NAMD’s Board of Directors issued a statement calling for Congress to carefully consider the impacts of the Graham-Cassidy proposal to repeal and replace the Affordable Care Act. The proposal will fundamentally reform Medicaid financing, and its two-year implementation period poses serious challenges for states. Changes of this magnitude require additional deliberation by policymakers, with input from all Medicaid stakeholders, and therefore needs more time than the few remaining legislative working days allow.
This statement, approved by a supermajority of the NAMD Board, is not intended to represent the views of all 56 Medicaid Directors.
NAMD Calls for CHIP Reauthorization Before End of FY 2017
On September 13, NAMD sent a letter to the Chairmen and Ranking Members of the Senate Finance Committee and the House Energy and Commerce Committee to request immediate prioritization of a Children’s Health Insurance Program (CHIP) reauthorization. NAMD requested a reauthorization of at least, but not limited to, two years, along with maintenance of the 23-percentage point FMAP enhancement. A failure to reauthorize CHIP before the end of FY 2017 on September 30 could produce unnecessary disruption for states, providers, and the children and families covered by the program.
CMS Issues Request for Information (RFI) on the Future Direction for the Center for Medicare and Medicaid Innovation
Last week, the CMS Innovation Center (Innovation Center) issued an informal Request for Information (RFI) seeking feedback on a new direction to promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes. The Innovation Center welcomes stakeholder input on the ideas on additional ideas and concepts, and on the future direction of the Innovation Center.
Comments will be received through November 20, 2017. For more information, please click here.
Mental Health Parity and Addiction Equity Act (MHPAEA) Template for the Children’s Health Insurance Program (CHIP)
The Centers for Medicare & Medicaid Services (CMS) has updated the CHIP State Plan template to facilitate state efforts in submission of a state plan amendment to document consistency with parity regulations published on March 30, 2016. The rule is designed to strengthen access to mental health and substance use services for people with Medicaid or CHIP coverage, aligning with protections already required of private health plans. The Mental Health Parity and Addiction Equity Act of 2008 generally requires that health insurance plans treat mental health and substance use disorder benefits comparable to medical and surgical benefits.
The template can be accessed on Medicaid.gov here. Updates for MHPAEA were made to sections 6 and 8.
CMS Eases Access to Replacement DME In Harvey-Hit Areas, But Competitive Bidding Remains
Under Section 1135 or 1812(f) of the Social Security Act, the Centers for Medicare & Medicaid Services (CMS) has issued several blanket waivers as a result of Hurricane Harvey affecting skilled nursing facilities, home health agencies, critical access hospitals, acute housing, medical file replacement, IPPS hospitals, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). Under the DMEPOS waiver, the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required for replacement when DMEPOS is lost, destroyed, irreparably damaged, or otherwise rendered unusable. However, only suppliers chosen by the DMEPOS bidding program may provide the equipment in certain areas.
To learn more about CMS’s administrative actions, please click here.
Medicaid Disaster Response Toolkit
CMS’s Disaster Response Toolkit is now available on Medicaid.gov. It includes information on:
State Plan Flexibilities;
HCBS in Public Health Emergencies;
Using Section 1115 Demonstrations for Disaster Response; and
Section 1135 Waiver Flexibilities.
CMS requests that for Medicaid-related issues related to an emergency or disaster, agencies contact the State Only Technical Assistance (SOTA) Co-Lead who will triage questions and facilitate a response. This is intended to provide a smoother and more efficient experience for states when working across CMS on Medicaid/CHIP/BHP-related issues.
