August 5 Update

In This Week’s Update:

  • Price Transparency Proposed Rule
  • CMS Partial Medicaid Expansion Statement
  • State Updates: CO, LA, MN, ND, NV, NH, UT, VA, WA & WY
  • Medicaid Waivers with Housing Supports
  • ROI Calculator for SDOH
  • Pediatric Mental Health Care in the Emergency Department


Price Transparency Proposed Rule

As a follow-up to last month’s presidential executive order on transparency in health care pricing, this week the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would require hospitals to publish online standard charges and rates they negotiate with insurers. The information will need to be made available in a format which consumers can understand and will allow for the comparison of prices, or hospitals could face civil monetary penalties of $300 a day.


CMS Partial Medicaid Expansion Statement

Also this week, in case you missed it, CMS issued a statement on partial Medicaid expansion on the heels of announcing it would not approve Utah’s partial Medicaid expansion request. The statement clarifies CMS’ position on partial expansion and establishes that CMS will continue to approve demonstrations that comply with current policy.


State Updates: CO, LA, MN, ND, NV, NH, UT, VA, WA & WY

  • Louisiana – A study authored by researchers at Tulane University, and funded by the Louisiana Department of Public Health, found that Medicaid expansion resulted in better access to care among the newly eligible population. The Tulane study evaluated general measures of access including affordability of care, wait times for appointments and time elapsed since last accessing care. 
  • Minnesota – MNsure, the state’s official health insurance marketplace, announced recipients for the fiscal year 2020 Navigator Outreach and Enrollment Grant Program. This year’s 24 grants totaled $4.2 million and will fund 43 organizations across the state. The grants will support targeted outreach to uninsured populations and sustain a robust statewide navigator network to provide application, enrollment and renewal assistance to Minnesotans who need help to get and maintain coverage.
  • Nevada – Governor Sisolak announced that the state is accepting applications for appointment to the Nevada Patient Protection Commission, created by SB 544. The Commission is charged with conducting a comprehensive review of the state’s health care system and challenges as well as initiatives surrounding the quality, accessibility and affordability of health care statewide.
  • New Hampshire – A federal judge vacated the U.S. Department of Health and Human Services’ approval of New Hampshire’s Section 1115 waiver, which made participation in work or community engagement a condition of Medicaid eligibility for the expansion population.
  • Utah – Governor Gary Herbert issued an update on the status of Utah’s Medicaid expansion following the publication of CMS’ statement that it would not be approving requests to partially expand Medicaid. The update provides information for consumers and also clarifies the state’s plan for pursuing implementation of SB 96, the authorizing legislation.
  • Virginia – Governor Ralph Northam announced that more than 300,000 Virginia adults are enrolled in health coverage and receiving medical services following the Commonwealth’s expansion of its Medicaid program. The Virginia Department of Medical Assistance Services is tracking Medicaid expansion enrollment through a dashboard.
  • Washington – In an effort to eliminate hepatitis C in Washington state by 2030, Governor Jay Inslee issued a directive that orders state agencies to work with local public health, tribal governments, and other partners to create and implement a statewide hepatitis C elimination plan.
  • Wyoming – The Wyoming Department of Health is seeking public comments for its Section 1115 waiver application, which seeks to expand Medicaid coverage to all state residents for the specific purpose of air ambulance transportation and would treat air ambulance rides as a public utility. Waiver goals include reducing the average cost of air ambulance flights while ensuring a set level of access and quality, and eliminating surprise billing of patients.
  • Colorado and North Dakota – CMS officially approved both Colorado and North Dakota’s Section 1332 waiver applications for reinsurance programs beginning in plan year 2020. The SHVS tracking map for state 1332 waiver activity is updated to reflect these latest developments.


Medicaid Demonstration Waivers with Housing Supports: An Interim Assessment

A new report by Rutgers University’s Center for State Health Policy examines the initial implementation of Medicaid housing support demonstrations in four early-adopter states: California, Maryland, Illinois and Washington. Funded by the Robert Wood Johnson Foundation, the report describes preliminary observations regarding program design and characteristics of each state’s Medicaid housing support waiver and highlights the unique approaches these states are taking to address homelessness-related health care costs in Medicaid. A follow-up report, likely to be released in early 2020, will dive deeper into start-up implementation challenges and strategies these states have taken to address them.


Return-on-Investment Calculator for Meeting the Needs of Complex Patients

Recognizing that it takes more than just health care to address health concerns, especially for high-need, high-cost (HNHC) patients and that health care organizations are increasingly looking to forge partnerships with community-based organizations (CBOs) that provide some of the services their patients need, the Commonwealth Fund released a Return on Investment (ROI) Calculator. The calculator allows organizations to learn how their social needs investment might pay off in terms of cost savings and changes in the amount of health care complex patients use and is designed to help CBOs and their health system partners plan sustainable financial arrangements to fund the delivery of social services to HNHC patients.


Pediatric Mental Health Care in the Emergency Department

The number of children seeking care for a mental health crisis in an emergency department (ED) is on the rise. Furthermore, with often limited mental health services, hospitals in rural areas bear an excessive burden. To address these issues, the Health Resources and Services Administration released a toolkit of literature references and tools that can be used by hospitals to support the creation of care pathways to improve the identification and management of children and adolescents who present to the ED in a mental health crisis. The toolkit also contains a template designed to help hospitals establish a customized care pathway, with special acknowledgment given to the unique challenges that face rural communities. Interested individuals can tune into a webcast on August 15 to learn more about the toolkit and how it can be used.