Analysis of the 2019 Affordable Care Act Payment Notice: Implications for States
The U.S. Department of Health & Human Services released on April 9, 2018 its annual Notice of Benefit and Payment Parameters, a collection of policies governing the ACA’s marketplaces, insurance reforms, and premium stabilization programs. The first such annual notice issued under the Trump Administration, it contains a number of provisions that require state officials to make important decisions on short notice that will affect plan benefits, premiums, and marketplace operations. State Health and Value Strategies hosted a webinar, together with experts Sabrina Corlette and Justin Giovannelli from Georgetown’s Center on Health Insurance Reforms, Joel Ario from Manatt Health and Jason Levitis, to help participants untangle the rule and its many implications for states.
Protected: 2018 SGC Resources
State Health and Value Strategies (SHVS) hosted a Small Group Convening on April 12 and 13, 2018 in Minneapolis, Minnesota bringing together state officials and technical experts to discuss issues currently being confronted by state Medicaid agencies.
Children’s Health Insurance Program Extended through Fiscal Year 2027
CHIP covers nearly 9 million children and is a key contributor to record-low levels of uninsurance among children. However, Congress only provided funding for CHIP through FY 2017, which ended September 30. After a series of short-term patches that left states with a great deal of uncertainty, Congress passed a six-year extension of CHIP in January. Three weeks later, on February 9, Congress extended the program for another four years, reauthorizing the program through FY 2027. This issue brief summarizes key features of the 10-year CHIP extension.
Medicaid: The Linchpin in State Strategies to Prevent and Address Opioid Use Disorders
The nation’s opioid epidemic claimed more than 42,000 lives in 2016, and more than 2 million people in the United States have an opioid use disorder (OUD)—with nearly another 10 million at risk due to misuse of these drugs. Yet, only 1 in 5 people suffering from an OUD receive treatment. Today, Medicaid covers more than 1 in 3 people with an OUD, and program spending for people with an OUD in 2013 (before Medicaid expansion in many states) was more than $9 billion. In this issue brief, data from three states—New Hampshire, Ohio and West Virginia—highlight Medicaid’s role as the linchpin in states’ efforts to combat the opioid epidemic.
Global Budgeting for Rural Hospitals
Global budgeting is an innovative payment approach for rural hospitals that can enhance financial solvency and advance population health. Hospitals with global budgets know their revenues in advance of the year and so can concentrate on providing the services their communities need as well as on the prevention and management of chronic illness. Maryland rural hospitals have received global budgets since 2010; selected Pennsylvania rural hospitals will be starting on global budgets soon.
Analysis of the Trump Administration’s Proposed Short-Term Health Plan Rule: Implications for States
The Secretaries of Health and Human Services, Treasury, and Labor released a proposed rule to implement the President’s October 12, 2017 executive order calling for expanded availability of short-term limited duration health plans that do not have to comply with Affordable Care Act standards. The proposed rule would relax current federal rules by allowing short-term plans to be sold for a duration of up to 12 months. It also modifies required consumer disclosures about these products.
Model Legislation for State Individual Mandate
[*Updated Feb. 21, 2018*] The tax bill passed in December 2017 repealed the penalty associated with the Affordable Care Act’s individual shared responsibility provision, also known as the individual mandate. The provision required those who could afford health coverage to either maintain coverage, qualify for an exemption, or make a payment with their federal income tax return. The Congressional Budget Office projects that repealing the mandate penalty will increase insurance premiums by 10 percent on average and result in 13 million more persons being uninsured. A number of states have expressed an interested in examining a state-level individual mandate, which Massachusetts has had in place since before the ACA.
How State Programs are Defining and Tracking MCO Implementation of APMs
State Health and Value Strategies hosted a webinar on how states are utilizing a variety of approaches to require and assess the use of APM strategies through their contracted health plans. Beth Waldman from Bailit Health highlighted findings from a SHVS resource entitled State Medicaid Approaches for Defining and Tracking Managed Care Organizations Implementation of Alternative Payment Models. Staff from the Rhode Island Office of the Health Insurance Commissioner and Texas Health and Human Services Commission participated to share insights on their APM approaches.
Categorizing Value-Based Payment Models According to the LAN
State Health and Value Strategies is hosting a webinar on categorizing value-based payment models according to the LAN Alternative Payment Models (APM) Framework. Megan Burns from Bailit Health highlights findings from an upcoming SHVS resource for states, Categorizing Value-Based Payment Models According to the LAN Alternative Payment Model Framework: Examples of Payment Models by Category. The webinar provides real-world examples of what types of payment models fit within the LAN categories. Kat Latet, Manager, Health System Innovation at Community Health Plan of Washington participates and discusses the development and categorization of their APM.
Categorizing Value-Based Payment Models According to the LAN Alternative Payment Model Framework: Examples of Payment Models by Category
As the movement from volume to value-based payment progresses, more state purchasers are requiring their contracted health plans to implement alternative payment models (APMs) with the goals of improving the quality of care and reducing costs for taxpayers. The LAN APM Framework is an increasingly common method being used by states to measure plan progress toward implementation of APMs. This brief provides real-world examples of APMs within the LAN categories and can help states and other interested purchasers develop a common understanding of what types of payment models fit within the framework categories.