HHS Awards $144 Million to Prevent & Treat Opioid Addiction; HRSA Awards over $200 Million for Mental Health and Substance Abuse Treatment
Recently, the Department of Health and Human Services (HHS) announced the award of $144.1 million to 58 state, local, and community-based grantees to continue the battle against opioid addiction, in accordance with Secretary Tom Price’s five-point framework for prevention, treatment and recovery services. The funds will be disbursed under six separate grant programs listed below, the first four of which were authorized in the Comprehensive Addiction and Recovery Act (CARA) of 2016, ( P.L. 114-198), and the last of which received an increase in funding in the fiscal year 2017 Omnibus Appropriations bill:
First Responders: $44.7 million in CARA funding for the purpose of providing training and medication for emergency treatment of opioid overdose (awardees);
State Pilot Grant for Treatment of Pregnant and Postpartum Women: $9.8 million in CARA funding to support family-based services for pregnant and postpartum women with a primary diagnosis of a substance use disorder (awardees);
Building Communities of Recovery: $4.6 million in CARA funding to increase the availability of long-term recovery support for substance abuse and addiction (awardees);
Improving Access to Overdose Treatment: $1 million in CARA funding to expand access to FDA-approved drugs or devices for emergency treatment of opioid overdose (awardee);
Targeted Capacity Expansion: Medication Assisted Treatment (MAT): $35 million to expand access to MAT for persons with an opioid use disorder seeking treatment (awardees); and
Services Grant Program for Residential Treatment for Pregnant and Postpartum Women: $49 million to expand services for women and their children in residential substance abuse treatment facilities, among other services (awardees).
In a separate announcement, the Health Resources and Services Administration (HRSA) announced the award of over $200 million in grants to 1,178 health centers and 13 rural health organizations in the Health Center Program to increase access to substance abuse and mental health services in the primary care setting.
Comment Period: Quality Measure for Medicaid Beneficiaries Receiving LTSS (Ends October 5, 2017)
CMS announced that it is accepting comments on measure specifications, and justification, for a candidate measure for Medicaid beneficiaries who receive long-term services and supports (LTSS), such as home and community-based services (HCBS).
CMS’ solicitation is part of a broader project in which it has contracted with outside entities to develop measures for programs serving Medicare-Medicaid enrollees and Medicaid-only enrollees. CMS intends to develop measures for: (1) dual-eligible beneficiaries; (2) individuals receiving LTSS through MCOs; and (3) individuals with substance use disorders (SUDs), beneficiaries with complex care needs and high costs; beneficiaries with physical and mental health needs; or Medicaid beneficiaries who receive LTSS in the community.
The Measure Information Form (MIF), Measure Justification Form (MJF) and public comment template are available here. The comment window closes October 5th, 2017.
IAP Releases Data Use Agreement Factsheet
Data sharing is a critical component of many Medicaid payment and delivery system reform efforts, particularly for those targeting BCNs. Leveraging data from many different sources and across agencies can be complex and extremely challenging, often requiring the creation of inter-agency Data Use Agreements (DUAs).
Developed by the IAP’s Improving Care for Medicaid Beneficiaries with Complex Care Needs and High Costs (BCN) program area, this factsheet highlights some of the challenges faced by states participating in the BCN program area, as well as several resources these states found useful in developing DUAs, including two state example DUAs. States embarking on inter-agency data use can leverage these tools as they pursue data sharing as part of their Medicaid delivery system reform efforts.
Graham-Cassidy ACA Repeal Package Enters Final Week, with Path to Passage Narrowing
Last week saw dramatic developments in Congressional Republicans’ hopes to repeal and replace the Affordable Care Act (ACA). Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) introduced an updated version of their proposal to block grant ACA funds, including Medicaid expansion funds, to the states, as well as convert the Medicaid program into a per-capita cap financing system. This bill represents the last possible vehicle for passing an ACA repeal package under FY 2017 budget reconciliation instructions, which expire on September 30.
After the bill’s introduction, several think tanks produced preliminary analyses assessing potential state funding impacts (discussed below in the “Take Note” section of the newsletter) and many provider groups, patient advocacy groups, insurers, and other stakeholders announced their opposition to the package. The public pressure, combined with a consistent public posture against the bill from Sen. Rand Paul (R-KY) and concerns voiced by Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK), both of whom voted against prior Senate repeal packages, suggested the bill would have difficult path forward.
That path became even rockier last Friday afternoon, when Sen. John McCain (R-AZ) announced his opposition to the bill as it is currently drafted, reiterating his call for regular order and a bipartisan process. Over the weekend, Sen. Ted Cruz (R-TX) announced his opposition, and suggested Sen. Mike Lee (R-UT) was also opposed to the package. And yesterday evening, Sen. Collins publicly announced her opposition to the bill. Her announcement came as the Senate Finance Committee entered the last hours of a marathon hearing on the package.
