HMA Weekly Roundup

Arkansas

Arkansas to Transition Medicaid Managed Care Dental Program Back to Fee-for-Service. The Arkansas Department of Human Services (DHS) announced on June 3, 2024, that it is ending its Medicaid managed care dental program and will return to a fee-for-service structure, which is expected to launch on November 1, 2024. Management of the program will shift to the DHS Division of Medical Services. Delta Dental of Arkansas and Managed Care of North America (MCNA) currently administer the program serving 572,047 beneficiaries. Read More

Arkansas Releases MES Procurement Support RFP. The Arkansas Department of Human Services (DHS) released on May 31, 2024, a request for proposals (RFP) for a procurement assistance contractor in anticipation of the state’s upcoming Medicaid Enterprise System (MES) Core and MES Decision Support System (DSS) procurements. The current MES Core contract ends December 1, 2028, and the current DSS contract ends July 1, 2027. Proposals are due July 10, and intent to award is anticipated for September 6. The contract will run for one year beginning on January 1, 2025, with up to six one-year renewals. Read More

Colorado

Colorado Governor Signs Bills Addressing Housing, Nutrition Support Funding, Prescription Drug Access. The Colorado State House Democrats reported on June 3, 2024, that Governor Jared Polis signed two major health-related bills into law. HB 24-1322, sponsored by Representatives Shannon Bird (D-Westminster) and Kyle Brown (D-Louisville), will redirect Medicaid funds to housing and nutrition programs. The bill requires the Colorado Department of Health Care Policy & Financing (HCPF) to pursue a Medicaid Section 1115 waiver to fund housing and nutrition services and to conduct a feasibility study to determine how Medicaid can pay for nutrition services. SB 24-110, sponsored by Senate Majority Leader Robert Rodriguez (D-Denver), prohibits HCPF from requiring prior authorization for certain antipsychotic medications. Read More

Florida

Florida CHIP Lawsuit Dismissed; Medicaid Redetermination Lawsuit Trial Date Approaches. Health Payer Specialist reported on June 3, 2024, that a judge dismissed Florida’s lawsuit against the U.S. Department of Health and Human Services over rules prohibiting states from dropping beneficiaries from the Children’s Health Insurance Plan if their parents did not pay premiums on time. Florida would have to challenge the regulations with the Centers for Medicare & Medicaid Services before filing a lawsuit. Separately, a lawsuit against the Florida Agency for Health Care Administration regarding Medicaid redeterminations is set to go to trial in late June or early July. The suit alleges Florida disenrolled adult beneficiaries without giving them proper notification. Read More

Florida Governor Signs Bill to Establish Rural Emergency Hospitals. Health News Florida reported on May 29, 2024, that Florida Governor Ron DeSantis signed a bill, sponsored by Senator Corey Simon (R-Tallahassee), that would establish the category of rural emergency hospitals in the state, consistent with federal law, which allows these hospitals to receive Medicare payments to provide emergency services, observation care, and outpatient services without providing inpatient care. The measure, which was passed unanimously by the state Legislature, will take effect July 1. Read More

Hawaii

Hawaii Receives Federal Approval to Provide Medicaid Coverage for Community Palliative Care. Hawaii News Now reported on June 4, 2024, that Hawaii has received federal approval through a state plan amendment to cover community palliative care through Medicaid. The new benefit will allow coverage for Medicaid beneficiaries with serious or terminal illnesses, including services for improving life quality and addressing physical and emotional needs. Read More

Indiana

Indiana Receives Federal Approval to Transition LTSS to Managed Care. The Indiana Capital Chronicle reported on June 4, 2024, that Indiana received federal approval for its Section 1915c Home and Community Based Services PathWays for Aging demonstration, which will transition Medicaid long-term services and supports (LTSS) to managed care, beginning July 1. Individuals served by the state’s expired Aged and Disabled Waiver that are 60 or older will be enrolled into PathWays for Aging, and individuals under the age of 60 served by that program will move to the Health and Wellness waiver. The state also received approval to pay for parental care of seriously disabled children through Structured Family Caregiving, which pays a per diem amount. Read More

