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In the newsletter this week is the NAMD Fall Conference, early bird registration ends October 6. NAMD sends feedback to Mental Health Parity Task Force and addresses Medicaid IMD exclusion. See state jobs for openings in Rhode Island and Washington state.

MD Updat

Update
September 28, 2016
From the NAMD Desk
 
NAMD Fall Meeting, November 6-8 in Arlington, Virginia
The NAMD Fall Conference is less than 6 weeks away. Early-bird registration is available until October 6, so don’t delay in registering! Updated agenda and registration information can be found here.

 

NAMD Provides Feedback to the Mental Health Parity Task Force 
On August 30, NAMD provided recommendations to the Mental Health and Substance Use Disorder Parity Task Force. The Task Force, which was created by President Obama in early 2016, includes key Administration leaders and is charged with examining parity implementation and enforcement. NAMD’s letter to the Task Force underscores Medicaid Directors’ commitment to the objectives of parity and provides two recommendations. First, it urges the Task Force to bring vital attention to the institutions for mental disease (IMD) exclusion as a barrier to parity and to develop comprehensive solutions to address it. Second, the letter asks the Task Force to consider additional time for Medicaid programs to comply with the regulation, given the unique issues for Medicaid in implementing it. These challenges include conducting the complex parity analysis in states that carve out certain services and applying parity to long-term services and supports.

 

The Task Force is expected to release a report with its findings and recommendations by October 31, 2016.

NAMD Memo Addresses Medicaid IMD Exclusion
Last week, NAMD released a memorandum for interested congressional staff on the institutions for mental disease (IMD) exclusion. There has been growing interest from congressional staff in understanding the IMD exclusion and landscape of existing state flexibilities to mitigate it, especially with the recent decision from the Center for Medicare and Medicaid Innovation (CMMI) not to extend the Medicaid Emergency Psychiatric Demonstration (MEPD). The new memo examines the context of the IMD exclusion; the pathways available to states to mitigate it and the limitations of each of these pathways; as well as the questions/issues CMMI’s decision on the MEPD has raised for states.

In This Issue

REGISTER NOW!
Early bird fees until October 6
NAMD Fall Meeting
Nov. 6-8, 2016
 

Information and registration

here.

 

Reg Update

 

CMS Extends Comment Period for Medicaid Quality Measures
The deadline for submitting public comments on Medicaid measure specifications (and justification for quality measures currently under development and testing) has been extended to Friday, October 7.  If you wish to comment on these measures (zip files can be found here), please submit your comments to
MedicaidQualMeasures@mathematica-mpr.com; you may also send any questions to this email address.  As a reminder, the measure concepts address the following areas and/or populations:
 
  1. Medicare-Medicaid (dual) beneficiaries and Medicaid beneficiaries using home and community-based services;
  2. Medicaid beneficiaries in managed long-term services and supports programs;
  3. Medicaid beneficiaries with complex care needs and high costs;
  4. Medicaid beneficiaries with substance use disorders; and
  5. Medicaid beneficiaries and Medicare-Medicaid (dual) beneficiaries with physical-mental health integration needs.
Please find more information  here.
CMS Publishes FAQ on Section 1557 Nondiscrimination Requirements
Under Section 1557 of the ACA, HHS will soon require covered entities post Notices of Nondiscrimination and Taglines that alert individuals with limited English proficiency (LEP) to the availability of language assistance services.  In advance of the approaching deadline (October 17, 2016), the HHS Office of Civil Rights (OCR) has updated its website with a
FAQ; HHS OCR has also made available a
table displaying the top 15 languages spoken by individuals with LEP in each State, the District of Columbia, Puerto Rico and each U.S. Territory, based on OCR’s research.