With the public opposition of Sens. Paul, McCain, and Collins, it appears that the Graham-Cassidy bill will not advance. However, work continues to mitigate the impact of the bill on key states like Alaska, Kentucky, and Arizona. A preliminary Congressional Budget Office score of the package certifies that it does meet reconciliation budget savings requirements, with deficit reduction of $230 billion over the next decade, though it is unable to predict the specific impact on coverage. However, CBO does anticipate millions of individuals losing existing coverage under the package.
Despite the public opposition of three Republican Senators all but ensuring the bill’s failure, it may still be introduced to the Senate floor for a vote as soon as today.
Revival of ACA Repeal Sidelines Bipartisan Individual Market Reforms
As the partisan push to repeal and replace the ACA was revived last week, Senate leadership made it clear that the bipartisan work in the Senate Health, Education, Labor and Pensions (HELP) Committee was no longer a priority. The HELP Committee, under the leadership of Chairman Lamar Alexander (R-UT) and Ranking Member Patty Murray (D-WA), was encountering challenges in its negotiations to stabilize the individual market, and the already-slim chances of a bill being passed to that effect in the next week are now nil.
SFC Releases CHIP Reauthorization Package; Action Not Anticipated This Week
On September 18, Senate Finance Committee (SFC) Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) introduced bipartisan legislation to reauthorize the Children’s Health Insurance Program (CHIP). The legislation, S. 1827, provides details on SFC’s previously-reported plan to reauthorize CHIP, including:
A five-year reauthorization;
Maintaining the 23-percentage point increase to CHIP FMAP through FY 2019, reduce the enhancement to 11.5 percentage points in FY 2020, and return to regular FMAP in FY 2021-2022;
Maintaining current CHIP maintenance of effort (MOE) requirements through 2019, and allowing MOE to expire for individuals above 300% FPL in FY 2020 and beyond.
The SFC legislation does not yet identify offsets for its package, a question the House continues to focus on in its own CHIP negotiations. Given the Senate’s focus on Graham-Cassidy this week, CHIP is highly unlikely to be reauthorized prior to the end of FY 2017.
Democratic Senators Introduce “Medicare for All” Bill
Recently, Senator Bernie Sanders (I-VT) and over a dozen Democratic Senators introduced a bill aimed at expanding the Medicare program to begin covering younger populations, and ultimately to replace several areas currently covered by private insurance. The bill would also greatly expanded Medicare covered services and require no cost sharing or deductibles. While the bill does not yet have a cost associated with it, the price tag is expected to be substantial, and no offsets are yet identified. It is not expected to be seriously considered by Congress.
RECAP: SFC Hearing Explores Factors Limiting Access to Care
On September 12, the Senate Finance Committee (SFC) held a hearing titled “Health Care: Issues Impacting Cost and Coverage.” A recording of the hearing, full witness list, and submitted witness testimony is available on the SFC website here.
The hearing was far-ranging and touched on several topics, including a Republican focus on increasing the flexibility of 1332 waivers, repealing the ACA’s insurer and medical device taxes, and reforming the individual and employer mandates. Democrats expressed skepticism around 1332 waivers, seeing a potential avenue for sidestepping the ACA’s insurance market protections, and also discussed measures to lower prescription drug prices.
In the News
NYT Assesses State Readiness to Implement Graham-Cassidy Block Grants
On September 21, The New York Times published a story titled “The GOP Bill Forces States to Build Health Systems from Scratch. That’s Hard.” The article reviews the Graham-Cassidy ACA block grants, and the types of political and operational decisions states would need to make by 2020 in order to take advantage of these funds. Noting that some state legislatures will not meet until 2019, further exacerbating the timeline challenges, the piece suggests that inadequate time to plan and implement these systems could pose significant risk to individuals and markets. State procurement rules would also extend the implementation timeframe states face.
