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Joint Finance Committee Votes Down Insurance Policy Readability Improvements

OCI Hearing on Readability

The Joint Finance motion was inspired by a public hearing, advertised only in the Wisconsin Administrative Register, to hear input on the "Emergency Rule." ABC for Health's Executive Director Bobby Peterson presented testimony at this May 3 hearing, speaking on the importance of consumer protections, the necessary access to information that is lacking, and the feasibility of electronically accessing insurance policies. Erin Aagesen and Jeff Burkhart, representing Wisconsin Literacy and the Literacy Network, respectively, testified to restoring readability to the pre-determined Flesch Reading Score. Physicians like Dr. Paul Smith and members of the community also voiced strong opinions on the importance of readability. No one testified in favor of the emergency rule. What's more, of 55 written testimonies received by OCI, 54 opposed the rule change, and only one was in favor of it. Of the written testimonies, only Health Tradition Health Plan supported rolling back the readability requirements, in a letter signed by Steven Kunes, Executive Director; Alan Krumholz MD, Medical Director; Michael-Eckstein, Director of Sales and Marketing; and Jennifer Oliver, Compliance Officer/Quality Manager.

Read Guy Boulton's May 7 article in the Milwaukee Journal Sentinel: Mandate for easy-to-read health insurance policies dumped.

Vol. 7, No. 9
May 16, 2011

In this issue:

On our website:
HealthWatch Membership
Upcoming Coalition Meetings

Joint Finance Committee To Debate DHS Budget on May 18

The Joint Finance Committee will reconvene on Wednesday, May 18 for a full day with agenda items, including items below concerning the Department of Health Services. Click below to read the budget papers in advance of the meeting:

• Supplemental Security Income -- Reestimate and Program Transfer
• Delete State Family Planning Funding
• Fees for Patient Health Care Records
• "Family Planning Only" MA Optional Eligibility Group

Case Tip

The New Income Maintenance Manual & Request a Fair Hearing

On May 13, Release 11-01 of the Income Maintenance Manual was made, changing some "first steps" in the fair hearing process.

At first glance, the new IMM release appeared to make the appeals process easier for individuals who disagree with a decision from a state-administered program. Upon closer inspection, however, the process for filing an appeal is actually more strict.  

For individuals wishing to request an appeal of a decision for BadgerCare Plus, Medicaid, or Refugee Assistance Program (RAP), or if the individuals requesting an appeal are Child Care participants and providers or SeniorCare participants, they must make their requests for Fair Hearing on the specific Request for Fair Hearing Forms and the member must sign her name on that form.

The old rule used to say:   

OLD: When a request is made orally, [the agency will] put it in writing immediately. If it's made in person, have the client sign it. Forward all hearing requests to the Division of Hearings and Appeals (DHA).

The new rule eliminates the “action step” of the agency reducing the oral request to paper on behalf of the member.

NEW: When a request is made orally, provide the customer the option to put the request in writing immediately. If it's made in person, have the member sign the Request for Fair Hearing form.

There is some leniency in the rule change, however, for individuals receiving FoodShare benefits. The new rule indicates that a FoodShare member may request an appeal of a decision on FoodShare orally, and the agency will transcribe the request into writing immediately. The request will be entered on a “Request for Fair Hearing Form” and faxed to the Division of Hearings and Appeals. The agency must also accept a hearing request on an agency denial of restoration of FoodShare benefits.

Advocacy Tip: When working with a family who wishes to appeal a decision on their benefits, whether it be FoodShare, BadgerCare or other program benefits, insist that the appeal request be made in writing on the required form with a signature. The “Request a Fair Hearing Form” is available online. Keep this link handy and help individuals find, complete, and sign this form to begin their appeal process.

