May 4, 2018: New HHS Secretary Comments and State Updates

Secretary of Health and Human Services Alex Azar addressed the World Health Care Congress this week and focused his remarks on value-based care and the role of the Department of Health and Human Services (HHS) in transforming the health care system in the United states “into one that pays for value.” Azar outlined four areas of emphasis for HHS: health information technology; health care pricing transparency; new models in Medicare and Medicaid; and reducing barriers to care coordination. Secretary Azar concluded his remarks by promoting All of Us, a new initiative of the National Institutes of Health that hopes to gather data from over a million U.S. residents.

Also, in case you missed it, last week the Centers for Medicare & Medicaid Services (CMS) released the feedback it received in response to the request for information on the new direction of its Innovation Center. Updates follow.

  • California – A new report, commissioned by the California Health Care Foundation and authored by our colleagues at Georgetown’s Center on Health Insurance Reforms, provides an overview of the current market for short-term plans in California and explains how changes to federal policy around short-term plans might affect California’s individual health insurance market.
  • Colorado – Governor John Hickenlooper signed a bill that will remove the current requirement that families of children and youth with intellectual and developmental disabilities, who also have complex behavioral supports needs, must relinquish custodial rights of their child so he or she can qualify for vital services and supports provided by the Children’s Habilitation Residential Program (CHRP) waiver. Currently, these services are only available to children in the foster care program. The Department of Health Care Policy and Financing will seek federal approval of changes to the CHRP waiver to implement the bill.
  • New Hampshire – The Department of Health and Human Services submitted an 1115 waiver application for authority to support Medicaid payments for individuals receiving substance use disorder services in an institution for mental disease (IMD).
  • New Jersey
    • The Department of Health announced the “Healthy Women, Healthy Families initiative,” that will provide $4.3 million in grant funding to community-based programs as part of intensified efforts to decrease disparities in birth outcomes and reduce black infant mortality. Up to 12 grantees will be funded statewide.
    • In response to CMS’ request for comment on the proposed rule on short-term limited duration insurance (STLDI), Marlene Caride, Acting Commissioner of the Department of Banking and Insurance, submitted a letter notifying CMS that the sale of STLDI is prohibited in New Jersey’s individual market and warned that permitting the sale of these plans elsewhere in the country would cause harm to the nation’s health insurance market and to consumers.
  • North Carolina — The North Carolina Department of Health and Human Services announced that it received approval from CMS to begin a pilot project to offer rehabilitation services for adults who have suffered traumatic brain injury on or after their 22nd birthday. The pilot project was included in the Department’s 1915(c) waiver request to CMS.

Upcoming Webinar – Save the Date!

Medicaid Buy-In: State Options and Design Considerations

Tuesday, May 15, 2018 3:30 to 4:30 p.m. ET

In recent months, several proposals have been introduced at both the federal and state levels that would permit people above Medicaid eligibility levels to “buy in” to Medicaid or would leverage the Medicaid program to strengthen coverage across the individual market and Medicaid. In this webinar, the Robert Wood Johnson Foundation’s State Health and Value Strategies (SHVS) program, together with technical assistance experts from Manatt Health, will examine the central considerations that a state must take into account when developing a Medicaid buy-in proposal, the primary models for state-administered Medicaid buy-in proposals, and the administrative considerations and authorities needed for each model. The webinar will also review Section 1332 waiver authority and related deficit neutrality and pass-through funding implications that states will want to consider as they craft their buy-in proposals. We will also highlight states’ current efforts to develop buy-in initiatives.

Registration (required) at the following link:

Improving Health Equity in States

The 100 Million Healthier Lives Initiative, convened by the Institute of Healthcare Improvement, announced the networks for States of Solutions, an initiative that will bring together governmental and nongovernmental agencies in 15 states to improve health equity. Partners in selected states will apply a health equity lens as they improve a range of population health challenges from chronic disease to birth outcomes to mental health to economic disparities. During phase one of the initiative, states and partners will begin planning and building a foundation to advance equity by instituting improvement strategies and pursuing systems-level change within their organizations. States that make substantial progress during Phase I will move into Phase II of the initiative, where partners will engage in equity action labs and pursue initiatives to advance strategic and coordinated actions across sectors and communities to improve health equity.

Prospects for Bipartisanship in Health Reform

David Jones, assistant professor at Boston University School of Public Health, has followed up last year’s Milbank Fund supported work on health care values with a trip to two states in the heartland of America. Jones wanted to find out what Republican and Democrat legislators were concerned about when it comes to health reform. Jones’ report, Views from the Heartland: Prospects for Bipartisanship in Health Reform, shares seven consistent themes from policymakers in Colorado and Kansas that illustrate what a bipartisan conversation on health reform would look like, how challenging it may be, and how to move it forward.

Opioid Crisis In Medicaid: Saving Mothers And Babies

A recent post on the Health Affairs blog considers the role Medicaid can play in improving the outcomes of pregnant and postpartum women and infants effected by the opioid epidemic. Medicaid covers nearly half of all births and 80 percent of births of babies with neonatal abstinence syndrome (NAS). The post highlights existing barriers in care delivery for both mothers and babies, in particular the absence of treatment programs tailored to pregnant and postpartum women. For infants diagnosed with NAS, traditional approaches to treatment include treatment of the infant in a neonatal intensive care unit, often separating mother and infant, while research suggests that minimizing this separation may improve clinical outcomes. The post outlines policy opportunities to improve outcomes for women and infants enrolled in Medicaid.