Changes in population-based payment models in health care delivery have spurred enhanced efforts toward closer integration between state purchasers of health care and state, county, and local public health officials. This issue brief, developed by Bailit Health Purchasing LLC and Dr. Karen Hacker, investigates approaches that state agencies might employ in order to better integrate public health and health care delivery as a means of improving health and the value of health care, and it is organized according to seven features of integration. The issue brief is accompanied by three case studies providing additional detail to some of the examples cited in the brief.
Medicaid and the Indian Health Service: New Guidance Explains How States May Secure Additional Federal Funds
Recent guidance released by the Centers for Medicare and Medicaid Services (CMS) in February 2016 increases the range of Medicaid services and providers for which states may claim full federal funding. States with significant American Indian and/or Alaska Native (AI/AN) populations stand to benefit from this increased federal Medicaid funding. This issue brief, developed by Manatt Health, summarizes the new policy expanding federal funding for state Medicaid services provided to AI/AN populations, and explains the ways in which these additional funds reduce the cost of Medicaid expansion for states.
Provider assessments, fees, and taxes are tools available to states to generate funds to cover the non-federal share of Medicaid payments. This issue brief, developed by the State Network team at Manatt Health, examines two revenue sources that states may utilize to fund the non-federal share of Medicaid expansion: provider assessments and provider donations. Both of these are authorized by federal law and have been used by states in connection with Medicaid expansion. The issue brief summarizes the rules regarding their use and describes the ways in which they have been utilized in several states.
In addition to the impact that state decisions to expand Medicaid have had on coverage rates across the country, there is an increasing body of evidence showing consistent economic benefits among these states. This report, prepared by Manatt Health, is an update to an April 2015 State Network report, and examines data regarding Medicaid expansion in eleven states, demonstrating that states continue to realize budget savings and revenue gains as a result of expanding Medicaid.
Webinar: Final 2017 Notice of Benefit and Payment Parameters and Letter to Federal Marketplace Issuers
The Department of Health and Human Services (HHS) recently published its final Notice of Benefit and Payment Parameters for 2017, as well as the final version of its 2017 letter to Qualified Health Plan (QHP) issuers participating in the federally-facilitated marketplace (FFM). The State Network team at Manatt Health led a webinar explaining this final rule and what it will mean for states.
The State Network 1332 Waivers Affinity Group continued with a presentation from the team at Manatt Health Solutions. This webinar included an overview of the small group market requirements in the ACA, and the efforts of three states to preserve their innovative pre-ACA programs.
With states increasingly moving to develop population-based payment arrangements with provider organizations, the critical role of safety-net providers has become a challenging consideration for states. While safety-net providers typically lack the capital, experience, and/or scale to operate as an Accountable Care Organization (ACO), their role in state Medicaid programs underscores their integral role in the implementation of a population-based payment strategy with ACOs.
The State Network 1332 Waivers Affinity Group continued with a presentation from the team at Manatt Health Solutions. This webinar included a review of the basics around 1332 waivers, including what is allowed to be waived and the guardrails that apply to waivers. Following recent joint agency guidance from the Department of Health and Human Services and the Department of the Treasury, the team at Manatt reviewed the ways in which the guardrails are further defined, and the standards that will apply to them.
The recently released Proposed Payment Notice for 2017 formalizes a fourth model of marketplace - State-Based Marketplace/Federal Platform. Along with State Based Marketplaces, State Partnership Marketplaces and the Federally Facilitated Marketplace, states have a range of choices for what their Marketplace looks like. A key question for states will be how these different models help to achieve coverage goals.
Developing a State-based Quality Measurement Program Using an Episode-of-Care Framework: Recommendations for State Purchasers
In attempting to move toward value-based payments, there exist the inherent challenges posed by the availability of data. States wishing to accelerate the transformation of the existing delivery system into one that delivers high quality and affordable health care have to take action to develop a comprehensive data collection and reporting mechanism. Such an approach can be taken using episodes of medical care as the central unit of measure.