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Presentation transcript:

Patient Protections Essential Health Benefits ACA More ACA Pathways to Coverage Final Question Final Question Health Care Reform Jeopardy!

Game Show Directions (1) View as a slideshow, starting on the first slide. (2) Click on the question value ( ). (3) Click the slide to view the question. Click again to view the answer. (4) Use the home button after each question. Keep a record (on your own) of the scores of both teams and which questions have been asked. ©Norman Herr, 2003

AnswerQuestion Patient Protections Answer: The provision of the ACA that prohibits discrimination based on health status, including the use of genetic information and other health status factors, in considering eligibility for coverage, effective in Question: What is guaranteed issue and guaranteed renewal?

AnswerQuestion Patient Protections Answer: The provision of the ACA that protects individuals from “maxing out” their health insurance plans over the course of their lifetimes. Question: What is the removal of lifetime benefit caps?

AnswerQuestion Patient Protections Answer: The provision of the ACA, that allows children with life-limiting conditions enrolled in Medicaid to receive both curative and hospice care. Question: What is concurrent care?

AnswerQuestion Patient Protections Answer: The health insurance industry practice of dropping coverage because a consumer made an inadvertent error on the application, which the ACA now prohibits, except in cases of fraud. Question: What is recession?

AnswerQuestion Patient Protections Answer: The provision of the ACA that allows parents to keep their adult ‘children’ on their health insurance, regardless of dependent status. Question: What is extended young adult coverage to age 26?

AnswerQuestion Essential Health Benefits Answer: The Essential Health Benefits. Question: What must all new individual policies and small group plans sold inside and outside of the Marketplace provide?

AnswerQuestion Essential Health Benefits Answer: One of four types of health insurance plans a state could choose to define its essential health benefits. Question: What is a benchmark plan?

AnswerQuestion Essential Health Benefits Answer: Large group, grandfathered, and self- funded plans. Question: What kind of plans are exempt from including the Essential Health Benefits?

AnswerQuestion Essential Health Benefits Answer: Pediatric services, including oral and vision care, rehabilitative and habilitative services and devices, prescription drugs, and mental health and substance abuse services; including behavioral health. Question: What are some of the EHBs that are particularly important to CYSHCN?

AnswerQuestion Essential Health Benefits Answer: The kinds of state-specific benefits that certain private insurance must cover, and if passed before 12/31/11, are included in a state’s EHBs. Question: What are state mandated benefits?

AnswerQuestion ACA Answer: The Medical Loss Ratio. Question: Also known as the 80/20 rule, what provision of the ACA mandates that health insurers limit spending for administrative services, advertising, and other non-medical expenses?

AnswerQuestion ACA Answer: Uniform coverage summaries. Question: Since September 2012, what must insurers provide so consumers can easily understand benefits and coverage?

AnswerQuestion ACA Answer: The type of health plan where employers use their own money to fund their employees health expenses. Question: What is a self-funded or ERISA plan?

AnswerQuestion ACA Answer: To provide a framework for the amount, scope, and duration of each of the Essential Health Benefits. Question: What is the purpose of a benchmark plan?

AnswerQuestion ACA Answer: Affordable, adequate, and continuous health care coverage Question: What does every CYSHCN need and deserve?

AnswerQuestion More ACA Answer: The Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act. Question: What two federal laws together comprise the ACA?

AnswerQuestion More ACA Answer: Health Homes Question: Which provision of the ACA allows states to amend their Medicaid programs to provide six additional services to enrollees with two or more chronic conditions; one condition and the risk of developing another; or at least one serious and persistent mental health condition?

AnswerQuestion More ACA Answer: Case management; care coordination; health promotion; transition; individual and family support; referral to community and social support services. Question: What six additional health services and supports do Health Home enrollees?

AnswerQuestion More ACA Answer: Well-child visits and preventive services. Question: Under the ACA, which health services are provided with no cost-sharing?

AnswerQuestion More ACA Answer: Plans that have not raised their premiums or reduced their benefits since March 23, Question: What are grandfathered plans?

AnswerQuestion Pathway to Coverage Answer: A pathway to Medicaid for childless adults, 19 to 65, who are not pregnant and not disabled, and whose household income is less than 133% FPL. Question: What will the optional adult Medicaid expansion provision of the ACA create?

AnswerQuestion Pathways to Coverage Answer: The removal of stair-step eligibility and a more comprehensive public benefit. Question: What will the mandatory increase in children’s Medicaid eligibility from 100% to 133% FPL mean for 6 to 19 year olds in states with separate CHIP programs that use the current federal minimum to determine eligibility?

AnswerQuestion Pathways to Coverage Answer: The marketplace or exchange. Question: Starting October 1, 2013, where can individuals and families compare and shop for health insurance and potentially receive tax credits and cost sharing subsidies?

AnswerQuestion Pathways to Coverage Answer: Navigators and other assistors. Question: Who can help individuals and families understand health insurance choices, and the application process for marketplace coverage?

AnswerQuestion Pathways to Coverage Answer: EPSDT and reduced cost-sharing. Question: What are two advantages of moving 6 to 19 year olds from CHIP to Medicaid?

AnswerQuestion FINAL QUESTION Answer: The MCHB-funded national center dedicated to improving health care coverage and financing for CYSHCN. Question: What is the Catalyst Center?