The AETC Capitol Region Telehealth "Power Podcast" series allows you to listen to experts in the field from your computer or mobile device. Designed for the busy professional, you can learn about cultural competence in the treatment of HIV/AIDS from your office or "On-The-Go."

ACA: What Clinicians need to Know: Special 1 Hour Webinar

View the PowerPoint presentation slides here.

Faculty:

Timothy Harrison, PhD
Senior Policy Advisor
Office of HIV/AIDS and
Infectious Disease Policy (OHAIDP)
US Department of Health and Human Services

Learning Objectives:

• Describe how the Affordable Care Act applies to the clinicians’ role as care provider.
• Describe the concept of coordinated care via the formation of medical team organizations, which allow for improved clinical outcomes for patients.
• Identify those components of the plan that cover certain preventive services without charging a deductible, co-pay or coinsurance.
• State how insurers are prohibited from denying coverage or discriminating due to pre-existing conditions in children and adults respectively.

Questions and Answers

Mr. Johnson is from Puerto Rico. Is he eligible to receive ACA? It was not clear that he is an American Citizen.

Puerto Ricans are U.S. citizens and therefore Mr. Johnson is eligible to apply for insurance under the ACA.   

Is alcohol abuse covered under the ACA?

Yes, mental health and substance abuse is now one of the essential health benefits under the Affordable Care Act.

As a clinician in private practice and a low volume HIV provider, I am participating in this training to help develop my clinical skills since the ACA is now forcing me to care for patients that my practice previously did not treat but referred out. Under ACA am I at risk if I refuse care to patients with HIV if I do not feel that I am not clinically competent to do so?

As providers we want to provide the best possible care for our patients. A referral system that better addresses the needs of a client is certainly better than not and so certainly if you are able to continue to refer clients to services that provide them care that is important. There are a range of potential primary and related services that might be in play, it may not just be primary care, there could be additional that are important. And so being able to refer or link clients who are requiring services is most important.

Is health literacy included in the ACA? How do you suggest private practitioners like me insure that this provision is met?

Health literacy particularly in the age of more complex management is really critical, both from a consumer standpoint (under what he/she is dealing with) also from a provider standpoint (understand the range of drugs, the range of interactions that are important for his/her client). There are a number of related services provided by both Centers for Medicare and Medicaid Services (CMS) and Health Resources and Services Administration (HRSA) that addresses this issue of health literacy, that is available to anyone including providers that will help both in terms of navigation of ACA, but also more specifically navigation of ACA as it relates to HIV and AIDS. You can reach out and we could provide you with a link to participate in TA and training opportunities, but the issue health literacy is critical for us moving forward, for both provider and client.

How do you see the ACA impacting the anticipated outcomes of the National HIV/AIDS Strategy?

The ACA is an essential piece to have us move forward in the National HIV/AIDS Strategy. It is one of the structural improvements that will allow us to address some areas that heretofore were not being effectively addressed. Chief among them: (1) the number of people without health insurance; (2) the number of people denied health insurance because of HIV/AIDS; and (3) the number of people kicked out of plans because of cost or time limits. It is important in order to both put folks into care systems of insurance also enable them to stay there and benefit from the medication, wrap around services, etc that are important. If you look at the essential health benefits mental health, prescription drugs, preventive and wellness all have a great potential impact on people living with HIV/AIDS and on those at risk.  It is definitely a significant structural investment in our health systems and the opportunity for people at risk, or living with HIV/AIDS to be impacted; along with many of the others - biomedical development, behavioral development all working in tandem to make the opportunity for a better health outcomes possible.

Can you please explain more about State-based health insurance marketplaces, with subsidies based on income?

With the creation of the Affordable Care Act market places can be created by:

• State
• State/Federal Partnerships
• Federal Government

Created by HHS when states decide either not to establish its own marketplace or the state marketplace does not meet minimal federal standards. State based marketplaces are mandated by the ACA. There is a clearinghouse where eligible individuals and businesses can compare and purchase private insurance and state has primary responsibility for its operations. Federal funds to support states during planning and implementation and first year of operations are available.  

The essential health benefits include hospitalization and inpatient care, what about outpatient care?

The essential health benefits provide ambulatory patient services (outpatient care) coverage.