (LEP).

Post a notice regarding non-discrimination policies. Provide non-discrimination notice in English and include

taglines in the top 15 languages spoken by individuals with LEP within the state.

If less than 15 employees just the top 2 languages other than English

ACA SECTION 1557 – TAG LINE English

[Name of covered entity] complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Spanish (Español) [Name of coveredentity] cumple con las leyes federales de

derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

French Creole (Haitian Creole) [Name of covered entity] konfòmaklwasoudwasivil Federal

kiaplikabyo e li pa fèdiskriminasyonsoubazras, koulè, peyiorijin, laj, enfimiteoswasèks.

ACA HEALTH INSURANCE Average increase is 25 percent Carriers pulling out of the market 1.4 million people will be lose their plan

ACA HEALTH INSURANCE Risk Corridor completely ineffective

Insurers requested $2.87 billion Government paid $362 million

17 of 23 approved healthcare cooperatives folded

3 of the 5 largest insurers have decided to significantly pull back United, Aetna and Humana

ACA HEALTH INSURANCE – EXPECTED BEHAVIOR

Consumers picking higher deductible plans or no plans

Employees moving to jobs with health insurance coverage

Narrow Networks

ACA HEALTH INSURANCE - ALTERNATIVES Increase outreach for self paying

customers Create and nurture networks Be creative with benefit plans

Life Insurance Long Term Care

MACRA Merit Based Incentive Payment System

(MIPS) Modified fee-for-service model Expected Model for Majority

Alternative Payment System (APM)

MACRA – MIPS COMPONENTS

Quality RepAlternative

Payment System (APM)orting (PQRS)

Resource Use or Cost (Value-based

Modifier)

Advancing Care Information (MU)

Clinical practice improvement

activities

MIPS

MACRA – CHRONIC CONDITIONS Diabetic Care

Identify Patients Annual Requirements

Education Vision Foot Care Nutrition

Weight Loss Documentation

MACRA - QUALITY REPORTING BASICS

• 50% in of total MIPS score in 2019, phases down to 30% in 2022• Full-year reporting periodMIPS weight

• 6 measures required out of 200 available, reported by physicians• Include one cross-cutting measure, one outcome measure (if

outcome measure not available, substitute with choice of another “high priority” measure)

• 3 population health measures from former VBM calculated by CMS administratively via claims (groups of 10 or more only)

Measures

• Each measure worth up to 10 points• 90 total points for groups >10• 80 total points for smaller groups (all-cause hospital readmission

measure not applied)• Distribution of points for each measure based on performance

benchmarks (80% for claims reporting, 90% for registry reporting)

Scoring

• Up to 4 bonus points may be added for reporting on outcome and high priority measures

• 1 bonus point possible for each measure captured and reported through CEHRT

• Total bonus points capped at 5% of those used to calculate the quality score

Bonus points

MACRA - COMPLIANCE (MEANINGFUL USE) 50 point base score threshold still

100% Security attestation required Measures reduced Exclusions eliminated Full year reporting

19

MACRA - TIMELINE 2016

2017

2018

2019

2020

2021

2022

2023

2024

2025

2026 on

Fee Schedule Updates

MIPS

QPs in Adv.APMs

0.5% annual baseline updates

No annual baseline updates

4%

5%

7%

9%Max

Adjustment(additional bonuses possible)

0.25% or 0.75

%

9%

9%

9%

5% bonus

MACRA – ICD 10

MACRA - ICD 10 October 1st Significance Trends Recommendations

SUMMARY Affordable Care Act (ACA) Medicare Access and CHIP Reauthorization Act (MACRA)

RESOURCES Taino Consultants Inc.

www.tainoconsultants.com Drdelgado@tainoconsultants.com

Diabetic Centers for excellence Lavern Dowell

People Helping People josedelgado@tainoconsultants.com

Stat Medical Telephone 904-824-4990 www.statmos.com

Vassallo Health Center Telephone 904-797-7722