Monday, October 31, 2016

Books: Got To Catch Them All!

The SAS PTA elementary book fair will be held from November 30 through December 2 from 7:45 a.m. to 3:15 p.m. in the elementary library. Click title to volunteer.

from Singapore American School http://ift.tt/2fpr9NV

2015-16 Annual Report

The year's report reflects many of the events and milestones, key academic indicators, new programs and instructional strategies in each division, the way that we steward our finances, and much more.

from Singapore American School http://ift.tt/2eu8sU8

Digital Citizenship Week

Digital Citizenship Week is here! Your child will have the opportunity to engage in activities that promote the use of technology safely, responsibly, and respectfully.

from Singapore American School http://ift.tt/2dXg6KI

Active Parenting Workshop Registration

Active Parenting is a six part program where each session builds on the previous workshop, facilitated by the elementary kindergarten to grade three school counselors.

from Singapore American School http://ift.tt/2eu9Rdi

Books: Got To Catch Them All!

The SAS PTA elementary book fair will be held from November 30 through December 2 from 7:45 a.m. to 3:15 p.m. in the elementary library. Click title to volunteer.

from Singapore American School http://ift.tt/2fpr9NV

2015-16 Annual Report

The year's report reflects many of the events and milestones, key academic indicators, new programs and instructional strategies in each division, the way that we steward our finances, and much more.

from Singapore American School http://ift.tt/2eu8sU8

Digital Citizenship Week

Digital Citizenship Week is here! Your child will have the opportunity to engage in activities that promote the use of technology safely, responsibly, and respectfully.

from Singapore American School http://ift.tt/2dXg6KI

Active Parenting Workshop Registration

Active Parenting is a six part program where each session builds on the previous workshop, facilitated by the elementary kindergarten to grade three school counselors.

from Singapore American School http://ift.tt/2eu9Rdi

Hawthorne by Pennyfarthing

Pennyfarthing Homes brings a stunning new development to Vancouver’s West side. This amazing development will consist of 1-3 bedroom residences ranging from 680 sq ft to 1,433 sq ft over 7 storeys.

The Hawthorne is situated next to the lovely Queen Elizabeth park and just a short walk along Cambie will bring you to the Oakridge mall where you will satisfy all you shopping and dinning needs.

Pricing has not yet been determined.  Please register and join our VIP list to be one of the first to receive information

 

The post Hawthorne by Pennyfarthing appeared first on Vancouver New Condos.



from Buildings – Vancouver New Condos http://ift.tt/2fxPwIh

Hawthorne by Pennyfarthing

Pennyfarthing Homes brings a stunning new development to Vancouver's West side. This amazing development will consist of 1-3 bedroom residences ranging from 680 sq ft to 1,433 sq ft over 7 storeys.

The Hawthorne is situated next to the lovely Queen Elizabeth park and just a short walk along Cambie will bring you to the Oakridge mall where you will satisfy all you shopping and dinning needs.

Pricing has not yet been determined.  Please register and join our VIP list to be one of the first to receive information

 

The post Hawthorne by Pennyfarthing appeared first on Vancouver New Condos.



from Buildings – Vancouver New Condos http://ift.tt/2fxPwIh

A New Health Affairs Blog Featured Topic: ‘Health Equity’

blog_healthequityseries_2

Health Affairs Blog is launching a new featured topic on "Health Equity."

Health disparities and health care disparities—including differential access to treatment and inequity in the quality of care—have been covered extensively in our journal and on the Blog, including most recently in our August 2016 issue and companion disparities eBook. In June 2017, Health Affairs will publish the first of two theme issues that builds on this literature, with an eye toward not just documenting disparities but also finding solutions for achieving equity. Many solutions will be cross-sectoral in nature, as we increasingly recognize that good health often begins in the social arena — influenced by access to adequate and safe housing, educational opportunities, child care, and other social determinants.

In the lead-up to the June 2017 issue, and continuing afterwards, we will publish blogs focused on achieving health equity as part of this new featured topic. We'll feature leading voices in the field, and encourage you to join the conversation by commenting on Health Affairs Blog posts. We also invite you to submit your own posts on topics such as achieving health equity, factors that contribute to disparities in health and health care, and interventions both inside and outside the health services sector that improve health and reduce disparities, including cross-sector collaborations. Read the first post in the series.

We are grateful for the support of The Kresge Foundation, The California Endowment, the Aetna Foundation, Episcopal Health Foundation, and The Colorado Health Foundation for this series on the Blog and for support of the larger health equity project.

All blog posts submitted for this topic are subject to Health Affairs' standard vetting and selection process. You can find our complete archive of historical posts on topics surrounding equity and disparities here.

Watch for another new Health Affairs Blog featured topic in the coming months on end-of-life issues. Follow new postings @Health_Affairs and through Health Affairs Today.



from Health Affairs BlogHealth Affairs Blog http://ift.tt/2dVoWsm

A New Health Affairs Blog Featured Topic: ‘Health Equity’

blog_healthequityseries_2

Health Affairs Blog is launching a new featured topic on “Health Equity.”

Health disparities and health care disparities—including differential access to treatment and inequity in the quality of care—have been covered extensively in our journal and on the Blog, including most recently in our August 2016 issue and companion disparities eBook. In June 2017, Health Affairs will publish the first of two theme issues that builds on this literature, with an eye toward not just documenting disparities but also finding solutions for achieving equity. Many solutions will be cross-sectoral in nature, as we increasingly recognize that good health often begins in the social arena — influenced by access to adequate and safe housing, educational opportunities, child care, and other social determinants.

In the lead-up to the June 2017 issue, and continuing afterwards, we will publish blogs focused on achieving health equity as part of this new featured topic. We’ll feature leading voices in the field, and encourage you to join the conversation by commenting on Health Affairs Blog posts. We also invite you to submit your own posts on topics such as achieving health equity, factors that contribute to disparities in health and health care, and interventions both inside and outside the health services sector that improve health and reduce disparities, including cross-sector collaborations. Read the first post in the series.

We are grateful for the support of The Kresge Foundation, The California Endowment, the Aetna Foundation, Episcopal Health Foundation, and The Colorado Health Foundation for this series on the Blog and for support of the larger health equity project.

All blog posts submitted for this topic are subject to Health Affairs’ standard vetting and selection process. You can find our complete archive of historical posts on topics surrounding equity and disparities here.

Watch for another new Health Affairs Blog featured topic in the coming months on end-of-life issues. Follow new postings @Health_Affairs and through Health Affairs Today.



from Health Affairs BlogHealth Affairs Blog http://ift.tt/2dVoWsm

Ushering In The New Era Of Health Equity

blog_healthequityseries

Editor's note: Joe Betancourt is one of the theme advisors for the June 2017 equity issue.

The passage of health care reform and current efforts in payment reform have fueled a significant transformation of the US health care system. An entire new set of structures is being developed to facilitate increased access to care that is cost-effective and high quality. High-value health care is the ultimate goal. Guided by the 2001 Institute of Medicine (IOM) report, Crossing the Quality Chasm, the nation has charted a path to deliver care that is safe, efficient, effective, timely, patient-centered, and equitable. There is no doubt that significant gains have been made in this effort, particularly in the area of patient safety. However, one key pillar of quality—achieving equitable care—has garnered significantly less attention than the others. Equity is the principle that quality of care should not vary based on patient characteristics such as race and ethnicity, gender, geographic location, or socioeconomic status.

The inclusion of equity among the pillars of quality emerges from longstanding research that has identified disparities in health and health care based on all of these patient characteristics. For example, minorities are significantly more likely to be diagnosed with and die from diabetes compared to whites. There is little doubt that negative social determinants—such as lower levels of education, lower socioeconomic status, unsafe neighborhoods, and "food deserts"—disproportionately impact minority populations, and thus contribute to their poorer health outcomes. Minorities are also more likely to be uninsured, and thus less likely to have a regular source of care, more likely to report delaying seeking care, and more likely to report that they have not received needed care — resulting in avoidable hospitalizations, emergency hospital care, and adverse health outcomes.

To further complicate matters, the 2002 IOM report Unequal Treatment found that even when minorities and whites had the same insurance and socioeconomic status, and when comorbidities, stage of presentation, and other confounders were controlled for, they still often received a lower quality of health care than whites. While these examples focus on disparities related to race and ethnicity, more recently disability and sexual orientation have been included as key components of equity, as well.

Earlier this year, Don Berwick laid out his vision of what will be "era three" of medicine and health care, sharing his perspectives about where health care has been, and where it's headed in this country. As someone who has focused on health equity for close to 20 years—with a particular focus on racial and ethnic disparities in health care—I thought this was an interesting lens to view equity through, examining where this field has been, and where it is headed.