BONUS Case Tip

Changes to Appeal Options for Fully-Insured Coverage Plans

If you receive a denial from your fully-insured (state-governed) health insurance company or from the HIRSP Authority (Health Insurance Risk Sharing Plan), you typically must exhaust all internal grievances before taking any other steps. These internal grievances are informal dispute resolution processes where the insurance company has the “final say” in your claim. Typically there are two. You do have the option of seeking an opinion from an unbiased or independent source. This process, called an “independent review,” allows you to present your medical and insurance documentation to an outside agency called an Independent Review Organization (IRO). The IRO then determines if the insurance company who denied your claim is indeed correct. In previous years, however, the determination of the IRO was binding to both the client and the insurance company. In other words, if the IRO determined that your denial was unreasonable, the insurance company was obligated to cover the claim. If the determination by the IRO upheld the decision of the insurance company, however, you would have no other recourse; the independent review was your last option of appeal.

Beginning in 2011, an individual who exhausts her fully-insured, or state governed, insurance grievances (or HIRSP grievance procedures) still can make an appeal to an IRO. The change in the law, however, impacts what happens next. If the individual is appealing the denial of 1.) a pre-existing condition or 2.) rescission, the final determination by the IRO is binding only to the insurer and NOT the insured individual. This means that if the determination favors the individual, the insurance company is required to cover the treatment in question. If the IRO denies the appeal, the individual is not bound by that decision, but instead has a final option of appealing to state court.

HealthWatch News

New HealthWatch Membership Year is Coming!

A new membership year begins July 1st!

A new membership drive for 2011-2012 is right around the corner! Watch your inbox and mailbox over the next week for information on renewing your membership or joining us for the first time! HealthWatch Wisconsin memberships connect you to great materials, information and events. Join as an individual or as an organization committed to unifying the public health workforce, with emphasis on teaching, training, and information sharing. The membership year runs July 1, 2011-June 30, 2012.

Other Benefits of Joining HealthWatch Wisconsin:

The Landscape of Health Care and Coverage is Changing in Wisconsin! HealthWatch can help! Members will receive publications and materials valued at over $200, FREE with membership. Publications that help you understand, explain and work with public and private insurance programs and navigation strategies are included in your membership, such as: “My Health Reform Guidebook,” the “AdvoKit,” “2011 Resources Guide," "My Medical Debt Survival Guide," "Non-qualified Immigrant Coverage Chart," BadgerCare Plus fact sheets and charts, and more!

Want to watch video trainings at your desk or in the comfort of your own home? HealthWatch Members throughout the 2011-2012 membership year will be eligible to log in to the HealthWatch Training Portal, accessible wherever there is an internet connection. Members also receive significant discounts to training events and conferences.

Plus, stay tuned for information about Packers Ticket Prize Drawings!

Questions? Call HealthWatch Wisconsin staff for more information: (608) 261-6939 ext. 204.

All Aboard! This Summer, Join Up with the BadgerCare+ Express!

HealthWatch continues to plan the “BadgerCare+ Express,” a coordinated, statewide tour of low-enrollment or uninsured areas where HealthWatch Wisconsin staff, members and leaders will educate consumers and service providers about the enrollment, legal and administrative hurdles that families encounter with BadgerCare+ health coverage programs. HealthWatch hopes to make six BadgerCare+ Express stops across Wisconsin, meeting with families and professionals, providing consumer assistance, and most importantly, conducting education on BadgerCare+ programs, complete with printed “3 Steps to Family Health Coverage” kits.

In select locations, ABC for Health's Health Benefits Counselors will convene workshops for individuals, families, and health care professionals to work through the “3 Steps of Family Health Coverage,” to help promote an understanding of the legal requirements of how to get, use, and keep health coverage. Included in these stops, where appropriate, are counseling sessions, going through eligibility requirements, completing applications, troubleshooting denials, facilitating renewals, and conducting education on other health care coverage programs.

Join us in the final stages of planning or sponsorship: if you know of any local end-of-summer events where the BadgerCare+ Express should stop or would like to help out with organizing a stop, please let us know! The Madison stop of the BadgerCare+ Express will be co-sponsored by the Dane County HealthWatch Coalition. The Milwaukee event will occur during Child Health Week, with co-sponsorship by the Milwaukee HealthWatch Coalition. We will announce the remaining stops soon! HealthWatch is eager to begin this very popular and successful model of enrollment and education for complicated BadgerCare+ and Medicaid coverage programs.

Complete HealthWatch Public Hearing Footage Now Online!