 

CMS Releases Year 2 Evaluation of Bundled Payment Initiative
On September 19, CMS released the second annual evaluation report for Models 2-4 of the Bundled Payments for Care Improvement initiative (including both retrospective and prospective bundled payments that may or may not include the acute inpatient hospital stay for a given episode of care). Describing the characteristics of the participants, it includes quantitative results from the first year of the initiative, demonstrating that:
  • 11 out of the 15 clinical episode groups analyzed showed potential savings to Medicare;
  • Orthopedic surgery under Model 2 hospitals showed statistically significant savings while showing improved quality as indicated by beneficiary surveys; and
  • Cardiovascular surgery episodes under Model 2 hospitals did not show any savings yet but quality of care was preserved.
According to CMS, future evaluation reports will have greater ability to detect changes in payment and quality due to larger sample sizes and the recent growth in participation of the initiative, which generally is not reflected in this report.
Read the report here.
RECAP: CMMI Highlights Changes to Accountable Health Communities Collaborative
On September 12, the Center for Medicare and Medicaid Innovation (CMMI) hosted a call with Medicaid Directors to explain recent modifications to Track 1 of its Accountable Health Communities (AHC) Collaborative. Divided into three tracks (Awareness, Assistance, and Alignment), the model is intended to support bridge organizations that are working to increase a patient’s awareness of available community services through screening, information dissemination, and referral. While Medicaid agencies cannot apply/serve as bridge organizations, CMMI clarified that Directors will play a crucial role in various AHC consortia comprised of providers, provider groups, clinical delivery sites, and Medicaid agencies. In doing so, it stipulated that as part of these AHC consortia, Medicaid agencies will be asked to:
  • Provide utilization information (via T-MSIS);
  • Collaborate with relevant bridge organizations on sustainability;
  • Dedicate staff time to for AHC-related services;
  • Report or facilitate the reporting of claims data;
  • Champion appropriate data shares across clinical delivery sites;
  • Provide a point-of-contact for data collection and reporting;
  • Ensure alignment with existing policies; and
  • Perform an annual review to ensure services aren’t duplicated.
Applications will close on November 3rd. For more information on the AHC model, please visit CMMI’s
FAQ or email accountablehealthcommunities@hhs.gov.
HHS Makes Awards to Health Centers for IT Enhancements
Last Thursday, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced more than $87 million in funding for 1,310 health centers in every U.S. state, the District of Columbia, Puerto Rico, the Virgin Islands and the Pacific Basin for IT enhancement. Coming from the Affordable Care Act’s Community Health Center (CHC) Fund (extended in 2015 via MACRA), the funding will support health information technology enhancements to accelerate health centers’ transition to value-based models of care, improve efforts to share and use information to support better decisions, and increase engagement in delivery system transformation.
For more information, click this link.

Hill Update

 

Congress Barrels Towards Short-term Funding Agreement 
Friday marks the end of federal fiscal year 2016 and with it the clock runs out on funding for much of the federal government. Senate Majority Leader Mitch McConnell (R-KY) last week introduced a stopgap funding measure — called a continuing resolution or CR — which would expire December 9. The Senate is scheduled to vote September 27 on the FY 2017 CR, which is attached to pending legislation H.R. 5325. The House of Representatives is expected to take up the measure after the Senate. A full omnibus funding bill is scheduled to be voted on during the lame duck session in December.
 
The measure would provide $1.1 billion to address the Zika virus and additional federal resources focused on the opioid crisis. More specifically, the funding measure includes $17 million for the Department of Health and Human Services (HHS) and $20 million for the Justice Department to start their programs under the Comprehensive Addiction and Recovery Act (CARA) of 2016, signed into law July 22.
House Overwhelmingly Passes H.R. 670, Special Needs Trust Fairness and Medicaid Improvement Act
On September 20, the House of Representatives voted 383 – 22 to pass H.R. 670, the Special Needs Trust Fairness and Medicaid Improvement Act. This legislation also incorporates elements of H.R. 5717, the Medicaid Data and Benefit Improvement Act. The bill features the following provisions:
  • Allows non-elderly disabled individuals to establish supplemental needs trusts for themselves. Assets in these trusts are not counted for purposes of income-based Medicaid eligibility;
  • Extends Medicaid tobacco cessation coverage for pregnant women for one year following the birth of the child;
  • Eliminates federal match for non-medically necessary cosmetic agents or hair-growth drugs in Medicaid; and
  • Allocates $10 million in FFY 2021 and $14 million in FFY 2022 to the Medicaid Improvement Fund, which is intended to support CMS management of the Medicaid program.

