HMA Weekly Roundup

California

California Extends Medicaid Coverage to Undocumented Residents. Bloomberg Law reported on June 27, 2022, that California Governor Gavin Newsom signed a fiscal 2023 budget that provides $628 million to extend Medi-Cal eligibility to an estimated 698,000 undocumented residents, regardless of age, effective January 1, 2024. The budget also establishes an Office of Health Care Affordability. Read More

Colorado

Colorado Receives Federal Approval to Establish Standardized Exchange Plan Option. Colorado Newsline reported on June 23, 2022, that Colorado has received federal approval for a Section 1332 waiver amendment establishing the Colorado Option, a standardized Exchange plan that insurers will be required to offer to individuals and to employers with less than 100 employees. Insurers must lower premiums on the option by 15 percent over the next three years. Read More

Hawaii

Hawaii to Restore Medicaid Dental Benefits to Adults in 2023. State of Reform reported on June 23, 2022, that Hawaii Med-QUEST will restore Medicaid full dental benefits for adults over age 21 in January 2023, pending federal approval. Dental benefits for adults were removed from Medicaid in 2009. Read More

Indiana

Indiana Awards MMIS Maintenance, Operations Contract to Gainwell Technologies. The Indiana Department of Administration announced on June 15, 2022, its intent to award Gainwell Technologies with the contract for Medicaid Management Information System (MMIS) Maintenance and Operations and Medicaid Business Operations for the Indiana Family and Social Services Administration. Gainwell was the only vendor to submit a proposal. The contract is worth over $2.9 million and will run for five years, including a one-year implementation period, plus two one-year renewal options.

Louisiana

Louisiana Enacts Bill Prohibiting Medicaid Plans from Conducting Provider Prepayment Reviews. The Louisiana State Legislature announced on June 17, 2022, that Governor John Bel Edwards signed Senate Bill 59, which prevents Medicaid managed care organizations from subjecting network providers to prepayment reviews of submitted claims, unless required by the Louisiana Department of Health. The bill is effective August 1, 2022. Read More

Massachusetts

Massachusetts Is Granted Temporary Extension of Existing 1115 Medicaid Waiver. The Massachusetts Executive Office of Health and Human Services announced on June 27, 2022, that federal regulators approved a temporary extension of the state’s existing MassHealth Section 1115 waiver, pending approval of a new five-year agreement submitted late last year. The temporary extension will expire on September 30, 2022. Read More

Nebraska

Nebraska is Seeking Not-for-profit Organizations to Provide Housing Stability Services. The Nebraska Department of Health and Human Services announced on June 29, 2022, it is seeking to award approximately $15 million in federal funds to not-for-profit organizations to provide housing stability services as part of the federal Emergency Rental Assistance program. Awards are expected to be between $100,000 and $2 million, and contracts will run for one year or until August 15, 2023. Read More

North Carolina

Legislative Budget Agreement Does Not Contain Provisions for Medicaid Expansion. North Carolina Public Radio/The Associated Press reported on June 29, 2022, that North Carolina lawmakers in the state House and Senate unveiled a budget agreement for fiscal 2023 that does not include provisions for Medicaid expansion. The Senate passed a Medicaid expansion bill earlier this month, while the House recently proposed its own Medicaid expansion legislation. Read More

House Committee Leaders Introduce Another Medicaid Expansion Bill. FOX8 WGHP reported on June 28, 2022, that the debate over Medicaid expansion in North Carolina will continue, with Republican leadership in the state House Rules Committee introducing a Medicaid expansion bill that would replace one already passed in the Senate. The bill would create a new process for drafting expansion legislation, including working with federal regulators and requiring approval by a Joint Legislative Committee on Medicaid Rate Modernization and Savings in December. In addition to expansion, the plan would invest in substance abuse treatment and mental health, and increase access to health care in rural areas. Read More

North Carolina House Signals That Debate Is Not Over on Medicaid Expansion Proposal. Spectrum News/The Associated Press reported on June 23, 2022, the North Carolina House Health Committee debated a bill (SB 408) directing the state to develop a Medicaid Modernization Plan, including recommendations on how to implement Medicaid expansion. The plan could only be implemented after a formal legislative vote. The state Senate already passed a Medicaid expansion bill (HB 149), which the House is not expected to vote on this session. Read More

