In the NAMD newsletter you will find the Fall Meeting registration is open. We cover the ABLE act guidance; Senate HELP hearing on market stablization; CHIP; and Oregon seeking Medicaid Director in state jobs section.
State Medicaid Director Letter: Implications of the ABLE Act for State Medicaid Programs
In a new State Medicaid Director Letter (SDML), the Centers for Medicare & Medicaid Services (CMS) provides guidance to states on how to treat “ABLE” accounts in Medicaid financial eligibility determinations. The Stephen Beck, Jr., Achieving a Better Life Experience Act of 2014 (the ABLE Act), enacted in 2015, created a program under which people with disabilities can save money for their disability-related expenses in tax-advantaged accounts. Because disability can serve as a basis for Medicaid eligibility, many individuals who apply for Medicaid on the basis of having a disability may be interested in opening an ABLE account. This letter provides guidance to states on the treatment of funds in, contributions to, and distributions from an ABLE account for purposes of Medicaid eligibility.
State Innovation Models (SIM) Round 1 Model Test 3rd Annual Evaluation Report
CMS released the third annual evaluation report for the State Innovation Models (SIM) Round 1 Model Test. Through SIM, CMS awarded Model Test cooperative agreements ranging from $33 to $45 million to 6 Test states (AR, ME, MA, MN, OR, & VT) in Round 1 to transform their health care system across multiple payers. Through these grants, the states are testing the ability of state governments to use their policy and regulatory levers to accelerate statewide health care system transformation from encounter-based service delivery to care coordination, and from volume-based to value-based payment.
CMS’s most recent evaluation report for SIM Round 1 Model Test can be found here. For more information, please click here.
CMS Reflects on Innovative Treatments, Calls for Innovative Payment Models and Arrangements
Recently, the FDA approved a new immunotherapy, Kymirah (tisagenlecleucel), for certain pediatric and young adult patients with B-cell precursor acute lymphoblastic leukemia (ALL) that is refractory or in second or later relapse. The manufacturer, Novartis, expects it will cost about $475,000 for the one-time personalizedtreatment, in which a patient’s immune cells are removed, modified so they attack cancer cells, and then infused back into the body. CMS is negotiating with Novartis while exploring the development of payment models and arrangements for new and potentially life-saving treatments. “CMS congratulates all of the scientists and researchers involved in the development of Kymriah,” said CMS Administrator Seema Verma. “Innovations like this,” she highlighted, “reinforce our belief that current healthcare payment systems need to be modernized in order to ensure access to new high-cost therapies, including therapies that have the potential to cure the sickest patients. Improving payment arrangements is a critical step towards fulfilling President Trump’s promise to lower the cost of drugs.”
To see CMS’s full press release, please click here.
2018 Health Insurance Exchanges Issuer County Map
Last week, CMS posted an update to the Health Insurance Exchanges Issuer County Map, which projects issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through September 6, 2017. According to the map, 1,487 counties – over 45 percent of counties nationwide – could have only one issuer in 2018. This could represent more than 2.6 million Exchange participants with only one health insurance option.
Congress Passes Hurricane Relief Bill, Extends Federal Government Funding and Debt Ceiling to December
Late last week, President Trump struck an unexpected deal with Senate Minority Leader Chuck Schumer (D-NY) and House Minority Leader Nancy Pelosi (D-CA) to tie initial Hurricane Harvey relief funds to a temporary extension of federal government funding and a lifting of the debt ceiling. The package includes $15 billion in funding for Hurricane Harvey relief, nearly double the amount initially considered in the Senate, and postpones questions on FY 2018 federal government funding and the debt ceiling to December 8.
These measures address three of the key legislative issues Congress needed to pass prior to September 30, though delaying FY 2018 funding decisions and the debt ceiling to December sets the stage for difficult negotiations at the end of the year.
Senate HELP Hearings Feature State Insurance Commissioners, Governors on Individual Market Stabilization
The Senate Health, Education, Labor and Pensions Committee (HELP) held two hearings last week on stabilizing the insurance marketplaces created under the Affordable Care Act (ACA). HELP Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) aim to use these hearings, the first two of a scheduled four, to serve as the basis for a bipartisan package of individual market stabilization actions, targeted for passage by the end of September.