 

SFC Republican Letter Calls for HHS OIG to Audit CMS Oversight of Medicaid Drug Benefit
On September 20, Republicans on the Senate Finance Committee (SFC) sent a letter to the Health and Human Services Office of the Inspector General (HHS OIG) calling for an examination of CMS’s oversight of the Medicaid drug rebate program (MDRP). The letter, prompted by the controversy over the pricing of the EpiPen allergy medication by manufacturer Mylan, draws upon points made by NAMD in a memo to Congress on the EpiPen scenario. The SFC letter notes that Mylan’s classification of EpiPen as a generic drug under the MDRP allowed the manufacturer to pay a 13% rebate, rather than the 23.1% rebate required for brand name drugs. Further, the generic classification also exempted Mylan from paying mandatory rebates on price increases that outpace inflation, required for brand name drugs and soon to be required for generic drugs upon implementation of the Bipartisan Budget Act of 2015. SFC notes that Mylan was subject to enforcement action in the past for violations of the terms of the MDRP.

 

Read the letter here.
Bipartisan House Letter Calls for Senate to Consider Mental Health Legislation
On September 22, a bipartisan group of 211 Representatives sent a letter to Senate leadership calling for the chamber’s consideration of H.R. 2646, the Helping Families in Mental Health Crisis Act. The letter reviews the landscape of the nation’s mental health system, noting provider shortages, coverage parity concerns, and linkages between mental health services and the justice system, homelessness, and poverty. It calls on the Senate to pass H.R. 2646 before leaving for their district work periods. The House passed the legislation earlier this year in a near unanimous vote of 422 – 2.

 

All EpiPen, All The Time
Recently lawmakers in both chambers of Congress continued to elevate their respective concerns and outstanding questions stemming from the EpiPen pricing controversy – the latest in a string of high-profile controversies involving the pricing strategies and costs for prescription drugs.

 

House Energy & Commerce Republicans sent a letter on September 12, asking the HHS Office of the Inspector General to investigate CMS’ oversight of the Medicaid Drug Rebate program because of concerns the agency allowed Mylan’s EpiPen to be classified as a generic even though it lacks competition, resulting in lower rebates. The GOP lawmakers say CMS’ response to the misclassification is late and its oversight of the program is poor.

 

The lawmakers write that, “Lax oversight by CMS appears to have resulted in increased program expenditures since the drug manufacturer paid a lower Medicaid generic rebate instead of the higher brand rebate–the latter of which also may have included an additional rebate if prices rose faster than inflation.”

 

The committee asks OIG to identify which staff oversee the program and to review their training on drug pricing and FDA classification of brand and generic drugs. They want requested information on whether CMS correctly relies on FDA’s classification and under what circumstances CMS allows the program to use a different drug classification. The lawmakers also ask OIG to investigate to what extent CMS used existing authorities to enforce policies over the past five years, how often has the agency identified misreported data and whether CMS used civil monetary penalties on drug manufacturers who provided false information. Additionally, the committee asks whether there are drugs in the same situation as EpiPen and how EpiPen’s misclassification affects the 340B program.

 

Meanwhile, the respective House and Senate oversight committees are scheduled to take on the issue. A House hearing scheduled for this week comes after Committee Chairman Jason Chaffetz (R-UT) and Ranking Member Elijah Cummings (D-MD) sent a bipartisan letter to the company requesting documents and communications regarding the increasing price of EpiPen, including documents relating to the company’s revenues from sales of EpiPen since 2007, manufacturing costs, and the amount of money the company receives from federal government health care programs.
FDA Officials Weigh in Amidst EpiPen Uproar
In a new blog post, the head of the Food and Drug Administration’s (FDA) drug evaluation department discussed the agency’s efforts to encourage innovation of new auto-injectors. The commentary comes in advance of an oversight hearing on EpiPen at which an FDA official is scheduled to testify.
The blog states that the FDA will continue to quickly review applications, especially for generics, but that the agency cannot be held accountable for the price of products. The piece notes that although the FDA “doesn’t regulate drug prices,” officials intend to focus on increasing competition as part of the broader effort to drive down costs for EpiPen users. The official wrote that the FDA had already approved four epinephrine auto-injectors to treat anaphylaxis, or severe allergic reaction, and that the alternative products were just as safe as EpiPen to use for treatment.

