July 13 Update: CMS suspends risk adjustment payments; Webinar on Stewart V. Azar decision; Improving transparency in health care

This week, the Centers for Medicare and Medicaid Services (CMS) issued a press release announcing the suspension of about $10.4 billion in risk adjustment (RA) payments for 2017 until litigation around the federal RA program is resolved. The announcement was in response to a February 2018 New Mexico district court ruling that the government’s methodology for implementing the RA program was “arbitrary and capricious.” For a summary of the press release and its related implications, check out this Health Affairs blog post and a blog post by our friend and colleague, Sabrina Corlette from Georgetown University.

As a follow-up to the press release, yesterday, CMS released proposed guidance clarifying implications of the New Mexico litigation on the federal RA program. The guidelines discuss suspension of RA payment and charges for benefit years 2014-2017 and notes that the 2019 program is not affected. The guidance further notes that a state that operates its own exchange may operate its own RA program and that states may request adjustments of up to 50 percent in RA transfers for plan years 2020 and beyond. Requests are due by August 1, 2018. Updates follow.

  • Delaware – The state legislature passed legislation establishing a study group to examine the adoption of a Medicaid buy-in program that would allow Delawareans with incomes above 138 percent of the federal poverty level to purchase insurance coverage through the Medicaid program; the study group is to report its findings by January 31, 2019. We continue to track Medicaid buy-in activity through this map on our website.
  • New Jersey – The Department of Health awarded $4.3 million across six state agencies to reduce infant and maternal mortality rates in the black community through its “Healthy Women, Healthy Families” program. In addition to the six grants, the Department of Health is also committing $450,000 to start pilot programs for doulas in Newark and Trenton. Of that, $50,000 will go to an independent evaluator to ensure the programs reduce the frequency of certain birth-related complications or procedures, including caesarean sections.
  • New Mexico – The New Mexico Health Insurance Exchange released a request for information from vendors on the establishment of a state-based online platform to offer health insurance coverage in the state. The state is gathering information on a solution which would enable it to offer a state-based platform versus operation as an state-based exchange on the federal platform. Currently, eligibility and enrollment functions are provided by healthcare.gov, while marketing, outreach, plan management, in-person assister training, and broker certification functions are carried out at the state level.
  • North Carolina – Our friends at the Center for Health Care Strategies recently spoke with Kelly Crosbie, Senior Program Manager of Health Transformation in the Division of Health Benefits (Medicaid), and Sally Herndon, head of the Tobacco Prevention and Control Branch in the Division of Public Health, to discuss how the state is using their 6|18 efforts to create cross-agency synergies to promote tobacco cessation in North Carolina. The state is focusing on reducing tobacco use under the Centers for Disease Control and Prevention’s 6|18 Initiative, as well as efforts to prevent type 2 diabetes and unintended pregnancy.
  • Oregon – The Oregon Health Authority held a public meeting of the Health Care Workforce Committee on July 11, 2018.  Agenda topics included a presentation on Oregon’s health care workforce labor market data, behavioral health updates, recommendations on promising strategies to improve the diversity of the workforce, and the state health care workforce needs assessment.
  • Utah – CMS is accepting comments on Utah’s amendment to their section 1115 waiver demonstration waiver requesting authority to add dental benefits for the adult beneficiaries who are receiving substance use disorder treatment; provide family planning services for men and women, ages 19-64, who have incomes at or below 95 percent of the federal poverty level; and provide crisis stabilization services to at-risk Medicaid-eligible children with significant emotional and/or behavioral challenges under the age of 22. Comments can be submitted through August 11, 2018.
  • Vermont – The Department of Financial Regulation (DFR) announced plans to file emergency regulations by August 1, 2018 in response to the United States Department of Labor’s (DOL) recently issued final rule regarding Association Health Plans (AHPs). DFR is seeking input from interested Vermont residents and stakeholders about the scope and content of the new regulations. Vermonters with questions or comments about AHPs and the new regulations are encouraged to submit them by July 25, 2018.
  • Wisconsin – CMS is accepting comments on Wisconsin’s 10-year renewal of its section 1115 demonstration called the SeniorCare Prescription Drug Assistance Program; to be continued through December 31, 2028. This demonstration has been in effect since September 1, 2002 and provides a comprehensive prescription drug benefit for seniors, age 65 or older, with income at or below 200 percent of the federal poverty level. SeniorCare has an open formulary nearly identical to that of Wisconsin Medicaid and covers over-the-counter insulin as well as prescription drugs with a federal rebate agreement. Cost sharing requirements are imposed based on individual or family income. The state is not proposing program changes. Comments can be submitted through August 4, 2018.

Upcoming Webinar – Save the Date!

Explaining the Stewart v. Azar Decision and Implications for States

Tuesday, July 24, 2018 4:00 to 5:00 p.m. ET

State Health and Value Strategies (SHVS) program, together with technical assistance experts from Manatt Health, will host a webinar to review the Stewart v. Azar decision and its potential implications for states with approved, pending or planned Medicaid waivers that include work/community engagement requirements. During the webinar, we will review the court’s findings and any Centers for Medicare & Medicaid Services guidance. Even in states not pursuing work/community engagement requirements, the court’s findings may shape what type of analysis will be necessary to demonstrate that future waivers advance the objectives of the Medicaid statute.

Registration (required) at the following link: https://rwjfevents.webex.com/rwjfevents/onstage/g.php?MTID=e9cc2e9ff4fcb39a192f820292752503e

Transparency In Health Care: Where We Stand And What Policy Makers Can Do Now

Our friend and colleague, Joel Ario from Manatt Health co-authored a Health Affairs blog post highlighting best practices to promote transparency in health care via initiatives, such as creation of all payer claims databases and statewide cost-driver reporting. The authors also note how states, such as Oregon, Massachusetts and New Hampshire, have led on this front and detail ways that the federal government can support transparency efforts.

Stabilizing and Strengthening the Individual Health Insurance Market

The Brookings Institution released a report examining the causes of instability in the individual market and identifies measures to help improve stability based off of interviews with key stakeholders in ten states. The report describes key marketplace stability efforts states are implementing including reinsurance efforts; Medicaid buy-in as a “public option”; assessing non-complying plans to fund expanded ACA subsidies; investing more in marketing and outreach; auto-enrollment in “zero premium” bronze plans; and allowing insurers to make mid-year rate corrections to account for any new regulatory changes.

Strengthening the Workforce to Improve Pregnancy Outcomes in Rural Areas

The Rural Health Information Hub published an article describing the challenges and health outcomes rural areas face as a result of workforce shortages in obstetrics and the loss of labor and delivery units in rural hospitals. The authors offer promising approaches to mitigate issues, including cross training family physicians and the nurses in fields like anesthesiology and surgery so that any combination of doctors and nurses can deliver babies and offering rural residency tracks in obstetrics and gynecology to help alleviate workforce shortages in rural areas.