Reuters: “Unbudgeted: How the opioid crisis is blowing a hole in small-town America’s finances”
As America’s opioid crisis takes more and more lives, communities on the front lines face a hidden toll: the financial cost. As Reuters reported last week, Ohio’s Ross County, where an alarming 75% of the 200 children placed into state care in the county have parents with opioid addictions, has witnessed a near doubling in the county’s child services budget to almost $2.4 million from $1.3 million due to the need for more intense and specialized child therapy. Across the country, countless other counties face similarly high costs due to rising emergency call volumes, medical examiner and coroner bills, and overcrowded jails and courtrooms. Indiana County, Pennsylvania, for example, has seen a doubling in autopsy and toxicology costs in six years, from $89,000 in 2010 to $165,000 in 2016, while in Mercer County, West Virginia, opioid-related jail costs are set to increase by $100,000 this year alone.
New York Times: “Amid Opioid Crisis, Insurers Restrict Pricey, Less Addictive Painkillers”
While the roles of drugmakers, pharmaceutical distributors, pharmacies, and doctors in responding to the opioid crisis have come under intense scrutiny in recent years, insurers and pharmacy benefit managers have received less attention. Last week, however, signs of a potential shift emerged when the New York State attorney general’s office sent letters to the three largest pharmacy benefit managers – CVS Caremark, Express Scripts and OptumRx – asking how they were addressing the crisis. According to concurrent analysis by the New York Times and ProPublica, insurers need to be examined, as they “are limiting access to pain medications that carry a lower risk of addiction or dependence, even as they provide comparatively easy access to generic opioid medications”; in the words of the Times, “they have erected more hurdles to approving addiction treatments than for the addictive substances themselves.” Alisa Erkes, for example, lives with stabbing pain in her abdomen that, for more than two years, was made tolerable by Butrans, a painkilling skin patch that contains a less-risky opioid, buprenorphine. But in January, her insurer, UnitedHealthcare, stopped covering the drug, forcing her and her doctor to settle on long-acting morphine, a cheaper but more addictive opioid. In sharing Erkes’s experience, the Times also reveals that several state Medicaid programs continue to either require advance approval before Suboxone (a drug that can treat opioid addiction) can be prescribed or place time limits on its use, both of which interfere with treatment.
New York Times: “Blaming Medicaid for the Opioid Crisis – How Easy Can Be Wrong”
“Medicaid expansion may be fueling the opioid epidemic in communities across the country,” wrote Senator Ron Johnson, Republican of Wisconsin. This theory, catapulted to prominence by several conservative opponents of the Affordable Care Act (ACA), has gained increased traction in recent months. Some data, reports the New York Times, seem to support this connection, establishing a link between Medicaid coverage and access to prescription opioids. In quoting the Department of Health and Human Services (HHS), however, the Times emphasizes that “connection does not necessarily prove causation, and additional research is required before any conclusions can be made.” Researchers on the subject recommend that, to understand the opioid epidemic and Medicaid’s role better, we should look much further back than 2013: OxyContin prescriptions for noncancer pain, for example, grew by a factor of almost 10 between 1997 and 2002, long before the ACA was signed into law; moreover, drug-related mortality rates doubled between 1999 and 2013, the year before most states expanded Meicaid.
The Wall Street Journal: “Drug Companies Tie Costs to Outcomes”
Outcry over high drug prices has increasingly turned attention to an alternative way of paying for prescription drugs in which pharmaceutical companies tie a portion of their reimbursements from insurers to drug effectiveness. Last year, for example, Merck & Co. and Eli Lilly & Co. each agreed to pay insurers back if their diabetes drugs didn’t reduce patients’ blood-sugar levels to specified targets; Amgen Inc. also recently agreed to pay a 100% refund to an insurer and patients if patients taking a $14,000-a-year cholesterol-lowering drug suffered subsequent heart attacks or strokes. Despite the promise of value-based pricing, reports the Wall Street Journal, there is little evidence that outcomes-based contracts actually bring down drug prices. Due to this lack of evidence, the Journal writes, there are many instances in which “a drugmaker and an insurer have tried a value-based deal for a year, little or nothing was paid in rebates, and the two sides reverted to a traditional volume-based contract.” The contracts, they argue, aren’t worth the additional expense and effort, leading many to believe strategies otherthan value-based pricing are needed to solve the drug price crisis.
