In This Week’s Update:
- Recent Webinar Highlights Race and Ethnicity Data Collection
- CMS Seeks Applications for CGT Access Model
- Notice of Funding Opportunity for the Transforming Maternal Health Model
- CMS Issues Guide to 2024 Access Final Rule
- CMS Spotlights Autism Data on Children Covered by Medicaid
Notice of Funding Opportunity for the Transforming Maternal Health Model
On June 26, 2024 the Centers for Medicare & Medicaid Services (CMS) released the Notice of Funding Opportunity (NOFO) for the Transforming Maternal Health (TMaH). SHVS published an expert perspective summarizing the key takeaways pertaining to the model as well as a slide deck that provides a detailed summary. CMS recommends that states submit a letter of intent to apply for the TMaH model and these optional letters of intent are due on August 8, 2024. Applications to participate in the model are due on September 20, 2024.
CMS Issues Guide to 2024 Access Final Rule
On July 12, CMS released a companion guide to the fee-for-service (FFS) policy modifications finalized in the Ensuring Access to Medicaid Services Final Rule (the “Access Final Rule”). This technical guidance is intended to “consolidate and supplement information to help states meet the requirements of the 2024 Access Final Rule once the requirements are in effect”—including with respect to payment rate transparency and FFS rate restructuring, home- and community-based services payment rate disclosure, and the interested parties advisory group.
CMS Spotlights Autism Data on Children Covered by Medicaid
CMS released an infographic with information on children with Medicaid and CHIP diagnosed with Autism. The infographic provides an overview of the prevalence of Autism, characteristics of Medicaid and CHIP enrollees with Autism, prevalence of common co-occurring health conditions, and utilization of treatment services. Approximately 5% of children with Medicaid or CHIP coverage are currently reported to have Autism or Autism Spectrum Disorder, which is significantly higher than children covered by private insurance or children without insurance coverage.
State updates: CO, CT, IA, MA, MI, NC, NH, NJ, NY, PA & UT
- Colorado – Governor Jared Polis and the Department of Regulatory Agencies’ Division of Insurance announced health insurance plans and premium savings for Coloradans in 2025 due to the state’s reinsurance program. Coloradans will save $477 million on premiums and avoid a nearly 23% premium increase. Preliminary review of the filings indicates that the average premium for Colorado Option plans in the individual market will increase by 4% as compared to non-Colorado Option plans, which are likely to increase by 6%.
- Connecticut – Governor Ned Lamont signed an executive order directing the establishment of the Connecticut Office of Equity and Opportunity. The Office will be led by a chief equity and opportunity officer who will be responsible for coordinating a number of activities, including developing statewide diversity, equity, and inclusion benchmarks and measures of progress; providing guidance to state agencies on how to engage and incorporate the perspectives of underresourced communities; and more.
- Iowa – The state has requested to extend the “Iowa Wellness Plan” section 1115 demonstration to continue providing coverage to the new adult group, and to continue demonstration elements including premiums, healthy behaviors, a waiver of non-emergency medical transportation, and a waiver of retroactive eligibility for certain enrollees. The demonstration also provides dental benefits for adults and children through a managed care delivery system.
- Massachusetts – The Healey-Driscoll administration announced $2.8 million in grant awards to six community-based clinics to make mental health urgent care more widely available in disproportionately affected areas. The grants will enable mental health centers to expand their capacity to provide behavioral health urgent care services that provide immediate care to those struggling with mental health and substance-use needs.
- Michigan – The Michigan Department of Insurance and Financial Services released the 2025 health insurance rate change requests for issuers. The requested annualized rate change is 10.7% in the individual market and 11.2% in the small group market.
- New Hampshire – CMS approved a five-year extension of New Hampshire’s section 1115 demonstration, “Substance Use Disorder, Serious Mental Illness, and Serious Emotional Disturbance, Treatment Recovery and Access.” Under the extension, New Hampshire received new authority to provide certain pre-release services to eligible incarcerated individuals for up to 45 days immediately prior to the individual’s expected date of release.
- New Jersey – The Division of Consumer Affairs announced proposed rules that would require physicians, nurses, and midwives who provide perinatal treatment and care to pregnant persons in New Jersey to undergo implicit and explicit bias training. The training is intended to address biases that negatively impact the quality of care delivered by healthcare providers to women of color during pregnancy, labor, delivery, postpartum, and neonatal periods. A similar proposed rule for physician assistants was published on June 17, 2024.
- New York – Department of Financial Services (DFS) Superintendent Adrienne A. Harris adopted guidance to protect consumers from unfair or unlawful discrimination by insurers using artificial intelligence. The guidance outlines DFS’ expectations for how all insurers authorized to write insurance in the state develop and manage the integration of external consumer data and information sources, artificial intelligence systems, and other predictive models.
- North Carolina – Governor Roy Cooper announced that more than 500,000 North Carolinians have enrolled in Medicaid expansion, a milestone achieved in seven months, which previous projections estimated could take as long as two years. Since December 2023, new Medicaid enrollees have filled more than 1.9 million new prescriptions for conditions like heart health, diabetes, seizures and other illnesses. Medicaid has also covered more than $28.6 million in claims for dental services since expansion began. The state will soon launch a Medicaid Expansion Service Utilization Dashboard to provide more insights into the health services new Medicaid enrollees use.
- Pennsylvania — Governor Josh Shapiro signed HB1993 into law, providing stronger protections for patients in Pennsylvania and increased regulatory oversight of pharmacy benefit managers (PBMs). HB1993 grants the Pennsylvania Insurance Department the authority to regulate PBM practices and contains several protections that will result in lower out-of-pocket costs for prescription medication.
- Utah – Utah submitted a request to amend its “Medicaid Reform 1115 Demonstration” to provide health-related social services to additional qualifying Medicaid-eligible groups and change the age eligibility for fertility preservation treatment for Medicaid-eligible individuals diagnosed with cancer.