HMA Weekly Roundup

Alabama

Alabama Releases Modular Electronic Visit Verification RFP. The Alabama Medicaid Agency released on October 25, 2023, a request for proposals (RFP) to reprocure a Modular Electronic Visit Verification vendor for home health and personal care services that require an in-home visit. The incumbent is HHAeXchange. Alabama will award one, two-year contract with three, two-year renewal options. Proposals are due December 27, and notification of intent to award will be announced February 28, 2024. The anticipated contract implementation date is July 1, 2024. Read More

California

California Submits Section 1115 Medicaid Waiver Amendment to Provide Rental Assistance. The Centers for Medicare & Medicaid Services (CMS) announced on October 20, 2023, that California has submitted for federal approval a Medicaid Section 1115 waiver amendment to provide up to six months of rental assistance for qualifying individuals who are homeless or at risk of homelessness. Public comments on amending the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 waiver are due by November 26, 2023. Read More

Florida

Florida Legislators File Bills to Study Impact of Potential Medicaid Expansion on Individuals Aged 18 to 26. Health News Florida reported on October 27, 2023, that Florida Representative Hillary Cassel (D-Dania Beach) and Senator Lori Berman (D-Boca Raton) filed separate bills that would require the Florida Agency for Health Care Administration to formally study the potential impact of Medicaid expansion on individuals aged 18 to 26. Specifically, the studies would assess the number of people who could obtain coverage, associated costs, and the use of expansion to address behavioral health needs. The Senate bill has been referred to the Health Policy, Appropriations on Health and Human Services, and Fiscal Policy committees. Read More

Florida Congressional Democrats Ask CMS to Monitor Their State’s Medicaid Eligibility Redeterminations Process. Florida Politics reported on October 30, 2023, that Florida Congressional Democrats asked the Centers for Medicare & Medicaid Services (CMS) to ensure their state follows proper protocols for Medicaid eligibility redeterminations. In a letter to CMS, lawmakers asked CMS to take action if it finds any unnecessary coverage losses. Florida has disenrolled over 730,000 beneficiaries since redeterminations resumed. Read More

Georgia

Georgia Bidding Conference for Medicaid Managed Care Contracts Is Attended by Several Health Plans. Health Payer Specialist reported on October 30, 2023, that Alliant HealthSolutions, AmeriHealth Caritas, CVS Health, Humana, Kaiser Permanente, Molina Healthcare, and UnitedHealth attended a bidding conference for Georgia’s recent request for proposals for the Georgia Families and Families 360° programs. Current incumbents Elevance, Centene, and CareSource also attended. Read More

Georgia Democratic Leaders Call on Governor to Implement Full Medicaid Expansion. Capitol Beat reported on October 25, 2023, that Georgia Democratic leaders are calling on Governor Brian Kemp to fully implement Medicaid expansion in Georgia, following slow enrollment in the state’s alternative expansion program Pathways to Coverage. The Pathways program includes work requirements and limits coverage to adults earning up to 100 percent of poverty. Read More

Kansas

Kansas Governor Calls For Medicaid Expansion Ahead of Legislative Session. KAKE reported on October 29, 2023, that Kansas Governor Laura Kelly will be making Medicaid expansion a top priority for the next legislative session. Polls show that about 70 to 80 percent of Kansans support expansion. Read More

Massachusetts

Massachusetts Submits MassHealth Section 1115 Amendment for Federal Approval. The Centers for Medicare & Medicaid Services announced on October 30, 2023, that Massachusetts submitted a waiver amendment to its MassHealth Medicaid and Children’s Health Insurance Plan Section 1115 Demonstration. The amendment seeks 12 months continuous eligibility for adults and 24 months continuous eligibility for individuals experiencing homelessness who are 65 and over; pre-release MassHealth services to individuals in certain public institutions; and expansion of Exchange subsidies. The waiver would also increase health-related social needs (HRSN) integration funding and expand HRSN services to include short-term post hospitalization housing and temporary housing for pregnant members and families, among other items. Public comments are open through November 20, 2023. Read More

