This week, our In Focus reviews a New York State Health Foundation-commissioned report titled, “An Assessment of the New York Health Act: A Single-Payer Option for New York State.” The study, conducted by the RAND Corporation, analyzes a proposal that would establish a single-payer system in New York. The proposal, known as the New York Health Act (NYH Act), was developed by New York Assembly Health Committee Chair Richard Gottfried. It was passed by the Assembly several years in a row, but has never been brought to a vote in the Senate. The New York State Health Foundation commissioned the study to provide an independent, rigorous, and credible analysis of the proposal to understand the near-term and longer-term impact of the single-payer proposal. The study assesses how the plan would affect health care coverage and costs in the state.
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New Hampshire Medicaid Care Management Draft RFP
This week, our In Focus reviews the New Hampshire Medicaid Care Management (MCM) Services Draft request for proposals (RFP), released by the state Department of Health and Human Services (DHHS) on July 9, 2018. The MCM program, worth $750 million in annualized spending, will provide full-risk, fully capitated Medicaid managed care services to approximately 181,000 beneficiaries from July 1, 2019 through June 30, 2024. The final RFP is expected August 10, 2018.
HMA Contributes to CPEHN Report on California’s Mental Health Equity Act
Principal Jeff Ring and Senior Consultant Helena Whitney recently coordinated and facilitated an advisory committee which provided recommendations for the implementation of California’s Mental Health Equity Act (AB 470, 2017). Using the Advisory Committee recommendations, they developed the California Pan-Ethnic Health Network (CPEHN) report, “Measuring Mental Health Disparities.”
AB 470 was proposed to mandate the Department of Health Care Services (DHCS) update the performance and outcome reporting system on mental health outcomes and utilization for beneficiaries receiving Specialist Mental Health Services in order to focus the Performance Outcomes System (POS) on disparities. Following the passage of the statute, CPEHN created an Advisory Committee of behavioral health and healthcare experts to develop recommendations for the DHCS to consider during its stakeholder engagement process.
After reviewing DHCS’ existing data and quality measures, the Advisory Committee identified data elements that the state performance outcome reporting system on mental health should include to further the work of tracking mental health disparities and achieving health equality.
Also considered was information obtained through interviews with selected subject matter experts who directed the Advisory Committee to additional performance measures and datasets, such as those currently in use by health plans that are participating in state and national pilot programs such as the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) Program, the Health Homes for Patients with Complex Needs Initiative, and the Whole Person Care Program.
Special consideration was given to measures that were (1) developed by nationally-recognized organizations such as the National Committee for Quality Assurance and the Consumer Assessment of Healthcare Providers and Systems Consortium, (2) are endorsed by the National Quality Forum, (3) are widely used by other states, (4) and/or are cited in the literature as “disparity-sensitive,” meaning that the measurements help identify inequities in health outcomes and access to services.
Per the requirements of the statute, the Advisory Committee organized its measure recommendations into two phases:
- Those that are currently available from county mental health plans or the state and should be included in the initial POS reports (“Phase I”).
- Those that could be added to county reporting systems and/or may be available from Medi-Cal managed care plans and should be included in future POS reports (“Phase II”).
Washington FQHC Alternative Payment Methodology
This week, our In Focus reviews a case study called, “Spotlight on Health Center Payment Reform: Washington State’s FQHC Alternative Payment Methodology,” authored and prepared for the National Association of Community Health Centers by Health Management Associates’ Principal Art Jones and Senior Consultant Liz Arjun. The study, published in May 2018, looks at Washington’s fourth federally qualified health center (FQHC) Alternative Payment Model (APM4), implemented in July 2017.
Medicaid Managed Care Enrollment Update – Q2 2018
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 28 states.[1] Many state Medicaid agencies post monthly enrollment figures by health plan for their Medicaid managed care population to their websites. This data allows for the timeliest analysis of enrollment trends across states and managed care organizations. Nearly all 28 states highlighted in this review have released monthly Medicaid managed care enrollment data into the second quarter (Q2) of 2018. This report reflects the most recent data posted. HMA has made the following observations related to the enrollment data shown on Table 1 (below):
MS Releases Children’s Health Insurance Program (CHIP) RFQ
This week, our In Focus Focus reviews the Mississippi Children’s Health Insurance Program (CHIP) request for qualifications (RFQ) issued by the state’s Division of Medicaid on June 8, 2018. The Mississippi CHIP program provides statewide health coverage in all 82 counties to children in families with incomes up to 209 percent of the federal poverty level (FPL). As of March 2018, 46,958 children were enrolled in CHIP.