At the second of the two hearings, governors from five states – Charlie Baker (R-MA), Steve Bullock (D-MT), Bill Haslam (R-TN), Gary Herbert (R-UT), and John Hickenlooper (D-CO) – testified before the Senate panel, calling on Congress to move quickly to stabilize the individual health insurance market and then embark on a serious effort to deal with skyrocketing health care costs. A key issue is the future of federal cost-sharing reduction (CSR) payments to health plans, which are used to help the insurers provide affordable coverage for low- and moderate-income families.
At Wednesday’s hearing, Sen. Alexander laid out elements of a potential compromise. Under his proposal, Republicans would agree to continuing the CSR payments, while Democrats would agree to give states greater freedom to relax some ACA insurance requirements. Senior Republican aides said the subsidies could be funded for two years, in exchange for adding a less comprehensive “copper” plan option for people older than 30. Democrats have shown little interest in allowing states the flexibility, which could allow them to chip away at guaranteed essential health benefits – a key demand among Republican negotiators. Two additional HELP Committee hearings are set for this week – the first with health care experts and the second with a panel including doctors and patient advocates.
SFC Holds Hearing on CHIP Appropriations
On September 7, the Senate Finance Committee (SFC) held a hearing focusing on the status of CHIP and issues around extending funding for the program, which is set to expire on September 30. While policymakers signaled a willingness to extend CHIP for five years at the hearing, few details emerged around questions of timing a package, the continuation of the enhanced FMAP, or funding offsets.
Witnesses testified regarding CHIP’s role in expanding insurance coverage for children, its success in bringing stability to families, and the operational challenges states will face if funding is not timely appropriated.
A recording of the hearing, witness list, and submitted testimony is available here.
Senate Appropriations Committee Advances FY 2018 HHS Spending Bill; House Continues Work on Omnibus Package
On September 6, the Senate Appropriations Committee advanced an FY 2018 spending bill for the Department of Health and Human Services (HHS), as well as the Departments of Labor and Education. The draft package includes $79.4 billion in discretionary HHS spending, a $1.7 billion overall increase from FY 2017. Salient details include $816 million in funding for opioid abuse and prevention activities, an increase of $665 million over FY 2016 funding levels, as well as additional investments in the National Institutes of Health.
Meanwhile, the House continues its own work on an omnibus spending package of eight appropriations bills. NAMD will share additional details as they become available.
In the News
Vox: Drug Overdose Deaths Skyrocketed in 2016…and Traditional Opioid Painkillers Weren’t the Cause
Preliminary figures from the National Center for Health Statistics suggest that there were more than 64,000 drug overdose deaths in 2016. Overtaking both heroin and prescription painkillers in terms of overdose deaths were synthetic opioids, including fentanyl. Specifically, traditional opioid painkillers, such as OxyContin and Percocet, were involved in about 14,400 overdose deaths in 2016, and heroin was involved in more than 15,400, while synthetic opioids were linked to more than 20,100 overdose deaths. Remaining overdose deaths involved other drugs, such as cocaine (which also increased). If these numbers hold up, writes Vox writer German Lopez, they corroborate the opioid epidemic as “America’s deadliest overdose crisis ever.” Reflecting on the origins of the opioid crisis as well as ways in which officials are cracking down on prescription painkillers, Lopez writes how many people who lose access to painkillers still suffer from addiction, turning to cheaper, more potent opioids like heroin and fentanyl. Looking to the future, he recommends a more comprehensive approach that restricts the availability of prescribed painkillers while enhancing access to addiction treatment.
Morning Consult: When It Comes to the Drug Pricing Debate, Talk Is Cheap
In the last several months, individual companies have begun to take actions in an attempt to address drug pricing concerns and demonstrate their ability to “self-police.” Using data from an opinion survey conducted by APCO Worldwide, Chrystine Zacherau and April Claassen explore to what extent these actions have actually made a difference in how these companies are perceived by the public and by legislators. They found that stakeholders “want to see companies demonstrate that they have patients’ best interests in mind, act as an advocate to improve access and affordability” by doing the following:
Advocating for policies aimed at improving access to medicines: Companies must have a point of view on how to improve access and affordability for patients, and publicly advocate for that position.
