On Wednesday, August 22, the Centers for Medicare & Medicaid Services (CMS) released a State Medicaid Director Letter (SMDL) memorializing CMS policy for ensuring that Section 1115 waivers remain budget neutral to the federal government. The SMDL describes CMS policy for calculating budget neutrality both for new waivers and for extensions of existing waivers with the implications for states with existing waivers, and those seeking to apply for waivers, discussed in this expert perspective.
State Medicaid Approaches for Defining and Tracking Managed Care Organizations Implementation of Alternative Payment Models
Beth Waldman, Michael Bailit and Mary Beth Dyer, Bailit Health
As state Medicaid programs emphasize a focus on value-based payment, they are increasingly requiring their Medicaid managed care organizations to implement alternative payment methodologies (APMs). With these new requirements, it is important for states to develop ways to ensure that their MCOs are complying with the APM requirements within their contract, and monitoring the progress and challenges with the implementation of APM strategies with Medicaid providers. The full 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. The State Health Policy Highlight, Defining and Tracking Managed Care Organizations Implementation of Alternative Payment Models, summarizes the strengths and challenges of different approaches to setting APM definitions, for those interested in a high-level overview of the operational issues involved.
On Wednesday, February 14, State Health and Value Strategies hosted a webinar based on the issue brief that highlighted selected approaches and tools used by states to track and assess MCO progress on increasing APMs