 

In the News

 

New York Times Reports on Health Home Aides’ Stagnant Wages
Health home aides represent one of the nation’s fastest-growing occupations, increasing from 700,000 to more than 1.4 million over the past decade. This growth is reassuring, given the number of home workers that will be needed to care for our increasingly aging population (analysists at PHI estimate an additional 633,000 workers will be needed by 2024). Yet, the meager wages and benefits the profession affords make it difficult for individuals to remain in the field for extended periods of time. In 2015, home care workers earned just $10.11 an hour (a decrease from 2005), meaning many have been pushed into poverty:  today, about a third of home care-workers receive food stamps, while 28% rely on Medicaid for health insurance. Concerned about these data, many groups have proposed or implemented solutions, including worker-owned cooperatives, registries, union membership, and various venture capital platforms. But the success of these initiatives, as well as the health of our nation’s senior population, relies on a larger prioritization of long-term health.
Read the article here.
NPR Reports on How Doctors Who Treat Opioid Addiction Often See Very Few Patients
Research from the RAND Corporation suggests that that doctors who are qualified to prescribe medication for opioid addiction typically treat just a handful of patients. The researchers also found that most patients weren’t prescribed treatment for very long, even though it can be used long term. For Bradley Stein, a psychiatrist and lead author of the study, the dearth of care for opioid addiction should drive more integrative care models, in which providers offer not only treatment but also mentorship, consultation, and clinical support through traditional and telehealth means.
Read the article here.

 

Modern Healthcare Reports on Michigan’s Alternative Medicaid Expansion
A new audit by the University of Michigan’s Institute for Healthcare Policy and Innovation reveals that Michigan’s alternative approach to Medicaid expansion is showing early signs of success, with 90% of those covered reporting that their insurance is affordable; 70% reporting that they are more likely to contact their doctor’s office before going to the emergency room; and 47.5% reporting that their physical health has improved thanks to coverage. The article juxtaposes Michigan’s success with the shortcomings of Indiana, where half of Medicaid enrollees are sometimes, usually or always worried about being able to make savings account contributions.
Read the article here.

 

Nebraska Medicaid Director to Lead Health Program Consolidation
Calder Lynch, director of Medicaid and Long-Term Care for the Nebraska Department of Human Services, is at the helm of the launch of Nebraska’s new Heritage Health system, set to combine the state’s physical health, behavioral health and pharmacy programs into one comprehensive system for clients. Contracting with three plans (Nebraska Total Care, United Healthcare, and WellCare), the state’s consolidation is intended to reduce administrative burden and enhance access for enrollees – in the words of Lynch, “For our members, it will really simplify things…It’s a step in the right direction.” The changes go into effect on January 1, 2017, at which each member will have the option of keeping the plan they chose or switching within 90 days. After that time frame, an open enrollment period will take place each year.
Read article here.
Boston Business Journal Reports on Massachusetts’s New Tool to Fight the Opioid Epidemic
In late August, Massachusetts launched a roughly $6 million Prescription Drug Monitoring Program (PDMP), intended to prevent prescription drug misuse, diversion, or duplication. Housing patient’s prescription history for Massachusetts pharmacies and out-of-state pharmacies delivering to Massachusetts patients, the tool uses a faster and easier-to-navigate interface to facilitate electronic medical record compatibility and data sharing across Massachusetts, Vermont, Rhode Island, and Connecticut. Going forward, Massachusetts anticipates that the program will receive 70,000 enrollees and soon encompass New York, Maine, and New Hampshire.
Read article here.
CMS Blog Reports that 49 States have Reduced Avoidable Hospital Readmissions
Recently released CMS data suggest that initiatives like the ACA’s Hospital Readmissions Reduction Program and CMS’s  Partnership for Patients have been successful in reducing hospital readmissions, enhancing quality during care delivery and transitions. Chiefly, the data show that since 2010, 49 states have seen Medicare 30-day readmission rates fall; 43 states have seen readmission rates fall by more than 5%; and 11 states have seen readmission rates fall by more than 10%.
Read article here.
Oregon DOJ Announces Settlement with Oracle on Exchange Troubles
On September 15, Oregon Governor Kate Brown and Attorney General Ellen Rosenblum announced a global settlement of the litigation between Oregon and Oracle. The settlement, valued at more than $100 million, includes cash payments to Oregon as well as a six-year Unlimited License Agreement (ULA) for products and services that can be leveraged by the Legislature to significantly modernize state government’s IT systems. According to a release from the state, the agreement also includes $60 million in free customer service support, a $10 million grant for science, technology, engineering and math (STEM) programs in Oregon schools, and $25 million to reimburse Oregon for litigation costs.
Read the press release here.

