Medically Underserved Population Status - A Progress Report. Barbara L. Kornblau JD, OTR University of Michigan - Flint

Transcription

1 Medically Underserved Population Status - A Progress Report Barbara L. Kornblau JD, OTR University of Michigan - Flint

2 Disclaimer

3 Objectives At the end of this session, participants will be able to: - Explain the role disabilities plays in the the Negotiated Rulemaking Process for Underserved Populations - Describe advantages and benefits for the people with DD/ID in the rulemaking process with regard to medically underserved populations

4 The Charge Primary Care Define/Methodology: - Medically Underserved Populations MUPs - Medically Underserved Areas MUAs - Health Profession Shortage Areas HPSAs Geographic HPSAs Population HPSAs - Facilities Designation

5 Who? 28 people who have to reach 70% consensus- spent 25+ days together 3 days of Root Canal with 28 of my new best friends

6 Representing FQHC Primary Care Docs Homeless, Migrant & Seasonal Farm Workers, Public Housing Residents Asian & Pacific Islanders/LEP Rural Health Clinics Ryan White Clinics Amer. Indians, LGBT, DD, PWD, HIV/Aids, Nurse Practitioners?, PAs? Data People

7 Data is Everything NHIS MEPS ACS BRFSS The Chart Book Dartmouth Atlas

8 Benefits Depending upon designation may be eligible: - To apply for a FQHC - To be a rural health clinic (group practice) - Increased reimbursement through Medicare - A bump-up on reimbursement or an encounter rate or cost-based reimbursement

9 Benefits National health service corp scholars State loan repayments & others

10 Benefits to the DD/ID Community Train more primary care providers to work with pwd and people with DD/ID in particular through the National Health Service Corps.

11 What Have We Achieved So Far Tentative agreements that can change Nothing is final but progress has been made Charge has been extended to October

12 Special Populations MUP 4 criteria for MUA/P - Factors indicative of health status of pop grp - Ability of pop. Members to pay for health svs. - Access to health services (Barriers) - Availability of HP to residents of a pop. grp

13 Special Populations MUP Three groups: Streamlined, Simplified, and regular Streamlined assumed to meet all 4 criteria programs (migrant & seasonal farm workers, homeless pop. & public housing res. - Members of Indian Tribes - Must do a local pop. count

14 Simplified Process Groups established by HHS legislation Groups assumed to meet 3 criteria - Legislation specifies health status issues and access barriers to care - National data verifies issues with ability to pay (5% above 100% nat. norm. pov. rate) Must provide local data to demonstrate insufficient provider capacity with pop count

15 Legislation Must be a statute administered by HRSA Leg. must name an identifiable subpop Must have Cong. findings that ID the sub pop as experiencing health disparities Findings must ID at least one barrier to access to care

16 Specific Legislation ID d Ryan White CARE Combating Autism Act DD Act TBI Act of 2008 Disadvantaged Minority Health Improvement Act

17 To Be Discussed Availability: P2P Count Provider count should include a count of providers trained to treat the specific sub population Controversy: How do we count NP s and PA s (.75? testing 1.0) Only primary care providers (no subspecialties

18 Regular Special Population Groups of people who have systematic-ally experienced greater social and/or economic obstacles to health and/or a clean environment based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation; geographic location; or other characteristics historically linked to discrimination or exclusion. Healthy People 2020 (Plus Native Hawiians)

19 Regular Special Must prove health status via (proposal) direct health measures, published lit on disparities, or HHS legislation, National/state/local data sets, proxy data???? Access to care Barriers to care Ability to pay lack of coverage? %FPL Availability of providers qualities how?

20 Magnet Clinics What about the doctor in Kentucky who treats people with DD/ID from 49 counties

21 Facilities???? Public/nonprofit or rural clinic Open to all regardless of cov./ability to pay Allow targeting one or more population - >50% of PCS provided to HIV, DD, LGBT, LEP, American Indians - Income thresholds for patients < 200% FPL Provider capacity TBD

22 Future Items Corrections Federal and state prisons are covered as facilities but not county jails - People loose their benefits - Many people in county jails are people with DD/ID, ASD, & MH

23 Overall weighting of Factors Variable 1 Access to Care Barriers Variable 2 Ability to Pay - Uninsured? - Low income???% of FPL - RWJ County indicators??? - Income??? Variable 3 Direct measures of health (ie low birth weight, preventable hospitalizations) and SDI

24 Social Deprivation Index Used as a measure of health status but does not include specific health measure or outcomes: - Poverty, education, etc - SDI highly correlates with disabilities

25 Barriers to Care Looks like disability will count as a barrier to care (tested & tentative)

26 Next Steps..