The First Era of Health Equity

With the release of Crossing the Quality Chasm, followed shortly after by Unequal Treatment, the first modern era of equity was underway. I say "modern" because the issue of disparities and equity was an issue well before the early 2000s, and to dismiss this reality would do a disservice to the many leaders and incredible work that occurred in decades past. Nevertheless, given the imprimatur of the IOM, these reports made disparities real and the need for equity legitimate, and caused health care leaders to take notice in ways they hadn't before.

Equity was no longer part of an activist agenda, but instead an issue that required mainstream focus and attention. That's not to say that leaders jumped into action. In fact, the predominant sense across the nation within health and health care was one of "not here, not me." Aside from progressive leaders and early adopters who began to place equity on the same footing as the other pillars of quality, the overwhelming majority either remained reluctant to admit that disparities existed in the health care settings they oversaw, or went on the slow burn, multiyear path of "studying the issue and what could be done."

Nevertheless, leaders were slowly socialized with facts in this period, and the mantra of "no one suspect, no one solution" allowed them to better understand the multifactorial nature of the problem, and the complexity of solutions needed to address them. Organizations such as the Joint Commission, the National Committee for Quality Assurance, and the National Quality Forum—often supported by foundations such as The Commonwealth Fund, The California Endowment, and Robert Wood Johnson—began to explore how they could exert their influence to drive change in this area. Whether through accreditation standards, incentives and awards, or new measures, these organizations set the table for significant progress in legitimizing equity and the need to address disparities. During this time there was little discussion about other areas of disparities beyond racial and ethnic disparities. Disparities that impacted individuals by disability status or sexual orientation, and the impact of social determinants on health, health care, and health disparities received limited attention. Most importantly, there wasn't much work on solutions to speak of. All of this notwithstanding, the first era was one of energy, optimism, and the building of some key foundational elements of the field.

The Second Era of Health Equity

The passage of the health care reform in 2010 and the push to increase value in health care, including achieving the triple aim of better care, better health, and lower costs, heralded the beginning of the second era of equity. A lot of energy was devoted to health insurance enrollment, and a litany of new structures (and acronyms) evolved to improve care delivery and to deliver on value, including ACOs (Accountable Care Organizations) and PCMHs (patient-centered medical homes), among others.

New cost "pressure points" such as readmission penalties and financial skin-in-the-game for population health, patient safety, and patient experience also took root. The emergence of electronic health records and meaningful use requirements became all consuming. "Hot spotters," "super-utilizers," and the "duals" (individuals covered by Medicare and Medicaid) became targets for new efforts to improve community health and control cost. The net-net here was that much of the oxygen was sucked out of the health care room and fledgling activities focusing on equity and disparities were receiving little attention. Foundations and other organizations that had been essential in the first modern era of equity now moved away from equity- or disparities-specific funding or activities in favor of "mainstreaming" this work (folding disparities into quality work, or as part of healthy communities' agendas, for instance) or focusing on other more pressing areas.

Despite this, advocates for improving quality, addressing disparities, and achieving health equity began to connect the dots for health care leaders, highlighting that if they really cared about quality and controlling costs, they needed to care about equity. Research had demonstrated that minorities, when compared to whites, tended to suffer more medical errors with greater clinical consequences; have longer length of hospital stays for the same clinical condition; experience higher rates of avoidable hospitalizations and 30-day readmission rates for congestive heart failure; experience more test ordering for similar conditions (particularly when there was a language barrier); and were under-used clinically beneficial, evidence-based care. Improving quality, addressing disparities, and achieving equity was not just the right thing to do, but also the smart thing to do, given the new financial structures developed to drive quality and value.

During this time, increasing attention was paid to the social determinants of health, and new efforts were launched to collect patient data related to disability and sexual orientation. We also began to see the first unintended consequences of health care transformation: for instance, hospitals that historically served poor, underserved, vulnerable, and minority communities were subject to significant readmissions penalties. A fierce debate began about whether organizations that serve larger vulnerable populations should be able to risk-adjust for patient socioeconomic status, thus allowing them a better chance at success. Proponents feel this is appropriate and reflects reality; opponents suggest that risk adjustment creates two standards of care, one for hospitals who care for vulnerable populations, and another for those who don't — in other words, it lets the former off the hook for delivering high-value, efficient, and effective care.

In sum, the second era of equity is one of rapid flux and a turning away from disparities and equity explicitly, while at the same time a period where a strong business case for addressing disparities and achieving equity has been made. The equity umbrella also began to expand to other groups and issues—such as individuals with disabilities and those from the Lesbian, Gay, Bisexual, and Transgender community—and incorporate the importance of the social determinants of health. Solutions still are few and far-between, hard to come by, and difficult to sustain — yet the hope remains that the movement to high-value care will finally make achieving equity a smart business decision.

The New Era of Health Equity

The new era of health equity is upon us. Health care reform marches forward, albeit with some real challenges ahead: care is costlier than anticipated under Obamacare, commercial insurers are pulling out of exchanges, and fickle political winds remain a constant threat. The real push towards value begins with the best ABC of health care yet—an acronym within an acronym—MACRA. The Medicare Access and CHIP Reauthorization Act is the Centers for Medicare and Medicaid Services' (CMS) effort to shift how providers are paid, from quantity of care to quality of care. Already we see the unintended consequences brewing, as ACOs are the better rewarded option in MACRA compared to the Merit-Based Incentive Program (MIPS), yet are less likely to exist in minority communities. ACOs are also less likely to recruit providers who take care of large minority populations.

That being said, several promising opportunities are on the horizon. First is the much greater focus on the social determinants of health. Serious efforts, especially as part of population health, are underway to meet the broader social needs of patients. This will, if constructed with attention to the needs of diverse populations, undoubtedly go a long way to address disparities and foster equity. Second, much more attention is being paid to all aspects of equity, and not just racial and ethnic disparities. Third, activities focused on diversity and inclusion, and especially new conversations about racism, implicit bias, and stereotyping as root causes for disparities, are bubbling up now more than ever before. This is likely a direct consequence of the coverage of police violence against Black citizens, the Black Lives Matter movement, and the current and toxic political climate around race relations. Although difficult and painful, it is fair to believe that these difficult conversations can take us to a better place on issues of disparities and equity, especially in health care. Fourth, we are seeing major campaigns encouraging hospitals to place a premium on equity, most prominent among them being the American Hospital Association's annual Equity of Care Award, and its #123forEquity pledge campaign, which over 1,300 hospitals nationwide have signed on to. Fifth, CMS has developed a major Equity Plan for Medicare that looks to drive the health care system toward a robust set of activities focused on addressing disparities and achieving equity, using CMS' influence as the nation's largest payer.

These are just some of the major trends and activities that will define the new era of health equity. It is important, however, to continue to highlight the importance of having multiple stakeholders at the table. Currently, health plans have been minimally engaged in this work, and the National Health Plan Collaborative, the nation's first and only effort to bring large health plans together to partner around addressing disparities and achieving equity, has long since faded into the sunset. What is needed now are concrete strategies, solutions and interventions to address disparities and achieve equity in all its facets. More research documenting problems is nice but unnecessary. We need to move beyond diagnosing the problem to addressing it. If we are in fact going to emerge from this next era of health equity successfully, the summary we'll write in 10 years should highlight all the new, sustainable, and financially viable interventions that finally allowed us to thread the needle and sew together cost, quality, safety, equity, and value for the purpose of eliminating disparities once and for all.



from Health Affairs BlogHealth Affairs Blog http://ift.tt/2fx1zWs

Ushering In The New Era Of Health Equity

blog_healthequityseries

Editor’s note: Joe Betancourt is one of the theme advisors for the June 2017 equity issue.

The passage of health care reform and current efforts in payment reform have fueled a significant transformation of the US health care system. An entire new set of structures is being developed to facilitate increased access to care that is cost-effective and high quality. High-value health care is the ultimate goal. Guided by the 2001 Institute of Medicine (IOM) report, Crossing the Quality Chasm, the nation has charted a path to deliver care that is safe, efficient, effective, timely, patient-centered, and equitable. There is no doubt that significant gains have been made in this effort, particularly in the area of patient safety. However, one key pillar of quality—achieving equitable care—has garnered significantly less attention than the others. Equity is the principle that quality of care should not vary based on patient characteristics such as race and ethnicity, gender, geographic location, or socioeconomic status.

