|
Medicaid, SCHIP and HIPPA
Medicaid
Title XIX of the Social Security Act, passed in 1965, established Medicaid, a federal/state entitlement program that pays for medical assistance for certain individuals and families with low incomes and resources. This program is a cooperative venture jointly funded by the federal and state governments (including the District of Columbia and the territories) to assist states in furnishing medical assistance to eligible needy persons.
Medicaid is the largest source of funding for medical and health-related services for America's poorest people, and the state share of funding to participate in Medicaid is generally the largest item (or close to it) in the state budgets.
Within broad national guidelines established by federal statutes, regulations and policies, each state
(1) establishes its own eligibility standards (but limited to individuals who fall into any of 25 specified categories);
(2) determines the type, amount, duration and scope of services;
(3) sets the rate of payment for services; and
(4) administers its own program.
Medicaid policies for eligibility, services and payment are complex and vary considerably, even among states of similar size or geographic proximity. A person eligible for Medicaid in one state may not be eligible in another, and the services provided by one state may differ in amount, duration or scope from services provided in a similar or neighboring state. Certain services must be covered by the states and other services are optional.
Because the Medicaid program is individualized by each state, the relationship between Medicaid and the Title V programs is also highly individualistic. A new Title V leader should meet with the Medicaid director regularly to ensure coordination between the programs for seamless services to clients, timely reimbursement to providers and development of an agenda of mutual concerns, such as oral health services for children.
AMCHP examines, tracks and disseminates information on national and state issues, needs, policies, plans and programs on service system development, organization and financing. The association identifies issues relevant to managed care, Medicaid, the State Children's Health Insurance Program and other health service delivery networks and also monitors the impact of welfare reform (Temporary Assistance to Needy Families) on Medicaid, SCHIP and MCH programs.
State Child Health Insurance Program (SCHIP)
The Balanced Budget Act of 1997 amended the Social Security Act to add Title XXI, the State Children's Health Insurance Program.
This legislation enables states to initiate and expand health assistance to uninsured, low-income children. The assistance can be provided primarily through two methods:
(1) a program to obtain health insurance coverage that meets certain requirements relating to the amount, duration and scope of benefits; or
(2) expanded eligibility for children under the state's Medicaid program.
This program allows each state to offer health insurance plans for children up to age 19 who are not already insured. Families who earn too much to qualify for Medicaid may be able to qualify for SCHIP, a capped entitlement for states. To be eligible for funds, states must submit a State Child Health Plan, including a description of the coordination with Title V programs.
A new Title V leader should meet regularly with the state's SCHIP director, because this program has greatly impacted the service delivery system for children. For example, in some states, the children with special health care needs (CSHCN) population was carved out of the general SCHIP population and the Title V program was assigned to provide their services. In other states, the CSHCN population was retained in SCHIP and the Title V program sets standards for the services they receive.
Like Medicaid, implementation of SCHIP is highly individualistic in each state, territory and jurisdiction; in some states it may be part of Medicaid. The Title V leader must be on good footing with the SCHIP leader and develop an agenda of mutual interest to assure high quality services for all children in the state.
Health Insurance Portability and Accountability (HIPPA)
HIPAA is the acronym for the Health Insurance Portability and Accountability Act of 1996. CMS is responsible for implementing various unrelated provisions of HIPAA, which may mean different things to different people. Title I protects health insurance coverage for workers and their families when they change or lose their jobs. It lowers the chance of losing existing coverage, eases the ability to switch health plans and helps people buy coverage if they lose an employer's plan and have no other coverage available.
Title II requires the Department of Health and Human Services to establish national standards for electronic health care transactions and national identifiers for providers, health plans and employers. It also addresses the security and privacy of health data. Title II is critically important to the administration of all health care services including Title V programs.
MCH leaders must ensure that the electronic data systems for patient records, billing and more are in compliance. The Title V leader will need to meet with the Medicaid leadership to discuss the program implications created by compliance in the Medicaid billing system. For example, state specific "dummy" codes have been eliminated. You'll need to discuss adequate reimbursement for Title V services with Medicaid leaders.
Related Products 
Related Websites
|
