In the absence of federal legislation, states are actively seeking tools to reform their health care systems. While 1115 waivers rightly get a lot of attention, because of their ability to reshape state Medicaid programs, the Affordable Care Act’s Section 1332 waivers continue to be a promising avenue for states to stabilize their health insurance marketplace. SHVS is tracking state activity and has many resources, including a template, for states interested in pursuing a Section 1332 waiver.
The Centers for Medicare & Medicaid Services (CMS) recently released the proposed annual Notice of Benefit and Payment Parameters for plan year 2020. The Notice proposes regulatory and financial parameters for qualified health plans on the Exchanges, plans in the individual, small group, and large group markets, and self-funded group health plans. State Health and Value Strategies hosted a webinar for states Friday, January 25 at 1:00 p.m. E.T. During this webinar, experts walked through key components of the notice and discuss potential state considerations and options for commenting on the proposed rule.
On January 23, State Health and Value Strategies hosted a webinar examining the complexities of state Medicaid oversight of the pharmacy benefit in the managed care environment. State Medicaid programs commonly rely on contracted Managed Care Organizations (MCOs) and their subcontracted Pharmacy Benefit Managers (PBMs) to manage the prescription drug benefit offered to Medicaid enrollees. The webinar offered states real world tips on how to best monitor and evaluate operational and financial performance of their MCOs and their subcontracted PBMs.