Affordable Care Act Toolkit

PAETC

Description

Technical Resources for ACA from TARGET Center

The Patient Protection and Affordable Care Act (ACA or the Affordable Care Act) is generating major changes in health insurance coverage and health care delivery in the U.S. ACA provisions are designed to increase the number of insured Americans (through private market reforms and expansion of Medicaid eligibility), reduce health care costs, and improve the health care system. Below are technical assistance resources to engage Ryan White agencies in the many changes that are underway, which will have an impact on coverage options for clients, payment mechanisms, and care delivery.

Protecting the Safety Net Project

A compilation of materials compiled in 2012 to guide safety net providers in adapting to ACA, with attention to development of third party billing/reimbursement systems and organizational restructuring to open up opportunities for funding and reimbursement as a result of expansion of Medicaid and commercial insurance. Resources include assessment questions for agencies exploring change and options to consider. Resources were developed by MOSAICA/Emily Gantz McKay Consulting for a Washington, DC partnership of grant makers. (August 2012)

Tools for Identifying Uninsured/New Coverage Populations

As a result of ACA’s new insurance coverage options, Ryan White-funded agencies will be transitioning clients to Medicaid (in expansion states) and individual health insurance. These changes will have an influence on allocation of funds to various core and support service categories and premium/co-pay support for clients transitioning to new coverage. In planning for these changes, agencies will make extensive use of data they have on the insurance and income status of their clients.

Supplementary data sources are also available from a number of national resources, which have been compiled on the TARGET Center. The Kaiser Family Foundation website provides comprehensive data in its “State Health Facts” and an online tool, Mapping the Effects of the ACA’s Health Insurance Coverage Expansions, allows users to determine, by zip code, the number of uninsured and the number buying insurance on their own. Enroll America’s “Where are the Uninsured?” generates state maps, using a combination of Census and CMS data. In addition, state-specific modeling reports provide estimators on the transition of people living with HIV/AIDS to Medicaid or private health insurance. These reports were prepared by Harvard’s Treatment Access Expansion Project.

NIATx Third-party Billing Guide

The guide outlines steps for substance abuse treatment agencies to increase their capacity to bill health insurance and Medicaid plans for their services as an increasing number of clients obtain public and private health insurance coverage under the ACA. While specific to substance abuse services, the guide outlines fundamentals to third party billing relevant to most programs.