October 25 Update

In This Week’s Update:

  • CMS Innovation Center’s Strategic Vision
  • State Updates: AL, CA, CT, MI, MN, MT, NC, TX & WA
  • Latest No Surprises Act Interim Final Rule
  • Building an Equity-Centered Data System
  • Medicaid Eligibility for COFA Migrants


CMS Innovation Center’s Strategic Vision

The Centers for Medicare and Medicaid Services Innovation Center (CMMI) held a webinar and released a white paper on its strategic priorities. During the webinar, CMS Administrator Chiquita Brooks-LaSure and CMS Innovation Center Director Liz Fowler outlined the Center’s vision for the next 10 years and highlighted five strategic objectives that will guide implementation of its vision to develop “a health system that achieves equitable outcomes through high quality, affordable, person-centered care.” The Center’s web page includes a link to the webinar slide deck and recording, as well as a Frequently Asked Questions document and will continue to be updated with relevant information.


HHS officially extended the federal public health emergency declaration for an additional 90 days, through January 15, 2022. State Health and Value Strategies updated its resource, Federal Declarations and Flexibilities Supporting Medicaid and CHIP COVID-19 Response Efforts Effective and End Dates, to reflect this latest renewal. 


State Updates

  • Alabama – CMS approved Alabama’s application for a Section 1115 demonstration entitled “Community Waiver Program.” The 1115 demonstration will operate concurrently with a home and community-based services 1915(c) waiver in Alabama, a new opportunity in the state’s Medicaid program to meet the needs of additional individuals who prefer to get long-term care services and supports in their home or community rather than an institutional setting. CMS also launched this week a new webpage for state Medicaid agencies and stakeholders to advance transparency and innovation for home and community-based services. Through the new page, state Medicaid agencies and stakeholders can access information about states’ plans to enhance, expand, and strengthen home and community-based services across the country using new Medicaid funding made available by the American Rescue Plan Act of 2021.
  • California – The Department of Health Care Services updated the schedule for the release of the Medi-Cal Managed Care request for proposal (RFP). The RFP will be released February 2, 2022, and the implementation date for all MCP contracts will be January 1, 2024.
  • Connecticut – Governor Ned Lamont highlighted the release of a report from the U.S. Centers for Disease Control and Prevention, which shows that Connecticut has the highest rate of childhood immunizations of any state in the nation. According to the report, Connecticut achieved an estimated 80.2 percent coverage rate for the recommended immunization series among children by age 24 months—well above the national average of 70.5 percent and above the average for the New England region of 79.7 percent.
  • Michigan – Governor Gretchen Whitmer signed legislation establishing the Health and Aging Services Administration within the Michigan Department of Health and Human Services (MDHHS). The newly-established agency will provide more coordinated services to Michigan’s growing aging population by combining the former MDHHS Aging and Adult Services Agency and Medical Services Administration under one umbrella within MDHHS. Michigan’s Medicaid office is also part of the new Health and Aging Services Administration. 
  • Minnesota – The Department of Human Services released a bulletin providing guidance for eligibility workers regarding Afghan immigrants’ eligibility for public programs. The bulletin explains that Afghan immigrants who are Special Immigrant Visa holders, Special Immigrant Conditional Residents, Special Immigrant Parolees, or Humanitarian Parolees in the United States are eligible for public programs to the same extent as refugees. As a reminder, SHVS recently hosted a webinar on state strategies to support Afghan evacuees in accessing health coverage.
  • Montana – The state has requested a new five-year Section 1115 demonstration to expand access to coverage for substance use disorder treatment, treatment for serious mental illness and serious emotional disturbance, and limited services for individuals 30 days prior to release from the criminal justice system. The federal comment period is open through November 18, 2021.
  • North Carolina – The North Carolina Department of Health and Human Services released a funding opportunity that will award a total of $5.8 million to at least nine organizations statewide to increase access to high-quality opioid use disorder treatment for people in the criminal justice system.
  • Texas – CMS announced that the Texas Health and Human Services Commission (HHSC) submitted a request to amend their Section 1115(a) demonstration to cover applied behavioral analysis services for children with autism spectrum disorder through the state’s Medicaid managed care program. HHSC would pay Medicaid plans using a non-risk model until experience data is available to set capitated rates. Public comments on the submitted Section 1115 waiver application will be accepted through November 14.
  • Washington – The Health Care Authority released an update on individuals from Afghanistan entering the U.S. as Humanitarian Parolees and their eligibility for Apple Health, the state’s Medicaid program. The update details Apple Health program eligibility based on immigration status.


Upcoming SHVS Webinar – Save the Date!

Promoting Health Equity in Medicaid Managed Care

Monday, November 1 from 1:00 to 2:00 p.m. ET

This webinar, hosted by State Health and Value Strategies, will review steps states can take to integrate health equity into their Medicaid managed care programs. Promoting Health Equity in Medicaid Managed Care: A Guide for States is a practical guide that offers a series of concrete actions state Medicaid agencies can implement internally and with their contracted health plans in pursuit of health equity. Medicaid’s role in providing health care coverage to individuals who experience economic and social disadvantage is leading many states to integrate health equity into their population health management strategies, focusing specific attention on reducing health disparities and addressing conditions that create health inequities. During the webinar, experts from Bailit Health will review the three sections of the Guide and facilitate a discussion with state officials. The webinar will include a question and answer session for participants.

Registration (required) at the following link: https://rwjfevents.webex.com/rwjfevents/onstage/g.php?MTID=e05e475166033edd4886ee3961c2e3046


The No Surprises Act Interim Final Rule on Dispute Resolution, Uninsured Protections, and External Review: Implications for States

On October 7, the U.S. Departments of Health and Human Services, Treasury, and Labor and the Office of Personnel Management published a third rule implementing the No Surprises Act (NSA). SHVS published an expert perspective that summarizes the provisions of this third rule, an interim final rule (IFR), and notes particular implications for state regulators. The IFR provides details on the independent dispute resolution process, good faith estimates for enrollees on the cost of services, the dispute resolution process for uninsured patients, and external review. Comments on the IFR are due December 6, 2021. SHVS has also created a resource page for states where individuals can find this expert perspective and other resources related to the implementation of the NSA.  


Charting a Course for an Equity-Centered Data System

The COVID-19 pandemic laid bare the gaps in the public health and health data infrastructure and illuminated the many ways in which they perpetuate vast health inequities. To work toward a modernized health data system, the Robert Wood Johnson Foundation established a National Commission to Transform Public Health Data Systems to reimagine how data are collected, shared, and used, and identify the investments needed to improve health equity. Commissioners examined both the systems and the data needed to ensure public health information works for all, including: who the data that is collected elevates, who is being centered in the data, who is being excluded, and why. The Commission released its recommendations, calling on government at all levels, business, community-based organizations, philanthropy, and others to take specific action to transform the public health data system. Their overarching recommendations offer a blueprint for change and provide specific calls to action for a broad range of sectors. The Foundation also announced $50 million in grantmaking toward that goal.


Medicaid Eligibility for COFA Migrants

This week, CMS released a State Health Official letter to provide states with policy and operational guidance to implement the extension of Medicaid eligibility, as required by the Consolidated Appropriations Act of 2021, to the citizens of the Freely Associated States living in the United States under the Compacts of Free Association (COFA). The letter addresses the extension of Medicaid eligibility to COFA migrants, changes to the Federal Exchange eligibility and enrollment platform and Federal Data Services Hub to implement the change to COFA migrants’ Medicaid eligibility, operational considerations for states, applicable Federal Medical Assistance Percentage rates, and territory considerations.