PracticeLink Magazine

FALL 2018

The career development quarterly for physicians of all specialties, PracticeLink Magazine provides readers with feature articles, compensation stats, helpful job search tips—as well as recruitment ads from organizations across the U.S.

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Page 38 of 91

Practice l F A ll 2018 39 R E F O R M R E C A P Scope of benefits The federal government established guidelines for what must be covered and then gives states leeway regarding additional details of coverage. Services that must be covered include: routine checkups, doctor visits, immunizations, prescriptions, dental care, vision care; inpatient and outpatient hospital care; laboratory, X-ray and emergency services. Routine well-child visits and routine dental visits must be available at no additional charge to families, but states may require copayments or deductibles for other services, provided the total amount for those charges and premiums do not exceed 5 percent of a family's income for a year. To determine the details of coverage, states are directed to use what the federal government calls "benchmark coverage." The benchmarks are: the standard Blue Cross/Blue Shield preferred provider option service benefit plan offered to federal employees; state employee coverage plan; or the h M o plan that has the largest commercial, non-Medicaid enrollment within the state. In addition, a state can provide coverage that is "actuarially equivalent" to the benchmarks, or the state can ask the Secretary of the u .S. Department of Health and Human Services for a waiver to provide a different type of coverage Cost savings for families A commission that advises Congress about C h IP, the Medicaid and C h IP Payment and Access Commission (MACPAC), notes that C h IP provides substantial savings for low- and moderate-income families. Using data from 2015, the commission said that the average premiums and cost-sharing per child under C h IP was only $158 per year, whereas the cost per child in an employer- sponsored plan was $891. In addition, C h IP provides for more coverage for dental, vision and audiology services than most employer-sponsored plans. Looking to the future, the commission advocates using C h IP funds to promote innovation, some of which may be similar to changes in health care for the adult population. Innovations might include focus on treatment of chronic conditions, obesity, managed care and alternative payment models. In addition, the commission urges more seamless coverage when children transition between different health insurance plans, including between C h IP and Medicaid. Support from AAP and AMA The American Academy of Pediatrics and the American Medical Association supported extension of funding for C h IP, both calling it a "vital program." The Pediatric Academy's policy statement would go a step further. The academy urged coverage not only for children through age 18, but added that all children, adolescents, and young adults to the age of 26 "should be covered by an affordable, quality health insurance plan that allows access to comprehensive essential care." JEFF ATKINSON ( is a professor for the Illinois Judicial Conference and has taught health care law at DePaul University College of Law in Chicago. Win! Find your next practice—and enter to win a $500 gift card—at CH ip at a glance 8.9 million n umber of children covered $16.9 billion The most paid by the federal government as the cost of the program 1997 Year established 2023 Date to which the program has now been extended

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