Oregon

Oregon Low-Income, Undocumented Residents To Gain Health Insurance July 1. The Oregon Capital Chronicle reported on June 23, 2022, that the Oregon Health Authority will implement a state-funded program offering health insurance to 12,000 low-income, undocumented residents aged 19 to 25 and 55 and up, effective July 1. The program, which is expected to cost $100 million in fiscal 2023, is distinct from Medicaid. Previously, low-income, undocumented individuals in the state received emergency care coverage only. Read More

Pennsylvania

Pennsylvania Health Plan, Hospital System Launch Social Care Network. Highmark Health and Allegheny Health Network announced on June 2, 2022, the launch of a multi-year effort to establish a social care network that will compensate 20 not-for-profit organizations addressing social determinants of health, such as food insecurity and housing for patients referred by the healthcare system. Part of the funding for the program comes from a $5 million grant Highmark received from the Richard King Mellon Foundation. Read More

Governor Proposes Fiscal 2023 Nursing Home Rate Increase. Spotlight PA reported on June 24, 2022, that Pennsylvania Governor Tom Wolf proposed allocating $91.25 million to increase nursing home reimbursement rates to an average of $210 per resident in fiscal 2023. The increase would be aimed at offsetting the cost of a plan to require nursing homes to raise levels of care. Read More

Pennsylvania HealthChoices Plan Selection Period Begins for Beneficiaries. The Pennsylvania Department of Human Services announced on June 22, 2022, the start of the plan selection period for beneficiaries enrolling in Medicaid Physical HealthChoices managed care plans. The selection period runs through August 16, with new HealthChoices contracts to be implemented on September 1. Read More

Rhode Island

Rhode Island to Establish Child Mental Health Task Force. The Providence Journal reported on June 25, 2022, that the Rhode Island legislature passed legislation to form a task force aimed at improving the delivery of mental health care services covered by Medicaid for children under the age of six. Less than eight percent of covered children received mental health services in 2018. Read More

Vermont

Vermont is Granted 1115 Waiver Extension Through 2027. Healthcare Innovation reported on June 28, 2022, that the Vermont Agency of Human Services received federal approval to extend the state’s Global Commitment to Health Section 1115 Medicaid waiver through 2027. The approval allows the state to continue existing programs and implement new initiatives for housing assistance, health information technology, maternal health, and substance use disorder. Read More

Virginia

Virginia Enacts 30 Percent Increase in Medicaid Dental Reimbursement Rates. CBS 19 News reported on June 22, 2022, that Virginia Governor Glenn Youngkin signed a 2022-24 budget that includes a 30 percent increase in Medicaid reimbursement rates for dental services. The increase goes into effect on July 1. Read More

Washington

Washington Releases Rebased Medicaid Hospital Payment Rates. The Washington Health Care Authority (HCA) released on June 22, 2022, updated Medicaid inpatient and outpatient hospital payment rates, effective July 1, 2022. HCA rebased prospective payment methodologies to better reflect cost differences for providing services. Read More

West Virginia

West Virginia Seeks 10 Percent Increase in Medicaid Ambulance Service Reimbursement Rate. West Virginia Public Broadcasting reported on June 22, 2022, that the West Virginia Department of Health and Human Resources is seeking a 10 percent reimbursement rate increase for ambulance service providers in response to rising fuel costs. The proposed rate increase would go into effect on July 1. Read More

National

HHS Releases RFI to Strengthen Primary Care System. Fierce Healthcare reported on June 28, 2022, that the U.S. Department of Health and Human Services (HHS) issued a request for information (RFI) on how to establish a federal infrastructure for improving primary care in the U.S., with an initial goal of releasing an action plan by the end of the year. HHS is seeking comments on primary care payments, delivery models, service integration, access, workforce education, training, digital health, care measurement, research, and barriers to implementing innovations. Responses are due on August 1. Read More

Information Gaps Remain in Federal Oversight of Medicaid Directed Payments, GAO Study Says. The U.S. Government Accountability Office (GAO) released a study on June 28, 2022, which found that information gaps remain in federal efforts to oversee of Medicaid directed payments by states, raising concerns over the potential for inappropriate payments. The study also noted that the effectiveness of recent efforts by the Centers for Medicare & Medicaid Services to enhance oversight of directed payments remains unknown. Thirty-six states received CMS approval for one or more directed payment initiative in 2021. Read More

Removing Prior Authorizations for OUD Treatments Has Mixed Effect on Medicaid Beneficiary Access to Care, Study Finds. Health Payer Intelligence reported on June 27, 2022, that removing prior authorizations for opioid use disorder (OUD) treatments like buprenorphine had a mixed effect on Medicaid beneficiary access to care, according to a JAMA Health Study. The study found that removing prior authorizations on buprenorphine led to a statistically significant decrease in buprenorphine prescriptions in California and a statistically significant increase in Illinois. The study used Medicaid State Drug Utilization Data for California and Illinois from 2013 to 2020 and compared it to eight control states. Read More