HealthWatch Wisconsin has posted the complete video footage of public testimony on the impact of proposed BadgerCare+ and Medicaid cuts that will affect 1.2 million Wisconsinites covered by these programs. In March, HealthWatch Wisconsin sponsored two days of public hearings during the HealthWatch Wisconsin Annual Conference, drawing hundreds of people to listen, learn, and for some, to share their stories and the stories of loved ones. HealthWatch Wisconsin staff was on hand to record participants' testimony.

View the public testimony footage online. 

Grapevine

Publications Free through DHS

Did you know that there is a massive library of publications available for FREE from the Department of Health Services? Check out their order form online! Best of all, you can do everything online - just search the publication library for the publication that you want to order and email the corresponding Forms Manager.

Coalition Roundup

Click here for a list of upcoming coalition meetings.

The Chippewa County HealthWatch Coalition met on May 10 at the Chippewa County Courthouse. Mike Rust of ABC for Rural Health came and spoke to the group about all of the ins and outs of HealthCheck treatment options for Medicaid-enrolled children. The next Chippewa County HealthWatch Coalition meeting is on September 13, 2011. For more information about the Chippewa County HealthWatch Coalition, please contact Rose Marsh.

Dane County HealthWatch Dane County HealthWatch met on May 2 at the Hawthorne Branch of the Madison Public Library. Patricia Frazak and Dan Stattelman-Scanlan of Public Health Madison & Dane County presented on their new Fetal and Infant Mortality Review (FIMR) process. Jon Peacock of the Wisconsin Council on Children and Families also attended and spoke on the issue of centralization and potential privatization of income maintenance services in Wisconsin. Finally, Dane County HealthWatch members discussed the new provider contracts for non-emergency medical transportation through LogistiCare at length. The next Dane County HealthWatch meeting will be June 6, back at the usual location at the Waisman Community Outreach Center on East Olin Ave, and the speaker, confirmed for now, will be Amy Mendel-Clemens, the Economic Support Division Administrator for Dane County. For more information about the Dane County HealthWatch Coalition, please contact Adam VanSpankeren.

The Eau Claire County HealthWatch Coalition had their most recent meeting on May 5 at the Luther Hospital Cafeteria. Paula Gibson, Community Relations Director for Harbor House Memory Care, came to speak to the coalition about Harbor’s services and new websites. Pat Perkins of the Eau Claire City-County Health Department gave an update from the annual statewide HealthWatch Wisconsin Conference. The Eau Claire County Coalition doesn't meet over the summer but will be back in action in September! For more information, please contact Lou Kelsey or Pat Perkins.

The Milwaukee HealthWatch Coalition met May 11 to welcome Ramona Gramling who gave overview of CORE/El Centro.  CORE/El Centro is a non-profit grassroots volunteer-driven organization that offers individuals of all income levels access to natural healing therapies, including massage, acupuncture, yoga, and more. In addition, attendees had a discussion about administering a competency of self-assessment as part of an overarching strategic plan for the coalition. For more information about the Milwaukee HealthWatch Coalition, please contact Nora Foshager.

The Pierce County HealthWatch Coalition had its kickoff meeting on Thursday, May 12!  Mike Rust of ABC for Rural Health came to speak to the group about what is changing - or potentially changing - with Medicaid and BadgerCare in Wisconsin. He also included an explanation of EPSDT for other services, including dental access. The meeting was well attended, and the steering committee collected feedback from the attendees to help shape future meetings. For more information about the Pierce County HealthWatch Coalition, please contact Lisa Raethke.

The Tri-County HealthWatch Coalition held its strategic planning session back in March and developed a draft work plan they presented to the group in April. The group determined that the plan was on the aggressive side, so the steering committee has been working on streamlining it to present a plan with reasonable timelines at their May meeting. Tri-County HealthWatch has also been working collecting the testimonies of people who will be affected by the proposed budget cuts, to send those testimonies to the Joint Finance Committee by the end of May. The group is also working to identify low-income families and get them signed up for BadgerCare+. The next Tri County HealthWatch Coalition meeting is May 24 at the Goodwill Community Center in Menasha. For more information about the Tri-County HealthWatch Coalition, contact Susan Garcia Franz or Connie Raether.