The inclusion of equity among the pillars of quality emerges from longstanding research that has identified disparities in health and health care based on all of these patient characteristics. For example, minorities are significantly more likely to be diagnosed with and die from diabetes compared to whites. There is little doubt that negative social determinants—such as lower levels of education, lower socioeconomic status, unsafe neighborhoods, and “food deserts”—disproportionately impact minority populations, and thus contribute to their poorer health outcomes. Minorities are also more likely to be uninsured, and thus less likely to have a regular source of care, more likely to report delaying seeking care, and more likely to report that they have not received needed care — resulting in avoidable hospitalizations, emergency hospital care, and adverse health outcomes.

To further complicate matters, the 2002 IOM report Unequal Treatment found that even when minorities and whites had the same insurance and socioeconomic status, and when comorbidities, stage of presentation, and other confounders were controlled for, they still often received a lower quality of health care than whites. While these examples focus on disparities related to race and ethnicity, more recently disability and sexual orientation have been included as key components of equity, as well.

Earlier this year, Don Berwick laid out his vision of what will be “era three” of medicine and health care, sharing his perspectives about where health care has been, and where it’s headed in this country. As someone who has focused on health equity for close to 20 years—with a particular focus on racial and ethnic disparities in health care—I thought this was an interesting lens to view equity through, examining where this field has been, and where it is headed.

The First Era of Health Equity

With the release of Crossing the Quality Chasm, followed shortly after by Unequal Treatment, the first modern era of equity was underway. I say “modern” because the issue of disparities and equity was an issue well before the early 2000s, and to dismiss this reality would do a disservice to the many leaders and incredible work that occurred in decades past. Nevertheless, given the imprimatur of the IOM, these reports made disparities real and the need for equity legitimate, and caused health care leaders to take notice in ways they hadn’t before.

Equity was no longer part of an activist agenda, but instead an issue that required mainstream focus and attention. That’s not to say that leaders jumped into action. In fact, the predominant sense across the nation within health and health care was one of “not here, not me.” Aside from progressive leaders and early adopters who began to place equity on the same footing as the other pillars of quality, the overwhelming majority either remained reluctant to admit that disparities existed in the health care settings they oversaw, or went on the slow burn, multiyear path of “studying the issue and what could be done.”

Nevertheless, leaders were slowly socialized with facts in this period, and the mantra of “no one suspect, no one solution” allowed them to better understand the multifactorial nature of the problem, and the complexity of solutions needed to address them. Organizations such as the Joint Commission, the National Committee for Quality Assurance, and the National Quality Forum—often supported by foundations such as The Commonwealth Fund, The California Endowment, and Robert Wood Johnson—began to explore how they could exert their influence to drive change in this area. Whether through accreditation standards, incentives and awards, or new measures, these organizations set the table for significant progress in legitimizing equity and the need to address disparities. During this time there was little discussion about other areas of disparities beyond racial and ethnic disparities. Disparities that impacted individuals by disability status or sexual orientation, and the impact of social determinants on health, health care, and health disparities received limited attention. Most importantly, there wasn’t much work on solutions to speak of. All of this notwithstanding, the first era was one of energy, optimism, and the building of some key foundational elements of the field.

The Second Era of Health Equity

The passage of the health care reform in 2010 and the push to increase value in health care, including achieving the triple aim of better care, better health, and lower costs, heralded the beginning of the second era of equity. A lot of energy was devoted to health insurance enrollment, and a litany of new structures (and acronyms) evolved to improve care delivery and to deliver on value, including ACOs (Accountable Care Organizations) and PCMHs (patient-centered medical homes), among others.

New cost “pressure points” such as readmission penalties and financial skin-in-the-game for population health, patient safety, and patient experience also took root. The emergence of electronic health records and meaningful use requirements became all consuming. “Hot spotters,” “super-utilizers,” and the “duals” (individuals covered by Medicare and Medicaid) became targets for new efforts to improve community health and control cost. The net-net here was that much of the oxygen was sucked out of the health care room and fledgling activities focusing on equity and disparities were receiving little attention. Foundations and other organizations that had been essential in the first modern era of equity now moved away from equity- or disparities-specific funding or activities in favor of “mainstreaming” this work (folding disparities into quality work, or as part of healthy communities’ agendas, for instance) or focusing on other more pressing areas.

Despite this, advocates for improving quality, addressing disparities, and achieving health equity began to connect the dots for health care leaders, highlighting that if they really cared about quality and controlling costs, they needed to care about equity. Research had demonstrated that minorities, when compared to whites, tended to suffer more medical errors with greater clinical consequences; have longer length of hospital stays for the same clinical condition; experience higher rates of avoidable hospitalizations and 30-day readmission rates for congestive heart failure; experience more test ordering for similar conditions (particularly when there was a language barrier); and were under-used clinically beneficial, evidence-based care. Improving quality, addressing disparities, and achieving equity was not just the right thing to do, but also the smart thing to do, given the new financial structures developed to drive quality and value.

During this time, increasing attention was paid to the social determinants of health, and new efforts were launched to collect patient data related to disability and sexual orientation. We also began to see the first unintended consequences of health care transformation: for instance, hospitals that historically served poor, underserved, vulnerable, and minority communities were subject to significant readmissions penalties. A fierce debate began about whether organizations that serve larger vulnerable populations should be able to risk-adjust for patient socioeconomic status, thus allowing them a better chance at success. Proponents feel this is appropriate and reflects reality; opponents suggest that risk adjustment creates two standards of care, one for hospitals who care for vulnerable populations, and another for those who don’t — in other words, it lets the former off the hook for delivering high-value, efficient, and effective care.

In sum, the second era of equity is one of rapid flux and a turning away from disparities and equity explicitly, while at the same time a period where a strong business case for addressing disparities and achieving equity has been made. The equity umbrella also began to expand to other groups and issues—such as individuals with disabilities and those from the Lesbian, Gay, Bisexual, and Transgender community—and incorporate the importance of the social determinants of health. Solutions still are few and far-between, hard to come by, and difficult to sustain — yet the hope remains that the movement to high-value care will finally make achieving equity a smart business decision.

The New Era of Health Equity

The new era of health equity is upon us. Health care reform marches forward, albeit with some real challenges ahead: care is costlier than anticipated under Obamacare, commercial insurers are pulling out of exchanges, and fickle political winds remain a constant threat. The real push towards value begins with the best ABC of health care yet—an acronym within an acronym—MACRA. The Medicare Access and CHIP Reauthorization Act is the Centers for Medicare and Medicaid Services’ (CMS) effort to shift how providers are paid, from quantity of care to quality of care. Already we see the unintended consequences brewing, as ACOs are the better rewarded option in MACRA compared to the Merit-Based Incentive Program (MIPS), yet are less likely to exist in minority communities. ACOs are also less likely to recruit providers who take care of large minority populations.

That being said, several promising opportunities are on the horizon. First is the much greater focus on the social determinants of health. Serious efforts, especially as part of population health, are underway to meet the broader social needs of patients. This will, if constructed with attention to the needs of diverse populations, undoubtedly go a long way to address disparities and foster equity. Second, much more attention is being paid to all aspects of equity, and not just racial and ethnic disparities. Third, activities focused on diversity and inclusion, and especially new conversations about racism, implicit bias, and stereotyping as root causes for disparities, are bubbling up now more than ever before. This is likely a direct consequence of the coverage of police violence against Black citizens, the Black Lives Matter movement, and the current and toxic political climate around race relations. Although difficult and painful, it is fair to believe that these difficult conversations can take us to a better place on issues of disparities and equity, especially in health care. Fourth, we are seeing major campaigns encouraging hospitals to place a premium on equity, most prominent among them being the American Hospital Association’s annual Equity of Care Award, and its #123forEquity pledge campaign, which over 1,300 hospitals nationwide have signed on to. Fifth, CMS has developed a major Equity Plan for Medicare that looks to drive the health care system toward a robust set of activities focused on addressing disparities and achieving equity, using CMS’ influence as the nation’s largest payer.

These are just some of the major trends and activities that will define the new era of health equity. It is important, however, to continue to highlight the importance of having multiple stakeholders at the table. Currently, health plans have been minimally engaged in this work, and the National Health Plan Collaborative, the nation’s first and only effort to bring large health plans together to partner around addressing disparities and achieving equity, has long since faded into the sunset. What is needed now are concrete strategies, solutions and interventions to address disparities and achieve equity in all its facets. More research documenting problems is nice but unnecessary. We need to move beyond diagnosing the problem to addressing it. If we are in fact going to emerge from this next era of health equity successfully, the summary we’ll write in 10 years should highlight all the new, sustainable, and financially viable interventions that finally allowed us to thread the needle and sew together cost, quality, safety, equity, and value for the purpose of eliminating disparities once and for all.



from Health Affairs BlogHealth Affairs Blog http://ift.tt/2fx1zWs

Easy Harvest Craft

Easy Harvest Craft for Kids

Fall is the perfect season for kids to create an Easy Harvest Craft. This adorable craft helps develop fine-motor skills and is perfect for school, home, or daycare.

