October 29 update: Updated federal 1332 guidance; Opioid SUPPORT Act webinar; Equity-oriented interventions

The Departments of Health and Human Services and Treasury (“the Departments”) released updated guidance setting forth their interpretation of Section 1332 of the Affordable Care Act (ACA), which authorizes states to waive certain provisions of the ACA. The guidance details new principles to be advanced by state waivers and outlines how the Departments will review waiver applications going forward. The guidance is effective immediately, though there is a 60-day comment period. For a summary of the guidance and implications for states, see this Health Affairs blog post.

In case you missed it, President Trump signed new opioid legislation into law last week. Among the provisions, H.R. 6 (115) expands access to addiction treatment through Medicaid and Medicare policies, including amending the prohibition against the use of federal Medicaid funds for services in “institutions for mental disease” for nonelderly adults. Kaiser Family Foundation has an issue brief that details the Medicaid-related provisions in the law, and State Health and Value Strategies will be hosting a webinar to explore the new law’s implications for states (see registration below). Updates follow.

  • Delaware –Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker issued a statement on the potential impact to health care and social services of proposed changes to the public charge rule by the U.S. Department of Homeland Security. DHSS will join with Governor John Carney’s office and other state agencies to monitor the proposed rule, study its potential impacts and work with community partners to support those populations affected in Delaware.
  • Idaho – The Department of Health and Welfare published the Opioid Needs Assessment, a report that details the number of opioid related deaths in the state as well as data regarding treatment needs in Idaho, availability of Medication Assisted Treatment, prevention efforts, and policies and legislation proposed or enacted in Idaho related to the opioid epidemic.
  • Illinois – The Illinois Department of Public Health released the state’s first Maternal Morbidity and Mortality Report. The report identifies statewide trends in maternal deaths and provides recommendations to help prevent maternal mortality.
  • North Carolina – The North Carolina Department of Health and Human Services received approval from the Centers for Medicare & Medicaid Services (CMS) of their amended 1115 Demonstration Waiver application. Under the amended waiver, North Carolina will transition to Medicaid managed care and integrate physical health, behavioral health and pharmacy benefits. CMS Administrator Seema Verma penned a Health Affairs blog on the innovative nature of the North Carolina Medicaid Reform Demonstration.
  • Oregon – The Oregon Health Authority released the Oregon Acute Opioid Prescribing Guidelines in an effort to help clinicians working in surgical, dental, primary care, emergency and urgent care settings make evidence-based prescribing decisions when treating pain.
  • Washington – The Washington Health Benefit Exchange, the state’s official health insurance marketplace, promoted in a press release the availability of 10 full-service enrollment centers that will offer in-person assistance to customers signing up for health and dental coverage through Washington Healthplanfinder during open enrollment.
  • Wisconsin – The Department of Health Services announced it was awarded a $445,000 Pediatric Mental Health Care Access grant to expand the state’s Child Psychiatry Consultation Program, which provides consultation and referral services to primary care providers working with children and adolescents with behavioral health concerns.

Upcoming Webinar – Save the Date!

The SUPPORT Act: New Tools for States to Address the Opioid Epidemic

Friday, November 16, 2018 12:00 to 1:00 p.m. ET

Every day, an average of more than 115 Americans die from an opioid overdose, reflecting a crisis that has evolved – but not dissipated. Following several months of bipartisan, bicameral hearings, markups, and negotiations about how to address the opioid epidemic, the Senate on October 3 passed H.R. 6, The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the “SUPPORT Act”). On October 25, President Trump signed the legislation. Most stakeholders agree that the bill is a significant step forward in addressing the opioid epidemic, reflecting a range of important policy changes such as initiatives to increase access to medication-assisted treatment (MAT), new grant, pilot and demonstration projects, and a series of changes to Medicaid and Medicare. During this webinar, experts from Manatt Health will review major health provisions of the new law and implications for states.

Registration (required) at the following link: https://rwjfevents.webex.com/rwjfevents/onstage/g.php?MTID=eec26c92949a448b215e2322692ee0f00

How Equity-Oriented Health Care Affects Health: Key Mechanisms and Implications for Primary Health Care Practice and Policy

A new study published in the Milbank Quarterly suggests that equity-oriented interventions at the point of care can begin to shift inequities in health outcomes for those with the greatest need. The longitudinal study surveyed patients at four primary care centers and found that providing more equity-oriented health care in primary care settings—including trauma-informed, culturally safe, and contextually tailored care—predicts improved health outcomes over time for people living in marginalizing conditions.

The National Landscape of Medicaid Managed Care Activity

The Institute for Medicaid Innovation, the non-profit Medicaid research group, released findings from its first national longitudinal survey that collected information from Medicaid managed care organizations (MCOs) on seven critical health dimensions. The survey examines MCO activity related to high-risk care coordination, pharmacy, value-based payment, behavioral health, women’s health, child and adolescent health, and long-term services and supports. The findings from the inaugural survey are intended to equip Medicaid stakeholders with the information needed to accurately articulate the national narrative about Medicaid managed care.

New CMS Model to Address Opioid Misuse Among Expectant and New Mothers

CMS announced the Maternal Opioid Misuse (MOM) model, which seeks to better align and coordinate care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD) through state-driven transformations of the delivery system. The CMS Innovation Center will execute up to 12 cooperative agreements with states, whose Medicaid agencies will implement the model with one or more “care-delivery partners” in their communities. The MOM model will serve pregnant Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries with OUD who have elected to participate. CMS anticipates releasing a Notice of Funding Opportunity in early 2019 to solicit cooperative agreement applications to implement the MOM model. A maximum of $64.6 million will be available across up to 12 state awardees over the course of the five-year model.