CKSN Corner

Covering Kids with Special Needs

The National Youth Leadership Network announces their new curriculum: Reap What You Sow: Harvesting Support Systems Curriculum Training Packages. Reap What You Sow brings youth and adults together to build support systems. For more information, click here.

May 18. Listening Session hosted by the WI Council on Children’s Long Term Supports, in collaboration with the Department of Health Services. This listening session will get input from families on cost-saving ideas related to the state's Medicaid programs. These ideas will help the Department of Health Services develop plans aimed at improving overall consumer care, streamlining program delivery and stabilizing programs to ensure long-term sustainability. These listening sessions can be accessed directly from your home: You do not have to travel anywhere.

When:      May 18, 9:30-10:30am, Secretary Dennis Smith

Where:     Telephone Conference Call or Internet Live Meeting

July 25-27. Leadership, Legacy, and Community: A Retreat to Advance Maternal and Child Health (MCH) Scholarship and Practice. Hyatt McDonald's Lodge, Oak Brook, IL. Learn more information here, or register here.

Ops Memos

Release 11-01 of the Income Maintenance Manual (IMM) was made May 11, 2011. See more on this release above in the Case Tip.

State & National News

Analysis and Comment

Joint Finance Committee Denies Funding to Civil Legal Services

In the April 1 edition of the HealthWatch Update, HealthWatch Wisconsin brought you analysis titled "The Defunding of Civil Legal Services in Wisconsin," commenting on Governor Walker's budget bill eliminating all indigent civil legal service funding. This funding is currently a Department of Administration budget item. (In comparison, indigent civil legal services were in the 2009-2011 biennial budget at a $1,958,600 appropriation in FY 10 and a base-year appropriation of $2,546,100 in FY 11.) 

In the May 12 gathering of the Joint Finance Committee, Senator Robert Jauch (D-Poplar) made a motion to restore $1 million to fund civil legal services in Wisconsin. Senator Lena Taylor (D-Milwaukee) spoke on the motion, saying, "This motion puts $1 million in these services. There are costs from people coming into the courts unrepresented. We learned of this issue two budget cycles ago when the State Bar of Wisconsin presented a study that included a comparison of civil legal services," in addition to a comparison of how other states put $11 or $12 million to build efficiencies into the court system. Taylor continued, "These programs also provide services for working class families-providing an opportunity to get guidance...I would encourage members [of this committee] to support this motion." The motion to restore funding to civil legal services failed on party lines, with the four Democrats on the committee voting for the motion, and the 12 Republicans voting against.

ABC for Health is one of the dedicated non-profit public interest law firms that will feel the impact of this cut. ABC’s attorneys and health benefits counselors help individuals and families determine the best health coverage choices, apply for health coverage programs, negotiate with insurance companies, and challenge insurance claim denials. Cutting civil legal services will harm thousands of Wisconsin families.

Headlines

BadgerCare Plus Basic Audit Letter Report
Legislative Audit Bureau, 9 May 2011
"The Basic Plan was established to provide temporary, unsubsidized health insurance for childless adults on a waiting list for Medical Assistance coverage. Through December 2010, expenditures exceeded revenues by $140,300, and the deficit would have been larger without $1.1 million in federal grant funding that may not be available in the future. Despite recent programmatic changes, concerns remain about the Basic Plan's sustainability." Additional Links of Interest:

• BadgerCare Basic Enrollment Frozen
• State freezes enrollment, raises premiums, for health pool serving childless adults
• Solvency Reports issued December 2010

Wisconsin Poverty Report: Were Antipoverty Policies Effective in 2009?
Institute for Research on Poverty, May 2011
"In this third annual Wisconsin Poverty Report, we use the Wisconsin measure to examine need in 2009 and changes in economic security from 2008 to 2009."

Rule would discourage states' cutting Medicaid payments to providers
Robert Pear, The New York Times, 2 May 2011
"The Obama administration is proposing a rule that would make it much more difficult for states to cut Medicaid payments to doctors and hospitals. Dennis G. Smith, secretary of the Wisconsin Department of Health Services, described the proposal as 'a federal power grab.'”

