HMA Weekly Roundup

California

California Seeks to Raise Medi-Cal Asset Limit for Elderly, Individuals with Disabilities. Business Insider reported on April 9, 2022, that the asset limit for eligibility for Medi-Cal programs will increase from $2,000 to at least $130,000 per household for the elderly, individuals with disabilities, nursing home residents, and other special groups, effective July 1, pending federal approval. The asset limit would be eliminated by 2024. Read More

California Medicaid Plan to Fight $55 Million State Fine. Health Payer Specialist reported on April 8, 2022, that California-based LA Care Health Plan will fight a $55 million state fine over allegedly failing to respond to enrollee grievances in a timely fashion, according to chief executive John Baackes. LA Care has already appealed the fine, which was imposed by the California Department of Managed Health Care and the California Department of Health Care Services last month. Baackes said that if the appeal fails, the plan will fight the fine in court. Read More

Delaware

Delaware DHSS Launches Website Allowing Individuals to Compare Health Care Costs. The Delaware Department of Health and Social Services (DHSS) launched on April 7, 2022, a website called CostAware, which allows individuals to compare the average cost of five episodes of care at six Delaware hospital systems and seven episodes of care at five accountable care organizations. The website, which uses 2019 medical claims data, compares costs for hospital cardiac procedures, C-section birth, emergency department visits, knee and hip replacement, and vaginal delivery, as well as ACO costs for blood count, colonoscopy, doctor visits, hemoglobin A1c, head CT, lumbar spine MRI, and screening mammography. Read More

Florida

Florida Health Plan Misses Deadline to Challenge $9.1 Million Fine Over Claim Denials. Florida Politics reported on April 10, 2022, that Centene/Sunshine State Health Plan of Tampa missed the deadline for challenging a $9.1 million fine from the Florida Agency for Health Care Administration related to the failure to pay thousands of claims for children with serious, chronic conditions. The deadline to pay the fine is April 18. Read More

Florida Health System Settles Federal Lawsuit Over Medicaid Claims. Health News Florida reported on April 8, 2022, that BayCare Health System agreed to pay $20 million to settle a federal Medicaid false claims lawsuit, which alleged that Baycare made donations to the Juvenile Welfare Board of Pinellas County to increase its share of federal Medicaid matching funds. BayCare denied any wrongdoing. Read More

Governor Signs Medicaid Managed Care, Nursing Home Legislation. Health News Florida reported on April 7, 2022, that Florida Governor Ron DeSantis signed two pieces of Medicaid managed care legislation into law. The first (SB 1950) reduces the state’s 11 Medicaid managed care regions to nine ahead of an upcoming health plan procurement. The second (HB 855) requires the Agency for Health Care Administration to report plan performance by demographic group to help address disparities. DeSantis also signed a bill (HB 1239) that attempts to address nursing shortages by reducing the daily hours that certified nursing assistants are required to care for residents. Read More

Illinois

Lawmakers Approve Wide-Ranging Medicaid Bill Expanding Certain Benefits, Coverage. Health News Illinois reported on April 11, 2022, that the Illinois general assembly approved a Medicaid omnibus bill (House Bill 4343), which includes funding for youth mental wellness checks, lowering the age of eligibility for undocumented adults to 42 from 55, increasing psychiatric and perinatal services, and adding coverage of midwives and acupuncture services. The bill also directs the Illinois Department of Healthcare and Family Services to apply for federal approval for 12 months of continuous eligibility for adult Medicaid beneficiaries. Read More

Legislature Allocates $225 Million in Federal Relief Funds to Nursing Homes in Fiscal 2023 Spending Plan. Health News Illinois reported on April 11, 2022, that the Illinois legislature passed a fiscal 2023 spending plan, allocating $225 million of federal relief funds to nursing homes to help address staffing shortages. The bill also directs $58.7 million in federal relief funds to safety net hospitals (on top of $69.8 million in general funds), $30 million to ambulance service providers, and $49.2 million to behavioral health services. Read More

