HMA Weekly Roundup

Arkansas

Arkansas Releases RFI for Medicaid Managed Care Module of MMIS Replacement. The Arkansas Department of Human Services released on January 17, 2023, a request for information (RFI) for a potential Medicaid managed care module of the state’s planned replacement of its Medicaid management information system (MMIS). The solution must automate assignment and management of Medicaid beneficiaries across multiple managed care organizations, support the centralized management and oversight of the state’s financial management requirements, and provide integration with existing MMIS modules and systems. Responses are due on February 17. Read More

California

California Launches Stimulant Use Disorder Treatment Pilot Program. Managed Healthcare Executive reported on January 17, 2023, that California Medicaid launched a pilot program with Pear Therapeutics to treat stimulant use disorder through a contingency management program. The program will be initially launched in 24 counties in early 2023. Read More

Delaware

Delaware Requests 5-year Extension of Diamond State Health Plan Section 1115 Waiver. The Centers for Medicare & Medicaid Services announced on January 13, 2023, that Delaware requested a five-year extension of its Delaware Diamond State Health Plan Section 1115 waiver, in which Medicaid members are covered by managed care plans. The waiver also covers long-term services and supports, enhanced behavioral health services, adult dental services, and coverage for former foster care youth under age 26. The current waiver expires on December 31, 2023. The federal public comment period will be open until February 12. Read More

Florida

Florida Governor Announces Proposal to Regulate PBMs. Health News Florida reported on January 12, 2023, that Florida Governor Ron DeSantis outlined a proposal to regulate pharmacy benefit managers (PBMs). The plan would bar PBMs from requiring consumers to use mail programs for prescriptions and increase the information PBMs must provide the state regarding company affiliations. DeSantis also hopes to end surprise billing and prescription drug overpayments. Read More

Georgia

Georgia Democratic Lawmakers to Prioritize Medicaid Expansion During Legislative Session. WABE reported on January 13, 2023, that Democratic lawmakers in Georgia will prioritize Medicaid expansion during the current legislative session. Georgia Governor Brian Kemp did not include full expansion in his proposed fiscal 2024 budget, but he did include $52 million to fund the implementation of Georgia Pathways to Coverage, a limited Medicaid expansion program that includes work requirements. Read More

Kansas

Kansas Governor Proposes Medicaid Expansion in Fiscal 2024 Budget. The Kansas Reflector reported on January 12, 2023, that Kansas Governor Laura Kelly is proposing Medicaid expansion in her fiscal 2024 budget. State House and Senate leaders both oppose expansion. Read More

Iowa

Iowa Faces Class Action Lawsuit Claiming it Failed to Provide Medicaid-Eligible Children With Mental Health Care. Ropes & Gray announced on January 17, 2023, the filing of a class action lawsuit claiming that Iowa is denying Medicaid-eligible children their right to mental health care, including intensive care coordination, in-home therapeutics services, and crisis response services. The suit was filed along with with co-counsel Disability Rights Iowa, Children’s Rights and National Health Law Program. Read More

Illinois

Illinois, Medicaid Plan Face Federal Investigation Over Medical Care for Foster Children. The Chicago Sun Times reported on January 13, 2023, that the Centers for Medicare & Medicaid Services is opening an investigation into claims that Medicaid health plan Centene failed to provide basic medical care to Illinois foster children under its contract with the state YouthCare program. Read More

Louisiana

Louisiana Releases RFP for Permanent Supportive Housing Services Funded in Part by Medicaid. The Louisiana Department of Health released on January 17, 2023, a request for proposals (RFP) for contractors to provide Permanent Supporting Housing (PSH) services in nine regions of the state. Many of the PSH households will be funded through the Medicaid program. The state intends to award seven to 10 three-year contracts, with a two-year extension option. Proposals are due by February 24, 2023. Read More

Maine

Maine Lawmakers Introduce Bill to Extend Medicaid Coverage to Adult Non-citizens. The Maine Wire reported on January 16, 2023, that Maine House Speaker Rachel Talbot Ross (D-Portland) and other lawmakers introduced a bill (LD 199) that would appropriate state funds to extend MaineCare Medicaid coverage to asylum seekers, refugees, and individuals who are in the country illegally. If passed, Maine would be the first state to offer Medicaid coverage to adult residents who are illegally in the country. Read More

Michigan

Michigan Doulas Push for Higher Medicaid Reimbursement Rates. The Detroit Free Press reported on January 16, 2023, that doulas in Michigan are pushing for higher Medicaid reimbursement rates since the state implemented a policy on January 1 that allows Medicaid to cover doula services. The current overall rate is $1,150, which includes a $700 base rate and up to six pre- or post-natal visits at $75 each. Read More

Mississippi

Mississippi Lawmakers to Consider Bills on Medicaid Expansion, Postpartum Coverage. The Associated Press reported on January 16, 2023, that Mississippi lawmakers will consider bills on whether to implement Medicaid expansion and extend postpartum Medicaid coverage from 60 days to 12 months. Lawmakers are also considering bills to help hospitals that are struggling financially by creating grant programs or tax credits. Read More

Montana

Montana Representative Introduces Bill to Increase Medicaid Reimbursement Rates for Psychiatric Treatment Facilities With Children. Choteau Acantha reported on January 17, 2023, that Montana representative Jane Gillette (R-Gallatin County) introduced a bill (HB 147) that would increase the Medicaid reimbursement rate to 133 percent of the rate in effect on July 1, 2022, for psychiatric residential treatment facilities and therapeutic group homes treating children, which would match the rate paid to out-of-state providers. As of November 2022, 61 children were at in-state facilities and 67 were out-of-state. The bill is aimed at having more children treated in-state. Read More

Montana Considers Rule to Require Prior Authorizations for Abortions Covered by Medicaid. The Associated Press reported on January 12, 2023, that the Montana Department of Public Health and Human Services is considering a rule that would require prior authorization for abortions covered by Medicaid. Montana is one of 16 states in which Medicaid is required to cover the costs of medically necessary abortions based on state law or court order.

