On January 15, 2022, health insurers will be subject to new federal requirements to cover and waive cost-sharing for over-the-counter diagnostic tests for COVID-19 for the duration of the federal public health emergency. Past federal guidance required insurers to fully cover COVID-19 tests, but allowed them to require enrollees to first obtain a health professional’s determination that a test is medically necessary. The new requirements, published January 10, enable consumers to obtain the tests directly from pharmacies or online retailers without being seen by a health professional. With case rates surging and the costs of over-the-counter COVID-19 tests ranging from $14 to $34, this new benefit should provide significant financial relief to privately insured individuals. This expert perspective focuses on key provisions of the new coverage requirements as well as health equity considerations and implications for state insurance regulators.
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