Take Note

 

Commonwealth Fund Makes the Case for Medicaid’s Value
In a new issue brief, the Commonwealth Fund assesses the multifaceted role Medicaid plays in our healthcare system as the nation’s largest health insurer, providing coverage to nearly 73 million Americans. In doing so, it makes the case for Medicaid’s value, exploring how it:
Provides a comprehensive set of benefits as well as strong financial protections;
  • Meets the complex medical needs of vulnerable patients;
  • Provides critical support to safety-net health providers and systems;
  • Facilitates state-level delivery reform; and
  • Brings vital federal resources to states.
Read the issue brief here.

 

NCQA Releases 2016 – 2017 Health Plan Ratings
The National Center for Quality Assurance (NCQA) recently released the results 1,000 health plan survey evaluating clinical quality, member satisfaction, and NCQA accreditation. Assessing all states and plan types, the report emphasizes care outcomes and how the patients feel about the care they are receiving.
To access the data, click this link.
OIG Reports on Meaningful Use Payments in Three States
The Office of the Inspector General (OIG) at Health and Human Services (HHS) recently released three reports on meaningful use payments in Ohio, Oklahoma, and West Virginia, exploring whether the state agencies made Medicaid electronic health record (EHR) incentive program payments in accordance with federal and state requirements. These programs, according to OIG, may be at greater risk of improper payments than other programs because they are new and have complex requirements.  In Ohio, Oklahoma, and West Virginia, OIG found incorrect payments totaling $526,000, $680,368, and $295,962, respectively. To ameliorate these discrepancies, OIG recommends that the states:
  •  Refund the net overpayments to the Federal Government;
  • Adjust remaining incentive payments to account for incorrect calculations; and
  • Review the calculations for the hospitals/providers not included in the review to determine whether payment adjustments are needed, and refund any overpayments identified.
The links to the reports are as follows:
Ohio, Oklahoma, and West Virginia.
NEW DATA: Census Bureau Annual Survey
Figures from the annual Census Bureau Survey show that about 4 million Americans gained health insurance last year, decreasing the nation’s uninsured rate to 9.1%, the lowest level since before the Great Recession. Although not as high as the increase between 2013 and 2014, these substantial gains were driven primarily by an expansion of coverage among people buying individual policies, rather than getting health benefits through a job. Over the two-year period from 2013 to 2015, the figures additionally reveal that the number of individuals covered by Medicaid expanded by two percentage points; in the 31 states, plus the District of Columbia, that have expanded their Medicaid programs, the Survey found greater improvements in insurance coverage compared with those states that have not expanded the program.
Read the press release here.
SMART-D TOOLKIT: State Options for VBP in MDRP
Last week, the State Medicaid Alternative Reimbursement and Purchasing Test for High-Cost Drugs (SMART-D) released a set of reports, intended to bring clarity to the complicated landscape of drug purchasing for state Medicaid programs and provide alternative payment models (APMs) to help improve patient access to evidence-based therapies while allowing states to predict and manage prescription drug costs. A collaborative effort led by a team from the Center for Evidence-based Policy at the Oregon Health & Science University, SMART-D seeks to map out the landscape of Medicaid drug purchasing; identify alternative payment options for states; work to increase patient access and improve outcomes; identify specific opportunities to collaborate with drug manufacturers; and provide implementation, technical assistance and support to states in three phases. The next phase of the project will culminate in a detailed analysis of how states can assess their level of interest in and readiness for any of the APMs identified in phase one. The final phase will center on providing technical assistance for the implementation of APMs within state Medicaid programs.