Harvard Business Review: “What Harvey Is Teaching the Health Care Sector About Managing Disasters”
In a recent article, Neil Gandhi, regional medical director of emergency medicine for the Houston Methodist Hospital System, and Ranu Dhillon, senior health advisor with experience responding to the Ebola crisis in Africa, Hurricane Katrina in Louisiana, and the 2010 earthquake in Haiti, articulate important lessons that could help governments and health systems in dealing with the aftermath of Hurricane Irma and other major catastrophes down the road:
Deploy existing resources creatively to address unforeseen challenges;
Think twice before closing smaller medical facilities to avoid hospital ER inundation;
Schedule medical staff and give them time off to avoid burnout; and
Establish clear and trusted sources of information.
Looking toward the long-term, Gandhi and Dhillon urge readers not to underestimate the power of the human spirit, enjoining us to sustain the compassion and solidarity observed so frequently in the wake of Hurricanes Harvey and Irma as we transition from immediate response to long-term recovery in the months ahead.
Kaiser Health News: “FDA Moves to Guard Against Abuse Of ‘Orphan Drug’ Program”
The Food and Drug Administration (FDA) is changing the way it approves medicines known as “orphan drugs” after revelations that drugmakers may be abusing a law intended to help patients with rare diseases. Indeed, according to a recent investigation by the Kaiser Health News, many drugs that have orphan status are not entirely new. Of the roughly 450 drugs that have won orphan approval since 1983, more than 70 were drugs first approved by the FDA for mass-market use, including cholesterol blockbuster Crestor, Abilify for psychiatric disorders, and rheumatoid arthritis drug Humira, the world’s best-selling drug. In response, FDA Commissioner Scott Gottlieb announced he wants to ensure financial incentives are granted “in a way that’s consistent with the manner Congress intended” when the Orphan Drug Act was first passed. In addition to a pending Government Accountability Office (GAO) investigation, Gottlieb plans to shift the way the FDA handles orphan drugs by:
Eliminating a backlog in drug applications for orphan designation or status;
Mandating that drugmakers prove their medicine is clinically superior before getting the market exclusivity that comes with being an orphan; and
Closing the loophole for pediatric orphan drugs by requiring all drugs approved for common adult diseases, like inflammatory bowel disease, undergo pediatric testing when getting approval as a pediatric orphan drug.
Pennsylvania’s State Monitoring Program Reduces Prescription Drug Abuse
Pennsylvania’s prescription drug monitoring program, says the state’s physician general, has been critical in reducing “doctor shopping,” the practice visiting multiple physicians to obtain multiple prescriptions for opioids or benzodiazepines, classes of drugs that would otherwise be illegal. In one year, the number of people in Pennsylvania who visited five or more doctors or pharmacists to obtain a prescription dropped 86%, while the number of people who went to 10 or more doctors or pharmacists was eliminated entirely. “The PDMP,” said one pharmacist, “makes it a lot easier to make sure you’re looking out for the patient’s well-being.”
New England Journal of Medicine: Dreams Deferred – The Public Health Consequences of Rescinding DACA
President Donald Trump has announced that the Deferred Action for Childhood Arrivals (DACA) program, a landmark immigration program introduced during the Obama administration, will be rescinded as of March 2018. The recent policy debates about DACA have centered on the program’s economic consequences, while its substantial – and important – public health benefits have been less discussed. Evidence indeed shows that rescinding DACA will have profound adverse population-level effects on mental health. Moreover, these effects will most likely be potentiated by the broader hostile political climate surrounding immigration.
Think Tanks Release Analyses of Graham-Cassidy Bill
Throughout the week last week, several think tanks issued analyses of the Graham-Cassidy proposal, which proposes converting Medicaid to a per-capita cap financing system and block granting all ACA funds, including Medicaid expansion funds.
Avalere: Graham-Cassidy-Heller-Johnson Bill Would Reduce Federal Funding to States by $215 Billion
Last week, Avalere Health released an analysis of the Graham-Cassidy bill which projects both the national and state-by-state impact of the legislation’s Medicaid per capita caps and the ACA-related funding block grants. Key findings from this analysis include:
$215 billion cut to states from 2020 – 2026:
Differential impact across the states. Most (37) will lose funding; some (16) will see increases
Financing variation ranges from funding reductions of $78 billion to funding enhancements of $35 billion, compared to current law
$498 billion cut to states from 2020 – 2027, reflecting 2027 funding cliff; and
$4.15 trillion cut 2020 – 2036; all states will lose federal funding in the long-term analysis.