Fall is the perfect season for kids to create a Simple Harvest Craft for Kids. This craft helps develop fine-motor skills and is perfect for school or home!

Easy Harvest Craft

This cute little fall ornament is perfect for the refrigerator.

To make this craft you will need:

  • Yellow and green craft foam
  • Corn
  • Scissors
  • Ribbon
  • Glue Dots
  • Pen
  • Glue

After gathering supplies, draw 2 leaves on the green foam. Next draw a long corn shape on the yellow foam.

RELATED: No-Carve Pumpkin Ideas

Easy Harvest Craft for Kids

Invite children to cut out the foam pieces. Next, show them how to spread glue onto the yellow foam and cover it with corn kernels.

Easy Harvest Craft for Kids

Attach the green foam leaves to the corn on the cob with Glue Dots or tacky craft glue.

Easy Harvest Craft for Kids

Cut off a strip of ribbon, then attach it to the back of the corn. Allow the craft to dry completely before hanging.

Easy Harvest Craft for Kids

More Harvest Crafts for Kids

Click the images below for more creative ideas.

free printable harvest buddy craft

Free Printable Harvest Buddies Craft

Pumpkin Patch Pudding Treat

Pumpkin Patch Pudding

The post Easy Harvest Craft appeared first on Kids Activities Blog.



from Kids Activities Blog http://ift.tt/2eeRfRe

Easy Harvest Craft

Easy Harvest Craft for Kids

Fall is the perfect season for kids to create an Easy Harvest Craft. This adorable craft helps develop fine-motor skills and is perfect for school, home, or daycare.

Fall is the perfect season for kids to create a Simple Harvest Craft for Kids. This craft helps develop fine-motor skills and is perfect for school or home!

Easy Harvest Craft

This cute little fall ornament is perfect for the refrigerator.

To make this craft you will need:

  • Yellow and green craft foam
  • Corn
  • Scissors
  • Ribbon
  • Glue Dots
  • Pen
  • Glue

After gathering supplies, draw 2 leaves on the green foam. Next draw a long corn shape on the yellow foam.

RELATED: No-Carve Pumpkin Ideas

Easy Harvest Craft for Kids

Invite children to cut out the foam pieces. Next, show them how to spread glue onto the yellow foam and cover it with corn kernels.

Easy Harvest Craft for Kids

Attach the green foam leaves to the corn on the cob with Glue Dots or tacky craft glue.

Easy Harvest Craft for Kids

Cut off a strip of ribbon, then attach it to the back of the corn. Allow the craft to dry completely before hanging.

Easy Harvest Craft for Kids

More Harvest Crafts for Kids

Click the images below for more creative ideas.

free printable harvest buddy craft

Free Printable Harvest Buddies Craft

Pumpkin Patch Pudding Treat

Pumpkin Patch Pudding

The post Easy Harvest Craft appeared first on Kids Activities Blog.



from Kids Activities Blog http://ift.tt/2eeRfRe

Sunday, October 30, 2016

180 {Gorgeous} Fall Crafts

Fall Crafts feat

We are gathering lots of fall crafts to keep us busy while we start to spend more time indoors.   Fall colors are so beautiful that it makes it really easy to come up with lots of crafts and art projects.

The other cool thing about fall crafts is that we get to bring nature inside and use it to create fun things.   Below you will find crafts that use apples, pine-cones, leaves and even rice.   What a fun way to celebrate Autumn!

180 Gorgeous Fall Crafts180 {Gorgeous} Fall Crafts

Create fall leaves by following the free leaf template here and tissue paper in your favorite fall colors.

Decorate your own fall tree with this printable coloring page and add glitter or paint for a sparkly tree!

Use a paper plate and some construction paper to make a fun fall apple.

Go on a walk to collect leaves and then take them inside and dip them in paint to turn them into stamps.

Make a craft that looks like a rake with leaves from the yard and popsicle sticks.

Fall-Crafts-square

Make this super cute turkey craft with carmel candy corn. Yum!

Use an old book to make this really festive fall pumpkin craft.

If you're making fall themed sensory bins, here is the perfect way to make colored rice.

Use small sticks from the yard to make a twig photo frame to display your favorite family photo!

Here are 15 ways to make fall scented play dough for a fun indoor activity.

Make this Warhol inspired art using leaves, crayons and water colors.

turkey-crafts

Here  are the rest of the  fall crafts.  You can even add your own!   By linking up, you give other blogs permission to link back to your site and use one photo in a roundup post.   Family friendly links only, please.


The post 180 {Gorgeous} Fall Crafts appeared first on Kids Activities Blog.



from Kids Activities Blog http://ift.tt/1xiP4hK

180 {Gorgeous} Fall Crafts

Fall Crafts feat

We are gathering lots of fall crafts to keep us busy while we start to spend more time indoors.   Fall colors are so beautiful that it makes it really easy to come up with lots of crafts and art projects.

The other cool thing about fall crafts is that we get to bring nature inside and use it to create fun things.   Below you will find crafts that use apples, pine-cones, leaves and even rice.   What a fun way to celebrate Autumn!

180 Gorgeous Fall Crafts180 {Gorgeous} Fall Crafts

Create fall leaves by following the free leaf template here and tissue paper in your favorite fall colors.

Decorate your own fall tree with this printable coloring page and add glitter or paint for a sparkly tree!

Use a paper plate and some construction paper to make a fun fall apple.

Go on a walk to collect leaves and then take them inside and dip them in paint to turn them into stamps.

Make a craft that looks like a rake with leaves from the yard and popsicle sticks.

Fall-Crafts-square

Make this super cute turkey craft with carmel candy corn. Yum!

Use an old book to make this really festive fall pumpkin craft.

If you’re making fall themed sensory bins, here is the perfect way to make colored rice.

Use small sticks from the yard to make a twig photo frame to display your favorite family photo!

Here are 15 ways to make fall scented play dough for a fun indoor activity.

Make this Warhol inspired art using leaves, crayons and water colors.

turkey-crafts

Here  are the rest of the  fall crafts.  You can even add your own!   By linking up, you give other blogs permission to link back to your site and use one photo in a roundup post.   Family friendly links only, please.


The post 180 {Gorgeous} Fall Crafts appeared first on Kids Activities Blog.



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New Rule On Excepted Benefits, Short-Term Coverage; Mental Health And Substance Use FAQs

Tim-ACA-slide

On October 28, the Departments of Health and Human Services, Labor, and Treasury released a final rule governing excepted benefits coverage, lifetime and annual limits, and short-term limited duration coverage. The regulations finalize in part proposed regulations issued by the departments in June.

The Final Rule

The final rule adopts essentially unchanged the portions of the proposed rule it covers. However, two of the topics addressed by the proposed rule—group fixed dollar indemnity coverage and expatriate plans—are not being finalized at this time. The final regulations also do not address specified disease policies (such as cancer policies), a topic on which the departments had requested comment in the notice of proposed rulemaking.

Excepted Benefits

Most of the Affordable Care Act's insurance reforms apply to non-grandfathered individual and group insurance coverage and self-insured group coverage. They do not apply, however, to a category of insurance coverage called excepted benefits. This category was created by the Health Insurance Portability and Accountability Act (HIPAA), an insurance reform statute from the late 1990s. Excepted benefits are a diverse assortment of insurance coverage, including

  • insurance that only incidentally provides health benefits (like auto liability or worker's compensation coverage);
  • limited scope health coverage (such as dental, vision, and long-term care coverage);
  • "noncoordinated" excepted benefits coverage, which is not coordinated with group health coverage and pays benefits regardless of whether such benefits are provided (such as specified disease or indemnity coverage); and
  • coverage that is supplemental to some other form of coverage (like Medicare or Tricare supplemental coverage or coverage supplemental to a group health plan.)

