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Happy New Year! NAMD announces their new leadership. Also in the newsletter you will see comments on managed care pass-through payments; Community First Choice; PACE; eight states to participate in CCBHC demo; and a State Network Issue Brief on Per Capital Caps proposal.

January 4, 2017
From the NAMD Desk
NAMD Rings in the New Year!
Welcome to the first NAMD newsletter of 2017! January marks the official start of the terms of service for NAMD’s new President, Vice President, and Board. These leaders will guide NAMD’s priorities and work over what looks to be an eventful next two years. As a reminder, the new leadership and Board are:


NAMD President: Christian Soura, South Carolina
NAMD Vice-President: Judy Mohr Peterson, Hawaii
Immediate Past President: Tom Betlach, Arizona


East Region Board Representatives:
Kate McEvoy, Connecticut
Shannon McMahon, Maryland


South Region Board Representatives:

Beth Kidder, Florida

Becky Pasternik-Ikard, Oklahoma


Mid-West Region Board Representatives:
Chris Priest, Michigan

Calder Lynch, Nebraska


West Region Board Representatives:
Gretchen Hammer, Colorado

MaryAnne Lindeblad, Washington


Territories Board Representative:

Sandra King Young, American Samoa


NAMD Comments on Managed Care Pass-Through Payments Rule
On December 22, NAMD submitted comments in response to a CMS Notice of Proposed Rulemaking (NPRM) addressing the use of pass-through payments in Medicaid managed care programs. The rule sought to clarify CMS interpretation of the final Medicaid managed care rule’s pass-through payment provisions and cap the expansion or creation of such payments at amounts set in contracts as of July 5, 2016.


In our comments, NAMD called for CMS to withdraw the NPRM and revisit its overall approach to managed care pass-through payments. The letter notes that CMS’s interpretation creates differential incentives between fee-for-service and managed care delivery systems and poses barriers to states seeking to enhance their use of managed care to drive programmatic reform. Additionally, the application of this interpretation retroactively to July 5, 2016 would set a troubling precedent for CMS clarification of existing policy. In the event the regulation is finalized, NAMD calls for CMS to set a more appropriate effective date for the policy.


Read the comments  here.
In This Issue

Reg Update


CMS Releases Community First Choice Guidance Package
On December 30, the Centers for Medicare and Medicaid Services (CMS) published a State Medicaid Director letter (SMD) providing guidance on the 1915(k) Community First Choice (CFC) state plan option. CFC allows states to amend their state plans to provide home and community-based attendant services and related supports without the use of a waiver and independent of the type, nature, or severity of an individual’s disability. CFC services receive an enhanced FMAP of six percentage points above the state’s regular FMAP.


The SMD provides detail on specific FMAP available for CFC, including state activities that will be matched at the administrative rate of 50% and how states must document activities to receive administrative match. It also reviews CFC level of care and financial eligibility requirements, reviews applicable CFC services and service models, person-centered planning, and applicable home and community-based settings, among other topics. CMS also encourages states to utilize CFC services in a manner that is integrated with the state’s existing long-term services and supports (LTSS) and HCBS programs.


The SMD is available here and the SPA pre-print and technical assistance resources are available on CMS’s website here.


CMS Releases PACE Innovation Act RFI
Today, CMS published a Request for Information (RFI) on a new Program of All-inclusive Care for the Elderly (PACE) model, stemming from the PACE Innovation Act of 2015. Comments on the RFI are due by February 10.
The RFI consists of two primary components. The first requests stakeholder input on a potential five-year PACE-like model demonstration for dually eligible Medicare-Medicaid beneficiaries who are ages 21 and older, have physical disabilities, and require nursing facility level of care. This model would be deployed in states via an 1115 demonstration waiver. In addition to comments on the model design and its components, CMS also seeks stakeholder input on the types of technical assistance that would be necessary for state participation in this model.
The second component of the RFI seeks comment on additional populations for which a PACE-like model of care would be beneficial.


The RFI is available here.


CMS Updates Guidance on Justice-Involved Individuals
On December 23, the Centers for Medicare and Medicaid Services (CMS) issued updated guidance on federal requirements for providing Medicaid services to justice-involved individuals. This update amends previous guidance issued earlier in 2016 by removing previous requirements for hospital specialty units that provide services to justice-involved individuals. The goal of this policy change is to ensure hospitals can meet the security needs for these individuals.


The remainder of the guidance remains unaltered, and discusses the requirements that must be met by individuals, services, and providers for Medicaid to provide covered services to justice-involved individuals. Read the updated guidance


Behavioral Health Clinic Demonstration States Announced
In late December, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced the eight states that will participate in the Certified Community Behavioral Health Clinic (CCBHC) demonstration. These states are: Minnesota, Missouri, New York, New Jersey, Nevada, Oklahoma, Oregon, and Pennsylvania.
This two-year demonstration was authorized under Section 223 of the Protecting Access to Medicare Act of 2014. Under the effort, states will use a prospective payment system to reimburse designated clinics (or CCBHCs) for the provision of an expanded array of mental health, substance use disorder, physical health screening, and care coordination services. Selected states will begin the demonstration by June 30, 2017.


