NAMD is pleased to announce that, effective immediately, Judy Mohr Peterson, Ph.D., Medicaid Director for the state of Hawaii, is stepping into the role of president of NAMD’s board of directors. Dr. Mohr Peterson has 20 years of public health experience, including six years as Medicaid director for Oregon where she helped lead the state’s health system transformation and coverage expansion. In the words of NAMD Executive Director Matt Salo, “We are thrilled to have Judy in this critical role for NAMD because she brings both a pragmatic and aspirational vision for Medicaid as our nation’s most important health and long-term care program.”
Also joining the board leadership as vice-president is Kate McEvoy, Connecticut’s Medicaid Director since 2013 and a current NAMD board member. “Kate brings extensive Medicaid knowledge, vital advocacy experience, and leadership innovations to the NAMD board,” says Salo; the NAMD team looks forward to her leadership as VP. Tom Betlach, the Medicaid Director for Arizona, as well as one of the longest serving Medicaid directors in the country, will continue in his role as past president of the board.
CMS Seeks Comments on Medicaid Quality Measure Concepts
As part of the Innovation Accelerator Program (IAP), the Centers for Medicare and Medicaid Services (CMS) started a three-year quality measure development effort. This effort is aimed at filling quality measurement gaps by developing new measures or refining existing ones for Medicaid beneficiaries. CMS will be seeking public input on three new measure concepts over the coming weeks and is posting information about them online here. The measure concepts include:
Use of pharmacotherapy for opioid use disorder. The comment period for this measure concept is open until May 10, 2017, and input may be submitted to SUDQualMeasures@mathematica-mpr.com.
All-Cause Inpatient Admission Rate for Medicaid Beneficiaries with Complex Care Needs and High Costs. CMS anticipates that the comment period for this measure will be open from April 24 – May 12, 2017. Comments may be submitted to BCNQualMeasures@mathematica-mpr.com.
Stratification for Medicaid Beneficiaries with Serious Mental Illness: Proportion of Days Covered: 3 Rates by Therapeutic Category. CMS anticipates that the comment period for this concept will be open May 18 – June 9, 2017, and comments may be submitted to PMHQualMeasures@mathematica-mpr.com.
HHS Awards $485 Million in Cures Funding for States to Address Opioid Abuse
Last week, the Department of Health and Human Services (HHS) announced $485 million in 21st Century Cures Act-authorized funding for 50 states, the District of Columbia, and four territories to address opioid abuse. Marking the first of two anticipated rounds of funding, the $485 million will enable a “comprehensive array of prevention, treatment, and recovery services.” Between now and the second round of funding, HHS plans to seek input from states and territories to ensure that “resources are applied in the best manner possible.” The agency noted that states and territories will be “asked to identify best practices, lessons learned, and key strategies that can help HHS further target these funds in the subsequent year.”
The Call for Public Comment for Non-Acute Mental Health Service Utilization (Duals-12); Closes on April 27, 2017
Mathematica Policy Research is seeking public comment on a measure specification and justification for a quality measure called non-Acute Mental Health Service Utilization that is currently under development and testing for potential use by the Centers for Medicare & Medicaid Services (CMS) and State Medicaid agencies. This is a measure of the percentage of beneficiaries with a mental health service need who received non-acute mental health services in the measurement period. A memo listing questions on which public comment is requested, as well as the measure information form (MIF) and measure justification forms (MJF), are available in a zip file in the Download section on this web page.
Congress Returns from Recess This Week; Preventing Government Shutdown on Top of To-Do List; AHCA Vote Could be in the Cards
This week will see Congress returning from its two-week recess, with one must-pass issue at the top of its list: funding the federal government for the remainder of FY 2017. A short-term federal funding package passed in the closing days of the previous administration is set to expire this week, with only four legislative days available in the week for a solution to be implemented. The possibility of complications in the funding package are real, and include whether cost-sharing reduction (CSR) payments for issuers selling plans on the Exchanges should be funded – a point of ongoing legal contention between the House and the administration. President Trump has also suggested funding for a southern border wall could be tied into the negotiations.
Yet another complicating factor is the possibility that a vote on an amended version of the American Health Care Act (AHCA) may take place during the week. Over the recess, members of the moderate House GOP Tuesday Group and the conservative Freedom Caucus continued negotiations, which resulted in an amendment to the AHCA which would allow states to waive essential health benefits and community rating rules. The amendment is not yet in legislative text and no formal scoring or whip count has taken place, making predictions about the viability of its passage difficult to assess. The lack of legislative language, in particular, suggests that pressure to hold a vote this week will not amount to action.
In the News
Morning Consult reports on sustaining the transition to value-based care
In this Op-Ed, Aver Inc. president and CEO Nick Augustinos strives to answer the crucial question, “What is the role of value in our health care system?” Augustinos argues that value-based norms for reimbursement and reward have been replacing fee-for-service for quite some time, beginning in the mid-1980s with diagnosis-related groups, capitated payments, and pay-for-performance programs. Despite what at times can be stagnant progress, Augustinos maintains that value-based payment is here to stay and may even accelerate in the coming years, citing the Trump administration’s vocal preference for a market-driven transition to value as well as government-engineered models like MACRA. Looking to the future, Augustinos emphasizes the importance of creativity, flexibility, and multi-sector coordination to help organizations effectively implement value-based payment models, voicing his conviction that “value-based payment systems will soon be the state of the art in American health care.”