Excepted benefit coverage is not minimum essential coverage under the ACA, so individuals who have only excepted benefit coverage must still pay the individual responsibility coverage tax and large employers that offer only excepted benefit coverage to their full-time employees will have to pay the employer responsibility penalty if it otherwise applies. There is concern that individuals who purchase excepted benefits may not be aware how limited the coverage is and that they may not know that they will have to pay the penalty. There is also concern that individuals who purchase excepted benefit coverage rather than ACA-compliant coverage may be healthier than average purchasers of ACA-compliant coverage; thus, their absence from the individual insurance market may be a factor contributing to destabilization of the individual market risk pool.

Short-Term Coverage

Short-term, limited duration coverage is not excepted benefit coverage under HIPAA and the ACA. Rather, it is sui generis—it can only be sold in the individual market but is not individual market coverage subject to the ACA. Short-term coverage was intended to be transitional coverage, for example for individuals between jobs.

There is evidence, however, that insurers have been selling short-term coverage for terms of up to a year and extending the coverage indefinitely so that it effectively substitutes for ACA-compliant coverage. The preface to the regulation notes that short-term coverage grew from 1 to 1.5 million member months from 2013 to 2015. It is quite possible that some purchasers did not realize how limited their coverage was, that it was not guaranteed renewable, and that it did not free them from having to pay the individual responsibility penalty.

Neither HIPAA nor the ACA defined how short "short-term" is, but prior regulations required the term of coverage to be less than 12 months. The October 28 final regulations provide that short-term coverage must be for a period less than three months. This accords with the time period that individuals may remain without coverage without having to pay the individual responsibility penalty. The policy contract and all application materials connected with enrollment must also prominently display a warning stating:

THIS IS NOT QUALIFYING HEALTH COVERAGE ("MINIMUM ESSENTIAL COVERAGE") THAT SATISFIES THE HEALTH COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. IF YOU DON'T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT WITH YOUR TAXES.

The regulation also provides that the less-than-three-month limit applies to any extensions "that may be elected with or without the issuer's consent." This provision is intended to keep insurers from indefinitely extending short-term coverage. The Departments, however, rejected the suggestion from commenters that individuals not be allowed to purchase short-term coverage if they had previously been covered under a short-term policy, deeming such a policy to be too difficult to enforce. Insurers are not therefore, actually prohibited from renewing short-term policies as long as they do not guarantee renewability.

Similar Supplemental Coverage

"Similar supplemental coverage" that supplements and fills gaps in group health coverage is excepted benefit coverage. The final rule clarifies that supplemental coverage must either

  1. cover benefits that are not covered by the primary coverage and are not essential health benefits in the state where the coverage (including expatriate coverage) is issued;
  2. cover cost-sharing for primary benefits; or
  3. both provide supplemental benefits and cover cost-sharing.

Similar supplemental group coverage does not include coverage that becomes secondary or supplemental only under a coordination of benefit provision. The regulation does not explicitly supersede earlier guidance that provided that supplemental coverage could not cost more than 15 percent of the cost of the primary coverage and could not differential among individuals in eligibility.

Travel Insurance

The final rule also recognizes travel insurance as a new category of excepted benefits. It defines travel insurance as insurance coverage for the personal risks of planned travel, such as trip interruption or cancellation, loss of baggage, damages to accommodations or rental vehicles, and sickness, accident, disability, or death during travel, as long as health benefits are not offered on a standalone basis and are incidental to other coverage. Travel insurance does not include comprehensive medical protection for travelers with trips lasting six months or longer, such as expatriates or deployed military personnel.

Essential Health Benefit Definition For The Purposes Of Annual And Lifetime Dollar Limits

Finally, the final rule defines essential health benefits (EHB) for purposes of the ACA's annual and lifetime dollar limits. Non-grandfathered health plans subject to the ACA cannot impose annual or lifetime dollar limits on EHB. This prohibition applies to large group plans, but large group plans are not required to cover the EHB, which must be covered by individual or small group plans.

The final rule defines EHBs for plans that are not required to cover EHB as any EHBs covered by an EHB-benchmark plan in any state (including state-mandated benefits that qualify as EHB) or benefits under one of the three largest Federal Employees Health Benefit Program plans (including any benefits added to meet EHB regulatory requirements).

Group Fixed Dollar Indemnity Plans

As noted at the outset, the final rule does not include proposed provisions governing group fixed dollar indemnity plans. These proposed rules would have required group fixed indemnity plans to be offered on a per-time-period rather than per-service basis and would have required a warning in application, enrollment, and reenrollment materials that fixed-dollar indemnity coverage is not minimum essential coverage and cannot be relied to meet the individual responsibility requirement. A similar notice requirement already applies to individual fixed indemnity coverage. A further requirement for individual fixed indemnity coverage—that the coverage be sold only to individuals who attest that they have ACA-compliant primary coverage—was invalidated by a federal court earlier this year, but was not part of the proposed rule for group fixed indemnity coverage.

The final rule takes effect for coverage for policy and plan years beginning after January 1, 2017. The Departments will not enforce the requirement that short-term coverage be less than three months, however, for products sold before April 1, 2017, as long as the coverage ends on or before December 31, 2017. States may also elect not to enforce the time limit for coverage sold before April 1.

Mental Health And Substance Use Disorder Parity Report And FAQs

On October 27, the President's task force on Mental Health and Substance Use Disorder Parity released its final report. The report was accompanied with a blog post, fact sheet, disclosure guide for making the most of mental health and substance use disorder benefits, and a set of frequently asked questions (FAQs) issued jointly by the Departments of Labor, Health and Human Services, and Treasury. HHS is also unveiling a beta version website designed to help consumers find the appropriate federal or state agency to help them with mental health and substance use disorder parity complaints, appeals, or other actions.

This post will not review the Task Force report itself, but rather focuses on the FAQs, which implement certain recommendations of the report. These FAQs supplement and clarify a number of FAQs and other guidance issued by the Departments in the past on MHSUD parity.

Tobacco Cessation Services

The first FAQ is really a request for information. The Affordable Care Act requires health plans and insurers to cover preventive services given an "A" recommendation by the United States Preventive Services Task Force (USPSTF). On September 22, 2015, the USPSTF updated its tobacco cessation "A" recommendation; the group recommended that "clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide both behavioral interventions and FDA-approved pharmacotherapy for cessation to adults who use tobacco." The USPSTF further recommended that "[b]oth intervention types (pharmacotherapy and behavioral interventions) are effective and recommended; combinations of interventions are most effective, and all should be offered." The USPTSTF recommendation identifies seven FDA-approved over-the-counter and prescription drugs that are effective for tobacco cessation; it also indentifies effective individual, group, and telephonic behavioral interventions.

Health plans and insurers must cover tobacco cessation services consistent with this recommendation without cost sharing for plan years beginning a year after the recommendation was made—that is, September 22, 2016. Even though the date for compliance has passed, the Departments request comments on whether plans and issuers may use reasonable medical management techniques to limit pharmaceutical tobacco cessation interventions available without cost-sharing, individually or in combination; the number of quit attempts that should be allowed per year or the duration of interventions; or the behavioral interventions available without cost sharing.

Mental Health Parity and Addiction Equity Act

The remainder of the FAQs deal with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The MHPAEA provides that group health plans and insurers that offer mental health or substance use disorder (MH/SUD) service benefits may not impose financial requirements and quantitative and non-quantitative treatment limitations (NQTLs) that are more restrictive than the predominant financial requirements and treatment limitations that they apply to substantially all medical and surgical benefits. The FAQs address in detail what these requirements mean.

Disclosure Of MH/SUD Medical Necessity Determinations And Reasons For Claims Denials

The requirements of the MHPAEA can only be enforced if the financial requirements and treatment limitations imposed by an insurer are health plan are known. The MHPAEA requires, therefore, the health plans and insurers disclose their criteria for MH/SUD medical necessity determinations and reasons for claim denials to consumers, providers, and regulators. Information on standards applied for medical benefits may also be necessary to perform parity analysis. The FAQs ask whether model forms for requesting disclosures would be helpful to consumers, providers, and regulators, and whether additional steps would be helpful to ensure compliance with disclosure requirements. The FAQs specifically cite the portal mentioned above which consumers can use to identify the federal or state agency that can help with disclosure requirements and appeals.

The financial parity requirements of the MHPAEAA prohibit group health plans or insurers from imposing financial requirements (such as copayments or coinsurances) or quantitative treatment limitations (such as day or visit limits) on MH/SUD benefits in a classification (such as inpatient or outpatient treatment or prescription drugs) that are more restrictive than the predominant levels that apply to substantially all medical and surgical benefits in the classification of services. A requirement is considered to apply to substantially all medical/surgical benefits in a classification if it applies to at least two-thirds of all medical/surgical benefits in the classification. If it does not apply to at least two-thirds of medical/surgical benefits, it cannot be applied to MH/SUD benefits in that classification.

