CMS Proposed Rules Part 2: Coverage, Financing, Payment and Quality
On Friday, May 26, State Health and Value Strategies hosted a webinar that provided an overview of CMS’ recently released proposed rules: (1) “Managed Care Access, Finance, and Quality” (or the “Managed Care Proposed Rule”), which focuses on managed care delivery systems; and (2) “Ensuring Access to Medicaid Services” (or the “Access Proposed Rule”), which focuses on fee-for-service delivery systems and program improvements for home and community-based services across delivery systems. During the second webinar in this three-part series, experts from Manatt Health focused exclusively on key provisions in the “Managed Care” proposed rule related to coverage, financing, payment, and quality. Presenters highlighted areas where CMS is requesting comment (due July 3, 2023) and reviewed considerations for state officials.
1115 Demonstration Facilitation Tool: Crosswalk of Requested Reentry Demonstration Features to Federal Requirements and California’s Approved Demonstration
On January 26, 2023, the Centers for Medicare & Medicaid Services (CMS) approved California’s request to amend the California Advancing and Innovating Medi-Cal Section 1115 demonstration. On April 17, 2023, CMS released a State Medicaid Director Letter (SMDL), “Opportunities to Test Transition-Related Strategies to Support Community Reentry and Improve Care Transitions for Individuals Who Are Incarcerated.” The following tool can be used as part of a state’s discussions with CMS regarding a requested demonstration’s proposed features as compared with the reentry requirements outlined in the SMDL and California’s section 1115 demonstration approval.
CMS Proposed Rules Part 1: Access to Care and Transparency
On Tuesday, May 23, State Health and Value Strategies hosted a webinar providing an overview of CMS’ recently released proposed rules: (1) “Managed Care Access, Finance, and Quality” (or the “Managed Care Proposed Rule”), which focuses on managed care delivery systems; and (2) “Ensuring Access to Medicaid Services” (or the “Access Proposed Rule”), which focuses on fee-for-service delivery systems and program improvements for home and community-based services across delivery systems. During the first webinar in this three-part series, experts from Manatt Health provided an overview of the access to care and access monitoring proposals included in both rules. Presenters highlighted areas where CMS is requesting comment (due July 3, 2023) and reviewed considerations for state officials.
State Spotlight: Oklahoma’s Award-Winning Communications Campaign to Promote Medicaid Expansion Enrollment
The Affordable Care Act’s Medicaid expansion allows for the expansion of Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level (FPL) and provides states with an enhanced federal matching rate for their expansion populations. On June 30, 2020, the Oklahoma Medicaid Expansion Initiative, State Question 802, passed by a majority vote to expand Medicaid eligibility to adults ages 19 to 64 whose income is 138% of the FPL or lower. This state spotlight describes the Oklahoma Health Care Authority’s approach to outreach and education in support of overall enrollment goals.
Federal Declarations and Flexibilities Supporting Medicaid and CHIP COVID-19 Response Efforts Effective and End Dates
To help states respond to the ongoing COVID-19 pandemic, the White House, the U.S. Department of Health and Human Services, and the Centers for Medicare and Medicaid Services have invoked their emergency powers to authorize temporary flexibilities in Medicaid and the Children’s Health Insurance Program. Congress’s legislative relief packages have provided additional federal support for state Medicaid programs, subject to certain conditions. The timeframes for these emergency measures are summarized in the chart, including the effective dates and expiration timelines dictated by law or agency guidance. This SHVS product has been updated to reflect the expiration of the PHE at the end of the day on May 11, 2023 and related guidance from CMS regarding the unwinding of certain Medicaid flexibilities. The document also includes a timeline of key Medicaid unwinding provisions included in the Consolidated Appropriations Act, 2023.
Section 1115 Demonstration Opportunity to Support Reentry for Justice-Involved Populations: CMS Guidance
On Tuesday, May 2, State Health and Value Strategies hosted a webinar that provided an overview of CMS’ guidance that outlines the opportunity for states to waive the inmate exclusion and receive federal financial participation for expenditures for certain pre-release healthcare services provided to individuals who are incarcerated and otherwise eligible for Medicaid. The webinar built on the recently published expert perspective, CMS Issues Guidance on Section 1115 Demonstration Opportunity to Support Reentry for Justice-Involved Populations.
Compendium of Medicaid Managed Care Contracting Strategies to Promote Health Equity
The Compendium identifies approaches states are taking within their Medicaid managed care programs to promote health equity and highlights examples from states to further illustrate how they are implementing specific approaches and includes excerpts from state contract and procurement documents. The Compendium synthesizes information across select states and categorizes their approaches to support cross-state learning. State policymakers and Medicaid officials can use the Compendium to develop managed care procurements or update and operationalize key managed care contract provisions.
Buying Value
The Buying Value website, which is supported and maintained by State Health and Value Strategies in partnership with Bailit Health, hosts a suite of resources to support states interested in designing a measure set that will align with other priority national measure sets, as well as those that may already be in use in a state or region. The Buying Value Measure Selection Tool assists states in aligning measure sets. The Buying Value Benchmark Repository, is a database of non-HEDIS and modified HEDIS measures in use by state purchasers and regional health improvement collaboratives and associated performance levels.
Ensuring Compliance with Federal Renewal Requirements
State Health and Value Strategies hosted a working session for state officials responsible for unwinding the Medicaid continuous coverage guarantee, or for operationalizing, refining, and overseeing E&E processes, including redeterminations/renewals and systems changes. During the session, presenters (1) provided a brief overview of this diagnostic assessment tool that states can use to assess compliance with federal renewal requirements, (2) discussed common mitigation areas, such as the inability to conduct ex parte renewals for non-Modified Adjusted Gross Income (non-MAGI) enrollees, or no online renewal capabilities, and (3) offered mitigation strategies to correct non-compliance and promote continuity of coverage and care during the unwinding.
Tracking Medicaid Enrollment Growth During the COVID-19 Pandemic Databook
The Tracking Medicaid Enrollment Growth During the COVID-19 Pandemic Databook provides a comprehensive, detailed look at Medicaid enrollment trends to-date. Using Medicaid enrollment data from over 40 states, the Databook provides a comprehensive, detailed look at Medicaid enrollment trends from the beginning of the COVID-19 pandemic through December 2022. The Databook provides enrollment detail by state across four eligibility categories: expansion adults, children (including those enrolled in CHIP), non-expansion adults, and aged, blind, and disabled individuals. It also compares enrollment trends across expansion and non-expansion states. The latest version of the Databook (as of March 2023) has been updated through December 2022.