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Healthcare Accountability Act xxxvi,xxxvii,xxxviii,15San Francisco, CaliforniaOverviewIn 2001, San Francisco’s mayor introduced the Healthcare Accountability Act (HCAO)requiring contractors that provide services to the City and County to either (option 1) offer healthplan benefits to all employees or (option 2) make payments to the City and County for use bythe Department of Public Health to help partially offset the cost of services for uninsuredworkers.ImpactAn estimated 16,050 uninsured workers were projected to benefit from HCAO. Thisincluded 1,900 for-profit contractors, 2,650 non-profit contractors, 5,750 Airport tenants, and5,750 tenants of City property.MandateA city/county contractor has one of two options in order to abide by HCAO.Option 1: The employer must offer the covered employee a plan that is as good or betterthan what is outlined in the Minimum Standards. HCAO’s Minimum Standards requireemployers to offer at least one health plan that is a Health Maintenance Organization (HMO).Employers may not require employees to pay a monthly premium contribution toward the HMOplan. This HMO must not charge employees a deductible of any amount for any services orbenefits covered in the package. Co-payments for office visits (including PCP, perinatal andmaternity, preventive care, and family planning) shall not exceed $15 per visit for a ClosedPanel HMO; and $20 per visit for all other HMO models. The employee’s annual out-of-pocketmaximum shall not exceed $2,500.Each plan must be comprehensive and provide coverage for the following services:• Office visits (including PCP, perinatal and maternity, preventive care and familyplanning)• Hospital inpatient• Prescription drugs• Outpatient services and procedures• Diagnostic services (X-ray, labs, etc.)• Perinatal and maternity care• Emergency room and ambulance• Mental health services, outpatient and inpatient• Alcohol and substance abuse care, outpatient and inpatient detox• Rehabilitative therapies• Home health• Durable medical equipment• Hospice care• Skilled nursing services15 Personal Communications with Anne Kronenberg, San Francisco Department of Public Health, May 2005D-26
Option 2: Employers must pay a fee of $2 per employee/per hour, with a weeklymaximum of $80 or $320 per month. The fee is higher than the current HMO average premiumfor 2003 ($222/month). It also compares favorably to the premiums for Kaiser, Blue Shield andthe PacAdvantage plans. A fee of this level ensures that both providing insurance and payingthe fee remain viable alternatives for employers.Exemptions/WaiversBusinesses may be exempt from HCAO for a number of reasons. Some reasonsinclude the following: (1) if the business employees too few employees (20 or fewer employeesfor for-profits, and 50 or fewer employees for non-profits; (2) if the contract is with a public entity,(3) if the contract was entered before 2001, (4) if the contract duration is less than a year.FinancingThe City/County estimated that HCAO would cost approximately $4 million annually.This is based on the assumption that one-third of all contracts would be renewed or modified.These additional costs were to be funded through the City’s General Fund.III. Lessons LearnedInnovative Strategies for Expanding CareOur review suggests that there are design features that can be used to expand systemsof local safety net care including: new organizational forms that allow for community-wideplanning and coordination, standardized eligibility processes to identify and limit patientpopulations and assign them to a medical home, integrated data systems to make patienteligibility and medical information readily available to providers, provider networks that offeraccess to comprehensive services, case management services to encourage care coordination,and provider payment methods that create incentives to serve low-income uninsured patients.Existing governance structures often present difficulties when trying to operate acoordinated health care safety net system involving multiple agencies, public and privateproviders, and different sources of financing. One of the ways that safety nets have extendedcare is to make organizational changes that establish relationships among community-basedsafety net organizations and ensure commitments to work toward common goals, such ascommunity-wide planning and service coordination. The actual form taken to achieve theseorganizational improvements may include:Consolidation - When health care agencies merge for policy, administration and deliveryof services. The main intent is to centralize authority and provide a more efficient andaccountable system.Collaboration - When health care agencies develop arrangements to take jointresponsibility for policy, administration and delivery of services.D-27
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Appendix ATask Force Members and St
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Hector Balcazar, Ph.D.Regional Dean
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Charles Haley, M.D., M.S.Medical Di
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Michael McKinney, M.D.Senior Execut
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M. Roy Wilson, M.D.PresidentTexas T
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Appendix BMedicaid and the State Ch
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services. There are two broad types
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Mandatory and Optional Covered Popu
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• Nurse-midwife services;• Fede
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Disproportionate Share Hospital Pro