Financial Requirements And Quantitative Treatment Limitations

If a financial requirement or quantitative limitation does apply to at least two-thirds of medical/surgical benefits in a classification, the level that may be applied to MH/SUD benefits in the classification may not be more restrictive than the predominant level that applies to medical/surgical benefits (defined as the level that applies to more than one half of medical/surgical benefits subject to the limitation in the classification). The determination of the portion of medical/surgical benefits subject to the quantitative limit is based on the dollar amount of all plan payments for medical/surgical benefits in the classification expected to be paid under the plan for the plan year. The MHPAEA regulations provide that "any reasonable method" may be used to determine the dollar amount of all plan payments.

The FAQs discuss at length how these determinations are to be made for small plans that lack sufficient claims volume to provide credible projections for the predominant levels that apply to substantially all claims. In these situations, the plan should not rely on data from its insurer or third party administrator's larger book of business, but should rather have a qualified actuary use a reasonable method for making projections, using data from similar plans with similar demographics and documenting assumptions used for the projections.

Non-Quantitative Treatment Limits

The remaining FAQs deal with non-quantitative limits. A plan or insurer cannot impose a NQTL with respect to MH/SUD benefits in a classification unless under the terms of the plan as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to MH/SUD benefits in the classification are comparable to, and are applied no more stringently than, those applied to medical/surgical benefits in the classification. Several of the FAQs address drugs that are used for treating opioid addiction.

The FAQs clarify that:

  • A plan or insurer may not require an enrollee to be examined in person by a representative of the plan prior to a MH/SUD inpatient admission if enrollees can be admitted for medical/surgical services with only a telephone interview;
  • A plan or insurer may not require an enrollee to participate in an intensive outpatient treatment program for MH/SUD before an inpatient admission, even though the same requirement is applied for medical/surgical services, if no such program is available for MH/SUD treatment in the enrollee's area;
  • A plan or insurer may not impose prior authorization or "fail-first" requirements for drugs used for treating opioid addiction if these requirements are not imposed on drugs used for treatment of medical/surgical conditions that have similar risks or indications;
  • A plan or insurer may not impose prior-approval for 30 day refills of opioid addiction treatment drugs, a requirement not consistent with nationally recognized treatment guidelines, if it follows nationally recognized treatment guidelines for requiring prior authorizations for medical/surgical drugs; and
  • Plans and insurers may not exclude coverage for court-ordered SUD treatment if they do not exclude coverage for court ordered medical/surgical treatment, but may require that court-ordered treatment be medically necessary.


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New Rule On Excepted Benefits, Short-Term Coverage; Mental Health And Substance Use FAQs

Tim-ACA-slide

On October 28, the Departments of Health and Human Services, Labor, and Treasury released a final rule governing excepted benefits coverage, lifetime and annual limits, and short-term limited duration coverage. The regulations finalize in part proposed regulations issued by the departments in June.

The Final Rule

The final rule adopts essentially unchanged the portions of the proposed rule it covers. However, two of the topics addressed by the proposed rule—group fixed dollar indemnity coverage and expatriate plans—are not being finalized at this time. The final regulations also do not address specified disease policies (such as cancer policies), a topic on which the departments had requested comment in the notice of proposed rulemaking.

Excepted Benefits

Most of the Affordable Care Act’s insurance reforms apply to non-grandfathered individual and group insurance coverage and self-insured group coverage. They do not apply, however, to a category of insurance coverage called excepted benefits. This category was created by the Health Insurance Portability and Accountability Act (HIPAA), an insurance reform statute from the late 1990s. Excepted benefits are a diverse assortment of insurance coverage, including

  • insurance that only incidentally provides health benefits (like auto liability or worker’s compensation coverage);
  • limited scope health coverage (such as dental, vision, and long-term care coverage);
  • “noncoordinated” excepted benefits coverage, which is not coordinated with group health coverage and pays benefits regardless of whether such benefits are provided (such as specified disease or indemnity coverage); and
  • coverage that is supplemental to some other form of coverage (like Medicare or Tricare supplemental coverage or coverage supplemental to a group health plan.)

Excepted benefit coverage is not minimum essential coverage under the ACA, so individuals who have only excepted benefit coverage must still pay the individual responsibility coverage tax and large employers that offer only excepted benefit coverage to their full-time employees will have to pay the employer responsibility penalty if it otherwise applies. There is concern that individuals who purchase excepted benefits may not be aware how limited the coverage is and that they may not know that they will have to pay the penalty. There is also concern that individuals who purchase excepted benefit coverage rather than ACA-compliant coverage may be healthier than average purchasers of ACA-compliant coverage; thus, their absence from the individual insurance market may be a factor contributing to destabilization of the individual market risk pool.

Short-Term Coverage

Short-term, limited duration coverage is not excepted benefit coverage under HIPAA and the ACA. Rather, it is sui generis—it can only be sold in the individual market but is not individual market coverage subject to the ACA. Short-term coverage was intended to be transitional coverage, for example for individuals between jobs.

There is evidence, however, that insurers have been selling short-term coverage for terms of up to a year and extending the coverage indefinitely so that it effectively substitutes for ACA-compliant coverage. The preface to the regulation notes that short-term coverage grew from 1 to 1.5 million member months from 2013 to 2015. It is quite possible that some purchasers did not realize how limited their coverage was, that it was not guaranteed renewable, and that it did not free them from having to pay the individual responsibility penalty.

Neither HIPAA nor the ACA defined how short “short-term” is, but prior regulations required the term of coverage to be less than 12 months. The October 28 final regulations provide that short-term coverage must be for a period less than three months. This accords with the time period that individuals may remain without coverage without having to pay the individual responsibility penalty. The policy contract and all application materials connected with enrollment must also prominently display a warning stating:

THIS IS NOT QUALIFYING HEALTH COVERAGE (“MINIMUM ESSENTIAL COVERAGE”) THAT SATISFIES THE HEALTH COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. IF YOU DON’T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT WITH YOUR TAXES.

The regulation also provides that the less-than-three-month limit applies to any extensions “that may be elected with or without the issuer’s consent.” This provision is intended to keep insurers from indefinitely extending short-term coverage. The Departments, however, rejected the suggestion from commenters that individuals not be allowed to purchase short-term coverage if they had previously been covered under a short-term policy, deeming such a policy to be too difficult to enforce. Insurers are not therefore, actually prohibited from renewing short-term policies as long as they do not guarantee renewability.

Similar Supplemental Coverage

“Similar supplemental coverage” that supplements and fills gaps in group health coverage is excepted benefit coverage. The final rule clarifies that supplemental coverage must either

  1. cover benefits that are not covered by the primary coverage and are not essential health benefits in the state where the coverage (including expatriate coverage) is issued;
  2. cover cost-sharing for primary benefits; or
  3. both provide supplemental benefits and cover cost-sharing.

Similar supplemental group coverage does not include coverage that becomes secondary or supplemental only under a coordination of benefit provision. The regulation does not explicitly supersede earlier guidance that provided that supplemental coverage could not cost more than 15 percent of the cost of the primary coverage and could not differential among individuals in eligibility.

Travel Insurance

The final rule also recognizes travel insurance as a new category of excepted benefits. It defines travel insurance as insurance coverage for the personal risks of planned travel, such as trip interruption or cancellation, loss of baggage, damages to accommodations or rental vehicles, and sickness, accident, disability, or death during travel, as long as health benefits are not offered on a standalone basis and are incidental to other coverage. Travel insurance does not include comprehensive medical protection for travelers with trips lasting six months or longer, such as expatriates or deployed military personnel.

Essential Health Benefit Definition For The Purposes Of Annual And Lifetime Dollar Limits

Finally, the final rule defines essential health benefits (EHB) for purposes of the ACA’s annual and lifetime dollar limits. Non-grandfathered health plans subject to the ACA cannot impose annual or lifetime dollar limits on EHB. This prohibition applies to large group plans, but large group plans are not required to cover the EHB, which must be covered by individual or small group plans.

The final rule defines EHBs for plans that are not required to cover EHB as any EHBs covered by an EHB-benchmark plan in any state (including state-mandated benefits that qualify as EHB) or benefits under one of the three largest Federal Employees Health Benefit Program plans (including any benefits added to meet EHB regulatory requirements).

