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In the newsletter this week, CMS releases Hospice Compare website, nominations for pain management task force, 21st Century Cures, and health insurance markets.

August 29, 2017
From the NAMD Desk
In This Issue

Save the Date
NAMD Fall Meeting
November 6-8, 2017
Hyatt Regency Crystal City
Register here.


Reg Update


CMS Releases Hospice Compare Website to Improve Consumer Experiences, Empower Patients
The Centers for Medicare & Medicaid Services (CMS) has unveiled its Hospice Compare website, which displays information in a ready-to-use format and provides a snapshot of the quality of care each hospice facility offers to its patients. The Hospice Compare site allows patients, family members, caregivers, and healthcare providers to compare hospice providers based on important quality metrics, such as the percentage of patients that were screened for pain or difficult or uncomfortable breathing, or whether patients’ preferences are being met. Currently, the data on Hospice Compare is comprised from 3,876 hospices.
By ensuring patients have the information they need to understand their options through the site, CMS is helping individuals make informed healthcare decisions for themselves and their families based on objective measures of quality. “The Hospice Compare website is an important tool for the American people and will help empower them in a time of vulnerability as they look for information necessary to make important decisions about hospice care for loved ones,” said CMS Administrator Seema Verma. In her words, “The CMS Hospice Compare website is a reliable resource for family members and care givers who are looking for facilities that will provide quality care.”
The Hospice Compare website will reflect current industry best practices for consumer-facing websites and will be optimized for mobile use. For more information, please visit  to view the new Compare site.
For more information, visit the Hospice Quality Public Reporting webpage.
HHS Seeks Nominations for CARA-Established Pain Management Task Force (Due: 30 Days)
Last week, the Department of Health and Human Services (HHS) announced its intent to establish the Pain Management Best Practices Inter-Agency Task Force (Task Force), and requested nominations for appointment to the Task Force. Established by the Comprehensive Addiction and Recovery Act of 2016, the Task Force will provide advice and recommendations to the Secretary for development of best practices for pain management and prescribing pain medication, and a strategy for disseminating such practices.
The Task Force will have not more than 30 members and will meet at least two times per year. HHS notes “the members of the Task Force shall include currently licensed and practicing physicians, dentists, and non-physician prescribers; currently licensed and practicing pharmacists and pharmacies; experts in the fields of pain research and addiction research, including adolescent and young adult addiction; experts on the health of, and prescription opioid use disorders in, members of the Armed Forces and veterans; and experts in the field of minority health.” In addition, HHS seeks nominations from individuals representing pain management professional organizations; the mental health treatment community; the addiction treatment community, including individuals in recovery from substance use disorder; pain advocacy groups, including patients; veteran service organizations; and groups with expertise on overdose reversal, including healthcare providers.
Nominations are due within 30 days of official publication, around Sept. 29, 2017. To learn more, please click here.
New ICRC Brief on Integrating Behavioral and Physical Health for Medicare-Medicaid Enrollees
A new ICRC brief, Integrating Behavioral and Physical Health for Medicare-Medicaid Enrollees: Lessons for States Working with Managed Care Delivery Systems, examines the experiences of six states that have achieved varying levels of behavioral health and physical health integration or collaboration for dually eligible beneficiaries within a managed care environment. Regardless of the model chosen, the report underscores, the essential components of integration or coordination are the same: (1) a combined culture of behavioral and physical health that focuses on whole-person care; (2) information sharing; (3) designated care management and coordination processes; (4) provider capacity building and training; (5) provider- level integration; and (6) program monitoring and quality improvement. Grounded in this finding, the ICRC report makes several recommendations, including:
  • States should seek to balance prescriptiveness with flexibility, particularly in the area of care management and coordination, when setting plan contract requirements;
  • Misalignment of the recovery model of care in behavioral health systems and the medical model of care in physical health systems can be the most difficult challenge to overcome during integration at the state, health plan, and provider levels; and
  • The lack of performance measures for behavioral health is a significant challenge to program monitoring and quality improvement.
Please read full brief here.
Potential RFI on the Direction of CMMI
Reports suggest that CMS officials have been working on a Request for Information (RFI) on the direction of the Center for Medicare and Medicaid Innovation (CMMI), according to sources familiar with the RFI.
More information can be found here.