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March 13, 2001, that limited the am
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year from FFY 2002-2004, $4.05 bill
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Medicaid beneficiaries. Section 191
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started in 2001 and 2002 to curb in
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urban and with fewer than 250,000 p
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Protection Act of 2000 and the Medi
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orientation). Recipients of Supplem
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enrollee is assigned a primary care
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Table 7. Texas Medicaid Policy Chan
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Table 8. Texas SCHIP Policy Changes
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families (through the employer’s
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share of the match must come from t
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Reinstating the Medically Needy Spe
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Endnotes1 Texas Health and Human Se
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35 Powers, Pyles, Sutter, and Vervi
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73 Office of Management and Budget,
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113 TexCare, Children’s Health In
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150 Lyndon B. Johnson School of Pub
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States by Groupings with Current El
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Medicaid and the State Children’s
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Graduate Medical Education ProgramA
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needs, however, there is a shortage
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15 Texas Association of Counties,
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ecording and evaluation; physical e
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Medicaid and the State Children’s
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ReferencesAmerican Academy of Pedia
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downloads/bipa.pdf#search='Medicare
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Texas Health and Human Services Com
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Appendix CAn Analysis of Reform Opt
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Encouraged by these low rates, Cong
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Establishing state-only tax incenti
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New York passed the Health Care Ref
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Hospital Cost Containment — Maryl
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dollar spent. 237 Texas spent almos
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Another option for small businesses
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• Medical equipment and supplies,
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pay the premiums for Medicaid benef
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Medicaid to children born after Sep
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Bill of Rights or “TABOR”; and
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The federal share for CHP+ is 65 pe
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SCHIP: increased eligibility in CHP
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• Medical equipment and supplies
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6. Funds obtained through the recov
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Status ReportMaineCare Program Expa
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the federal poverty level. 404 Sinc
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need their jobs as a source of empl
Page 116 and 117: Endnotes191 Deborah Chollet, Issue
Page 118 and 119: 225 Ibid.226 Maryland Health Care C
Page 120 and 121: 259 Kaiser Family Foundation, State
Page 122 and 123: SCHIP&subcategory=Medicaid+Spending
Page 124 and 125: 325 Kaiser Family Foundation, State
Page 126 and 127: 361 State Coverage Initiatives, Sta
Page 128 and 129: SCHIP&subcategory=SCHIP&topic=Feder
Page 130 and 131: An Analysis of Reform Options Devel
Page 132 and 133: ReferencesAdvantage Insurance and F
Page 134 and 135: Donnell-Kay Foundation. “Amendmen
Page 136 and 137: Kaiser Family Foundation. Demograph
Page 138 and 139: State Coverage Initiatives. Profile
Page 140 and 141: Appendix DLocal Initiatives to Expa
Page 142 and 143: with more coordinated services that
Page 144 and 145: FinancingSources of revenue include
Page 146 and 147: AdministrationThe Health and Hospit
Page 148 and 149: Until 1993, Denver Health (DH) was
Page 150 and 151: different benefit plans are offered
Page 152 and 153: Cost SharingPatient cost-sharing is
Page 154 and 155: management programs. I-Care promote
Page 156 and 157: the county indigent care plan. Bene
Page 158 and 159: Firstplan xxvi,12Moore County, Mich
Page 160 and 161: Benefits and ServicesEnrollees can
Page 162 and 163: EligibilityAs of 2005, enrollment i
Page 164 and 165: etween $23 and $120 per month. Ther
Page 168 and 169: Coordination - When health care age
Page 170 and 171: subsidized initiatives offer exposu
Page 172 and 173: arriers, two health plans attempted
Page 174 and 175: xxi Simmons, Sandy Coe, Gionfriddo,
Page 176 and 177: Table 1 (Continued). Local Care Ini
