State Medicaid Approaches for Defining and Tracking Managed Care Organizations Implementation of Alternative Payment Models
As state Medicaid programs emphasize a focus on value-based payment, they are increasingly requiring their Medicaid managed care organizations to implement alternative payment models (APMs). This brief focuses on different ways in which states may set standard APM definitions to a) track MCO progress toward meeting state APM goals, and b) support comparison of APM implementation within a state and nationally.
In response to President Trump’s October 12 executive order (EO), the U.S. Department of Labor (DOL) has published proposed rules to expand the availability of health coverage sold through associations to small businesses and self-employed individuals. The public has until March 6, 2018 to submit comments on these proposed rules and this brief provides state health officials with a review of the content of the proposed rules and examines the implications for those interested in commenting on the rule.
New Work and Community Engagement Requirements: Overview of Federal Activity and State Considerations
On January 11th, the Centers for Medicare & Medicaid Services released a State Medicaid Director letter providing guidance for states seeking 1115 waivers that condition Medicaid eligibility on work and community engagement, quickly followed by approval of Kentucky’s 1115 waivers that include these requirements. Both the new guidance and recent waiver approval represents a significant departure from past Administrations’ positions. In this webinar, the State Health and Value Strategies program, together with technical assistance experts from Manatt Health, review the new guidance, including key design parameters, budget neutrality requirements, and monitoring and evaluation criteria. The webinar also discusses state legal, policy and operational considerations for implementing work and community engagement requirements and highlight key elements of Kentucky’s waiver approval.
State Health and Value Strategies hosted a webinar the first week of January to outline state considerations and options to address federal policy changes that could impact individual market stability. Technical experts from Georgetown’s Center on Health Insurance Reform, Manatt Health, and others discussed the implications of individual mandate repeal in the tax bill and opportunities for state action, including reinsurance and state-level policies to incentivize enrollment. In addition, experts discuss potential changes to short-term policies that could also impact enrollment and premiums in the individual market. The webinar also explores potential budget impacts of the tax legislation on other health programs, including Medicaid.
States continue to develop strategies to strengthen coverage across the individual market and Medicaid. In recent months, we have seen several proposals at both the federal and state levels that would leverage state Medicaid programs as a key component of coverage stability and affordability strategies. The webinar highlights and defines potential policy options, including the “Medicaid Buy-in,” that states may consider to leverage Medicaid to achieve their goals with respect to coverage availability and affordability. We discuss the conditions that make each option more or less favorable for a state, and implementation issues or other considerations in play for states.
State Medicaid agencies are increasingly turning to managed care organizations (MCOs) to cover more Medicaid enrollees, including those with complex needs. The ongoing shift from a fee-for-service payment model to a value-based payment model at the health plan and provider level puts even more importance on Medicaid managed care procurement strategies and approaches.
At least seven states have submitted 1115 waivers requesting authority to introduce work requirements for some Medicaid beneficiaries. Many more states are considering them. We examine key design considerations for states, including the populations to which work requirements may apply; exemptions based on health status or community conditions (e.g. rates of unemployment; access to transportation); definition of work (how many hours per month? Per year? Will school, job training, and volunteer work satisfy a work requirement?); and, use of verification and attestation in determining whether work requirements apply and are being met. We also look at state operational issues including integrating work requirements with a streamlined online, electronic application and renewal process.
Value-Based Innovation by State Public Employee Health Benefits Programs provides an overview of three areas of value-based innovation and then affords a deeper examination into specific examples of state employee purchaser activity in California, Connecticut, Massachusetts, Minnesota, Tennessee, and Washington. Despite their differences in size and scope, these state health care purchasers found they could learn from their colleagues in other states as they strive to improve the value of care. For a summary of the examples from the six states, we have also published an Overview that highlights policy innovations and findings to date.
With three states using Section 1332 waivers to help fund reinsurance programs for the 2018 plan year, many more state officials are considering the model for their state in future years. Having worked directly with the 2018 reinsurance states, State Health and Value Strategies is pleased to present the following to-do list for states as they consider reinsurance for 2019.
State Health and Value Strategies (SHVS) and the National Academy for State Health Policy (NASHP) co-hosted an ancillary session at the 2017 annual NASHP meeting on October 23, 2017 in Portland, Oregon. The meeting was entitled “Managed Long-Term Services and Supports: Value-Based Purchasing Strategies, Challenges and Opportunities” and focused on supporting state learning, skill-building, and strategy development to foster sound Medicaid managed care (MMC) policies and value-based purchasing (VBP) strategies specific to long term services and supports (LTSS).