Senate Passes Nursing Home Payment Reform Legislation. WGEM reported on April 7, 2022, that the Illinois Senate unanimously passed legislation to reform nursing home Medicaid payment rates to incentivize increased staffing in facilities. The bill includes a 15-month transition period to the new payment model and will pay all facilities at the higher rate designated for well-staffed nursing homes for six months to incentivize hiring. It also provides for extra payments to facilities with more than 70 percent patients on Medicaid. Read More

Illinois Bill Would Tie Medicaid Nursing Home Payments to Quality, Staffing Levels. The Chicago Tribune reported on April 6, 2022, that Illinois lawmakers are expected to vote on a bill that would tie Medicaid nursing home funding to care quality and staffing levels. The bill is aimed at for-profit nursing homes with large Medicaid populations. Illinois Medicaid spends $2.5 billion per year to cover approximately 45,000 individuals in nursing homes. Read More

Louisiana

Louisiana Awards NEMT Contract. The Louisiana Department of Health (LDH) announced on April 12, 2022, its intent to award a contract to MediTrans for Medicaid non-emergency medical transportation (NEMT). The contract will be implemented July 1, 2022, and run for three years, with options to extend for up to two more years. The state also received proposals from incumbent Southeastrans, OneBunchHookUp, Veyo, and We Lift. Read More

Maryland

Legislature Passes Bill to Provide Medicaid Dental Coverage to Adults. 47 ABC reported on April 6, 2022, that the Maryland legislature has passed legislation to provide Medicaid adults with dental coverage, including diagnostic, preventive, restorative, and periodontal services. The bill, which would take effect on January 1, 2023, awaits signature by Governor Larry Hogan. Read More

Massachusetts

Massachusetts Releases Medicaid ACO RFR. The Massachusetts Executive Office of Health and Human Services (EOHHS) released on April 13, 2022, a request for responses (RFR) to procure MassHealth accountable care organizations (ACOs) under two models: Medicaid Accountable Care Partnership Plans (ACPPs) and Primary Care ACOs (PCACOs). ACPPs are paid capitation rates and bear risk for members’ cost of care, while PCACOs contract directly with MassHealth and are paid a monthly administrative rate. The new contracts will look to enhance expectations for primary care and behavioral health delivery; increase the focus on children, youth, and families; and create incentives to improve health equity. Responses are due on July 15, with contracts to run from April 1, 2023, through December 31, 2027, with an option to extend in any increments up to December 31, 2032. Read More

Nevada

Nevada Medicaid Enrollment Among Immigrants Is at All-Time High. Nevada Current reported on April 7, 2022, that the number of Nevada legal permanent residents enrolled in Medicaid increased 43 percent between March 2020 and February 2022 to a record high of almost 41,000, according to data from the Nevada Department of Health and Human Services. The increase is attributed to the roll back of the public charge rule and continuous eligibility during the pandemic. Read More

New York

New York Files 1115 Waiver Amendment Seeking Authority to Spend $13.5 Billion in Medicaid Funds to Address Health Equity. New York State Department of Health filed on April 13, 2022, an amendment to its Medicaid 1115 waiver seeking authority to spend $13.5 billion in Medicaid funds over five years for a demonstration project aimed at addressing health disparities and delivery system problems magnified by COVID-19. The state will conduct two virtual hearings on the waiver amendment. The public comment period is open until May 13. Read More

New York Medicaid Director Brett Friedman Steps Down. Crain’s New York reported on April 8, 2022, that New York Medicaid director Brett Friedman will be stepping down effective May 1. Amir Bassiri, the current deputy Medicaid director, will replace him. Read More