Hill Update


Congress to Return Next Week to a Busy Legislative Calendar in September
Congress will return from August recess on September 5, and will have little time to address several must-pass legislative issues before the end of the 2017 fiscal year on September 30. On the docket are bipartisan efforts to bring short-term stability to the individual insurance markets, securing a federal budget or continuing resolution for FY 2018, lifting the debt ceiling, and funding the Children’s Health Insurance Program (CHIP).
It is unclear whether Congress will be able to accomplish all of these objectives in its relatively short legislative window in September, though comments from lawmakers during recess indicate some groundwork on most of these issues. In particular, Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) have announced two hearings to explore bipartisan approaches to individual market stabilization. The hearings will take place on September 6 and 7, and feature testimony from state insurance commissioners and Governors.
On CHIP, the picture appears murkier. There does not yet appear to be agreement on whether to continue the Affordable Care Act (ACA)’s 23 percentage point match enhancement and maintenance of effort provisions. The decision to address CHIP separately from a package of Medicare and other health program extenders, or whether CHIP legislation may be impacted by larger health reform efforts, also remains to be seen.
Senate Democrats Call for FDA to Ban Sale of Menthol Cigarettes
On August 22, eight Senate Democrats sent a letter to Food and Drug Administration (FDA) Commissioner Scott Gottlieb calling for the FDA to use its tobacco regulation authority to ban the sale of menthol cigarettes. The letter notes evidence that menthol cigarettes are targeted to youth and African Americans. It also discusses recommendations from the FDA’s Tobacco Products Scientific Advisory Committee and previous FDA proposed rulemaking on the issue, citing lack of progress since 2013. The Senators request that the FDA provide updates on its work since that time, and a timeline for final action.
Read the letter here.


In the News


Representative Brett Guthrie: Time to Modernize Medicaid’s Broken Waiver Process
In a new op-ed, Rep. Brett Guthrie (R-KY) calls for improvements in the Medicaid waiver process, representing what he calls “an unacceptable time frame that impedes state innovation and sound program management.” Evidence indeed suggests that the Centers for Medicare and Medicaid Services (CMS) takes more than six months to approve a waiver, with several states having to wait for more than a year (including Kentucky).  Guthrie ascribes the “needlessly long, cumbersome, and uncertain” process to CMS’s “‘Mother, may I?’ mentality,” as well as their staff’s lack of firsthand experience in Medicaid programs. For solutions, Guthrie echoes NAMD’s 2017 legislative priorities list, especially our institutional call for states to “patch together numerous waiver authorities and coordinate the siloed federal funding streams for these various services and programs.”
Please read the op-ed here.
Kaiser Health News: Childhood Torment, Social Isolation Can Turn Minds Toward Hate
In the wake of the Charlottesville hate riots, Kaiser Health News examines how traumatic childhood experiences can predispose individuals to social isolation and, in certain circumstances, racially-fueled indignance. Involvement with white nationalist groups like those demonstrating in Charlottesville, says psychologist Ervin Staub, professor emeritus at the University of Massachusetts-Amherst, usually entails individuals “finding no other socially acceptable and meaningful ways to fulfill important needs – the need for identity; the need for a feeling of effectiveness; the need for a feeling of connection.” In the words of Tony McAleer, a former organizer for the White Aryan Resistance, of the pull of white nationalism after years of being beaten at an all-boys Catholic school, “I felt power where I felt powerless. I felt a sense of belonging where I felt invisible.” A 2015 report from the National Consortium for the Study of Terrorism and Responses to Terrorism (known as START) corroborates this link between childhood trauma and hate group involvement, reporting that half of former members of violent white supremacist groups were victims of childhood physical abuse and about 20 percent were victims of childhood sexual abuse. With the alt-right gaining power online, effectively harnessing Twitter, YouTube and other social media platforms to spread their message, writes Kaiser, it is imperative that we better understand and respond to the ways in which traumatic experience can shape the way individuals mobilize around hateful ideologies, preventing “young, impressionable” people from participating in such activity.
Please read article here.
Pulse Check Interview with Former HHS Secretary Kathleen Sebelius
In a recent Pulse Check interview, Politico spoke with Kathleen Sebelius, the former HHS secretary who oversaw the rollout of Obamacare. In the interview, Sebelius shares her thoughts on the current administration’s strategy, what she thinks HHS should be prioritizing, and what’s been overlooked because of the intense focus on repeal and replace.
To listen to the interview, please click here.
New tool helps physicians learn if their opioid prescribing is appropriate
While the medical community is beginning to see guidance on responsible opioid prescribing, such as from the
Centers for Disease Control and Prevention and the
American Society of Interventional Pain Physicians, it typically remains very high level, designed to avoid blatant misuse without addressing specific populations. To rectify this dearth of what Bruce Harmory, partner and chief medical officer in the health and life sciences practice of Oliver Wyman, calls “contextual relevance,” Harmory and Johns Hopkins surgeon and a leader in national patient safety, Dr. Marty Makary, have developed “appropriateness measures,” which show the range of prescribing patterns and identify the average number of pills prescribed for this procedure or that type of patient. Grounded in detailed conversations with specialists from across the country, these measures will serve as an actionable guidepost.
  • Arming physicians with appropriateness measures can help them determine whether their prescribing behavior for opioids is consistent with peer-developed guidelines;
  • Helping administrators identify physicians whose prescribing patterns routinely fall outside the best-practice range; and
  • Connecting physicians with pain specialists and other experts to develop individual prescribing standards based on the latest best practices.
To read full article, please click here; to access measures, please click here.