Massachusetts Legislature Considers Medicaid Coverage of Doula Services. The Scope Boston reported on October 25, 2023, that Massachusetts lawmakers are considering legislation that would allow Medicaid coverage of doula services during pregnancy and up to 12 months postpartum. Another bill would standardize the doula certification process. The initiatives are aimed at addressing the high rate of serious birth complications among African-Americans in the state. Read More

Mississippi

Mississippi Medicaid Managed Care Procurement Stalls Following Protests from UnitedHealthcare, Elevance. Mississippi Today reported on October 27, 2023, that the Mississippi Medicaid managed care procurement remains stalled following protests from UnitedHealthcare and Elevance/Amerigroup. The two companies were not awarded contracts. The state has extended current contracts to June 2024. Read More

Montana

Montana Submits Section 1115 Medicaid Waiver Amendment to Cover Fertility Preservation Services. The Centers for Medicare & Medicaid Services (CMS) announced on October 26, 2023, that Montana submitted for federal approval a Medicaid waiver amendment to cover fertility preservation services for certain individuals with cancer ages 12 to 35. Public comments on amending the Montana Additional Services and Populations Section 1115 waiver are due by November 25, 2023. Read More

Nebraska

Nebraska Launches iServe Benefits Application Portal. The Star Herald reported on October 25, 2023, that Nebraska launched iServe Nebraska this month, providing a platform where individuals can use a single application for state benefits like Medicaid, childcare, food assistance, and other forms of economic assistance. Read More

New Hampshire

New Hampshire Providers to Receive Another Increase in Medicaid Payment Rates. The Portsmouth Herald reported on October 26, 2023, that several New Hampshire Medicaid providers will see another rate hike in January, on the heels of a three percent increase in July. The increases, part of a state budget allotment of $134 million (nearly $300 million including federal matching funds) for Medicaid rate hikes, will benefit home and community-based services providers, ambulance providers, children’s dental, and pregnancy care providers. Read More

New York

New York Announces $4 Million in Grant Funding for Mental Health Clinics. Crain’s New York Business reported on October 26, 2023, that the New York Office of Mental Health (OMH) will provide $4 million in grant funding to mental health clinics serving patients with serious needs in an effort to improve patient engagement, community-based efforts, and outreach to underserved populations. Licensed clinics can receive up to $49,500 each to support in-person or telehealth services. Grant applications are due by December 20. Read More

Oregon

Oregon Incorrectly Terminates Medicaid Coverage for 2,268 Beneficiaries. Oregon Public Broadcasting reported on October 27, 2023, that Oregon incorrectly disenrolled 2,268 Medicaid beneficiaries during September Medicaid eligibility redeterminations, including 619 children. Another 1,226 beneficiaries incorrectly received letters stating that their Medicaid coverage will be terminated at the end of October, and 11,700 people were wrongfully informed that they had coverage renewed through the end of the year. The state will send out new notices in November to all affected people. Read More

Pennsylvania

Pennsylvania Bill Would Reinstate Medicaid Coverage of Most Dental Services. WITF reported on October 26, 2023, that Pennsylvania Senator Jay Costa (D-Allegheny) sponsored a bill that would reinstate coverage of most types of Medicaid dental care. Pennsylvania eliminated the majority of Medicaid dental care coverage in 2011. Read More

Pennsylvania Long-term Care Facilities Await Funding, Face Staffing Shortages. WJAC Johnstown reported on October 31, 2023, that funding for Pennsylvania long-term care (LTC) facilities has been stalled pending passage of fiscal code legislative allowing budgeting funds to be distributed. The state legislature also passed a bill to address staffing shortages in LTC facilities, which will allow Certified Nurse Aids to train to become Certified Medication Aides. Read More