New York Enacts Fiscal 2023 Budget Raising Medicaid Spending Cap, Giving Providers 1 Percent Rate Hike. Crain’s New York reported on April 11, 2022, that New York enacted its final fiscal 2023 budget. The budget includes a 4.7 percent increase in the Medicaid global spending cap and a 1 percent increase in reimbursement rates for Medicaid providers. The bill also restores a provider rate cut of 1.5 percent from the prior administration. The rate increase is retroactive to April 1. Legislators previously rejected Governor Kathy Hochul’s proposal to introduce competitive bidding for Medicaid managed care plans. Read More

North Carolina

North Carolina Medicaid Expansion Committee Discusses Certificate of Need Reform. The Winston-Salem Journal reported on April 11, 2022, that North Carolina Senator Joyce Krawiec (R-Forsyth) proposed changing the state’s certificate-of-need (CON) laws as a way to expand access to health care at a meeting for the committee on Access to Healthcare and Medicaid Expansion. CON opponents say that adding competition would lead to new services and facilities, which could force providers to lower fees for high-risk procedures. Meanwhile, advocates say CON protects against for-profit groups picking the most profitable medical procedures and leaving not-for-profit systems with the sickest patients who may be uninsured. The committee will meet again on April 26. Read More

Oregon

Governor Establishes Taskforce to Develop Medicaid Bridge Plan. The Oregon Capital Chronicle reported on April 11, 2022, that Oregon Governor Kate Brown has established a task force to develop a bridge plan for individuals disenrolled from Medicaid when the federal public health emergency ends. The task force, which consists of 13 stakeholders appointed by Brown, will be co-chaired by state Representative Rachel Prusak (D-Tualatin) and state Senator Elizabeth Steiner Hayward (D-Portland). Read More

Pennsylvania

Pennsylvania Applies for 1115 Waiver Extension for Former Foster Youth, Substance Use Treatment. The Centers for Medicare & Medicaid Services announced on April 12, 2022, that Pennsylvania has applied for a five-year extension of a Medicaid Section 1115 waiver extension that allows the state to provider Medicaid coverage to former foster care youth under age 26 who were under the care of another state when they turned 18. The waiver also covers substance use disorder treatment for short-term residents at Institutions for Mental Disease. The waiver extension would run through September 30, 2027. The federal public comment period is open until May 12. Read More

Pennsylvania Expands Medicaid Postpartum Coverage to One Year After Giving Birth. WESA reported on April 11, 2022, that the Pennsylvania Department of Human Services has extended Medicaid postpartum coverage to one year after giving birth. Previously, Medicaid-eligible women were covered up to 60 days after giving birth. The state implemented this change through the authority created by the American Rescue Plan Act. Read More

Rhode Island

Rhode Island Names Kristin Pono Sousa Medicaid Director. EIN Newsdesk reported on April 6, 2022, that Rhode Island has named Kristin Pono Sousa as Medicaid program director, effective April 10. Sousa has served as interim director since December 2021. Read More

Wisconsin

Wisconsin Seeks Public Comments on Draft Waiver to Extend Postpartum Medicaid Coverage. The Wisconsin Department of Health Services announced on April 6, 2022, that it is seeking public comment for a draft waiver request to the Centers for Medicare & Medicaid Services to extend postpartum Medicaid coverage from 60 days to the last day of the month 90 days after the last day of pregnancy. Governor Tony Evers has recommended extending postpartum coverage to one year. Public comments can be submitted until May 6. Read More

West Virginia

West Virginia Medicaid Commissioner to Serve as President of NAMD Effective 2023. The West Virginia Department of Health and Human Resources announced on April 11, 2022, that Cindy Beane, who currently serves as commissioner of the state Bureau for Medical Services, will also serve as president of the National Association of Medicaid Directors (NAMD) effective in 2023. Beane will hold the title of NAMD president-elect effective immediately. Read More

National

Biden Administration Awards $43 Million in Grants to 93 Rural Health Care Providers, Community Groups. Kaiser Health News reported on April 13, 2022, that the Biden administration awarded $43 million in grants to 93 rural health care providers and community groups in 22 states. A total of $475 million has been set aside for rural health care organizations by the American Rescue Plan Act. Read More