Group Fixed Dollar Indemnity Plans

As noted at the outset, the final rule does not include proposed provisions governing group fixed dollar indemnity plans. These proposed rules would have required group fixed indemnity plans to be offered on a per-time-period rather than per-service basis and would have required a warning in application, enrollment, and reenrollment materials that fixed-dollar indemnity coverage is not minimum essential coverage and cannot be relied to meet the individual responsibility requirement. A similar notice requirement already applies to individual fixed indemnity coverage. A further requirement for individual fixed indemnity coverage—that the coverage be sold only to individuals who attest that they have ACA-compliant primary coverage—was invalidated by a federal court earlier this year, but was not part of the proposed rule for group fixed indemnity coverage.

The final rule takes effect for coverage for policy and plan years beginning after January 1, 2017. The Departments will not enforce the requirement that short-term coverage be less than three months, however, for products sold before April 1, 2017, as long as the coverage ends on or before December 31, 2017. States may also elect not to enforce the time limit for coverage sold before April 1.

Mental Health And Substance Use Disorder Parity Report And FAQs

On October 27, the President’s task force on Mental Health and Substance Use Disorder Parity released its final report. The report was accompanied with a blog post, fact sheet, disclosure guide for making the most of mental health and substance use disorder benefits, and a set of frequently asked questions (FAQs) issued jointly by the Departments of Labor, Health and Human Services, and Treasury. HHS is also unveiling a beta version website designed to help consumers find the appropriate federal or state agency to help them with mental health and substance use disorder parity complaints, appeals, or other actions.

This post will not review the Task Force report itself, but rather focuses on the FAQs, which implement certain recommendations of the report. These FAQs supplement and clarify a number of FAQs and other guidance issued by the Departments in the past on MHSUD parity.

Tobacco Cessation Services

The first FAQ is really a request for information. The Affordable Care Act requires health plans and insurers to cover preventive services given an “A” recommendation by the United States Preventive Services Task Force (USPSTF). On September 22, 2015, the USPSTF updated its tobacco cessation “A” recommendation; the group recommended that “clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide both behavioral interventions and FDA-approved pharmacotherapy for cessation to adults who use tobacco.” The USPSTF further recommended that “[b]oth intervention types (pharmacotherapy and behavioral interventions) are effective and recommended; combinations of interventions are most effective, and all should be offered.” The USPTSTF recommendation identifies seven FDA-approved over-the-counter and prescription drugs that are effective for tobacco cessation; it also indentifies effective individual, group, and telephonic behavioral interventions.

Health plans and insurers must cover tobacco cessation services consistent with this recommendation without cost sharing for plan years beginning a year after the recommendation was made—that is, September 22, 2016. Even though the date for compliance has passed, the Departments request comments on whether plans and issuers may use reasonable medical management techniques to limit pharmaceutical tobacco cessation interventions available without cost-sharing, individually or in combination; the number of quit attempts that should be allowed per year or the duration of interventions; or the behavioral interventions available without cost sharing.

Mental Health Parity and Addiction Equity Act

The remainder of the FAQs deal with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The MHPAEA provides that group health plans and insurers that offer mental health or substance use disorder (MH/SUD) service benefits may not impose financial requirements and quantitative and non-quantitative treatment limitations (NQTLs) that are more restrictive than the predominant financial requirements and treatment limitations that they apply to substantially all medical and surgical benefits. The FAQs address in detail what these requirements mean.

Disclosure Of MH/SUD Medical Necessity Determinations And Reasons For Claims Denials

The requirements of the MHPAEA can only be enforced if the financial requirements and treatment limitations imposed by an insurer are health plan are known. The MHPAEA requires, therefore, the health plans and insurers disclose their criteria for MH/SUD medical necessity determinations and reasons for claim denials to consumers, providers, and regulators. Information on standards applied for medical benefits may also be necessary to perform parity analysis. The FAQs ask whether model forms for requesting disclosures would be helpful to consumers, providers, and regulators, and whether additional steps would be helpful to ensure compliance with disclosure requirements. The FAQs specifically cite the portal mentioned above which consumers can use to identify the federal or state agency that can help with disclosure requirements and appeals.

The financial parity requirements of the MHPAEAA prohibit group health plans or insurers from imposing financial requirements (such as copayments or coinsurances) or quantitative treatment limitations (such as day or visit limits) on MH/SUD benefits in a classification (such as inpatient or outpatient treatment or prescription drugs) that are more restrictive than the predominant levels that apply to substantially all medical and surgical benefits in the classification of services. A requirement is considered to apply to substantially all medical/surgical benefits in a classification if it applies to at least two-thirds of all medical/surgical benefits in the classification. If it does not apply to at least two-thirds of medical/surgical benefits, it cannot be applied to MH/SUD benefits in that classification.

Financial Requirements And Quantitative Treatment Limitations

If a financial requirement or quantitative limitation does apply to at least two-thirds of medical/surgical benefits in a classification, the level that may be applied to MH/SUD benefits in the classification may not be more restrictive than the predominant level that applies to medical/surgical benefits (defined as the level that applies to more than one half of medical/surgical benefits subject to the limitation in the classification). The determination of the portion of medical/surgical benefits subject to the quantitative limit is based on the dollar amount of all plan payments for medical/surgical benefits in the classification expected to be paid under the plan for the plan year. The MHPAEA regulations provide that “any reasonable method” may be used to determine the dollar amount of all plan payments.

The FAQs discuss at length how these determinations are to be made for small plans that lack sufficient claims volume to provide credible projections for the predominant levels that apply to substantially all claims. In these situations, the plan should not rely on data from its insurer or third party administrator’s larger book of business, but should rather have a qualified actuary use a reasonable method for making projections, using data from similar plans with similar demographics and documenting assumptions used for the projections.

Non-Quantitative Treatment Limits

The remaining FAQs deal with non-quantitative limits. A plan or insurer cannot impose a NQTL with respect to MH/SUD benefits in a classification unless under the terms of the plan as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to MH/SUD benefits in the classification are comparable to, and are applied no more stringently than, those applied to medical/surgical benefits in the classification. Several of the FAQs address drugs that are used for treating opioid addiction.

The FAQs clarify that:

  • A plan or insurer may not require an enrollee to be examined in person by a representative of the plan prior to a MH/SUD inpatient admission if enrollees can be admitted for medical/surgical services with only a telephone interview;
  • A plan or insurer may not require an enrollee to participate in an intensive outpatient treatment program for MH/SUD before an inpatient admission, even though the same requirement is applied for medical/surgical services, if no such program is available for MH/SUD treatment in the enrollee’s area;
  • A plan or insurer may not impose prior authorization or “fail-first” requirements for drugs used for treating opioid addiction if these requirements are not imposed on drugs used for treatment of medical/surgical conditions that have similar risks or indications;
  • A plan or insurer may not impose prior-approval for 30 day refills of opioid addiction treatment drugs, a requirement not consistent with nationally recognized treatment guidelines, if it follows nationally recognized treatment guidelines for requiring prior authorizations for medical/surgical drugs; and
  • Plans and insurers may not exclude coverage for court-ordered SUD treatment if they do not exclude coverage for court ordered medical/surgical treatment, but may require that court-ordered treatment be medically necessary.


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Simple Kitchen Science with Green Kid Crafts

Green Kid Crafts

Using the Green Kid Crafts subscription box is the ultimate savior for some of us moms who are either not natural born creatives or simply don’t have the time to think up the best educational crafts for our kids.

Green Kid Crafts

What is Green Kid Crafts?

Green Kid Crafts is a subscription box service that was made to educate your children with fun crafts. Each box has directions for crafts and the supplies that you need to do them.

Using a kid activity subscription box is the best way to cut down on the amount of time you spend preparing the activity and maximize the amount of quality time you spend with your kids learning.

Green Kid Crafts highlights STEAM activities (science, technology, engineering, arts, and math) that help spark your kid’s imagination.

All of the materials that come with the subscription (and even the box!) are eco- friendly, which can help you as a parent ignite an educational conversation with your children about what it means to take care of our environment!

Green Kid Crafts

What we learned from Green Kid Crafts

Our box’s theme this month was based on kitchen science! We received enough materials to complete 3 kitchen science crafts and enough directions to complete 3 more bonus crafts.

The first science experiment we learned how to make soap. Green Kid Crafts provided all of the materials needed and the only adult help needed is to melt the bar of soap in the microwave.

After the soap was melted the kids were able to decorate the soap with glitter and erasers. It was fun for my daughter to see how once we poured the melted (and decorated) soap in to the star shaped mold it hardened and took the shape of the container it was in!

What a great lesson on the properties of liquids and solids!

The second kitchen science experiment we learned how to make fizzy bath bombs. We did have to have vegetable oil from home, but the rest of the materials are provided.

