August 17 Update

In This Week’s Update:

  • New CMS Rural Health Model
  • Expert Perspective on CMS Premium Rebate Guidance
  • COVID-19 State Updates: AR, MD, NC, NJ, PA, RI, VA & WA
  • Other State Updates: AK, NE, NY, OK & PA 
  • New Strategies for Financing LTSS
  • Lessons from OR for Engaging Consumers
  • Maternal and Obstetric Care Challenges in Rural America


New CMS Rural Health Model

Last week, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a new payment model, the Community Health Access and Rural Transformation (CHART) Model. There are two options for participation: the Community Transformation Track will provide $75 million in seed money to 15 rural communities, and in the Accountable Care Organization Transformation Track providers enter two-sided risk arrangements as part of the Medicare Shared Savings Program (MSSP) and may use all waivers available in the MSSP program. CMS is hosting a webinar on August 18 that will provide an overview of the model.


Expert Perspective on CMS Premium Rebate Guidance

Also last week, State Health and Value Strategies (SHVS) published a new expert perspective, authored by Affordable Care Act tax expert Jason Levitis, on the recent guidance from CMS permitting health insurance issuers to provide certain premium rebates for 2020. The expert perspective summarizes the guidance, explains how it affects key stakeholders, and notes some questions that remain unanswered. Updates follow.


COVID-19 State Updates: AR, MD, NC, NJ, PA, RI, VA & WA

  • Maryland – Governor Larry Hogan was joined by Insurance Commissioner Kathleen Birrane, insurance companies, and the Maryland Health Benefit Exchange to announce the reopening of the coronavirus emergency Special enrollment period until December 15.
  • New Jersey – Governor Phil Murphy, Department of Health Commissioner Judith Persichilli, and Department of Human Services Commissioner Carole Johnson announced the administration’s proposal to provide long-term care facilities with $155 million in additional funding as they look to reopen to visitors and resume normal operations.
  • North Carolina – The North Carolina Department of Public Safety, Division of Emergency Management and the North Carolina Department of Health and Human Services announced an expedited reimbursement program that aims to expand non-congregate sheltering options in communities across the state.
  • Pennsylvania – Governor Tom Wolf and Lt. Governor John Fetterman highlighted the recommendations from a report by the COVID-19 Response Task Force for Health Disparity. The report includes six recommendations focused on policy topics related to health disparity, ranked in order of urgency: housing, criminal justice, food insecurity, health disparity, education, and economic opportunities.
  • Virginia – Governor Ralph Northam announced that the Virginia Department of Health will conduct a pediatric coronavirus disease serology study in Northern Virginia. The study, completed in collaboration with Inova Health System, will measure the proportion of children and teens with antibodies to COVID-19.
  • Washington – Governor Jay Inslee announced the creation of two funds to help workers during the COVID-19 pandemic. The Immigrant Relief Fund will provide $40 million to assist Washington residents who are unable to access federal stimulus programs due to their immigration status, and the Food Production Paid Leave Program will provide $3 million of financial resources to certain food production workers who remain home when ill. The governor also issued a proclamation that sets forth the parameters for the Washington COVID-19 Food Production Paid Leave Program. 
  • Arkansas and Rhode Island – Maryland Governor Larry Hogan, Arkansas Governor Asa Hutchinson, and Rhode Island Governor Gina M. Raimondo announced that Arkansas and Rhode Island have joined the bipartisan interstate testing compact for rapid point-of-care antigen testing. The compact now includes ten governors.


Other State Updates: AK, NE, NY, OK & PA

  • Alaska – The  Department of Health and Social Services and the Alaska Native Tribal Health Consortium is accepting public comments on the draft state health improvement plan, Healthy Alaskans 2030, until September 2, 2020.
  • Nebraska – The Nebraska Department of Health and Human Services continues to invite community partners and providers to participate in Medicaid expansion webinars aimed to inform the public about Heritage Health Adult/Medicaid Expansion.
  • New York – Governor Andrew M. Cuomo announced $972,717 has been awarded to five addiction treatment service providers across New York State to enable them to purchase and operate mobile treatment vehicles.
  • Oklahoma
    • The Oklahoma Health Care Authority (OHA) formally withdrew its SoonerCare 1115(a) Healthy Adult Opportunity research and demonstration waiver application request to CMS.
    • OHA is pursuing a model to carve out dental managed care services as the agency transitions to a managed care delivery service for Oklahoma Medicaid. The new dental managed care model will take effect in 2021.
  • Pennsylvania – Insurance Commissioner Jessica Altman released the 2021 requested rate filings for health insurance plans and highlighted that the average rate requests would result in an average 2.6 percent decrease in premiums in the individual market.


Financing Long-Term Services and Supports: Learning from New State Initiatives

new report, supported by the Robert Wood Johnson Foundation, and authored by the LeadingAge LTSS Center at UMass Boston and the Center for Consumer Engagement in Health Innovation at Community Catalyst, examines emerging state-based long-term services and supports (LTSS) financing initiatives. The report, through a case-study approach, describes the financing reforms being pursued by six states. The authors describe the policy change that was proposed or adopted in each of the six states and identify the common themes that emerged from key stakeholder interviews across the states. The report highlights the implications and lessons learned that may be helpful to inform LTSS policy development at both the state and federal levels.


Supporting Consumer Engagement: Lessons from Oregon

The Milbank Memorial Fund has published a case study that examines efforts and investments on the part of the Oregon Health Authority (OHA) to meaningfully engage consumers. The case study examines the community advisory councils that serve to integrate the state’s Medicaid program, Oregon Health Plan, with community member voices into coordinated care organizations. Authors Renée Markus Hodin and Madison Tallant of Community Catalyst found that key factors of success include devoting state-level staff and financial resources to the program; creating strong lines of communication among the Oregon Heath Authority, the coordinated care organizations, and the consumer advisory councils; and providing opportunities, including in-person events, for councils to learn from one another.


Maternal and Obstetric Care Challenges in Rural America 

Maternal mortality disproportionally affects Black and American Indian/Alaska Native women in the U.S. Additionally, there are disparities between rural and urban populations. According to publicly available data from the U.S Center for Disease Control and Prevention analyzed by Scientific American, rural areas had a pregnancy-related mortality ratio of 29.4 per 100,000 live births versus 18.2 in urban areas in 2015. Rural Health Information Hub is hosting a webinar on August 26 that will highlight maternal health challenges and discuss barriers to maternal health care in rural communities. During the webinar, the National Advisory Committee on Rural Health and Human Services will also present on the committee’s site visit and policy recommendations.