Manatt: Impacts of New Graham-Cassidy Repeal and Replace Proposal
Manatt released an analysis on the Graham-Cassidy proposal, focused exclusively on the ACA block grant funding. The analysis assesses the national and state-by-state impact of the block grants, and includes tables reflecting unadjusted funding impacts compared to current law, as well as the impacts of a hypothetical population adjustment, which HHS may apply under the legislation. Key findings include:
$81.6 billion cut to states from 2020 – 2026; and
32 states receive a cut in 2020, down to 27 states by 2026. 29 states will see cuts between 2020 – 2026. Differential impact, in some states cuts of 25% or more.
Impact adjusted by Medicare geographic price index:
31 states see cuts from 2020 -2026; and
Adjustment must be budget neutral – so still $81.6 billion cut in total, but distributed differently across states than the unadjusted scenario.
Kaiser Family Foundation: State-by-State Estimates of Changes in Federal Spending on Health Care Under the Graham-Cassidy Bill
In this brief, the Kaiser Family Foundation estimates changes in federal funding due to the new block grant program and the Medicaid per enrollee cap on a state-by-state basis under the Graham-Cassidy bill relative to current law. This analysis addresses changes in federal funding for health coverage under the bill but does not project changes in the number of people covered. Key findings from the brief include:
Overall federal funding for coverage expansions and Medicaid would be $160 billion less than current law under the Graham-Cassidy bill over the period 2020-2026. Thirty-five states plus the District of Columbia would face a loss of funding;
Federal funding under the new block grants would be $107 billion less than what the federal government would have spent over the period 2020-2026 for ACA coverage;
There would be a significant redistribution in federal funding across states under the block grant: Overall expansion states would lose $180 billion for ACA coverage and non-expansion states would gain $73 billion over the 2020-2026 period; and
The Medicaid per enrollee cap would lead federal spending for the traditional Medicaid program to be $53 billion lower from 2020-2026 than it would be under current law.
NASPO and NASCIO Release Joint Roadmap For State Information Technology (IT) Procurement Reform and Process Transformation
The National Association of State Procurement Officials (NASPO) and the National Association of State Chief Information Officers (NASCIO) have released a joint roadmap for state information technology (IT) procurement reform and process transformation. The two associations have worked in tandem toward deeper engagement and partnership on this important issue for nearly two years. More recently in February 2017, NASPO and NASCIO established a joint task force on IT procurement negotiations. This roadmap, encompassing practical recommendations, implementation methods, and the publication as a whole, is the result of the work of this task force, an in-person workshop, and a survey of CPOs and CIOs across the country on topics related to IT procurement. Forty states responded to the survey questions and provided invaluable feedback to NASCIO and NASPO.
A copy of the recommendations of the joint task force is available on both NASPO and NASCIO websites at www.nascio.org/procurement.
Avalere: Projecting the Impact of an Individual Market Stabilization Package for 2018
Lower than expected enrollment, rising premiums, and declining issuer participation have led to an increased focus by state and federal policymakers alike on stabilizing the individual health insurance market. Legislative proposals aimed at addressing these concerns are currently being discussed and may include a range of policies, including funding for a reinsurance program, a continued moratorium of the Section 9010 health insurance tax (HIT), funding for cost-sharing reductions (CSRs), and additional flexibility for states to manage their individual markets. In light of this, America’s Health Insurance Plans (AHIP) requested that Avalere model a package of market stability proposals and their potential impact on the individual market for the 2018 benefit year. In their analysis, Avalere found that these proposals may lead to:
A reduction of individual market premiums-as compared to current law–by 13% to 17% for 2018, driven primarily by the reinsurance program as well as the continued HIT moratorium;
An additional 200,000 – 300,000 individuals enrolled in coverage (and subsequently a comparable amount fewer uninsured) ;
A decrease in risk scores from 1.34 to 1.33 due to the enrollment of some younger, healthier individuals; and
Increased government spending compared to current law between $18.6B and $21.8B, depending on the size of the stabilization investment.