Vital signs: Health secretary Smith criticizes new fed effort to increase access to health care for the poor
Shawn Doherty, The Cap Times, 3 May 2011
"Anybody who had thought the Obama administration might roll over under the increased pressure from Republican states like Wisconsin chafing at the Medicaid bit is wrong. We're headed for a showdown later this year."

Editorial: Repair, not raze, state health plan for the uninsured
The Oshkosh Northwestern, 12 May 2011
"Less than a year after it was created, a state program to extend health to single people is in trouble that requires the repair, not the razing of the program."

Florida pushing new fees for most Medicaid recipients
Phil Galewitz, Kaiser Health News, 15 May 2011
"Florida wants to be the first state in the nation to charge most of its Medicaid recipients a monthly premium as well as $100 for using the ER for routine care.But even supporters acknowledge that the new fees, passed recently by the state legislature as part of a sweeping Medicaid measure, face long odds getting federal approval."

Wait lists loom under proposed freeze on FamilyCare
Karen Madden and Jake Miller, Wausau Daily Herald, 16 May 2011
"For more than 400 residents in five counties served by the state's long-term care program, Gov. Scott Walker's proposed budget could mean they won't get services for at least two years."

Walker wants private sector to run assistance programs
Jessica Vanegeren, Cap Times, 11 May 2011
"Walker’s proposal would give the state Department of Health Services the authority to enter into contracts with public and private entities to receive applications, determine eligibility, conduct fraud investigations, implement error reduction procedures and recover overpayment of benefits for all FoodShare and Medicaid recipients."

Blog: Medicaid might be a better target for cuts than Medicare
Sam Baker, The Hill, 8 May 2011
"More than $1.3 trillion of the savings in Rep. Paul Ryan’s (R-Wis.) budget proposal would come from Medicaid. So far, those plans haven’t attracted the same political furor as the budget’s Medicare components. Some Democrats have been blunt about the reason: Seniors vote in large numbers, whereas Medicaid primarily serves children and the poor."

Milwaukee infant mortality rate still high, despite years of effort, millions spent
Crocker Stephenson and Ben Poston, Milwaukee Journal Sentinel, 7 May 2011
"Year after year, the city continues its rudderless and fragmented approach, with over 100 health initiatives that, lacking collective impact, fail to generate communitywide results."

High-risk health coverage pools grow by 6,000 enrollees
Phil Galewitz, Kaiser Health News, 6 May 2011
"Enrollment varies widely by state. Pennsylvania has the highest enrollment with 2,684 people while North Dakota has enrolled just six people."

House GOP won't push Medicare vouchers
Associated Press, 5 May 2011
"Lawmakers and the White House bowed to political realities in pursuing a deal to allow more government borrowing in exchange for big spending cuts."

Vital signs: Global warming is world's biggest public health threat, visiting author says
Shawn Doherty, The Cap Times, 5 May 2011
"Anybody who had thought the Obama administration might roll over under the increased pressure from Republican states like Wisconsin chafing at the Medicaid bit is wrong. We're headed for a showdown later this year."

Republicans want to require photos on FoodShare, BadgerCare Plus cards
Jason Stein, The Milwaukee Journal Sentinel, 5 May 2011
"Republican lawmakers want to reduce fraud by requiring photos on the benefits cards used for food assistance and health care programs."

States ask US court to overturn health overhaul
Associated Press, 5 May 2011
"The federal government argued that the requirement is a 'quintessential exercise' of the legislative branch's powers, but the states that oppose it countered Wednesday that the mandate is an 'indefensible' and unprecedented move by Congress."

Needed health care put off because of high cost, UW study shows
Bill Novak, The Cap Times, 3 May 2011
"The high cost of health care is hurting everyone, with parents forgoing taking their sick kids to the doctor even if they have health insurance and make enough money to cover the cost, according to a new study from researchers at UW-Madison."

House acts to cut money for key part of health law
Associated Press, 3 May 2011
"The House Republican drive to dismantle the new health care law piece by piece advanced Tuesday with a vote to disrupt the flow of federal dollars for health insurance exchanges, an integral part of the law's goal of expanding insurance coverage."