North Carolina

North Carolina Senate Leader Includes Medicaid Expansion Among Priorities. The Carolina Journal reported on January 11, 2023, that North Carolina Senate president pro tempore Phil Berger (R-Rockingham) hopes to pass Medicaid expansion legislation during the current session. In 2022, the state House and Senate each passed separate versions of expansion legislation, but could not agree on a single bill. Read More

South Carolina

South Carolina to Continue Several Flexibilities After COVID-19 PHE Ends. The South Carolina Department of Health and Human Services announced on January 18, 2023, that it will continue and make permanent after the public health emergency (PHE) ends the following temporary flexibilities initiated by federal regulators during the COVID-19 pandemic: COVID-19 testing without copays and the application of caries arresting medicament. Flexibilities that will remain for a year after the PHE ends include COVID-19 vaccination with a copay, suspension of an annual limit of 12 ambulatory care visits, and waiver of copays for all evaluation and management codes. Temporary flexibilities that will end when the PHE ends include early pharmacy refill denials being bypassed for fee-for-service members and the extension of the timeframe for submitting prior authorization documents to seven days.

South Dakota

South Dakota Seeks Additional Employees to Implement Medicaid Expansion by July 2023. KELOLAND reported on January 17, 2022, that the South Dakota Department of Social Services is requesting 68 additional full-time employees to implement Medicaid expansion for nearly 58,000 individuals. The state intends to submit Medicaid State Plan amendments for federal approval in March 2023 and implement expansion in July 2023. Read More

South Dakota Releases Medicaid Expansion Third-Party Administrator RFI. The South Dakota Department of Social Services released on January 9, 2023, a request for information (RFI) regarding implementation of a third-party administrator (TPA) for the state’s Medicaid expansion population. The TPA would handle prior authorization, provider claims processing and payment, customer service and support, and data analytics and reporting. Responses are due by February 23, 2023. Read More

Utah

Utah Submits Waiver Amendment to Provide LTSS, Integrated Behavioral Health Services. The Centers for Medicare & Medicaid Services announced on January 12, 2023, that Utah submitted requests to amend its Medicaid Reform Section 1115 waiver to allow individuals to provide long-term services and supports (LTSS) to patients with complex behavioral conditions. Another amendment would allow individuals to receive existing covered physical and behavioral services in an integrated model through a contracted local mental health authority, which will be selected through a request for proposals. The federal comment period will be open until February 12. Read More

Utah House Representative Files Bill to Extend Postpartum Medicaid Coverage from 60 Days to 12 Months. State of Reform reported on January 12, 2023, that Utah House Representative Rosemary Lesser (D-Ogden) filed a bill to extend postpartum Medicaid coverage from 60 days to 12 months. Lesser also plans to introduce legislation to expand income eligibility for Medicaid to 200 percent of the federal poverty level. Read More

Wyoming

Wyoming House Committee Advances Bill to Extend Medicaid Postpartum Coverage. The Sheridan Press/Wyoming News Exchange reported on January 16, 2023, that the Wyoming House Labor, Health and Social Services Committee advanced a bill to extend Medicaid postpartum coverage to 12 months from 60 days. The bill will now be debated by the full state House. Read More

National

CMS to Audit Schizophrenia Diagnoses, Post All Nursing Home Citations on Care Compare. The Centers for Medicare & Medicaid Services (CMS) announced on January 18, 2023, that it will conduct off-site audits of assessment and coding of individuals with a schizophrenia diagnosis to reduce inappropriate use of antipsychotic medications in nursing homes. CMS will also begin displaying all nursing home citations, even those being disputed, on its Care Compare website for consumers. Read More

53 Percent of State Medicaid Eligibility Determinations Were Processed in Under 24 Hours from April to June 2022. The Centers for Medicare & Medicaid Services (CMS) reported on January 17, 2023, that 53 percent of state Medicaid Modified Adjusted Gross Income (MAGI) eligibility determinations were processed in under 24 hours from April to June 2022. Oklahoma had the highest percentage processed in under 24 hours at 100 percent, while Nevada, North Carolina, and South Dakota had the lowest at zero percent. Read More

CMS Announces Medicare Accountable Care Partnerships Will Cover 13.2 Million Enrollees in 2023. The Centers for Medicare & Medicaid Services (CMS) announced on January 17, 2023, that Medicare accountable care initiatives will cover more than 13.2 million Medicare beneficiaries through more than 700,000 providers and organizations in 2023. The programs include the Medicare Shared Savings Program; the Accountable Care Organization Realizing Equity, Access, and Community Health Model; and the Kidney Care Choices Model. CMS has a goal of providing 100 percent of traditional Medicare beneficiaries with accountable care relationships by 2030. Read More