Massachusetts

Massachusetts Lifts Asset Limit for the Medicare Savings Program. The Massachusetts Executive Office of Health and Human Services announced on May 31, 2024, that the Medicare Savings Program (MSP) asset limit has been lifted as of March 1. Read More

Michigan

Michigan Selects Eight PIHPs for Substance Abuse Recovery Incentives Pilot Program. The Michigan Department of Health and Human Services announced on June 4, 2024, that it approved eight pre-paid inpatient health plans (PIHPs) to participate in the Recovery Incentives Pilot, an evidence-based treatment program for substance use disorders offered by the state for Medicaid and Healthy Michigan beneficiaries. Participating PIHPs include NorthCare Network; Southwest Michigan Behavioral Health; Mid-State Health Network; Community Mental Health Partnership of Southeast Michigan; Detroit Wayne Integrated Health Network; Oakland Community Health Network; Macomb County Community Mental Health; and Region 10 PIHP. The Recovery Incentives Pilot is set to launch in October 2024 and will run for two years. Read More

BCBS-MI Names Tricia Keith President, CEO Beginning in January 2025. Health Payer Specialist reported on May 17, 2024, that Blue Cross Blue Shield of Michigan has named Tricia Keith president and chief executive, effective January 1, 2025. Keith currently serves as executive vice president, COO, and president of emerging markets for BCBS of Michigan. Read More

Minnesota

Minnesota Releases Medicaid, MinnesotaCare IHP RFP. The Minnesota Department of Human Services released on May 31, 2024, a Request for Proposals (RFP) for providers interested in participating in the state’s Integrated Health Partnerships (IHP) Demonstration, an accountable care model that serves Medicaid and MinnesotaCare. The program, which currently has 25 IHPs serving more than 530,000 beneficiaries, offers two tracks: Track 1 (non-risk) and Track 2 (upside and downside risk). Letters of intent are due August 2 and proposals are due August 14. Awards are expected September 6, 2024. Contracts will run from January 1, 2025, through December 31, 2028, and may not exceed a total of five years. Read More

Missouri

Missouri Reinstates Medicaid Premium Payments for Three Programs. Fox4 reported on May 29, 2024, that Missouri is reinstating Medicaid premiums for the Children’s Health Insurance Program, Ticket to Work Program, and the Spend Down Program. Beneficiaries must pay May invoices in order to be covered beginning June 1, and those that fail to pay the premiums will be disenrolled. Read More

Missouri Disenrolls 197,525 Medicaid Beneficiaries During Redeterminations From June Through April. Missouri Independent reported on May 31, 2024, that Missouri has disenrolled 197,525 Medicaid beneficiaries based on eligibility redeterminations from June 2023 to April 2024. Of those disenrolled, 110,938 were children. The state has nearly 18,000 pending eligibility cases as of April. Read More

Montana

Montana Owes Providers $8.5 Million in Delayed Payments Amid Medicaid Unwinding. The Daily Montanan reported on June 3, 2024, that 21 Montana healthcare facilities are owed an estimated $8.5 million in delayed Medicaid reimbursements. The delayed payments largely stem from the Medicaid redetermination process, according to a survey conducted by the Montana Healthcare Association. The average delays for processing new Medicaid applications are three to six months long and reimbursements related to new applications go back 90 days. Read More

Nevada

HMA Releases Report Examining Nevada’s MAABD Program. Nevada Medicaid released on May 30, 2024, a report by Health Management Associates (HMA) evaluating Nevada’s Medical Assistance for the Aged, Blind, and Disabled (MAABD) program, with particular focus on the long-term services and supports (LTSS) landscape, stakeholder engagement, and program recommendations. The MAABD program provides LTSS to elderly individuals or people who have physical disabilities and has faced challenges, including high costs, underfunding, and geographic gaps in services. To address these challenges, HMA recommends developing aligned short and long-term quality strategies, separating MLTSS and fully integrated dual eligible special needs (FIDE-SNP) programs for adults aged 65 or over, implementing the Program of All-Inclusive Care for the Elderly (PACE) model of care, and enrolling MAABD individuals 64 and under into Medicaid managed care contracts in 2030. Read More