Take Note


HMA: A National Survey of Medicaid Readiness for Electronic Visit Verification
In December 2016, Congress enacted the 21st Century Cures Act, which requires states to implement Electronic Visit Verification (EVV) for Medicaid-financed Personal Care Services and Home Health Care Services by January 1, 2019 and January 1, 2023, respectively. In a new report, Health Management Associates (HMA) presents findings from a survey of states’ readiness to implement EVV in their Medicaid programs. The responses offered insights about states’ EVV understanding, preparations and features of interest, revealing that:
  • 26 of the 29 total respondents had some familiarity with the Cures Act requirements;
  • 8 respondents have already implemented EVV;
  • 5 states have submitted an advance planning document (APD) to CMS;
  • 3 states have plans to submit an APD; and
  • 16 respondents requested more information about the Cures Act and EVV requirements.
To read the full report, please click here.
Commonwealth Fund: How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care
Prior to 2010, one-third of women who tried to buy a health plan on their own were either turned down, charged a higher premium because of their health, or had specific health problems excluded from their plans. Beginning in 2010, the Affordable Care Act (ACA) worked to rectify this, installing consumer protections, particularly coverage for preventive care screenings with no cost-sharing and a ban on plan benefit limits, to improve the quality of health insurance for women, while helping women gain coverage through the ACA’s marketplaces or through Medicaid. A new report by the Commonwealth Fund examines the effects of ACA health reforms on women’s coverage and access to care. It finds, chiefly, that:
  • Women ages 19 to 64 who shopped for new coverage on their own found it significantly easier to find affordable plans in 2016 compared to 2010;
  • The percentage of women who reported delaying or skipping needed care because of costs fell to an all-time low; and
  • Insured women were more likely than uninsured women to receive preventive screenings, including Pap tests and mammograms.
To read full report, please click here.
Commonwealth Fund: How Medicaid Expansion Affected Out-of-Pocket Health Care Spending for Low-Income Families
Using data from the Consumer Expenditure Survey, a new report from the Commonwealth Fund assesses how the Medicaid expansion affected out-of-pocket health care spending for low-income families compared to those in states that did not expand, while considering whether effects differed in states that expanded under conventional Medicaid rules vs. waiver programs. It finds that compared to families in non-expansion states, low-income families in states that did expand Medicaid saved an average of $382 in annual spending on health care. In these states, low-income families were further less like to report any out-of-pocket spending on insurance premiums or medical care than were similar families in non-expansion states. For families that did have some out-of-pocket spending, spending levels were lower in states that expanded Medicaid. Low-income families in Medicaid expansion states were also much less likely to have catastrophically high spending levels.
To read the full report, please click here.
Health Affairs asks, “Did Medicaid Expansion Affect the Opioid Epidemic?”
In a recent brief, Health Affairs addresses the newfound theory that the ACA’s Medicaid expansion has either caused or exacerbated the opioid epidemic. The authors find that while public policy could have played a role in our current prescription abuse crisis, there is minimal evidence to support the notion that Medicaid expansion served as a causal and/or principal factor. First, they write, trends in opioid deaths nationally and by Medicaid expansion status predate the ACA; second, counties with the largest coverage gains actually experienced smaller increases in drug-related mortality than counties with smaller coverage gains; and third, the fact that Medicaid recipients fill more opioid prescriptions than non-recipients largely reflects greater levels of disability and chronic illness in the populations that Medicaid serves, not a Medicaid-endowed penchant. In fact, the Medicaid program can very feasibly help those addicted to opioids: Since January 2016, the Centers for Medicare and Medicaid Services (CMS) outlined broad scale flexibilities already available in the Medicaid program to expand access to medication assisted treatment, and states have begun taking up these flexibilities. Indeed, for many opioid users and their families, Medicaid provides the only affordable treatment option and path to recovery.