“Mentally ill accessing less U.S. health care,” reports Reuters
In this article, Reuters reports on a new study revealing that people with serious psychological distress are three times more likely to be too poor to afford care and 10 times more likely to be unable to pay for medications. For the study, researchers examined survey data on health care use from 2006 to 2014 for a nationwide sample of 207,853 U.S. adults ages 18 to 64; about two-thirds of participants were white and almost one-third had at least a college education. By the end of the study in 2014, 9.9% of adults with serious psychological distress couldn’t afford to see a mental health care provider, while 9.9% also could not pay for drugs. These findings suggest the ineffectiveness of the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act (ACA), both of which were designed to help individuals with serious psychological distress. That said, the study lacked the data to examine how states’ different approaches to expanding Medicaid coverage through the ACA might influence whether mentally ill adults could get needed care. Furthermore, the study did not give due consideration to the ways in which untreated mental illness “impacts people’s jobs and performance in school, which in turn influence their ability to access health care,” says Dr. Joseph Puyat of the Center for Health Evaluation and Outcome Sciences at the University of British Columbia. In the words of Dr. Puyat, “Even when access is provided for by publicly-funded insurance coverage, people with untreated mental illness face challenges adhering to their treatment.”
This past month, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration gave more than 700 nurse practitioners (NP’s) and physician assistants (PA’s) the authority to write prescriptions for the anti-addiction medication buprenorphine, with the goal of helping them treat more patients. This allowance could mark a pivotal moment for buprenorphine access: There are more than 222,000 NP’s and about 109,000 PA’s in the nation, and many of them offer primary health care in rural parts of the nation where the opioid crisis is most acute. That said, 28 states prohibit NP’s from prescribing buprenorphine unless they are working in collaboration with a doctor who also has a federal license to prescribe it, while more stringent laws in Oklahoma, Tennessee and Wyoming explicitly prohibit NP’s from prescribing buprenorphine. The ability of NP’s and PA’s to prescribe buprenorphine will therefore hinge on whether states scope of practice laws, as West Virginia has done and Oregon is taking steps to do.
Last week, the Medicaid and CHIP Payment and Access Commission (MACPAC) held a public meeting. Meeting materials, including an agenda and slides, are available on MACPAC’s website here.
At the meeting, commissioners discussed a variety of topics, including:
Anticipated Rates of Exhaustion of Appropriated CHIP Funds: Commissioners reviewed MACPAC staff analysis of when states were expected to exhaust appropriated CHIP funds, given current appropriations cease at the end of FY 2017. Commissioners noted the operational timelines states operate under for CHIP and the need for a timely Congressional appropriation to avoid harming program beneficiaries.
Medicare Shared Savings Programs for Duals: Commissioners analyzed circumstances where dually eligible Medicare-Medicaid beneficiaries may be eligible for Medicare shared savings programs, but are not enrolled in the programs. MACPAC staff noted varying state policies and application processes as a potential enrollment barrier. Some Commissioners stated that the Medicare program’s cost growth is relatively unmanaged by states, which may make states less inclined to allocate scarce resources to subsidizing Medicare premiums. The possibility of not charging premiums for duals was raised as a counterpart to the increased premiums Medicare charges for high-income beneficiaries.
Analysis of AHCA: MACPAC staff took an in-depth look at the Medicaid per-capita cap funding formula in the American Health Care Act. Commissioners noted many challenges posed by the funding formula, as well as the unclear interaction between this legislation and the complex statute underlying the Medicaid program.
MLTSS HCBS Network Adequacy: MACPAC staff presented initial findings from reviews and interviews of states and stakeholders around network adequacy issues for Medicaid home and community-based services in managed long-term services and supports programs. Findings suggested that states focused on time, distance, and continuity of care for these standards, with low concern about ability to comply with the Medicaid managed care rule’s LTSS network adequacy provisions. Commissioners discussed the importance of education and training standards for the diverse and fluid LTSS workforce, as well as the difficulty in federal mandating of LTSS standards when objective standards for these services are not well understood.
The commission also reviewed draft chapters for its upcoming June report to Congress, which will focus on program integrity in Medicaid managed care programs, Medicaid’s response to the opioid epidemic, and mandatory and optional Medicaid benefits and populations.
Avalere, Medicaid Per Capita Caps Could Cut Funding for Dual Eligible Beneficiaries
According to new analysis from Avalere, proposals to limit per capita federal Medicaid funding growth based on medical inflation could lead to a $44 billion spending cut for dual eligible beneficiaries, a $13 billion spending cut for all aged Medicaid beneficiaries, and $91 billion for all disabled Medicaid beneficiaries over 10 years. In examining the impact of capped funding at the state level, Avalere also found that states would see across-the-board reductions on federal spending attributable to duals’ care, ranging from 6% to 9% in 2026. Combined with per capita caps, Avalere predicts, state efforts to reduce costs could lead to reductions in covered benefits for duals, leading to higher rates of hospitalizations and other acute services covered by Medicare.
GAO, CMS Should Build on Current Oversight Efforts by Further Enhancing Collaboration with States
In this report, the Government Accountability Office (GAO) examines CMS’s oversight and support of states’ Medicaid program integrity efforts, investigating (1) How CMS tailors its reviews to states’ circumstances; (2) States’ experiences with collaborative audits; and (3) CMS’s steps to share promising program integrity practices. It finds that CMS has tailored its state program integrity reviews to states’ managed care delivery systems and other areas at high risk for improper payments and that it lacks a systematic approach to collecting promising state program integrity practices and communicating them to other states; moreover, GAO identified several barriers which hinder collaborative audits, including staff burden or problems communicating with contractors. To further improve its support of states’ Medicaid program integrity activities, GAO recommends that CMS identify opportunities to address barriers that limit states’ participation in collaborative audits and more effectively collect and share promising program integrity practices.