Affordable Care Act (ACA) tools for rural providers

By Brock A. Slabach, MPH, FACHE posted 09-04-2013 12:42 PM


Since the passage of the ACA in 2010, the advent of its major provisions always seemed far away. In less than 4 weeks the State or Federal Marketplaces will begin offering insurance policies to the general public, with coverage to be effective Jan. 1. Many have hoped that the political winds would shift and the entire law would be repealed. Rural providers should be preparing now for participation in the ACA regardless of hopes and desires to the contrary.

Providers should be concentrating on dicovering the Qualified Health Plans (QHP) that are going to be offered in your area. Per number 5 below, you should know in mid-September which QHP’s will be offered in your Marketplace. The next question is whether your facility has a contract with all of the QHPs in your market. If not, contact the QHP and ask to be contracted to serve those insured by that QHP. If you’re an “Essential Community Provider” (ECP), which is defined as 340B eligible, the ACA requires “network adequacy’ of ECPs within a QHP. Insist on that if you’re having trouble obtaining a contract.

Next, you can provide leadership in your community to ensure that your patients are covered. Subsidies are available in the Marketplaces for as much as 94% of the premium cost. Below are a listing of tools and services that the Office of Rural Health Policy (ORHP) and HHS has made available to assist you in this effort. Please take advantage of these resources.

  1. The publicly available Certified Application Counselor training (with situational questions) has been posted here (click on “Content of CAC training courses”). The training files include:
    1. Training Overview
    2. Assistance in the Individual Marketplace
    3. Eligibility and Enrollment
    4. Health Insurance Basics
    5. Marketplace Basics
    6. Privacy and Security
    7. Standard Operating Procedures Manual


  2. 10 things you should know as a provider and 10 things to tell your patients. These are documents to help you in your discussion with your staff and patients. 
  3. On Wednesday, the Internal Revenue Service released a final rule on the shared responsibility payment for not maintaining minimum coverage, detailing exemptions to the “individual mandate.” The rule is a companion to the final rule published by the U.S. Dept. of Health and Human Services (HHS) in June. A full list of HHS regulations and guidance (including the final rule published today) concerning the Health Insurance Marketplace can be found at Insurance Exchanges.


  4. The Henry J. Kaiser Family Foundation’s Subsidy Calculator can now be embedded on your website, along with other materials from the Foundation. Click here for instructions to embed the Subsidy Calculator.


  5. Click here for an overview of what states with a State-based Marketplace are planning and already doing to promote outreach and education.


  6. HHS notified insurance companies that it will be signing final agreements with the plans to be offered through the Marketplace in mid-September.


  7. Michigan’s Senate recently approved a form of Medicaid expansion. This is a reminder to stakeholders in all states to keep abreast of changes in the status of your state’s activity around Medicaid expansion – it can change at any point.

These are opportunities for your community to decrease its level of those uninsured. This could be an important population health activity for your community to consider, getting members of your community insured. There is a relationship between insurance coverage and health status. Perhaps, there could be nothing more important you, as providers, can do to increase the overall health of your population.