August 24 Update: Budget neutrality & Section 1115 demonstration waivers; SHVS webinar: ADT data & coordinating care; Health systems partner to transform Medicaid

There was significant federal activity this week with several announcements from the Centers for Medicare & Medicaid Services (CMS). On the Medicaid side, CMS released a State Medicaid Director Letter (SMDL) on budget neutrality for section 1115 demonstration waivers. Our friends and colleagues at Manatt Health have authored an Expert Perspective for State Health and Value Strategies (SHVS) that reviews the SMDL and discusses the implications for states. In addition, the Center for Medicare and Medicaid Innovation Center (CMMI) announced the Integrated Care for Kids (InCK) Model this week, a new child-centered service delivery and state payment model for children covered by Medicaid and the Children’s Health Insurance Program. Finally, on the Marketplace side, CMS awarded $8.6 million in funding to 30 states and the District of Columbia to help strengthen their respective health insurance markets; for more information on these grants and how states can use them, check out this Health Affairs blog post. Updates follow.

  • Arizona
    • The Arizona Department of Child Safety released a request for information soliciting feedback and information on aspects of an integrated health plan that would provide comprehensive medical, dental, and behavioral health services for children and youth in foster care.
    • Governor Doug Ducey and Blue Cross Blue Shield of Arizona (BCBSAZ) announced the launch of Mobilize AZ, a program to address the misuse of opioids and other substances and reduce overdose-related deaths in Arizona. BCBSAZ is investing $10 million in the program that will be used to support prevention, treatment, and recovery programs.
  • Illinois – Governor Bruce Rauner announced that he signed a bill package that increases access to mental health and substance use disorder treatment. The five-bill package includes legislation that reduces barriers to outpatient treatment and partners law enforcement agencies with substance abuse service providers to focus on preventative actions.
  • Louisiana – Governor John Bel Edwards put out a press release highlighting findings from the 2017 Louisiana Health Insurance Survey that the number of residents who are uninsured has fallen to half of what it was in 2015 and that more Louisianans are getting better access to care since Louisiana expanded Medicaid.
  • Maine – Maine’s Supreme Judicial Court issued an opinion this week in a lawsuit brought against Governor Paul LaPage for failing to comply with a ballot initiative approved by voters to expand Medicaid. In the opinion, the Supreme Judicial Court ordered LePage to submit a state plan amendment to expand Medicaid but also allowed LePage’s legal battle against expansion to proceed.
  • Maryland – CMS approved Maryland’s Section 1332 waiver to implement a reinsurance program. Maryland was the last of pending applications this year. We have updated our map of state activity to include a link to the approval letter.
  • New York
    • The New York State Department of Health is in the midst of sophomore year of its Value Based Payment University (VBP U). The second year of VBP U includes additional semesters of materials that serve as a deeper dive into VBP fundamentals. The materials from semester one and semester two of sophomore year are now available.
    • The New York Department of Corrections and Community Supervision released a request for information regarding the interest and capabilities of vendors to provide an electronic health records software and supporting services for use in a correctional setting.
  • Ohio – The Ohio Department of Medicaid released a follow-up to the study of the impact of Medicaid expansion it conducted for the Ohio General Assembly in 2016. The new report examines ten research themes and questions including the impact on workforce participation and health risk behaviors of enrolling in Medicaid.

Upcoming Webinar – Save the Date!

Using Hospital Admission, Discharge, and Transfer Data to Coordinate Care: Lessons from Tennessee and Washington

Thursday, September 6, 2018 1:00 to 2:00 p.m. ET

SHVS will host a webinar featuring the use of admissions, discharge, and transfer (ADT) data feeds by two states, Tennessee and Washington, and how they use the data to coordinate care for patients with behavioral health and other complex care issues. Presenters will provide an overview of their respective state programs, including operational and financing strategies, linkages to quality metrics and outcomes, and alignment with other statewide payment and delivery system efforts.

Registration (required) at the following link:

Health Systems Partner to Transform Medicaid

This week, 17 major hospital systems announced a partnership focused on sharing best practices and working collaboratively to improve care for Medicaid patients. The Medicaid Transformation Project will focus initially on Medicaid care delivery for behavioral health, women and infant care, substance use disorder and avoidable emergency department visits. Throughout the two-year mission, 280 hospitals will collectively implement new Medicaid care models and digital solutions. The project is jointly led by AVIA — a hospital innovation network — and former CMS Acting Administrator Andy Slavitt.

Roadmap to Using Telehealth to Promote Children’s Health and Wellbeing
Nemours Children’s Health System, Winter Park Health Foundation, and NORC at the University of Chicago released a Roadmap for Action as a guide for stakeholders to move toward wider adoption of school- and child-care-based telehealth programs to promote children’s health and wellbeing. The roadmap is informed by a stakeholder convening of experts from 13 states and includes best practices, evidence-based outcomes, key considerations to overcoming systemic barriers, and next steps to support greater access to quality children’s health care.

State Approaches to Health Equity

The Association of State and Territorial Health Officials (ASTHO) published a blog post highlighting how states are at the forefront of advancing health equity by implementing public health policies, plans, initiatives, reporting, and partnerships. Highlighted examples include the Colorado Equity Action Guide and D.C.’s state health improvement plan. The post also highlights ASTHO’s 2018 State of Health-in-All Policies report that features case studies from nine states and profiles their health equity activities.