National

CMS Releases Final Rule to Increase Payments to ESRD Facilities by 2.1 Percent. The Centers for Medicare & Medicaid Services (CMS) issued on October 27, 2023, a final rule raising the end-stage renal disease (ESRD) prospective payment system base rate to $271.02, ultimately increasing total payments to ESRD facilities by approximately 2.1 percent. Additionally, the final rule will increase payments for certain new dialysis drugs. Read More

HRSA Requires 340B Registration for Offsite, Outpatient Hospital Facilities. Modern Healthcare reported on October 26, 2023, that several hospital offsite clinics are at risk of losing 340B drug discount program eligibility under a new policy implemented by the Health Resources and Services Administration (HRSA). Participating hospitals must now register offsite clinics with HRSA and list them on Medicare cost reports to qualify for 340B discounts, reversing a prior HRSA policy. Hospitals have 90 days to notify HRSA that they have started the process to comply with the new policy. Read More

Senators Introduce Medicaid Bill to Permanently Cover Medication-assisted Treatment for Substance Use Disorder. U.S. Senator Maggie Hassan (D-NH) announced on October 30, 2023, the introduction of a bill to permanently provide Medicaid coverage for medication-assisted treatment for substance use disorder. The bill, co-sponsored by Marsha Blackburn (R-TN), would permanently extend coverage currently made available through the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act), which expires in 2025. Read More

Biden Administration Releases Proposed Rule to Improve Surprise Billing Dispute Resolution Process. The Centers for Medicare & Medicaid Services (CMS) announced on October 27, 2023, that the Biden Administration released a proposed rule aimed at improving the No Surprises Act independent dispute resolution process. The rule would strengthen communications between payers and providers, encourage open negotiations, and make other administrative changes. Read More

Senators Introduce Bill Ensuring 12-Month Continuous Medicaid, CHIP Coverage. The Sidney Daily News reported on October 26, 2023, that U.S. Senators Sherrod Brown (D-OH), Tammy Baldwin (D-WI), Elizabeth Warren (D-MA), and Sheldon Whitehouse (D-RI) introduced a bill ensuring 12-month continuous eligibility to all individuals on Medicaid and the Children’s Health Insurance Program (CHIP). The Stabilize Medicaid and CHIP Coverage Act bill is aimed at preventing coverage losses as a result of short-term changes to beneficiary incomes. Read More

CMS Nursing Home Staffing Proposal Faces Lawmaker Opposition. Modern Healthcare reported on October 25, 2023, that Republican lawmakers voiced opposition during a House Energy and Commerce Health Subcommittee hearing on proposed rules that would raise pay for home health workers and institute staffing minimums at nursing homes. Democrats at the hearing supported the rules, which were proposed by the Centers for Medicare & Medicaid Services (CMS). Read More

MACPAC Meeting Is Scheduled for November 2-3. The Medicaid and CHIP Payment and Access Commission (MACPAC) announced on October 27, 2023, that its next meeting will be held on November 2-3. Among the topics for discussion will be Medicaid continuous coverage unwinding, including data-informed efforts and outreach strategies by states. Read More

HHS Proposes New Rule to Penalize EHR Information Blocking by Providers. Fierce Healthcare reported on October 30, 2023, that health care providers determined by the Office of Inspector General to have committed information blocking will no longer be considered as meeting “meaningful use” requirements for electronic health records (EHR), according to a proposed rule from the U.S. Department of Health and Human Services (HHS). The rule targets providers participating in existing Centers for Medicare & Medicaid Services programs. The public comment period will be open through January 2, 2024. Read More

Medicaid, CHIP Enrollment Falls in July 2023, CMS Reports. The Centers for Medicare & Medicaid Services (CMS) reported on October 31, 2023, that enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) was approximately 91.5 million in July 2023, a decrease of 1.1 million from June 2023. Medicare enrollment was 66.2 million, up 144,137 from June 2023, including 32.3 million in Medicare Advantage plans. More than 12 million Medicare-Medicaid dual eligibles are counted in both programs. Read More