April 22, 2015 The Honorable John Boehner

April 22, 2015
The Honorable John Boehner
Speaker of the House
H-232, The Capitol
Washington DC 20515
The Honorable Nancy Pelosi
House Democratic Leader
H-204, The Capitol
Washington, DC 20515
The Honorable Kevin McCarthy
House Majority Leader
H-107, The Capitol
Washington, DC 20515
The Honorable Steny Hoyer
House Democratic Whip
1705 Longworth House Office Building
Washington DC 20515
The Honorable Steve Scalise
House Majority Whip
H-329, The Capitol
Washington, DC 20004
Re: HR 2, the Medicare Access and CHIP Reauthorization Act of 2015
Dear House leaders:
On behalf of Altegra Health, I would like to thank you for your leadership in the passage of HR 2, the
Medicare Access and CHIP Reauthorization Act of 2015. HR 2 contains important provisions that will
allow Altegra Health to improve the lives of health plan members, particularly low-income Medicare
Advantage (MA) beneficiaries.
About Altegra Health
Altegra Health operates in all 50 states from 7 regional offices, as well as its headquarters in Miami
Lakes, Florida, to provide a complete range of services to health plans, health plan members, and
providers, including:
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Risk adjustment: Risk analytics, encounter reporting, and chart audit/coding solutions
Quality performance: HEDIS®/quality solutions; member healthcare communications
Program assistance: Identification and assisted enrollment into government-funded healthcare
programs, community assistance programs, and privately-funded programs through our My
Advocate™ service
Advisory services: Consulting services that improve performance for health plans and providers
Altegra Health works with some of the largest health plans and providers in the nation, including:
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Payers: More than 150 MA, Managed Medicaid, and Commercial Market plans
Providers: Hospital systems, provider groups & integrated delivery networks
Arizona • California • Florida • Georgia • Illinois • Minnesota • New Jersey • Philippines • Puerto Rico | AltegraHealth.com
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Other markets: Accountable Care Organizations (ACOs), health insurance marketplace, ICD-10
transition
The mission of Altegra Health is to help healthcare organizations and their members receive the
financial resources and other benefits to which they are entitled, enabling quality care at the right time,
leading to improved health at a lower cost, and overall, a better quality of life. Altegra Health utilizes
health plan data and Altegra Health’s proprietary predictive analytics algorithms to assist health plans in
delivering integrated health-related interventions that are specifically tailored to their members. In
carrying out this mission, Altegra Health is committed to maintaining the strictest regulatory compliance
and data security for health plans and the members that they serve.
Qualifying Individual (QI) extension
Altegra Health identifies MA beneficiaries who may benefit from dual enrollment in the Medicare
Savings Programs (MSP), including payment of their Part B premiums, and assists them in applying for
MSP to the appropriate state Medicaid agency. Altegra Health has helped MA low-income beneficiaries
cumulatively secure approximately $1.8 billion in Part B premium savings.
Altegra Health is extremely pleased that HR 2 permanently extends the QI program. As you know, the QI
program allows MSP beneficiaries between 120-135 percent of the federal poverty level (FPL) to qualify
for the payment of their Part B premiums. In the past, uncertainty about the future of the QI program
has led to unnecessary delays in eligibility determination, which has negatively impacted health
outcomes. Altegra Health’s experience with these low-income beneficiaries shows that MSP enrollment
is linked with a greater likelihood that they will access appropriate treatment, leading to lower
healthcare costs and better health outcomes. Altegra Health also finds that this population is more
satisfied with their MA plan because of these benefits. Altegra Health is appreciative that there will be
no uncertainty about the future of this critical program.
ICD-10
Altegra Health works closely with health plans to ensure that they obtain accurate risk scores for their
members and supports policies that strengthen risk adjustment programs. Altegra Health’s services
begin with proprietary technology and expertise to assist health plans in converting their source data
and managing errors to facilitate timely and accurate submission to the Risk Adjustment Processing
System (RAPS) and Encounter Data System (EDS) for MA plans; the EDGE server for commercial plans as
a result of the Affordable Care Act (ACA); and certain states where Medicaid risk adjustment programs
exist. Altegra Health adds proprietary technology and analytics that are utilized by health plans to
evaluate the documented health status of their members, identifying gaps between health status,
provider documentation and reported quality scores and risk scores.
As you know, the conversion to the International Classification of Diseases-10 (ICD-10) Code Set will be
implemented on October 1, 2015. The increased number of codes will allow Altegra Health to have more
detailed information about the documented health status of health plan members, which will lead to
more effective follow-up with members to seek the patient-centered treatments and procedures
needed to improve their health and lower health costs. Altegra Health is appreciative that HR 2 does not
contain a delay to ICD-10 implementation.
AltegraHealth.com
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Conclusion
Altegra Health thanks House leaders for all of their work in the passage of HR 2. Altegra Health
particularly commends House staff for their tireless work on these issues. HR 2 is important legislation
that will allow Altegra Health to improve the lives of health plan members, particularly low-income MA
beneficiaries.
Please feel free to reach out to me or our team if we can be of assistance to you in the future.
Sincerely,
Kevin C. Barrett
President & CEO
AltegraHealth.com
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