New York

New York MCOs Made Medicaid Payments to Unverified Providers Totaling $1.5 Billion, Audit Finds. Crain’s New York Business reported on June 5, 2024, that five managed care organizations (MCOs) spent $1.5 billion on payments to physicians, hospitals, and pharmacies that were not vetted to be reimbursed through Medicaid, according to an audit by New York Comptroller Thomas DiNapoli. The audit, which reviewed claims from January 2018 through June 2022, also found that the MCOs paid $916 million in claims for services by in-network providers whose IDs did not match with a Medicaid enrolled provider and $833 million in claims for services by providers whose Medicaid application was denied or withdrawn. Read More

New York Senate Advances Bill to Provide Medicaid Reimbursement, Support for Emergency Medical Services. The New York State Senate reported on May 29, 2024, that it has passed a bill package to provide Medicaid reimbursements to medical service agencies for point-of-response treatment without requiring further medical evaluations. The legislation will also expand the ability of ambulances to administer life-saving blood transfusions, recognize general ambulance services as essential, and provide financial relief to New York’s emergency service first responders. Read More

North Dakota

North Dakota Completes Medicaid Redeterminations, Disenrolling 40 Percent of Beneficiaries. KFYR TV reported on June 4, 2024, that North Dakota has completed its 13-month Medicaid redetermination process, with about four in 10 Medicaid beneficiaries losing coverage. In total, the state conducted reviews for 134,000 beneficiaries. Read More

Tennessee

Tennessee Awards Medicaid Dental Contract to Renaissance Life & Health Insurance Company. Renaissance Life & Health Insurance Company of America announced on May 30, 2024, that Tennessee has awarded it a contract to serve as the statewide Medicaid Dental Benefits Manager (DBM) for five separate state DBM programs. The state’s five DBM programs cover adult and child TennCare enrollees, children enrolled in the CoverKids program, and adults with intellectual or developmental disabilities. The contract is anticipated to begin July 1, 2025. Read More

National

CMS Releases ACO Primary Care Flex Model RFA. The Centers for Medicare & Medicaid Services (CMS) released on May 30, 2024, a request for applications (RFA) for participation in the Accountable Care Organizations (ACO) Primary Care (PC) Flex Model, which is a new voluntary payment model that will focus on advanced primary care delivery for low revenue ACOs participating in the Medicare Shared Savings Program. Model participants will receive a one-time advanced shared savings payment and monthly prospective population-based payments. The ACO PC Flex Model aims to support care delivery transformation, innovation, and team-based approaches to improve quality and reduce costs of care. The model will begin on January 1, 2025. ACOs that participate will jointly participate in the Shared Savings Program. The deadline to submit an application to the Shared Savings Program is June 17, 2024. Read More

HHS Selects Ten Additional States to Participate in CCBHC Demonstration. The U.S. Department of Health and Human Services (HHS) announced on June 4, 2024, that ten additional states were selected for participation in a two-year Certified Community Behavioral Health Clinic (CCBHC) Medicaid Demonstration Program, aimed at increasing access to crisis and behavioral health care in communities. The ten states are Alabama, Illinois, Indiana, Iowa, Kansas, Maine, New Hampshire, New Mexico, Rhode Island, and Vermont. Read More

CMS Releases 2022 Quality Payment Program Performance Information. The Centers for Medicare & Medicaid Services (CMS) released on May 30, 2024, the 2022 Quality Payment Program performance information through the Medicare.gov compare tool and in the Provider Data Catalog (PDC). The Medicare.gov compare tool allows patients and caregivers to compare Medicare providers and groups on Merit-based incentive payment system (MIPS), qualified clinical data registry, and consumer assessment of healthcare providers and systems measure. The PDC includes CMS’ required reports on the final scores of MIPS-eligible clinicians, names of eligible providers in Advanced Alternative Payment Models (APMs), and the performance and names of certain APMs. The information is available for doctors, clinicians, groups, virtual groups, and Accountable Care Organizations. Read More