This experiment can help you facilitate a lesson on chemical reactions. What causes the bath bombs to fizz?

Don’t worry, in case you aren’t a science fanatic Green Kid Crafts tells you how to explain the process to your kids!

The third experiment was my daughter’s favorite. We used baking soda and colored tabs dissolved in vinegar to create bubbling volcanoes!

Using some vinegar from home, you dissolve the color tabs inside to make the volcanoes colorful. Once you drop the colored vinegar onto the baking soda you and your kids can watch the bubbling volcanoes come to life!

Green Kid Crafts

The Green Kid Craft subscription box is a great, easy to use, educational activity for both kids and parents. We will definitely be using this subscription box service in the future!

For more easy and fun science experiments that won’t feel like learning check out the 101 Coolest Simple Science Experiments book!

The post Simple Kitchen Science with Green Kid Crafts appeared first on Kids Activities Blog.



from Kids Activities Blog http://ift.tt/2f1eayh

Simple Kitchen Science with Green Kid Crafts

Green Kid Crafts

Using the Green Kid Crafts subscription box is the ultimate savior for some of us moms who are either not natural born creatives or simply don't have the time to think up the best educational crafts for our kids.

Green Kid Crafts

What is Green Kid Crafts?

Green Kid Crafts is a subscription box service that was made to educate your children with fun crafts. Each box has directions for crafts and the supplies that you need to do them.

Using a kid activity subscription box is the best way to cut down on the amount of time you spend preparing the activity and maximize the amount of quality time you spend with your kids learning.

Green Kid Crafts highlights STEAM activities (science, technology, engineering, arts, and math) that help spark your kid's imagination.

All of the materials that come with the subscription (and even the box!) are eco- friendly, which can help you as a parent ignite an educational conversation with your children about what it means to take care of our environment!

Green Kid Crafts

What we learned from Green Kid Crafts

Our box's theme this month was based on kitchen science! We received enough materials to complete 3 kitchen science crafts and enough directions to complete 3 more bonus crafts.

The first science experiment we learned how to make soap. Green Kid Crafts provided all of the materials needed and the only adult help needed is to melt the bar of soap in the microwave.

After the soap was melted the kids were able to decorate the soap with glitter and erasers. It was fun for my daughter to see how once we poured the melted (and decorated) soap in to the star shaped mold it hardened and took the shape of the container it was in!

What a great lesson on the properties of liquids and solids!

The second kitchen science experiment we learned how to make fizzy bath bombs. We did have to have vegetable oil from home, but the rest of the materials are provided.

This experiment can help you facilitate a lesson on chemical reactions. What causes the bath bombs to fizz?

Don't worry, in case you aren't a science fanatic Green Kid Crafts tells you how to explain the process to your kids!

The third experiment was my daughter's favorite. We used baking soda and colored tabs dissolved in vinegar to create bubbling volcanoes!

Using some vinegar from home, you dissolve the color tabs inside to make the volcanoes colorful. Once you drop the colored vinegar onto the baking soda you and your kids can watch the bubbling volcanoes come to life!

Green Kid Crafts

The Green Kid Craft subscription box is a great, easy to use, educational activity for both kids and parents. We will definitely be using this subscription box service in the future!

For more easy and fun science experiments that won't feel like learning check out the 101 Coolest Simple Science Experiments book!

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Saturday, October 29, 2016

30+ Thanksgiving Activities Toddlers Will LOVE

thanksgiving activities toddlers

I adore these 30+ Thanksgiving Activities for Toddlers! Even though Thanksgiving is packed in the part of the season when decorating and shopping is on my mind, there seems to be downtime around this holiday that is open for having a little family fun. Here’s several kids Thanksgiving ideas I’ve rounded up to help you get creating and making memories with your toddler.

Also check out these 25+ Thanksgiving Activities for 3 Year Olds. So many Thanksgiving activities to do with your kids!

thanksgiving activities toddlers

30+ Thanksgiving Activities Toddlers LOVE

thanksgiving activities toddlers

Thanksgiving Activities Toddlers Will LOVE

thanksgiving activities toddlers

  • Thanksgiving Coloring Pages – These simple shapes are great for toddler crayon skills.  The bonus is that they double as Thanksgiving placemats. -via Kids Activities Blog
  • Play Pumpkin Pie – This preciously adorable felt faux food is seasonally perfect.  Little hands will enjoy playing with their food while we will all be glad it is mess-free. -via Mama Smiles
  • Thanksgiving Tree – This is a family activity that can include everyone…including the little ones.  It is always a good thing to start the conversation of gratefulness. -via Kids Activities Blog
  • Torn Paper Turkey Craft – Oh how I giggle when everything you need for a craft is in the craft drawer.  This is one of those simple things you can pull out and do within the next 3 minutes. -via Coffee Cups and Crayons
  • Bottle Cap Turkey Magnets.  Go small.   Make fridge magnets with bottle caps. -via Crafty Morning
  • Thanksgiving Headband – Inspired by the Native Americans who made the first Thanksgiving possible. -via Kids Activities Blog
  • Thanksgiving Game – This simple game will have all the kids running with a grateful heart.  It can be modified for any level of play. -via Kids Activities Blog
  • Fine Motor Turkey – This is a simple homemade toy that will challenge toddlers and their proprioceptive abilities! -via Twodaloo
  • Cookie Cutter Stencil Tree – Using the cookie cutters in a kitchen drawer, your toddler can create art. -via Kids Activities Blog
  • Fall Family Outings – Lots of ideas to get the entire family outside to enjoy autumn and the Thanksgiving air. -via Kids Activities Blog
  • Thankful Hands – This simple craft involves hand tracing and a thankful spirit. -via Mama Smiles
  • Handprint Feathered Turkey –    A fun, easy preschool craft. -via My Cup Overflows
  • Coffee Filter Turkey – Using a salad spinner and some paint, this craft is sure to be a toddler hit! -via Kids Activities Blog

Tons of Thanksgiving Toddlers Activities

thanksgiving activities toddlers

 

  • Decorate a Turkey – I love how this simple activity can be made age-appropriate based on the materials you provide for turkey dressing (up). -via Blog Me Mom
  • Native American Dolls – These simple play people are upcycled toilet paper rolls and can be personalized to a toddler’s specifications. -via Crafty Moms Share
  • Handprint Ship – A toddler’s handprint is transformed into a pilgrim ship with a bit of paint and construction paper shapes.  It is something they will love to do and then send as a card. -via Kids Activities Blog
  • Pumpkin from a plate  – This site has several easy preschool crafts. -via She Knows
  • Pasta Turkeys – This silly sensory play is sure to be a hit with kids that adore their time to be filled with a tad of messy. -via 123 Homeschool 4 Me
  • DIY Art Placemats – Get the entire family involved in creating custom placemats from their art for Thanksgiving dinner! -via Kids Activities Blog
  • We are Thankful Display – Toddlers can get involved in the family thankfulness display. -via Kids Activities Blog
  • Colorful Turkey Suncatcher – Transform a little tissue paper into a bright and happy turkey to hang in the window.  This post has a free printable so your turkey will resemble a turkey too! -via Learn Create Love
  • Thankful Heart Tree – Another family thankful tree that makes a sweet holiday tradition. -via Kids Activities Blog
  • Thanksgiving Centerpiece – This table centerpiece is easy enough that a toddler can be involved in the process. -via Kids Activities Blog
  • Simple Thanksgiving Coloring Page – This simple design is perfect for baby’s first coloring page. -via Kids Activities Blog
  • Geometric Turkey – With some shapes that require little adult skill to create, a toddler can assemble their own colorful turkey and decorate. -via Blog Me Mom
  • Felt Turkey Assembly – If you are looking for a quiet activity, this is the perfect fit.  Felt cut into simple shapes that toddlers can make a turkey…or something else. -via Kids Activities Blog
  • Handprint Turkey – This child craft Thanksgiving tradition is always lots of fun. -via Mama Smiles
  • Footprint Turkey – This child craft Thanksgiving tradition has a twist! -via Kids Activities Blog
  • Paper Plate Boat – Build a ship out of paper plates.  If you are brave, grab some paint too. -via Kids Activities Blog
  • November Coloring Pages – This set of three free printable coloring pages can be used with crayons, paint or whatever a toddler thinks up! -via Kids Activities Blog
  • Thanksgiving Books for Kids – A list of books that will get your family in the Thanksgiving spirit. -via Kids Activities Blog

How do you include toddlers in your Thanksgiving activities? Share with us on our Facebook page!

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