August 10 Update: CMS proposes rule for 2018 risk adjustment payments; New SHVS resource: Medicaid work and community engagement requirements; Exploring the growth in Medicaid managed care

This week, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule to adopt the risk adjustment methodology that the U.S. Department of Health and Human Services previously established for the 2018 benefit year. In response to the February 2018 New Mexico district court ruling, the proposed rule includes an additional justification regarding the use of statewide average premiums to calculate risk adjustment transfers and explains the reasoning behind operating the federal risk adjustment program in a budget-neutral manner. Comments for the proposed rule will be accepted through September 7, 2018.

Also, in case you missed it, CMS launched the re-design of their online Newsroom web page this week which has a more modern look and makes the Newsroom easier to use and navigate. I like the new design and appreciate the improvements made to make it more accessible. Updates follow.

  • Alaska
    • The Alaska Department of Health and Social Services announced the release of Health Impacts of Opioid Misuse in Alaska. The report provides a broad overview of Alaska’s opioid epidemic and related trend data to help Alaskans better understand the scope of the serious public health crisis.
    • Governor Walker announced that he signed Senate Bill 105 which improves medical transparency in Alaska. The bill requires health care providers to publicly post the costs of their most common procedures, install signs to let patients know they can ask for estimates in advance, and requires that providers supply good faith estimates of what patients can expect to pay – including a full explanation of the charges – within 10 days of being asked.
  • Colorado – The Department of Health Care Policy and Financing hired a Director to head up its new cost control office which was created under Senate Bill 18-266, which directs the Department to pursue cost-control strategies in Medicaid and dedicates permanent staff to pursue these strategies along with value-based payments and other approaches. The Director is the first of several roles to be filled in the office.
  • Michigan – The Michigan Department of Health & Human Services publicized the availability of $16 million in federal funding for which organizations across the state can apply to provide comprehensive sexual assault services such as 24-hour crisis intervention, supportive counseling or culturally specific needs.
  • Minnesota – MNsure, the state’s official health insurance marketplace, announced that its broker enrollment center initiative will continue into its fifth year, with 14 broker agencies across Minnesota. The selected agencies provide and staff convenient walk-in sites for residents of surrounding communities.
  • New York – The Department of Financial Services (DFS) issued a press release describing the actions DFS has taken to reduce health insurance rates for 2019. Rates for New Yorkers in individual and small group markets are set to increase by 4.8 percent in 2019.
  • North Carolina
    • The North Carolina Department of Health and Human Services (DHHS) issued a request for proposals (RFP) for organizations wishing to participate in Medicaid managed care as Prepaid Health Plans when the program launches in 2019. DHHS will host an information session for organizations on August 21. Responses to the RFP are due October 12, 2018.
    • DHHS also announced that it awarded its contract for Medicaid managed care enrollment broker services to MAXIMUS. This is the first procurement contract award in the state’s shift to managed care. MAXIMUS will provide choice counseling, enrollment assistance and education to beneficiaries as they select from a variety of health plans.

New SHVS Resource: Work and Community Engagement Requirements in Medicaid

SHVS has published a new resource for states, Work and Community Engagement Requirements in Medicaid: State Implementation Requirements and Considerations by Manatt Health. CMS has approved state work/community engagement (CE) waivers in Arkansas, Indiana, Kentucky, and New Hampshire, and additional states have submitted or are poised to submit similar waivers. Manatt Health has produced a series of charts that outline the legal, policy, financial and operational tasks and issues that states will face in adding a work/CE condition to their Medicaid program. In case you missed it, SHVS also recently hosted a webinar, Explaining the Stewart v. Azar Decision and Implications for States, that provided an overview of the Stewart v. Azar decision and its potential implications for states with approved, pending or planned Medicaid waivers that include work/CE requirements.

Exploring the Growth of Medicaid Managed Care

The Congressional Budget Office released a report describing the growth in Medicaid managed care programs in states. The report provides information on enrollment in, and spending for, Medicaid managed care and analyzes factors affecting those measures—including the types of beneficiaries, geographic areas, and range of services that managed care programs cover. The report also includes information on how states’ use of Medicaid managed care programs have changed over time.

Supporting Social Service and Health Care Partnerships to Address Social Determinants of Health

Our friends at the Center for Health Care Strategies released a set of tools and resources to help facilitate effective partnerships between community-based and health care organizations. The resources and tools help partnerships address common barriers to partnering and identifies strategies to strengthen collaborative activities. Strategies include establishing a framework for integration, articulating value within the partnership, and estimating costs to help align goals and prioritize decisions.