CMS BPCI Advanced Model Resulted in Medicare Savings Totaling $465 Million. The Centers for Medicare & Medicaid Services (CMS) reported on May 30, 2024, that the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model resulted in an estimated $465 million net savings to Medicare during Model Year 4 (2021), according to its fifth annual BPCI Advanced evaluation report. The net savings offset the combined losses in the first 3 model years, which totaled $179.5 million. BPCI Advanced is a voluntary bundled payment model that tests whether linking payments for the multiple services beneficiaries receive during an episode of care leads to improved quality of care and lower costs for Medicare. Read More

Medicaid Unwinding Shows Significant Racial Disparities in Procedural Disenrollments. The New York Times reported on June 3, 2024, that Black and Hispanic people were twice as likely as white people to lose Medicaid due to procedural reasons, such as failure to complete paperwork, during the Medicaid redetermination process, according to a study from JAMA Internal Medicine. The study did not determine whether Black and Hispanic people were more likely to lose Medicaid overall. As of May, Medicaid enrollment has declined by 13 million nationwide. Read More

Medicaid, CHIP Enrollment Drops by Nearly 655,000 in February 2024, CMS Reports. The Centers for Medicare & Medicaid Services (CMS) reported on May 31, 2024, that enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) was approximately 83.4 million in February 2024, a decrease of 654,280 since January 2024. Medicare enrollment was nearly 67.1 million, up 69,037 from January 2024, including nearly 33.8 million in Medicare Advantage plans. More than 12 million Medicare-Medicaid dual eligibles are counted in both programs. Read More

CMS Extends State Reporting on Medicaid Renewals, Enrollment Amid Eligibility Redeterminations. The Centers for Medicare & Medicaid Services (CMS) released on May 30, 2024, a State Health Official (SHO) letter announcing that it is extending state reporting for certain Medicaid and Children’s Health Insurance Program (CHIP) metrics that states were required to report when they resumed normal Medicaid eligibility processes. Specifically, state reporting on renewal outcomes will continue after the Consolidated Appropriations Act, 2023 requirements end on June 30, 2024. Read More

Managed Care Plans in Five State’s Differ in EPSDT Service Prior Authorization Requirements, GAO Finds. The Government Accountability Office (GAO) released on May 29, 2024, a report which found that selected Medicaid managed care plans in five states had similar processes for authorizing Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services but differed in the services requiring prior authorization. The selected plans were from the District of Columbia, Florida, Massachusetts, Missouri, and Utah. The states’ oversight of managed care plans’ prior authorizations generally included reviewing plans’ policies and processes, data collection on approval and denials, and a review of a subset of denied authorizations. The GAO has recommended that the Centers for Medicare & Medicaid Services set expectations for monitoring the appropriateness of plans’ prior authorization decisions and clarify whether managed care plans can require prior authorization for EPSDT services when the state does not have such requirements. Read More

Republican Lawmakers Introduce Legislation to Bolster Access, Transparency in 340B Drug Pricing Program. Fierce Healthcare reported on May 29, 2024, that U.S. Representative Larry Bucshon (R-IN) introduced a bill to reform the 340B Drug Discount Program, which includes new hospital eligibility requirements and transparency requirements tasking grantee organizations to reporting how savings from the discounts are being used. The bill also codifies definitions of 340B patients and contract pharmacies and will prohibit hospitals from denying 340B patients access to the medications based on their ability to pay. Read More

CMS Releases Updates to Annual Guidance on Medicaid, CHIP Core Set Reporting. The Centers for Medicare & Medicaid Services (CMS) released on May 30, 2024, a State Health Official (SHO) letter which includes updates for mandatory annual state reporting of the Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP (Child Core Set) and the behavioral health measures on the Core Set of Adult Health Care Quality Measures for Medicaid (Adult Core Set). The letter includes guidance on mandatory reporting regulations; core set measures; populations and the population exemption process; stratification categories; measures subject to stratification; and annual updates to the 2025 Child and Adult Core Sets. Read More

Safety-net Clinics Cut Services, Staff Amid Medicaid Eligibility Redeterminations. KFF Health News reported on May 30, 2024, that safety-net clinics nationwide have cut services and staff amid the Medicaid eligibility redeterminations process, which has resulted in coverage termination for more than 22 million people. As a result, health centers have increasingly provided care without receiving payments. Approximately one in 10 community health centers have reduced staff and services or limited appointments. Read More