To read full brief, please click here.
The National Quality Forum’s (NQF’s) Pediatric Performance Measures Final Technical Report
Last week, the National Quality Forum’s (NQF’s) issued its Pediatric Performance Measures final technical report. The report evaluates 11 newly submitted measures and recommends four measures for endorsement:
  • GAPPS: Rate of Preventable Adverse Events Per 1,000 Patient-Days Among Pediatric Inpatients
  • Continuity of Primary Care for Children with Medical Complexity
  • Antibiotic Prophylaxis Among Children with Sickle Cell Anemia
  • Informed Participation
It should be noted that the Committee did not recommend the following measures: Appropriateness of Emergency Department Visits for Children and Adolescents with Identifiable Asthma; Rate of Emergency Department Visit Use for Children Managed for Identifiable Asthma: Visits per 100 Child-Years; Anticipatory Guidance and Parental Education; Ask About Parental Concerns; Family Centered Care; Assessment of Family Alcohol Use, Substance Abuse and Safety; Assessment of Family Psychosocial Screening.
For the full report, please click here.
JAMA Forum: Reforming Medicaid
On August 15, Andy Slavitt, MBA, and Gail Wilensky, PhD, joined together in offering six ways in which Medicaid can be improved:
  1. Making Medicaid a more outcomes-based program;
  2. Improving Medicaid financing, decreasing reliance on large supplemental pools while encouraging innovative investments in the social determinants of health;
  3. Ensuring proper access to care by eliminating nonaccountable pools of funding, allowing states to improve their reimbursement rates to specialists and help to expand access;
  4. Investing in a data, technology, and analytics infrastructure;
  5. Coordinating programs for dual-eligible beneficiaries and other populations; and
  6. Reducing administrative burden on states and allowing for more rapid innovation.
To implement these strategies, Slavitt and Wilensky recommend initiating a 12-month bipartisan review process that focuses on long-term reforms to improve care and reduce costs, while encouraging broad stakeholder involvement. Such a process, they write, would enable the Medicaid program to “develop [into] a higher-quality, more accountable, modern, and accessible system.”
State Health Commissioners Push Regulatory Changes to Stabilize Market
State insurance commissioners are pushing the Trump administration to embrace a slew of recommendations issued in July that they say would help stabilize the health insurance market, improve choice and affordability for consumers, and affirm states’ regulatory authority, in response to CMS’ request for stakeholders’ suggestions. Most of the commissioners’ proposals focus on amending or repealing rules seen as encroaching upon states’ traditional role in regulating their insurance markets, as well as loosening barriers to state flexibility.
State health commissioners are scheduled to testify before the Senate Health Committee on Wednesday, September 6th.
Read more here.

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.
Wisconsin Posting for Health Services Associate Manager
The Wisconsin Department of Health Services, Division of Medicaid Services (DMS) is currently recruiting to fill an Associate Director of Operations (Health Services Associate Manager) position in the Bureau of Milwaukee Enrollment Services (MilES). This important executive leadership position offers competitive pay and a top-rate benefits package.
Virginia Posting for Senior Programs Advisor, Eligibility
Virginia’s Department of Medical Assistance Services (DMAS) is currently seeking a new Senior Programs Advisor for Eligibility. The position will provide a unique opportunity to provide support to upper level management by developing a new and comprehensive approach to assessing and improving the process of determining eligibility. Responsibilities will include defining performance standards, developing metrics, collecting data and tracking measures, identifying trends and issues, and developing recommendations and corrective actions to ensure that the eligibility determination process is in compliance with all federal and state regulations and provides a high-quality consumer experience.



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