Partnering to improve access: Stakeholders like to see companies working with others in the system – health insurers, pharmacy benefit managers or others – to improve access to patients. This suggests innovative discount programs that have recently been implemented by companies to reduce prices to patients at the pharmacy are widely viewed as positive.
Sharing details on how medicines are priced: Transparency, transparency, transparency. Even if it doesn’t change how prices are determined, stakeholders expect to see companies disclosing more information about how their medicines are priced. Transparency helps improve trust and demonstrates companies are not taking advantage of patients or the system.
Stat: To Fight Opioid Epidemic, Senators Make the Case for ‘Partial Fill’ Prescriptions
As reported by Stat News, Sens. Elizabeth Warren (D-Mass.) and Shelley Moore Capito (R-W.Va.) wrote a series of letters last week asking major actors in the fight against the nation’s opioid crisis to consider endorsing “partial fill” policies, which would allow patients to receive less than a full prescription’s worth of medication on a single pharmacy trip. Such a provision would be permitted under a clause in the Comprehensive Addiction and Recovery Act, which allows pharmacies to dispense portions of prescriptions for Schedule II drugs, a classification encompassing many opioid-based painkillers. It also allows for patients to return to the pharmacy later if they feel the remainder of prescribed medication is needed.
New ICRC Brief: Medicaid Agency Partnerships with State Health Insurance Programs – Opportunities to Improve Care for Medicare-Medicaid Enrollees
In a new brief, Medicaid Agency Partnerships with State Health Insurance Programs: Opportunities to Improve Care for Medicare-Medicaid Enrollees, ICRC describes opportunities for Medicaid agencies to partner with State Health Insurance Assistance Programs (SHIPs). It highlights approaches used by three states – Arizona, Massachusetts, and Texas – in which SHIPs and Medicaid agencies have worked together to educate Medicare-Medicaid enrollees on new care delivery options. State experiences working with SHIPs, says the report, suggest two key actions to ensure effective collaboration: (1) maintain open dialogue and information sharing between state Medicaid agencies and SHIP partners; and (2) recognize SHIPs as a valuable existing resource for Medicaid agencies developing new integrated programs.
New Study in Health Affairs Shows That Medicaid Expansion for Adults Had Measurable Effects on Their Children
Increased coverage for children in low-income families since the implementation of the Affordable Care Act (ACA) suggests potential spillover or “welcome-mat” effects on the number of eligible children enrolled. Using data from the 2013-15 American Community Survey, this study provides the first national-level estimates of the welcome-mat effects on children’s coverage post ACA, revealing that approximately 710,000 low-income children gained coverage. According to the study, the impact was largest (5.7 percentage-point increase) among children whose parents gained Medicaid eligibility under the ACA expansion, compared to the 2.7-percentage-point increase observed among children whose parents were ineligible for Medicaid both pre and post ACA. The study also estimates that if all states had adopted the Medicaid expansion, an additional 200,000 low-income children would have gained coverage.
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.
NAMD Opening for Program Director, Medicaid Leadership
The National Association of Medicaid Directors (NAMD) seeks a Program Director to primarily oversee and support its growing Medicaid leadership portfolio, along with other initiatives.
The primary responsibility of the program director is to create a year-round program that offers multi-faceted leadership training for state Medicaid teams, including a mix of in-person events and virtual meetings; trainings geared toward teams, managers, and new Medicaid Directors; a mix of content and topics related to leadership; strategic communications around the portfolio; and other items.
The Arizona Health Care Cost Containment System (AHCCCS) is seeking a Deputy Director. Built on a system of competition and choice, AHCCCS is a $12 billion program that operates under an integrated managed care model, through a Research and Demonstration 1115 Waiver. Contracted health plans coordinate and pay for medical services delivered by over 60,000 health care providers for 1.9 million individuals and families in Arizona.
The Deputy Director reports to the AHCCCS Director and is responsible for the oversight of the administrative and programmatic operations and managing the agency’s fiscal, budgetary, and strategic planning functions.