Access the SMART-D toolkit here.
AAP Recommendations on MAT for Adolescents with Opioid Use Disorders
In its new report, the American Academy of Pediatrics (AAP) explores how to improve access to effective treatments for opioid use disorders for adolescents and young adults. Specifically, AAP recommends that:
  • Care networks increase resources to improve access to medication-assisted treatment of opioid-addicted adolescents and young adults, encompassing resources for medication-assisted treatment within primary care and access to developmentally appropriate substance use disorder counseling in community settings;
  • Pediatricians consider offering medication-assisted treatment to their adolescent and young adult patients with severe opioid use disorders or discuss referrals to other providers for this service; and
  • Researchers focus on developmentally appropriate treatment of substance use disorders in adolescents and young adults, including primary and secondary prevention, behavioral interventions, and medication treatment.
Read the report here.
New CDC Tools to Support States in Fight against the Opioid Overdose Epidemic
The CDC recently launched two new programs, Prescription Drug Overdose: Data-Driven Prevention Initiative (DDPI) and Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality, to further support states in the fight against the opioid overdose epidemic. Awarding $18 million over a three-year period to 13 states and the District of Colombia, DDPI will help states advance and evaluate their actions to address opioid misuse, abuse, and overdose, increasing state ability to collect data, develop impactful strategies, and work with communities in a more collaborative and effective way. The CDC’s Enhanced State Surveillance efforts, on the other hand, will provide funds to qualifying states to ensure more timely data on fatal and nonfatal opioid overdoses, as well as in-depth information on risk factors. With a collective $12.8 million, the 12 state awardees will use the funding to increase the timeliness of reporting nonfatal and fatal opioid overdose and associated risk factors; disseminate surveillance findings to key stakeholders working to prevent opioid-involved overdoses; and share data with CDC to support improved multi-state surveillance of and response to opioid-involved overdoses.
Related to these new initiatives, CDC is also scaling up efforts for an existing program, the Prescription Drug Overdose: Prevention for States (PfS), to further support states in the fight against the opioid overdose epidemic. As a result of increased funding in 2016, 14 PfS states are now receiving additional dollars in one-year supplemental funding to support their ongoing work.
Find more information here.

New ASTHO Resources on Medicaid & Public Health Partnership

Last week, the Association of State and Territorial Health Officials (ASTHO) released a collection of tools and resources aimed at supporting collaboration between state Medicaid agencies and state departments of public health. NAMD served as a partner to the project. The new resources that are available include:

  • Six state case studies, which highlight innovations in Colorado, Minnesota, New Hampshire, North Carolina, Texas and Vermont
  • A series of issue briefs, which aim to build a baseline knowledge of Medicaid and public health in order to support an informed interagency dialogue; and
  • A resource library of state-specific documents on Medicaid/Public Health partnerships, such as waivers, MOUs and state-issued guidance.
Medicaid agency staff may find these resources useful when exploring new opportunities to partner with your state public health agency. For more information or questions, please contact  Lindsey Browning at NAMD or  Megan Miller at ASTHO.

 

