November 19 Update: New Waiver Opportunity; Provider Consolidation; CMS Webinar

During the opening plenary at the National Association of Medicaid Directors fall conference, HHS Secretary Alex Azar announced a new opportunity for states to receive authority to pay for short-term residential treatment services in an institution for mental disease (IMD) for Medicaid beneficiaries with serious mental illness. Following Secretary Azar’s speech, the Centers for Medicare & Medicaid Services (CMS) released a letter to State Medicaid Directors outlining both existing and new opportunities for states to design innovative service delivery systems for adults with SMI and children with serious emotional disturbance.

Also, in case you missed it, State Health and Value Strategies hosted a webinar led by technical experts from Manatt Health on H.R. 6, the SUPPORT Act, which was signed into law on October 25 and provides funding and strategies to states to address the opioid epidemic. The slide deck from the webinar has been posted and SHVS will post the recording next week for those of you who missed it. Updates follow.

  • Alabama – The Alabama Department of Public Health announced that the infant mortality rate of 7.4 deaths per 1,000 live births in 2017 is the lowest in Alabama history and is an improvement over the 2016 rate of 9.1. The state recently developed an infant mortality reduction plan that includes a pilot project to reduce infant mortality by 20 percent in five years. Components of the pilot project include home visitation, preconception and interconception health care, screening for substance use, domestic violence and depression, safe sleep education, and breastfeeding promotion.
  • Alaska – The Alaska Department of Health and Social Services released the 2017 Drug Overdose Mortality Update, which examines all drug overdose deaths using Alaska mortality data from 2013 through 2017. The report highlights the need to not just focus on opioids, but to address the broader issues of substance misuse and addiction, including binge drinking and alcoholism, and how misuse of these substances affects public health, public safety, and the criminal justice system.
  • California – Covered California, California’s state-based exchange, is continuing its statewide bus tour to encourage consumers to sign up for health care coverage during the current open-enrollment period. The 10-day, 23-stop kickoff tour will travel more than 1,600 miles in November and feature individuals who have been enrolled through Covered California since the exchange first opened its doors.
  • Delaware – The Delaware Health Care Commission awarded the first value-based payment reform mini-grant to Christiana Care Health System to test a new reimbursement model focused on improving care coordination for patients with chronic behavioral health conditions as a primary diagnosis. The Health Care Commission will continue to announce mini-awards to applicants through the Value-Based Payment Reform Fund for work in the areas of data integration, care coordination, and readiness to integrate into an accountable care organization.
  • Illinois – Governor-elect JB Pritzker announced the formation and members of the Healthy Children and Families Committee of the transition team. The committee is the third of several working groups of the transition made up of subject-matter experts who will advise and guide the incoming Pritzker-Stratton administration.
  • Michigan – Michigan’s Medicaid state plan amendment (SPA) was officially approved by CMS this week. The approval now allows the state to enter into value-based payment arrangements with drug manufacturers and includes authority to leverage additional rebate agreements for “outcomes-based” contracts with manufacturers.
  • Nebraska – Governor Pete Ricketts, the Department of Health and Human Services’ (DHHS) Division of Behavioral Health (DBH), and the Nebraska Department of Education (NDE) announced new resources aimed at helping schools access mental health resources. One resource, known as the Behavioral Health Resources for Schools, is a toolkit for school personnel and includes a compendium of selected behavioral health topics to assist educators and school staff working with students with behavioral health needs.
  • New Jersey
    • The Department of Health announced an investment of nearly $7 million in new projects to fight smoking and e-cigarette “vaping” among youth. These efforts include an education campaign to warn teens and young adults about the dangers of e-cigarettes and other electronic “vaping” devices that allow users to inhale highly addictive flavored nicotine vapor.
    • The Department of Health published a new opioid data dashboard. The dashboard uses interactive data visualizations to display opioid and other drug-related overdose indicators for public health practitioners, researchers, policy-makers, and the public.
  • Wisconsin – The Wisconsin Department of Health Services announced grants to 15 counties to improve how they respond to people experiencing a mental health crisis. Each county will receive $20,000 to address local needs, including staff training, partnerships with law enforcement and schools, and new electronic systems to collect and share information on clients.

Upcoming Webinar – Save the Date!

HRA Proposed Regulations: State Implications and Responses

Wednesday, November 28, 2018 2:00 p.m.-3:00p.m. ET

State Health and Value Strategies will host a webinar for state officials to discuss the implications of the newly proposed regulations on health reimbursement arrangements (HRA) and possible state responses. The proposed rule represents the third of the three policy changes initiated by the October 12, 2017 Executive Order, which also called for loosening the rules on short-term limited-duration coverage and association health plans. Like those changes, the HRA proposed rule could have profound implications for health insurance markets, consumers, and Marketplaces. The webinar will feature Jason Levitis, who led ACA implementation at the U.S. Treasury Department, as well as experts from Georgetown University’s Center on Health Insurance Reforms and Manatt Health.

Registration (required) at the following link:

How Health Care Market Are Responding to Provider Consolidation

Georgetown’s Center on Health Insurance Reforms (CHIR) published three case studies of health care markets that have experienced recent provider consolidation and an interim report based on their findings. Increased consolidation among hospitals and physician groups have led to rising prices for health care purchasers and higher costs for consumers. Under increasing pressure from employer purchasers and policymakers to keep costs affordable while maintaining quality, insurers are exploring strategies to counter the increased clout of health care providers. The experts at CHIR are conducting a total of six case studies and the remaining three will be completed and published in 2019.

CMS to Host Webinar on Proposed Rule for Medicaid Managed Care

On November 8, CMS released a Notice of Proposed Rulemaking (NPRM) in the Federal Register for Medicaid and CHIP managed care. The proposed rule seeks to advance CMS’ efforts to streamline the Medicaid and CHIP managed care regulatory framework while supporting state flexibility and local leadership and promoting transparency and innovation in the delivery of care. CMS is hosting a webinar on Wednesday, November 28, 2018 from 1:00 to 2:00 pm EST. The call in to join the webinar is 1-877-267-1577 and the meeting ID is 991 662 228. The webinar will provide an overview of the regulatory revisions in the proposed rule. Public comments on the proposed rule can be submitted through January 14, 2019.

New Blog Series on Building the Home- and Community-Based Workforce

Health Affairs announced the launch of a new featured topic on its blog entitled “Workforce in the Community,” which will focus on building a workforce to meet the home- and community-based care needs of individuals living with serious illness. The series of posts will assess needs, explore what the current system delivers and where it falls short, and present evidence and reports on promising practices and approaches to building a home- and community-based workforce that can provide effective serious illness care. The series kicks off with a post on top priorities for strengthening the workforce to care for people with serious illness. Health Affairs is also soliciting posts for the series on topics such as understanding the needs of patients with serious illness in the community and disparities in access, treatment, and quality of home- and community-based care.