July 29 Update

In This Week’s Update:

  • Federal Drug Pricing Efforts
  • State Updates: AZ, CA, CO, IN, MI, MO, NH & TX
  • Health Equity for Kids
  • Non-emergency Medical Transportation


Federal Drug Pricing Efforts

Last week, federal-level health policy discussions focused on proposals to address prescription drug prices, as the Senate Finance Committee approved far-reaching legislation. The podcast What the Health? (starts at 1:27) discusses the various efforts.


State Updates: AZ, CA, CO, IN, MI, MO, NH & TX

  • Arizona – Arizona Health Care Cost Containment System (AHCCCS) is awaiting policy guidance from the Centers for Medicare & Medicaid Services (CMS) regarding the state’s ability to expand treatment coverage options for members who receive services in Institutions for Mental Disease. AHCCCS is exploring the option of submitting a State Plan Amendment or a Section 1115 waiver.
  • California – As part of its efforts to create a single-purchaser system for prescription drugs, the California Department of Health Care Services (DHCS) announced it will begin accepting proposals to transition Medi-Cal pharmacy services from contracted managed care plans to a directly negotiated fee-for-service system. The announcement creates the framework for a consolidated state negotiation and purchasing system for Medi-Cal pharmacy and a uniform Medi-Cal pharmacy provider network and pharmacy utilization policy, while allowing Medi-Cal Managed Care Plans to retain all care coordination, pharmacy adherence and disease management responsibilities.
  • Colorado
    • The Department of Health Care Policy and Financing issued a press release highlighting the Department’s various initiatives and policies to reduce opioid use among members of Health First Colorado, the state’s Medicaid program.
    • The Colorado Division of Insurance announced that Colorado health insurance companies that sell plans on the individual market expect to reduce premiums by an average of 18.2 percent over their 2019 premiums, provided the state’s Section 1332 application to implement a reinsurance program is approved.
  • Indiana – The Indiana Family and Social Services Administration submitted the Healthy Indiana Plan (HIP) Workforce Bridge Amendment to CMS. HIP Workforce Bridge would eliminate a common obstacle that can prevent HIP members from pursuing meaningful employment. The program would give qualifying outgoing HIP participants the ability to continue to use up to $1,000 for premiums, deductibles, copayments and coinsurance for the next 12 months during their transition to commercial coverage.
  • Michigan – The Michigan Department of Health and Human Services issued two new requests for proposals (RFP) to provide services to survivors of sexual assault. Funding awarded through the RFPs will support services such as 24-hour sexual assault hotline/helplines and sexual assault forensic examinations, among other services. 
  • Missouri – Governor Michael Parsons signed an Executive Order that establishes a Health Insurance Innovation Task Force, which is charged with developing concepts for a Section 1332 waiver application. 
  • New Hampshire – Governor Chris Sununu signed two bills into law that seek to enhance services provided through the state’s Medicaid program. SB 274 expands access to the home visiting programs to all Medicaid eligible children and pregnant women. HB 692 creates a value-based dental care program and directs the state Department of Health and Human Services to develop a comprehensive plan to ensure access to quality care.
  • Texas – Texas Health and Human Services announced the expansion of mental health services to help rural Texans experiencing early-onset psychosis. With $4 million from the Substance Abuse and Mental Health Services Administration’s Mental Health Block Grant, HHSC’s Coordinated Specialty Care program is adding 13 new sites to increase access to care, particularly in rural areas. 


Aligning Science, Practice, and Policy to Support Healthy Children

Early experiences and life circumstances shape prenatal and early childhood development, with powerful impacts on the developing brain and body that shape health outcomes across the life course and can span generations. With support from the Robert Wood Johnson Foundation, the National Academies of Sciences, Engineering, and Medicine convened a committee to apply the science of prenatal and early childhood development to policy, program, and systems changes. The resulting report, Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity, outlines steps needed to move children who are at risk for negative outcomes toward positive health trajectories, reducing health disparities.


Medicaid Non-Emergency Medical Transportation

Leavitt Partners released a white paper on the opportunities to improve program integrity in Medicaid’s non-emergency medical transportation benefit. The NEMT benefit enables Medicaid beneficiaries who lack reliable sources of transportation to use a benefit that will ensure they can access their primary care provider, dialysis appointment, child wellness check-up, addiction treatment, and other forms of non-emergent care. The white paper details strategies to improve the benefit, which has helped millions of beneficiaries access providers, while also reducing fraud and abuse within the program.