Title: The 47 Million Reasons Direct Basic Health Service Plan Community Centers (47MR Centers)
Overview: This amendment provides for federally funded community healthcare centers, non-Medicaid, state plan which combines the innovation and quality of private sector providing direct care facilities for basic health services, wellness, prevention, and stand alone catastrophic insurance plans for major illness.
Under this amendment, the federal government would provides funds to the participating states in order to allow such states to provide affordable health care coverage through private community healthcare centers combined with extending the catastrophic coverage of self insured government facilities to include coverage for the members of the 47MR Direct Basic Health Service Plan Community Centers or allowing for a wrap around stand alone catastrophic plan.
People with incomes above the Medicaid eligibility, above 300 percent federal poverty level(FPL) would be eligible for participation in these centers and these wrap-around stand alone catastrophic plans.
This approach takes advantage of an innovative, non Medicaid coverage model that protects the middle-class that can work at a state level for the people of that state. State government would use their share of federal dollars to empower 47MR Centers in local communities to include and negotiate with the healthcare systems for higher-quality, cost effective services for direct basic health services and wrap-around a stand alone catastrophic insurance policy to provide better value to individual and families in their state. Eligible individual and families would have access to several 47MR Centers at pre-negotiated monthly membership rate options paid direct to the centers for basic health services rather than being limited to fee for service distribution healthcare system offered through the Exchange as the only choice.
By using pre-negotiated monthly membership method for basic health care services, wellness, and prevention, we are improving access, eliminating administration cost, and dramatically reducing cost.
Description of Amendment: The Secretary of Health and Human Services would work with participating states to establish state 47 MR Direct Basic Health Services Plan Community Centers.
State 47MR Direct Basic Health Service Plan Funding: For the purpose of this amendment, a state’s 47MR Direct Basis Health Service Plan funding level would be based on the sum of the value of the direct monthly membership fee to the facility and the cost of individual insurance rate for the catastrophic insurance, which would be assumed eligible for the mandated coverage for the middle-class population in the state. Federal funds distributed to the state would be provided to independent state based trusts for innovative state of art community centers that would be used to negotiate for better medical services, supplies, and medical providers services for 47MR Direct Basic Health Services Plan Community Centers and its members.
Eligibility: The 47MR Direct Basic Health Service Plan Community Centers would be available to people with income over 300 percent of FPL. State could enroll the following middle-class person in their 47MR Direct Basic Health Service Plan Community Centers, as of July 1, 2010 upon availability of the centers: persons who (1) are under age 65; (2) are unemployed; (3) are residence of the community and states; (4) have gross income above 300 percent FPL; (5) choose to be a member of 47MR Direct Health Service Plan Community Centers and obtain stand-alone catastrophic policy coverage: (6) have access by participating in employer sponsored benefits program which include 47MR Centers.
Benefit package and tax credits: Minimum benefit package in the 47MR Direct Basic Health Service Plan Community Centers is set based on the levels provided in Marking Coverage Affordable section of the Chairman’s marks concerning wellness, Prevention, eliminating pre-existing condition, etc. The exception is in having these 47MR Centers deal direct with patients for basic health services and prevention without the current distribution insurance system. Rather a membership fee directly to the facility that meets the guidelines set by the state and HHS for middle-class people. Coverage commence for major illness and hospitalization based on a stand-alone catastrophic policy provided by the state or private sector meeting all the levels. The catastrophic insurance wraps around the 47MR Centers without limitations of HSA rules or deductibles. The tax credits to individuals and businesses for eligible population would have access to tax credits as available in the marks.
State would be encouraged to include innovative services in the 47 MR Centers, included but not limited to; triage, care coordination, care management, care maintenance for those with medical conditions, preventive services which includes a comprehensive physical examinations, risk assessment, and establishment of patient/primary care doctor relationship that maximizes patient involvement in healthcare decision making through educational learning of western and eastern philosophy for maintaining good health.
Health care service plan contracting; State will negotiates contract directly with 47MR Centers providers to ensure the guidelines for the state of the art centers meet the innovative services in the direct health service plan for middle-class people over 300 percent FPL.
The state will under the NAIC will regulate the stand-alone catastrophic policies which provide coverage offered to the members of the 47MR Centers, such as negotiations of payment rates, premiums, and in compliance with benefits package that may exceed the minimum requirement outline above. The Secretary of HHS would be required to verify that state 47MR Direct Basic Health Service Plan are operating within the federal cost and eligibility guidelines as stated above.
The state HHS in coordination with the NAIC are to consider and make suitable allowance for qualifying 47MR Centers based on differences in local communities and availability of healthcare providers resources. The HHS would be encouraged to find ways to upgrade and integrate the direct basic service plan negotiations with community hospitals, specialist, other providers to maximize the quality of care and efficiency and improve the continuity of information between all services providers and the patient.
Incentives to the 47MR Centers would be offered based on specific performance measures and standards based on the improvement of the patients risk assessment report, blood lab results, and physical exams and health outcome. Each 47MR Direct Health Service Plan Community Center must report to the HHS on the performance and results of its members. The NAIC will oversee the catastrophic insurance policy offered by state or private sector.
Cost Savings: State will be able through an independent state trust determine and fund to the 47MR Direct Basic Health Service Plan Community Centers. The 47MR Centers would be able to raise funds through membership in each community servicing the middle-class over 300 percent FPL. Medical providers’ services will be contracted by the 47MR Centers. Each community in the state will have state of the art center. The cost of the centers funded by the individuals, small business, and part-time employees will be direct to the facility overseen by the HHS. The state would be able to negotiate lower prices for medical services, supplies, lab work, hospital stays, etc. by directly purchasing and contracting for all the 47MR Direct Basic Health Service Plan Community Centers.
In addition, the catastrophic insurance policy which provides coverage for self-insured state plans as well as private sector stand-alone plans are one sixth of the cost of the comprehensive plan set at the levels in the Making Coverage Affordable section of the Chairman marks. Therefore combined with the 47MR Direct Basic Health Service Community Center facilities, people will pay a membership fees and affordable premium for catastrophic coverage which is one fraction of the cost, and each local community services their own people.
The high deductible associated with the catastrophic plan can be offset by the independent trust as well or philanthropic measures which exist today. This insures the 25 million uninsured middle-class people whom are not included and have no subsidy. This provides choices for them and give access to healthcare.
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