September 23 Update

In This Week’s Update:

  • CMS Planning Grant Awards for SUD
  • State Updates: CO, DC, NJ, NY, NC, RI, PA, TN & WA
  • Individual Marketplace Trends by County
  • Behavioral Health Provider Participation in Medicaid Value-Based Payment Models
  • New Resource on Surprise Medical Bills  


CMS Planning Grant Awards for SUD

Last week the Centers for Medicare and Medicaid Services (CMS) awarded $45 million in planning grants to 15 state Medicaid agencies to increase the treatment capacity of providers to furnish substance use disorder (SUD) treatment and recovery services. The planning grants are intended to increase the capacity of Medicaid providers to deliver SUD treatment or recovery services through: an ongoing assessment of the SUD treatment needs of the state; recruitment, training, and technical assistance for Medicaid providers that offer SUD treatment or recovery services; and improved reimbursement for and expansion of the number or treatment capacity of Medicaid providers.


State Updates: CO, DC, NJ, NY, NC, RI, PA, TN & WA

  • Colorado – Governor Jared Polis and the Colorado Division of Insurance announced that premiums for individual health insurance plans in Summit County will see decreases ranging from 39 to 47 percent compared to last year’s premiums. These decreases include savings from the state’s newly-passed reinsurance program and are also attributed to the formation of Peak Health Alliance, which brings together the individual, small group, and large group markets to negotiate prices with hospitals and doctors directly, rather than insurance companies negotiating on their behalf.
  • District of Columbia – The Department of Health Care Finance (DHCF) announced plans to move towards a fully managed Medicaid program over the next five years and will rebid its Medicaid managed care contracts to include 22,000 additional high-cost members. DHCF anticipates announcing the selection of the winning bidders in the spring of 2020. 
  • New Jersey – Human Services Commissioner Carole Johnson announced that the Department is providing over 1,200 doses of the opioid overdose antidote naloxone for free to participating shelters serving the homeless. A total of 36 shelters are participating in the initiative.  
  • New York – The Department of Health released a draft of its Section 1115 Medicaid Redesign Team waiver amendment request which seeks to extend the state’s Delivery System Reform Incentive Payment (DSRIP) program for an additional four years. The amendment requests an additional $8 billion in federal funds, of which $5 billion would be targeted to on-going DSRIP effort and $1.5 billion to social determinants of health. The state is accepting public comments on the draft amendment through November 4.
  • North Carolina – The Office of Rural Health was awarded a one-time $1 million grant from the Kate B. Reynolds Charitable Trust to support health care providers in 34 FEMA-identified counties affected by Hurricane Florence. The grant will provide up to $50,000 per applicant for infrastructure-related capital needs, emergency supplies, and equipment to sustain services during emergencies and natural disasters.
  • Rhode Island – HealthSource RI, the state’s official health insurance marketplace, announced the approval of health insurance premium rates for 2020 by Rhode Island’s Office of the Health Insurance Commissioner. The Rhode Island 2020 rates for individual market plans decreased on average compared to last year’s rates, due in part to the upcoming implementation of a statewide reinsurance program. The state estimates it saved Rhode Islanders over $15.5 million by cutting insurer’s proposed rate increases, and that without the reinsurance program, average individual rates would have increased up to 7 percent higher than 2019 rates.  
  • Pennsylvania – The Wolf Administration announced that it received $20 million in federal funding from CMS to continue the Money Follows the Person (MFP) grant. Pennsylvania has participated in MFP since 2008 and has used the funding to strategically invest in initiatives focused on housing and services for individuals with intellectual and developmental disabilities and autism.
  • Tennessee – The state released a draft proposal it plans to submit to CMS to amend its 1115 demonstration waiver. The state is proposing to convert the federal share of its Medicaid funding for core medical services to a block grant, capping the federal funding the state receives. TennCare, the state’s Medicaid program, is accepting public comments on the proposal through October 18.
  • Washington – The Washington Health Benefit Exchange, the state’s official health insurance marketplace, announced the certified 2020 Qualified Health Plans (QHPs) and Qualified Dental Plans (QDPs) that will be offered during the upcoming open enrollment period. A total of 66 QHPs and seven QDPs were confirmed by the Exchange Board following their approval from the Office of the Insurance Commissioner (OIC). The OIC calculated an overall record average rate decrease in the Exchange market of 3.27 percent for 2020 health insurance plans.


Marketplace Pulse: A Long Look at the Individual Market

The Robert Wood Johnson Foundation released an interactive tracker to help tell the story of insurer participation in the Affordable Care Act (ACA) market. The tracker shows the change over time in participation at the county level, and allows users to follow individual companies or categories of health insurers. The data reveal a business narrative that has been closely intertwined with the political story of the ACA marketplace and details premium and insurer participation trends by county.


Behavioral Health Provider Participation in Medicaid Value-Based Payment Models: An Environmental Scan and Policy Considerations

The National Council for Behavioral Health and the Center for Health Care Strategies released a new report highlighting the successes and challenges associated with implementing value-based payment models in Medicaid behavioral health care. Informed by a series of interviews with state and industry leaders and a review of state program guidelines, quality measures, and MCO contracts, this report provides: (1) an overview of the behavioral health system’s engagement in VBP in the U.S., with a focus on 11 states; (2) lessons on implementing VBP from the perspective of behavioral health providers; and (3) policy recommendations for how state and federal policymakers, MCOs, and other stakeholders can support the adoption of VBP within behavioral health care. It also identifies nine key themes that support successful behavioral health VBP design and implementation to inform efforts in states across the country.


New Resource on Surprise Medical Bills

Experts from Georgetown University’s Center on Health Insurance Reforms (CHIR) launched a new project to provide unbiased and comprehensive information on the issue of surprise medical bills. Leveraging their experience advising state insurance regulators and monitoring surprise medical bill legislation in all 50 states and before Congress, the goal of this initiative is to help policymakers protect consumers, promote affordability, and adopt comprehensive surprise medical bill protections. Under this new project, CHIR is offering an online resource center to help educate state and federal policymakers and share up-to-date research on surprise medical bills; technical assistance for policymakers on surprise medical bill issues; and a source of public education to share research and analysis with stakeholders.