November 25 Update

In This Week’s Update:

  • New SHVS Expert Perspective on Standardized Plans
  • State Updates: CO, CT, ID, NC, NJ, PA & WI
  • Implementing ASAM Criteria for SUD Treatment
  • Leveraging Medicaid MCOs in Payment Reform
  • Evaluating Medicaid Section 1115 Waiver Demonstrations
  • Stabilizing Individual Health Insurance Markets


New SHVS Expert Perspective on Standardized Plans

As a follow-up to the State Health and Value Strategies webinar on standardized plans, Sabrina Corlette from Georgetown University’s Center on Health Insurance Reforms wrote an Expert Perspective on the opportunities and implications for states. She outlines the benefits and risks of plan standardization, raises critical questions that states will need to consider, and offers a decision roadmap for states implementing a standardized benefit design requirement. In case you missed the webinar, a slide deck and recording are available.


State Updates: CO, CT, ID, NC, NJ, PA & WI

  • Colorado – The Colorado Division of Insurance and the Department of Health Care Policy & Financing delivered their final report for the development of a public option for affordable health insurance to the Colorado legislature.
  • Connecticut – Access Health CT, the state’s health insurance marketplace, released findings from a research study that assesses the uninsured and recently insured populations across Connecticut to gain a better understanding of who the uninsured are and what the drivers and barriers are that lead them to go without health insurance.
  • Idaho – The Idaho Department of Health and Welfare received approval letters from the Centers for Medicare & Medicaid Services (CMS) for four Medicaid state plan amendments necessary for the expansion of Medicaid. Idaho will begin providing coverage to newly eligible adults beginning January 1, 2020.
  • New Jersey – Governor Phil Murphy, Department of Banking and Insurance Commissioner Marlene Caride, and Treasurer Elizabeth Maher Muoio urged residents who need to enroll or reenroll in health coverage to do so before the Affordable Care Act Open Enrollment deadline on December 15. 
  • North Carolina – The North Carolina Department of Health and Human Services announced that implementation of managed care for the state’s Medicaid program, NC Medicaid, will be suspended. The General Assembly adjourned without providing new funding and program authority for the transition to managed care. Managed care will not go live on February 1, 2020 and NC Medicaid will continue to operate under the current fee-for-service model.
  • Pennsylvania – The Insurance Department released its draft Section 1332 waiver application for a state reinsurance program. Comments will be accepted until December 14. The SHVS map is updated to reflect this latest development.
  • Wisconsin
    • In a report to the legislature’s Joint Finance Committee, the Department of Health Services explained that it is waiting for additional feedback from CMS regarding the implementation of community engagement requirements for the Medicaid expansion population. The requirements were to be implemented as of November 1 and have been delayed until January 30, 2020.
    • The Governor’s Task Force on Reducing Prescription Drug Prices met for the first time to begin identifying solutions to lower costs for prescription drugs. The task force will meet monthly beginning in January to produce a set of recommendations for the governor by the fall of 2020.


Implementing ASAM Criteria for SUD Treatment through Medicaid Managed Care  

Last week SHVS released a new issue brief, Implementing the ASAM Criteria for SUD Treatment through Medicaid Managed Care. As the opioid epidemic continues, Medicaid programs are applying for SUD Section 1115 Demonstration waivers (SUD waivers) to expand Medicaid-funded treatment options. Some states with approved SUD waivers have formally implemented the American Society for Addiction Medicine (ASAM) Criteria to promote consistency in client placement for SUD treatment. The ASAM Criteria is a clinically driven multidimensional client assessment model that emphasizes treatment outcomes, client-specific lengths of service, and a team-based approach to care. This issue brief draws from the experiences of states that were among the first to implement their SUD waivers to profile how the ASAM Criteria is used within the context of managed care and utilization review, and the challenges and best practices associated with its use.


Leveraging Medicaid MCOs as Agents of Change in Payment Reform

On December 10, Catalyst for Payment Reform (CPR) is hosting a virtual summit to profile how Medicaid agencies are using their contracts with managed care organizations to hold health care providers accountable for better care and lower costs. Speakers from several state Medicaid agencies and leading experts, including SHVS Deputy Director Dan Meuse, will describe and discuss current and future strategies. CPR will also introduce a new resource for Medicaid agencies, employers, and other health care purchasers containing relevant contract provisions from across 39 states and the District of Columbia that implement Medicaid managed care. Interested individuals can register here.


Evaluating Medicaid Section 1115 Waiver Demonstrations

Manatt Health, with support from the Robert Wood Johnson Foundation, released a new issue brief, Evaluation of Medicaid Demonstrations under New CMS Guidance: State Considerations and Financial Resource Requirements, the third in their series on Section 1115 waiver demonstration monitoring and evaluation. Recent CMS guidance formalizes and strengthens requirements for the evaluation of state 1115 Medicaid demonstrations, affecting the complexity, and in turn, costs, of states’ evaluations. As states begin to design, implement, and define their required funding levels for demonstration evaluations, this brief is intended to serve as a resource to help them meet the evaluation standards set forth by CMS, including exploring the range of options for financing demonstration evaluations.


Stabilizing Individual Health Insurance Markets

The stability of individual health insurance markets is an area of concern that predates the Affordable Care Act. As part of the Agency for Healthcare Research and Quality-funded project Research Insights, Academy Health is hosting a webinar, Stabilizing Individual Health Insurance Markets, on Tuesday, December 17 that will identify the effects of a range of federal and state levers intended to strengthen the individual health insurance market’s infrastructure. During the webinar, speakers will explore key questions related to market stabilization efforts, including what strategies, from the available evidence, are effective in strengthening individual health insurance markets; what are signs of destabilization; and what are the most important questions for future research.