NAM: First Do No Harm – Marshalling Clinician Leadership to Counter the Opioid Epidemic
The National Academy of Medicine (NAM) has released a new special report: First Do No Harm: Marshalling Clinician Leadership to Counter the Opioid Epidemic. Commissioned by the National Governors Association (NGA), and authored by the leading national authorities on substance use disorders, the publication explores the role of clinicians in addressing opioid misuse and addiction, and communicates several key messages, including the importance of prioritizing non-opioid strategies for chronic pain management. Except in cases of active cancer or end-of-life care, writes NAM, nonpharmacological treatments and non-opioid analgesics should be explored first, as they can offer better pain relief and recovery outcomes, while conferring little or no risk of addiction, overdose, and death. In cases where an opioid may be necessary and appropriate, NAM recommends that providers follow a set of five basic axioms for responsible prescribing:
Understand and tailor treatment to each patient, prescribing opioids only when there is good reason to believe the benefit will outweigh any potential risk;
Employ precautionary protocols, including: obtaining a thorough, targeted medical history; checking the state prescription drug monitoring programs (PDMPs) database; and initiating therapy at the lowest possible dose and duration levels, among others;
Actively manage and monitor treatment, following through with an agreed-upon strategy for tapering medications and assessing for signs of dependence or withdrawal etc.;
Know your team and community resources, so you are prepared with the proper referrals and team-based treatment strategy;
Ensure access to treatment services, by educating yourself and your staff on the availability of treatment opportunities, as well as working to ensure their availability at the community level.
The National Committee for Quality Assurance (NCQA) Releases its 2017 – 2018 Health Insurance Plan Ratings
The National Committee for Quality Assurance (NCQA) has released its 2017 – 2018 Health Insurance Plan Ratings. The ratings are intended to provide consumers with data to compare how more than 1,000 health insurance plans performed in the quality areas of consumer satisfaction, prevention and treatment. In all, the NCQA rated 498 commercial, 386 Medicare and 178 Medicaid plans. NCQA notes that high and low performers are rare, with ten percent receiving a rating of 4.5 or 5.0 (out of 5.0) and only two percent receiving a rating of 1.0 to 2.0.
The top ten states with the highest rated plans (receiving a 4.5 or 5.0) over a three-year average are:
NCQA also observes that over the last three years, there’s been little movement with the top ten states. The exception is for Hawaii and Iowa, which were 11th and 12th respectively in 2015 and moved into the top ten in 2016 and 2017.
GAO: States Fund Services for Adults in Institutions for Mental Disease Using a Variety of Strategies
In a new report, the Government Accountability Office (GAO) finds that between 2010 and 2015, inpatient and residential behavioral health services capacity increased for adult mental health treatment. Accompanying this increased capacity, the Centers for Medicare & Medicaid Services’ (CMS) changed policies to allow some states to finance such care via institutions for mental disease (IMD). Even with these new funding sources, however, adult access to IMD services remains challenging. Officials from the six states GAO interviewed for this study reported that they have to rely on other options, such as state-only funding, or providing services in smaller non-IMD facilities, when Medicaid funds do not come through for IMD services. Some states also reported long waits for inpatient mental health services, while some facility officials said they regularly turn away patients and maintain waitlists.
Kaiser Family Foundation: Current Status of State Planning for the Future of CHIP
This factsheet provides an overview of current state plans for CHIP amid continuing uncertainty about future federal funding for the program and discusses how states and children would be affected if Congress does not extend funding by the September 30, 2017 deadline. It reveals that without federal CHIP funding, states will face many budgetary, operational, and coverage-related problems. To be sure, nearly all (48 of 50) responding states (including DC) assumed continuation of federal CHIP funding in their FY 2018 state budgets, meaning the majority of states will face a funding shortfall if Congress does not extend federal funding. Furthermore, although most states have not yet developed plans for actions they will take if Congress does not extend funding, some plan to close or cap enrollment and/or discontinue coverage for children in separate CHIP programs; such reductions in coverage will result in coverage losses for children and negative effects on children’s health and family finances.
