April 27 Update

In This Week’s Update 

  1. New SHVS COVID-19 Resources
  2. State Updates: AR, CA, LA, MN, NC, NE, NJ, OR, VA & WA
  3. Other State Updates: OK, OR, RI, WA
  4. COVID-19 and the Individual Market
  5. Increasing FMAP to Provide Fiscal Relief to States
  6. What Impact Has COVID-19 Had on Outpatient Visits?

1. New SHVS COVID-19 Resources

Last week, State Health & Value Strategies hosted a webinar, Impact of COVID-19 on Medicaid Managed Care Performance Incentives, on quality and cost performance issues related to Medicaid managed care and policy options for states to consider in response to the COVID-19 pandemic. The slides and a recording are posted.
 
SHVS continues to add new resources to its COVID-19 resource page. Recent updates include:

2. COVID-19 State Updates: AR, CA, LA, MN, NC, NE, NJ, OR, VA & WA

    • Addressing Social Risk Factors
      • California – In an effort to protect people who have behavioral health conditions and are experiencing homelessness and who would otherwise seek care in an emergency room, the Department of Social Services is coordinating a multi-department effort called Project Roomkey to provide non-congregate emergency shelter options for people experiencing homelessness. The effort is led by counties who enter into agreements with hotels and motels in order to provide the opportunity to self-isolate. Counties are working with local behavioral health departments to provide behavioral health services in these locations, including through telehealth.
      • Virginia – Governor Ralph Northam announced that Virginia’s collaborative efforts to release low-level offenders from local and regional jails in response to the COVID-19 pandemic are working, and the administration’s guidelines have been effective in decreasing the jail population.
    • Bulletins and Notices to Insurers
      • Oregon – The Oregon Department of Consumer and Business Services has extended its emergency order on insurance deadlines until at least May 23. Insurance companies must continue to do the following until the order is no longer in effect: institute a grace period for premium payments on all insurance policies issued in the state; suspend all cancellations and non-renewals for active insurance policies; extend all deadlines for consumers to report claims and communicate about claims; provide consumers the ability to make premium payments and report claims while maintaining safe social distancing standards.
    • COVID-19 Testing
      • Minnesota – Governor Tim Walz, representatives of the state’s health care delivery systems, the Mayo Clinic, and the University of Minnesota announced an initiative for rapid, widespread testing of COVID-19 in Minnesota. Through the partnership, Minnesota will implement a statewide testing strategy to test all symptomatic people, isolate confirmed cases, and expand public health surveillance tools.
      • Oregon – The Oregon Health Authority released revised guidelines for COVID-19 testing to prioritize impacted populations and all frontline workers. The guidelines continue to allow healthcare providers to make clinical decisions about their patients. In addition, if supplies allow, asymptomatic people within congregate care or group living systems can be considered for testing.
    • Data Reporting  
      • Nebraska – The Nebraska Department of Health and Human Services added hospitalization data to its COVID-19 dashboard. DHHS launched the dashboard in March as an informational resource for Nebraskans. It also provides daily updates to the state’s COVID-19 case totals along with other pertinent data.
      • New Jersey – Governor Murphy signed legislation requiring hospitals to report demographic data to the Department of Health. In conjunction with this signing, the COVID-19 Information Hub was updated with preliminary racial data that has already been collected. The legislation requires hospitals to report demographic data including age, ethnicity, gender, and race of individuals who have tested positive for COVID-19, who have died from COVID-19, and who have tried to get testing but have been turned away.
    • Expanding Workforce Capacity
      • Arkansas – Following the approval by CMS of Arkansas’s request to use Medicaid funds to temporarily increase the weekly income of long-term services and supports (LTSS) direct-care workers during the COVID-19 public health emergency, DHS released guidance that walks providers through the process of submitting the forms to request those payments for their direct care workers. 
      • Virginia – Governor Ralph Northam signed Executive Order Fifty-Seven, implementing several new policies to bolster Virginia’s health care workforce to assist with the Commonwealth’s COVID-19 response. The order adds physician offices and other health care facilities to the section in Executive Order Fifty-Two allowing hospitals, nursing facilities, and dialysis facilities to have out-of-state licensees provide in-state care. It allows Virginia-licensed nurse practitioners with two or more years of clinical experience to practice without a collaborative agreement. It also provides additional flexibility to hospitals in the supervision of interns, residents, and fellows, and allows hospitals to use fourth year medical students in the provision of care.
    • Special Enrollment Periods for Health Insurance
      • Minnesota – During the state’s special enrollment period for individuals who were uninsured in the wake of COVID-19, 9,482 Minnesotans enrolled in private health insurance plans through MNsure. The SEP ran from March 23 through April 21. Additionally, more than 13,700 applied for public health insurance programs during that time period.
    • Waiver Approvals
      • North Carolina – The North Carolina Department of Health and Human Services announced that it received approval from the Centers for Medicare and Medicaid Services to temporarily waive certain Medicaid policies as part of North Carolina’s response to COVID-19. DHHS received temporary modifications to home- and community-based services provided through Medicaid waivers. These requests include removing certain dollar and stay limits, expanding the type of locations where services can be delivered, and easing requirements for reviews of personalized care plans and in-person meetings. 
      • Washington – The state received approval from CMS for its COVID-19 Public Health Emergency Section 1115(a) demonstration waiver.
    • Other
      • California – Governor Gavin Newsom issued an executive order providing flexibility to the California Department of Health Care Services and Medi-Cal providers to ensure continuity of service to patients and customers not impacted by the effects of the COVID-19 pandemic. The executive order will allow fair hearings to continue for California Children’s Services on grievances and appeals to take place by phone or video conference. Additionally, the order will ensure flexibility for DHCS and the Department of Social Services to continue providing mental health care services and programs.
      • Louisiana – The Louisiana Department of Health announced that current Medicaid members will not lose coverage for any reason other than death, permanently moving out of state, or requesting an end to their coverage. Income from federal stimulus checks or additional unemployment benefits related to Coronavirus also will not affect Medicaid eligibility.
      • Virginia – Governor Ralph Northam signed Executive Order Fifty-Eight, which facilitates access to care for Medicaid recipients by eliminating copayments for individuals receiving coverage through the Family Access to Medical Insurance Security (FAMIS) program among, streamlines the process for admitting individuals to a nursing facility by suspending preadmission screening requirements, and implements other measures to increase access.

