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: • • • • 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: • • 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 • 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 2 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 3