MACPAC Comments on Medicare Proposed Rule Impacting Immunosuppressive Drug Benefit, Enrollment. The Medicaid and CHIP Payment and Access Commission (MACPAC) announced on June 27, 2022, support for the Centers for Medicare & Medicaid Services (CMS) proposed rule to extend the Medicare Savings Program coverage for individuals enrolled in the Medicare Part B immunosuppressive drug benefit, according to comments submitted to the agency. MACPAC also outlined support for CMS’ efforts to create streamlined eligibility and enrollment processes across Medicare and Medicaid, including a new Medicare special enrollment period for individuals who lose Medicaid eligibility after the public health emergency ends. Read More

CMS Urges Congress to Pass Legislation Extending Enhanced Exchange Subsidies. Fierce Healthcare reported on June 22, 2022, that the Centers for Medicare & Medicaid Services (CMS) is urging Congress to pass legislation extending enhanced Affordable Care Act (ACA) subsidies beyond 2022. Open enrollment for 2023 begins in November, and health plans are already developing 2023 rates. The enhanced subsidies led to a record 14.5 million individuals enrolling in Exchange plans for 2022. The Build Back Better Act would have extended the subsidies through 2025, but it stalled in the Senate. Read More

HUD Announces Grants, Voucher Funding to Address Homelessness. The Centers for Medicare & Medicaid Services announced on June 22, 2022, the availability of $365 million in grants and voucher funding to address unsheltered homelessness and homeless encampments. The funding, which is available through the U.S. Department of Housing and Urban Development (HUD), includes $54.5 million for permanent housing in rural communities and $43 million for roughly 4,000 incremental housing choice vouchers for vulnerable families. Read More

CMS Considers Mandating NCQA Health Equity Accreditation for Medicaid, Exchange Plans. Modern Healthcare reported on June 21, 2022, that the Centers for Medicare & Medicaid Services (CMS) is considering making National Committee for Quality Assurance’s (NCQA) Health Equity Accreditation mandatory for Medicaid and Exchange plans in an effort to address health disparities. The change would require that Medicaid and Exchange plans comply with new standards aimed at addressing disparities. NCQA launched the Health Equity Accreditation program in November 2021. Read More

Dual Eligibles Utilize Home Health Care at Twice the Rate of Medicare-Only Beneficiaries. Home Health Care News reported on June 27, 2022, that Medicaid and Medicare dual eligibiles utilize home health care at twice the rate of individuals who are only covered by Medicare, according to a report from ATI Advisory, with support from Arnold Ventures. The report also found that dual eligibles prefer Medicare Advantage plans, which offer supplemental benefits, more than Medicare-only beneficiaries. About 12 million of the 63.1 million Medicare beneficiaries are dually eligible. Read More

CMS to Launch New Risk-Based Payment Model for Medicare Cancer Care. Modern Healthcare reported on June 27, 2022, that the Centers for Medicare & Medicaid Services (CMS) announced the Enhancing Oncology Model, a new risk-based Medicare payment model aimed at improving cancer care. Under the new model, which will be effective July 1, 2023, and run for five years, providers will have upside and downside risk for patient quality and expenditures over a six-month episode of care. Providers can bill an additional monthly capitated rate of $70 for extra services and receive $30 per member per month extra for dual eligibles. The new model builds off of the Oncology Care Model, which will end on June 30 after six years. Read More

U.S. Supreme Court Upholds 2005 Federal DSH Payment Rule. Modern Healthcare reported on June 24, 2022, that the U.S. Department of Health and Human Services (HHS) acted appropriately when it changed the formula for how Medicare Disproportionate Share Hospital (DSH) payments are calculated in a 2005 rule, according to the U.S. Supreme Court. The rule includes patient days of individuals enrolled in Medicare Part A regardless of whether services were provided. Hospitals were expecting to receive additional funds if they won the case. The high court ruling reverses a decision by the U.S. Court of Appeals. Read More

CMS Proposes 4.2 Percent Decrease in Fiscal 2023 Medicare Home Health Provider Payments. Home Health Care News reported on June 23, 2022, that the Centers for Medicare & Medicaid Services (CMS) proposed a 4.2 percent decrease in aggregate fiscal 2023 Medicare home health provider payments. Under the proposal, home health providers would receive $801 million less compared to fiscal 2022. Read More