CMS Issues Technical Corrections to Managed Care Rule

Today, CMS released a final rule which corrects the technical errors that appeared in last year’s final managed care regulation (published on May 6, 2016 and effective as of July 5, 2016). These errors are strictly of a grammatical, syntactical, and/or structural nature and are not expected to have substantive policy ramifications.


Please find the regulation here.


CMS, SSA Sign Data Sharing Agreements with Three States
Recently, the Centers for Medicare and Medicaid Services (CMS) and the Social Security Administration (SSA) signed data sharing agreements with Montana, Pennsylvania, and Oregon. These agreements will allow these state Medicaid agencies to access SSA information from the CMS Federal Data Services Hub to make eligibility determinations for Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) applicants while making a Medicaid eligibility determination.


Hill Update


115th Congress Begins This Week
The 115th Congress officially convened yesterday, and both chambers are expected to have a busy agenda in the next several months. In addition to confirming President-elect Trump’s nominees for Cabinet positions, the Senate is beginning to take initial steps to consider the use of reconciliation budget authority to start the process of repealing the Affordable Care Act (ACA). Also looming are budget politics, as the short-term Continuing Resolution passed in late December is set to expire at the end of April.


In the News


New York Times Reflects on Expected Changes to the Affordable Care Act
As Congress returns after the New Year, the New York Times considers how efforts to overhaul the Affordable Care Act (ACA) may impact health care transformation. The article notes how the ACA has reshaped health care delivery and payment, shifting emphasis from treatment to prevention and the social determinants of health. Experts predict that while the legislation’s coverage provisions may be impacted by Trump’s presidency, ACA reforms like value-based purchasing, electronic health records, and innovative care models that improve quality and reduce costs are likely to continue.

Please find link to article  here.


Take Note


South Carolina Pay for Success RFI Open for Comment Through January 6

The South Carolina Department of Health and Human Services (SCDHHS) recently released a request for information (RFI) on the design and focus of a new incentive payment program for managed care organizations (MCOs) that would reward demonstrated improvement in health and social outcomes for beneficiaries. The program would support solutions that use preventive and population-based approaches to improve beneficiary outcomes, expand care coordination, and address the social determinants of health. It would also provide a financing opportunity for effective interventions that may not have previously been reimbursable. Through this RFI, SCDHHS hopes to gain innovative insights from other entities (including nonprofits, advocates, public sector agencies, and other stakeholders) to support and inform its efforts to develop effective managed care incentives for improving beneficiary health and quality of life. Responses are due by 5 p.m. EST Friday, Jan. 6, 2017.


Please find link to RFI here.


NQF MAP Preliminary Measure Recommendations Open for Comment Through January 13
In late December, the National Quality Forum (NQF)’s Measures Application Partnership (MAP) announced its preliminary 2016 – 2017 measures for consideration, which touch on clinical, hospital, and long-term care measures. NQF is accepting comments on these preliminary measures through January 13.


For more information, visit NQF’s website:


State Network Issue Brief on Medicaid Per Capita Caps Proposals

In this new report, Manatt Health addresses the implications of the incoming Congress and presidential administration’s plans to fundamentally overhaul the Medicaid program by capping federal funding to states. In reviewing past proposals, the report explores various issues/questions that may arise as a result of capped federal funding. These include:

  • Funding shifts for the elderly and people with disabilities;
  • Greater competition across beneficiary groups and providers;
  • Changes in federal and state Medicaid funding across states;
  • Potential funding cuts to eligibility and IT systems, federally qualified health centers, and cost-sharing mechanisms for low-income beneficiaries; and
  • Changes regarding Medicaid requirements for prescription drugs.
Please find link to the brief here.


Kansas Opening for Deputy Secretary
The Kansas Department of Health and Environment (KDHE) is seeking qualified candidates for the role of Deputy Secretary for Medicaid and Public Health. The deputy secretary will help oversee the Divisions of Public Health and Health Care Finance. This person will take a leadership role in many initiatives, like KDHE’s groundbreaking work in whole person care that includes the social determinants of health and in the development of a modular IT infrastructure for management and oversight of the Medicaid enterprise. The full posting is located here.
South Caroling Seeking Information Systems/Business Analyst
The South Carolina Department of Health and Human Services (Department) seeks a senior-level analyst for the Replacement Medicaid Management Information Systems (RMMIS) project, which is a multi-year effort to replace all Medicaid claims processing and related sub-systems.


The analyst serves as a technical and business expert using expertise to evaluate processes and recommend improvements to Department procedures, program operations, interdepartmental workflow, and organizational designs. The analyst will assign performance standards and in conjunction with RMMIS leadership, guide change management processes, develop project strategy, goals, objectives and plans. This position performs other duties as assigned adhering to all program, agency, State and other related policies, procedures, privacy, and timeliness standards.
Qualified candidates must have a bachelor’s degree in computer science or a related area and experience in computer system development and modification. Relevant experience may be substituted for the bachelor’s degree on a year for year basis.
For more information and to apply, please visit:



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