11 States to Text Medicaid Enrollees About Reenrollment After PHE Ends. Kaiser Health News (KHN) reported on April 13, 2022, that only 11 states plan to contact Medicaid enrollees via text about reenrollment after the end of the public health emergency (PHE), according to a KHN report. Thirty-three states plan to use the U.S. Postal Service, and 20 will phone enrollees. The Centers for Medicare & Medicaid Services has recommended that states use texts in addition to other methods to notify Medicaid members of post-PHE eligibility redetermination requirements. Read More

HHS Extends Public Health Emergency for 90 Days to July 15. CQ Roll Call reported on April 13, 2022, that U.S. Health and Human Services Secretary Xavier Becerra extended the public health emergency (PHE) by 90 days to July 15, 2022. The Centers for Medicare & Medicaid Services has said it will give states 60 days notice before the end of the PHE. Read More

HHS to Collect Information on Medical Debt from Providers, Factor Into Grant Decisions. Modern Healthcare reported on April 11, 2022, that the U.S. Department of Health and Human Services (HHS) will request data from more than 2,000 providers on their medical bill collection practices, lawsuits against patients, financial assistance, financial product offerings, and third-party contracting or debt-buying practices. The information will be used when HHS makes grantmaking decisions, and some of it will become public, with potential violations being shared with enforcement agencies. The policy follows an executive order from President Biden to reduce the burden of medical debt. Read More

MACPAC Recommends Improving Oversight of State Directed Provider Payments in Medicaid Managed Care. The Medicaid and CHIP Payment and Access Commission (MACPAC) released on April 7, 2022, a draft chapter of its June report to Congress, including recommendations aimed at improving the oversight of state directed provider payments in Medicaid managed care programs. The recommendations address the transparency of existing directed payment information, collection of provider-level data on directed payment spending, and clarification of directed payment quality goals. Read More

CMS Will Phase Out Temporary COVID-19 Nursing Home Regulation Waivers. Modern Healthcare reported on April 7, 2022, that the Centers for Medicare & Medicaid Services (CMS) will phase out temporary COVID-19 nursing home regulation waivers in 30 or 60 days, depending on the waiver. The waivers included allow physicians to delegate certain tasks to nurses and physician’s assistants, permit telehealth visits, and waive certain training requirements, among others. CMS will continue to offer state-based, county-based, and facility-based temporary waivers. Read More

House Lawmakers Introduce Bill to Enable Medicaid Value-Based Drug Agreements. Fierce Healthcare reported on April 7, 2022, that a bipartisan group of House lawmakers introduced a bill aimed at enabling the use of value-based drug purchasing agreements in Medicaid. The goal of the Medicaid VBP Act is to reimburse drug makers based on outcomes for new treatments like gene therapy. Read More

CMS Proposes $320 Million Cut to Nursing Home Medicare Payments in Fiscal 2023. Modern Healthcare reported on April 11, 2022, that the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would cut $320 million in Medicare Part A payments to nursing homes in fiscal 2023. The cut is meant to offset an unintended increase in payments during fiscal 2020 related to the transition to the Patient Driven Payment Model. The proposed rule also seeks feedback on establishing minimum staffing requirements for nursing homes and includes a plan to add three measures to the Skilled Nursing Facility Value-Based Purchasing Program. Read More

MedPAC Suggests Reducing Number of Risk Tracks in Medicare Alternative Payment Models. Modern Healthcare reported on April 8, 2022, that the Medicare Payment Advisory Commission (MedPAC) wants to streamline Medicare alternative payment models by reducing the number of risk tracks from seven to three. Sample tracks might be 50 percent upside-only shared savings for small organizations, 75 percent upside and downside shared savings for mid-sized organizations, and 100 percent upside and downside shared savings for large organizations. The proposed models, which would apply to the Medicare Shared Savings program and ACO REACH model, will be finalized in MedPAC’s June report. Read More