August 29 Update

In This Week’s Update:

  • No Surprises Act Final Rule
  • ASPE Projects Coverage Losses Post-PHE
  • Lessons From the California Health Care Quality and Affordability Act
  • States Take Charge of Healthcare Costs
  • Unwinding the Medicaid Continuous Coverage Provision: Projected Enrollment Effects
  • State updates: AL, CA, CO, CT, IN, MI, NV & WI

No Surprises Act Final Rule on Independent Dispute Resolution

Last week, the federal government issued a new final rule to further implement the federal independent dispute resolution process under the No Surprises Act (NSA). State Health and Value Strategies published an expert perspective that reviews the final rule and discusses its implications for state balance billing protections and oversight. Health Affairs also published a detailed summary of the final rule. As a reminder, SHVS has a one-stop page where you can find all of our NSA-related resources.

Also last week, SHVS published an expert perspective Communicating the PHE Unwinding: How States Are Conducting Outreach and Planning. The expert perspective highlights several states that have made their unwinding operational plans publicly available as well as examples of states’ ongoing communication efforts related to the end of the PHE, including outreach campaigns to Medicaid enrollees, strategies for collaborating with stakeholders, and collaborative initiatives within Marketplace states. Updates follow.

ASPE Projects Coverage Losses Post-PHE

The Office of the Assistant Secretary for Planning and Evaluation published a report that provides current HHS projections of the number of individuals predicted to lose Medicaid coverage at the end of the COVID-19 public health emergency (PHE) due to a change in eligibility or due to administrative churning. The report also predicts eligibility for alternative insurance coverage among those predicted to lose Medicaid eligibility and highlights legislative and administrative actions that can help minimize disruptions in coverage, including the passage of the Inflation Reduction Act, which provides enhanced Marketplace subsidies for three years that will benefit some individuals leaving Medicaid at the end of the PHE. As a reminder, SHVS has a one-stop resource page to support states as they plan for unwinding the PHE.

Lessons From the California Health Care Quality and Affordability Act

In late June, California’s governor signed the California Health Care Quality and Affordability Act, establishing a new Office of Health Care Affordability (OHCA) within the Department of Health Care Access and Information. The OHCA is charged with developing and implementing a new statewide, data-driven strategy for reducing healthcare cost growth and improving affordability. In a new webinar on Thursday, September 8, Manatt Health will lead a panel of state innovators discussing what makes California’s legislation unique; what it means for Californian payers, providers and consumers; and how this action will shift the policy landscape in the years ahead. The webinar will also share lessons learned and best practices for other states that have established similar initiatives.

States Take Charge of Healthcare Costs

The states participating in the Peterson-Milbank Program for Sustainable Health Care Costs (Connecticut, Nevada, New Jersey, Oregon, Rhode Island, and Washington) are implementing by law or executive order the establishment of public/private sector commissions to advise states on initiatives to improve healthcare affordability. States are soliciting input from their commissions as they: establish targets for per person healthcare costs growth in the state; measure per person cost growth by payer type (Medicare, Medicaid and commercial) relative to the target; analyze the drivers of cost growth; and consider policies to address those documented drivers. The cost growth target programs in some of these states are starting to understand the real costs of healthcare in their states, and a recent Milbank Memorial Fund analysis summarizes some key findings.

Unwinding the Medicaid Continuous Enrollment Provision: Projected Enrollment Effects

The Office of the Assistant Secretary for Planning and Evaluation published a report that provides current HHS projections of the number of individuals predicted to lose Medicaid coverage at the end of the COVID-19 public health emergency (PHE) due to a change in eligibility or due to administrative churning. The report also predicts eligibility for alternative insurance coverage among those predicted to lose Medicaid eligibility and highlights legislative and administrative actions that can help minimize disruptions in coverage, including the passage of the Inflation Reduction Act, which provides enhanced Marketplace subsidies for three years that will benefit some individuals leaving Medicaid at the end of the PHE. As a reminder, SHVS has a one-stop resource page to support states as they plan for unwinding the PHE.

State updates: AL, CA, CO, CT, IN, MI, NV & WI

  • Alabama – The Alabama Medicaid Agency will provide a COVID-19 public health emergency update for Medicaid providers and partners on September 15, 2022. Agency representatives will share how the Agency is preparing for the end of the PHE and the return to normal operations. The meeting is offered for attendees both in-person or virtual (online or by phone).
  • California – The California Department of Health Care Services (DHCS) released a request for information (RFI) for a new mobile crisis services benefit in the state Medicaid plan. The RFI invites potentially interested vendors to provide DHCS with information about training for, and implementation of, mobile crisis services. Responses are due by September 2, 2022. DHCS intends to submit a Medicaid state plan amendment to add qualifying community-based mobile crisis intervention services as a new benefit for Medi-Cal.
  • Colorado – The Department of Health Care Policy & Financing (HCPF) released a set of animated videos to help individuals understand their rights under a new rule that codifies federal standards for home and community-based services. The videos are available as a set through a YouTube playlist and are also avaliable in Spanish. The Department has developed a resource sheet to accompany the videos.
  • Connecticut – Access Health CT, the state’s official health insurance marketplace, announced it received a silver award in the Digital Health Awards—a national program recognizing the best online health resources for both consumers and professionals. These awards are organized by the Health Information Resource Center, a national clearinghouse in consumer health fields.
  • Indiana – The Indiana Family and Social Services Administration’s Division of Mental Health and Addiction announced the launch of a pilot program designed to engage incarcerated individuals with mental health and substance use disorders with certified peer professionals and wraparound services. The Integrated Reentry and Correctional Support program provides peer-driven support for inmates with mental health and substance use disorders upon arrival at one of the five Indiana county jail pilot sites.
  • Michigan – The Office of Policy and Planning at the Michigan Department of Health and Human Services announced the formation of the Community Information Exchange task (CIE) force. CIE builds the technology and relationships required to address the social needs like food, housing and education for people and their communities. This task force will develop a statewide plan for CIE guided by the notion that data sharing between healthcare and social service providers is critical to improving comprehensive care and achieving health equity.
  • Nevada – The Nevada Legislative Interim Finance Committee (IFC) approved more than $45 million in proposals using American Rescue Plan Act funding to support Nevada’s Children’s System of Care. The funding approved by IFC will help to build a System of Care to intervene earlier and provide care in an appropriate setting.
  • Wisconsin – The Wisconsin Department of Health Services opened the first round of applications for $30 million in grant funding to support home and community-based services (HCBS). Grant awards will range from $25,000 to $2 million. Successful applications will benefit people who use HCBS and their families or providers of HCBS and their employees, including projects that strengthen the HCBS system and support quality and innovation in the delivery of services in Wisconsin.