3. Other State Updates: OK, OR, RI, WA

  • Oklahoma – The Oklahoma Health Care Authority announced its submission of the federal Healthy Adult Opportunity demonstration waiver to CMS with a requested effective date of July 1, 2021. OHCA submitted a state plan amendment earlier this year to expand Medicaid to Oklahoma adults ages 19 to 64 with income less than 133% of FPL who do not otherwise qualify for Medicaid. That expansion will go into effect July 1, 2020. The HAO demonstration waiver applies only to this expansion population and does not affect current Medicaid members.
  • Oregon – The Oregon Health Authority released for public comment a request it plans to submit to CMS seeking approval to add four benefits to Oregon’s Essential Health Benefits beginning in 2022, including coverage for treatment by a chiropractor and acupuncture as well as increasing access to medication assisted treatment for opioid use disorder. The public comment period opens May 6.
  • Rhode Island – Executive Office of Health and Human Services Secretary Womazetta Jones named Deputy Secretary Benjamin Shaffer as the new Medicaid Director of the state of Rhode Island. Shaffer has been the Acting Medicaid Director since February. Congratulations Benjamin!
  • Washington – The state submitted an application to CMS seeking authority to receive federal financial participation for services provided in an Institute for Mental Disease (IMD) to Medicaid beneficiaries. The federal public comment period will be open from April 22, 2020 through May 22, 2020

4. Marketplace Pulse: COVID-19 and the Individual Market

The Robert Wood Johnson published a blog post examining the impact of COVID-19 on the individual health insurance market. The post highlights trends in costs associated with testing and treatment, changes in the use of other health-care services, and the recession and the impacts these aspects may have on premium rates in plan year 2021.

5. Increasing Federal Medicaid Matching Rates to Provide Fiscal Relief to States during the COVID-19 Pandemic

The COVID-19 pandemic is causing considerable stress on state budgets because of both increasing expenditures and declining revenues. Unlike the federal government, states cannot incur deficits. In a paper by the Urban Institute, the authors estimate the fiscal impacts of several approaches for increasing federal Medicaid matching rates and how they would affect the amount of fiscal relief states would receive. The approaches include a pre-COVID-19 baseline and the 6.2 percentage point increase under the Families First Coronavirus Act, as well as other options including a 100 percent FMAP for specific population groups and automatic rate enhancements tied to specific percentage point increases in each state’s unemployment rate.

6. What Impact Has COVID-19 Had on Outpatient Visits?

A new analysis published by the Commonwealth Fund examines the clinical and economic impacts of the COVID-19 pandemic on outpatient office visits, including its role in telehealth. Researchers at Harvard University and Phreesia, a health care technology company, analyzed data on changes in visit volume for the more than 50,000 providers who are Phreesia clients. The post includes illustrations on how declines in visits vary by both type of patient and geographic area and also shows that in increase in telehealth visits have only partially offset the drop-off in in-person visits since the pandemic began.