November 18 Update

In This Week’s Update:

  • CMS Announces Price Transparency Rules
  • State Updates: DE, ME, MN, NC, PA, RI, UT, WV, & WY
  • SUD Toolkit for Medicaid Leaders
  • Consumer Engagement Driving Change in Medicaid
  • Impact of Medicaid Block Grants on Community Health Center Revenues


CMS Announces Price Transparency Rules

Last week the Centers for Medicare & Medicaid Services (CMS) announced new rules to increase transparency for consumers by providing information about how much hospitals charge health insurers. Both rules stem from the Trump Administration’s June 2019 Executive Order. The Transparency in Coverage proposed rule relates to health plans sold on the Affordable Care Act (ACA) marketplaces and employer-sponsored insurance market. Plans would have to disclose the rates they have negotiated with providers in their networks, as well as the amounts they will allow for out-of-network care. Insurers would also have to tell patients in real-time, through an online tool, what they would owe out-of-pocket for all covered health care services. The administration also finalized a separate rule for hospitals, first proposed in July. Effective January 2021, facilities would have to disclose currently confidential rates they’ve negotiated with insurers. Hospitals will have to post that information online for 300 common services such as X-rays and lab tests in an easily understandable format; hospitals that don’t comply could face fines of up to $300 per day.


State Updates: DE, ME, MN, NC, PA, RI, UT, WV, & WY

  • Delaware – The Division of Public Health announced updates to its My Healthy Community data portal, which delivers neighborhood-focused population, environmental, and social determinant of health data to the public and allows users to understand and explore data about the factors that influence health. These data indicators also serve to highlight Delaware’s progress in meeting health care benchmarks as part of ongoing efforts to bring transparency to health care spending and to set targets for improving the health of Delawareans.
  • Maine – The Maine Department of Health and Human Services is accepting applications for its Health Home program. Selected Health Home practices will partner with community care teams and behavioral health home organizations to serve MaineCare members with chronic physical conditions and mental health needs. Applications will be accepted until December 9, 2019.
  • Minnesota – During the first 10 days of open enrollment, MNsure, the Minnesota state-based marketplace, announced it has seen over 3,230 new consumers sign up for 2020 private health insurance plans—nearly 50 percent more than in the first 10 days of last year’s open enrollment period. Including consumers who were automatically renewed into existing plans, MNsure has so far signed up 88,254 Minnesotans for 2020 private plan coverage.
  • North Carolina – The North Carolina Department of Health and Human Services issued a request for proposals for lead pilot entities (LPEs) to operate elements of the state’s $650 million Healthy Opportunities Pilot program. The state is seeking contracts with up to three LPEs for the pilot, which focuses on addressing the social determinants of health and is a key feature of the state’s planned transition to Medicaid managed care.
  • Pennsylvania – The Pennsylvania Department of Health launched the eWIC program for families in three counties who receive benefits in Pennsylvania’s Special Supplemental Nutrition Program for Women, Infants and Children (WIC), bringing the program to all 67 counties in the state. The eWIC card now allows families to shop for groceries in as many shopping trips as they need throughout the month, instead of just once a month via a paper check.
  • Rhode Island – The Rhode Island Department of Health and the Center for Women’s Behavioral Health at Women & Infants Hospital partnered to create the Rhode Island Maternal Psychiatry Resource Network. This new statewide program provides real-time psychiatric teleconsultation services for health care providers to help meet the behavioral health care needs of pregnant and post-partum patients in the state by offering help with diagnosis, treatment planning, medication management, and connections to community-based resources.
  • Utah – The Utah Department of Health and the Utah Coalition for Protecting Childhood hosted a roundtable discussion with community advocates to discuss how to reduce risk factors and increase protective factors associated with adverse childhood experiences, child maltreatment, abuse and neglect, and opioid misuse/overdose.
  • West Virginia
    • The West Virginia Department of Health and Human Resources (DHHR) selected Aetna Better Health of West Virginia to serve as the managed care organization for the specialized managed care program for children and youth in adoption and foster care placement. Under the contract, the state will integrate the oversight of its Socially Necessary Services (SNS) program to promote a holistic approach to care management for both medical and social services. SNS interventions are designed to maintain or establish safety, permanency, and well-being for the Bureau for Children and Families’ targeted populations of child protective and youth services.
    • DHHR also announced the West Virginia Children’s Health Insurance Program (WVCHIP) has added coverage for maternity services. Eligible populations include current WVCHIP members and newly pregnant women over age 19 with incomes between 185 percent and 300 percent of the federal poverty level and no other health insurance coverage. The new services include access to medical, pharmacy, dental, vision, behavioral health, and prenatal care.
  • Wyoming – The Wyoming Department of Health submitted a Section 1115 waiver demonstration application to expand Medicaid coverage for air ambulance transport services to all Wyoming residents. Public comments will be accepted through December 13, 2019.


Treating Substance Abuse: Toolkit for State Medicaid Leaders

Manatt Health, with support from Arnold Ventures, has developed Using Medicaid to Advance Evidence-Based Treatment of Substance Use Disorders: A Toolkit for State Medicaid Leaders. The Toolkit is designed to help state leaders identify Medicaid strategies from around the nation to expand treatment and recovery supports to those with opioid use disorder (OUD), implement in their respective states, and then evaluate and expand what works. The Toolkit uses an evidence-based approach to highlight the most effective strategies currently being leveraged to address the SUD and opioid epidemics at the state level. Given the fast-moving nature of these national epidemics, as well as the evolving response of state and local governments, the Toolkit also provides methods for monitoring and evaluating the efficacy of a chosen strategy in order to allow for timely adjustments to states’ approaches and amplify the body of evidence-based research.


How Consumers Are Shaping the Medicaid Program

A post on the Center for Consumer Engagement in Health Innovation’s blog details the importance of consumer engagement in centering Medicaid innovation on the needs of beneficiaries. The Kaiser Family Foundation’s 50-State Medicaid Budget Survey for State Fiscal Years 2019 and 2020 profiles the actions Medicaid programs are taking to address health equity, address social determinants of health, and improve long-term services and supports. As an example of how consumers have played a role in shaping the Medicaid program, the blog post profiles the role consumer advocates played in shaping Tennessee’s Employment and Community First CHOICES program for members with intellectual and developmental disabilities, the story of which Gabe Roberts, Tennessee’s Medicaid Director, shared at the release event for the Kaiser Survey.


Block Granting Medicaid: Estimates of Impact on Community Health Centers’ Revenues and Service Capacity

The Milbank Quarterly recently published a study from George Washington University that simulated the impact of Medicaid block grants and per-capita caps on community health centers’ total revenues and general service capacity. Researchers found that Medicaid block grants would reduce total health center revenues by 92 percent for the Medicaid expansion population and by 58 percent for traditional enrollees by 2024. The research team also created infographics showing estimated impacts in individual states which they published as part of a blog post. Additionally, in a Milbank Blog post, former director of the Virginia Department of Medical Assistance Services Jennifer Lee, MD, discusses the implications for community health centers and population health.