Earlier this month, the Medicaid and CHIP Payment and Access Commission (MACPAC) hosted its September meeting, during which Commissioners discussed the following topics:
Opportunities for Medicaid Reform: CMS Administrators Andy Slavitt and Gail Wilensky kicked off the meeting discussed the future of Medicaid reform, focusing on prioritizing care/removing barriers for dually eligible beneficiaries, the use of large funding pools in Medicaid’s financing structure, and the need to shift toward outcome-based payment.
Implications of the Latest Round of DSRIP for VBP: Commissioners discussed the efficiency of DSRIP during its testing period, and the amount of measurable economic and health outcomes that resulted. They also focused on the ability of DSRIP to allow healthcare providers to invest in infrastructure needed to monitor their own performance, while providing incentives for providers to change behavior.
Medicaid Enrollment and Renewal: Commissioners reviewed the effectiveness of the changes made to Medicaid enrollment post ACA enactment, and discussed if additional changes were needed. They also focused on improving program integrity, patient retention efforts, and administrative burdens associated with new enrollment policies and analyzing patient turnover rate – or ‘churn’ – within the Medicaid system.
State Flexibility and Program Accountability: Many of the Commissioners were concerned that they did not possess the expertise necessary to provide recommendations on these complex issues, particularly related to managed care oversight and the status of CMS’s Medicaid managed care final rule issued last year. Commissioners also expressed skepticism surrounding section 1115 waivers.
Policy Options for Controlling Medicaid Spending on Prescription Drugs: MACPAC staff provided the Commission with an overview on Medicaid payment and rebates for prescription drugs, and discussed factors that increase drug prices for all payers. The analysts then discussed potential policy responses to increased drug prices and increases to Medicaid drug spending.
Other issues that were discussed included managed care oversight, CMS Medicare-Medicaid coordination, and telemedicine.
Oregon Seeking State Medicaid Director
The Oregon Health Authority is looking for a passionate leader who is eager to influence and advance health system transformation in Oregon, to join our innovative team as the State Medicaid Director.
This key position is a catalyst in building strong collaborative relationships with public health, behavioral and oral health champions throughout the state. The State Medicaid Director provides overall leadership and direction for strategic program development, health policy and program implementations for the Oregon Health Plan, with an enrollment of over one million individuals.
Iowa Department of Human Services seeks a professional to lead the Iowa Medicaid Enterprise (IME). IME is a health care payor that provides comprehensive health care benefits to over 600,000 Iowans annually and has annual expenditures in excess of $ 5.6 billion. This key critical position serves on the Department’s executive management team.
The Medicaid Director is the primary architect of the strategy that establishes IME’s goals for optimal health outcomes and financial performance. This position defines program objectives and performance measures to ensure goals are attained. The role requires a superior knowledge of the insurance industry’s healthcare payment systems and CMS regulations, in order to integrate federal mandates into compliant state policy. This pivotal role provides vision and direction for IME staffs and contractors to implement strategies focused on effective delivery results. The Director must be an effective communicator to craft initiative messages and continually collaborate with a broad and diverse group of stakeholders inclusive of consumers, provider associations, legislators and CMS.
DCH is currently seeking a qualified Assistant Chief, of Performance Quality and Outcomes with the Medicaid Division.
Plans, develops and directs the Medicaid Quality Improvement functions. Provides leadership necessary to achieve national best practice performance levels in quality improvement. Ensures that the quality of healthcare services rendered by contracted managed care plans meets or exceeds professionally recognized community standards. Oversees a diverse range of support, operational, and programmatic activities for the Department of Community Health. Recommends and implements policies and procedures. Provides leadership to subordinate managers and staff. Interfaces with a diverse range of clinical and administrative professionals, resolves sometimes-complex policy and service issues within the group and directs data analytic and reporting activities. Ensures compliance with state, federal, and accreditation requirements.
The Health Care Authority is seeking a seasoned finance professional with ten plus years of executive leadership experience, especially with regard to managing multiple programs, mentoring and coaching, dealing with ambiguity, and providing vision and strategic leadership in a public environment.
The ideal candidate for this important position will also have prior experience in health care finance at a local, regional or national level, and will be adept at cultivating strong stakeholder relations. Desired personal characteristics include strong communication skills, high emotional intelligence, and the ability to work with diverse stakeholder groups and authorizing environments.