Page 178 and 179: Table 2 (Continued). Local Coverage
Page 180 and 181: Appendix EEducation and Health:A Re
Page 182 and 183: The human capital approach suggests
Page 184 and 185: etween standardized test scores (St
Page 186 and 187: INTRODUCTIONEducation plays a wide
Page 188 and 189: of children with chronic health con
Page 190 and 191: Implications. Given the current pre
Page 192 and 193: DiabetesPrevalence. Diabetes in chi
Page 194 and 195: Limitations. The cross-sectional de
Page 196 and 197: chronic lung disease, cystic fibros
Page 198 and 199: significant differences between tho
Page 200 and 201: Table 1. Prevalence of Selected Chr
Page 202 and 203: findings of lower test scores are b
Page 204 and 205: al (McKewen et al., 1998) report a
Page 206 and 207: Section 3. School-Based Interventio
Page 208 and 209: mathematics, science and oral expre
Page 210 and 211: Table 4. Summary of Research Findin
Page 212 and 213: etween SES and health is a dose-res
Page 214 and 215: Self-Rated Health. Evidence accumul
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economic hardship. One of the skill
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Education also improves the stabili
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sex in the expectation of a more pr
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TABLE 6. SUMMARY OF EXPLANATIONS FO
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According to the Census 2000 data,
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Policy Reports Recommendations (Tot
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Section 2. Recommendations on Schoo
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Childhood ConditionsSchool-based Pr
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Childhood ConditionsDiabetes (n=11)
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eduction in reading test scores com
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Table 10. Estimates of the Cost of
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National Asthma Education and Preve
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REFERENCESAck, M., Miller, I., & We
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Elo, I. T., & Preston, S. H. (1996)
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Kaemingk, K. L., Pasvogel, A. E., G
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Miller, D. S., & Miller, T. Q. (199
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Ross, C. E., & Wu, C. L. (1996). Ed
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Williams, D. R. (1990). Socioeconom
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SAMPLE, DESIGN, & INTERVENTIONACHIE
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SAMPLE, DESIGN, & INTERVENTIONStudy
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SICKLE CELL ANEMIAArmstrong(1996)SA
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SAMPLE, DESIGN, & INTERVENTIONSickl
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SAMPLE, DESIGN, & INTERVENTIONhemog
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SAMPLE, DESIGN, & INTERVENTIONStudy
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Curriculum Content: Statute §28.00
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• HEALTH PROMOTING ENVIRONMENTSch
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• COORDINATION/IMPLEMENTATIONCoor
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Education and Health: A Review and
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Appendix FState Regulation of Healt
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coverage they offer. 14 By 2004 onl
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poor health may make coverage more
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account for most, or even much, of
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More active state intervention in t
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Table 3 (GAO Appendix IV) shows whi
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Appendix GEmergency and Trauma Care
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The treatment of shock prior to sur
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the EMS needs in rural areas of the
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Level IV trauma centers should be a
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Table 2. Trends in Trauma Severity,
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the hospitals were on diversion or
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Representative Delisi was successfu
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Mental Health Access ChallengesCare
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fhttp://www.techproservices.net/his
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oohttp://www.saveourers.org/reports
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Appendix HBrief: Consulate ClinicDe
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In addition, the roundtable discuss
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clinic(s) affiliated with medical s
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Appendix ICommon Abbreviations
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HMOHRQOLHRSAICF/MRIHCTAIOMISSLBBLIU
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Appendix JPresentersDate/Location:
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Appendix KProvider Taxes: A Differe
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were previously categorized as char
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