MACPAC June Report to Congress Addresses Role of Managed Care in LTSS
This week, our In Focus comes from Senior Consultant Rachel Patterson, who provides an overview of Chapter 3 of the Medicaid and CHIP Payment and Access Commission (MACPAC) June 2018 Report to Congress on Medicaid and CHIP, which examines the growing role of managed care in long-term services and supports (LTSS). Chapter 3 includes research conducted by teams including HMA Principals Sarah Barth and Karen Brodsky regarding network adequacy for home and community-based service (HCBS) and Principals Sarah Barth, and Sharon Lewis and Senior Consultant Rachel Patterson regarding enrollment of people with intellectual and developmental disabilities (ID/DD) into MLTSS.
Report Examines the Models and Issues of Behavioral Heath Crisis Services
In a report prepared for the Michigan Health Endowment Fund, HMA Principal Steve Fitton and Senior Consultant Esther Reagan examine the models and issues of behavioral health crisis services.
Many people with behavioral health (mental illness and/or substance use disorder [SUD]) issues are arriving in hospital emergency departments (EDs) and not being well served in that setting. The ED is the wrong place at the wrong time for many patients – and for many reasons. These include being discharged prematurely, long waits in noisy EDs may exacerbate symptoms, the EDs may not have the professional staff best suited to provide services, and the ED itself is an expensive setting and can result in unnecessary and costly admissions for public and private insurers.
A number of models have been developed with the goal of improving the behavioral health emergency response environment. This report explores several models, including mobile crisis teams, co-located and dedicated behavioral health crisis emergency services units, behavioral health staffing in hospital EDs, and standalone behavioral health crisis centers. Strategies for moving forward, including addressing challenges in multiple areas are outlined as well.
HMA Prepares Report Describing Strategies to Increase MAT Prescribing
Senior Consultant Julia Elitzer, Managing Principal Jonathan Freedman, Senior Consultant Mary Russell, and Managing Principal Margaret Tatar recently prepared the report “Strategies to Increase MAT Prescribing,” for the Association of Community Affiliated Plans through a grant from the Open Society Foundations.
The report examines how to address opioid use disorder through the promotion of medication-assisted treatment (MAT). MAT is an approach that combines behavioral therapy and the administration of three medications – methadone, buprenorphine, and naltrexone – to treat addiction.
Massachusetts’ Duals Demo 2.0 to Grow the SCO and One Care Programs
This week, our In Focus section comes from Ellen Breslin in our Boston office who provides an overview of MassHealth’s Duals Demonstration 2.0 (“Duals Demo 2.0”) proposal to the Centers for Medicare and Medicaid Services (CMS) which is designed to “grow and sustain One Care and Senior Care Options (SCO) while encouraging innovation and care delivery improvement.” MassHealth currently provides coverage to about 310,000 dually-eligible individuals. Combined, MassHealth and Medicare spend more than $9 billion annually with costs nearly evenly split across the two payers.
HMA Contributes MLTSS Research to MACPAC Report
Principal Sarah Barth, Principal Karen Brodsky, Principal Sharon Lewis and Senior Consultant Rachel Patterson and other HMA colleagues contributed research under contract to MACPAC on standards for home and community-based services network adequacy in managed care for long-term services and supports (MLTSS) programs and on tailoring MLTSS programs for individuals with intellectual or developmental disabilities.
Benefit Options for the Medicaid Expansion Population: Alternative Benefit Plans and the Medically Frail
This week, our In Focus section highlights HMA Medicaid Market Solutions (MMS) which is supporting state flexibility in designing and implementing initiatives, including Section 1115 Demonstration Waivers, promoting member engagement, and personal responsibility. Over the coming weeks, HMA MMS will present a series of articles providing an in-depth look at the facets of these new Medicaid models.