GAO Makes Recommendations to Develop Long-Term Care Workforce
In its new report, GAO examines federal and state data available on the paid direct care workers who deliver LTSS, as well as the actions HRSA has taken to develop information and projections on this workforce. It finds that direct care workers who provide LTSS numbered an estimated 3.27 million in 2014, or 20.8% of the nation’s health workforce; it reveals that wages for these workers are generally low, averaging between approximately $10 and $13 per hour in 2015. While HRSA has developed some information on direct care workers, it has yet to provide projections of this workforce or develop methods to address data limitations. Going forward, GAO recommends that HRSA take steps to produce projections of direct care workforce supply and demand and develop methods to address data limitations in order to do so. HHS concurred with GAO’s recommendation, stating that developing projections for the direct care workforce is timely and important.
Read report here.
RJW Webinar on Using SNAP Information to Facilitate Medicaid Enrollment and Renewal
Recently released CMS guidance and newly established State Plan Amendment authority allows states to use Supplemental Nutrition Assistance Program (SNAP) data, under certain conditions, to enroll and re-determine Medicaid eligibility.  In order to assist states in the facilitation of Medicaid enrollment and renewal for eligible SNAP participants, the Robert Wood Johnson Foundation (RWJ) recently hosted a webinar, presenting some of the necessary considerations for leveraging these data for enrollment purposes.  Developed and presented by the team at Manatt Health, the webinar provided an overview of the federal requirements, identified implementation considerations, including Medicaid/SNAP income and household composition analysis and notice requirements, and facilitated a discussion on how the authority could be leveraged at application and renewal.
Watch webinar here.
FAIR Health Report on Increases in Health Spending Related to Opioid Treatment
A new report shows that from 2011 to 2015, insurers’ payments for patients with a diagnosis of opioid dependence or abuse grew from $32 million to $446 million, constituting a 1,375% increase over just four years. To be sure, this growth in spending is alarming in more ways than one, with the average annual cost for treating opioid-abusive patients standing at $19,933, compared to $3,435 for other patients. The report finds that the surge in spending on patients with an opioid diagnosis is likely the combination of several factors, including increased media attention and increased illegal use of narcotics. It also finds that the bulk of spending for opioid-abuse diagnosis and treatment stems from increased emergency room visits and expensive laboratory tests. The proliferation of such services, the report describes, has generated concerns over profiteering, while offering impetus for more education for providers on when and how much of a given intervention is required.
Read report press release here.
Pediatrics Groups Focus on Access
The American Academy of Pediatrics’ released a new document September 19, “Blueprint for Children: How the Next President Can Build a Foundation for a Healthy Future.” The blueprint is intended to provide a vision for the next presidential administration around improving the lives of children. AAP identifies critical problems with access for pediatric patients, unintended pregnancy, and other key issues. They cite factors that impede access to high-quality care including narrow networks; disparities in the geographic distribution of pediatric providers; coverage exclusions and carve-outs; payment inequities between Medicaid and other public programs; and high out-of-pocket costs including co-pays, deductibles, and co-insurance rates.
According to AAP, payment for services for children covered by Medicaid are significantly lower than payments for the same services for adults in the Medicare program. The group states that this payment inequity threatens the ability of providers to care for an increased number of Medicaid patients. The group recommends the administration improve access to Medicaid services by simplifying eligibility processes, reducing bureaucratic barriers to care, and streamlining enrollment, including through increasing linkages to other programs such as nutrition programs.
Read the report here.

 

Jobs
Medicaid Director Opening in Rhode Island
The Rhode Island Executive Office of Health and Human Services, is seeking a Medicaid Director to perform leadership and executive duties in the planning, coordinating, implementing and directing the Rhode Island Medicaid Program; to collaborate with other State agencies to ensure all publicly financed health care services are integrated and coordinated; and to do related work as required.

The closing date is October 13.
Click here for the full job description and to apply.

 

Washington State Seeking Deputy Chief Financial Officer
The Washington Health Care Authority is seeking a leader with strong management skills, health care rate setting and financial operations experience to fill the position of Deputy CFO.

 

The Deputy Chief Financial Officer (DCFO) serves in a key agency leadership position and is responsible for building and maintaining effective working relationships with the legislative and Office of Financial Management partners.  And as part of this position, the DCFO provides leadership in the development of financial strategies to manage overall financial trend and serves as a key external spokesperson for HCA as it relates to fiscal strategy and performance.  The DCFO directly oversees and is the decision maker for three key financial functions:
  • Procurement and rate setting for Medicaid and Public Employees Benefits (PEB).
  • Hospital Finance and Drug Rebates.
  • Federally Qualified Health Centers/Rural Health Clinics/Employer Sponsored Insurance (ESI).
See full posting and application:
Deputy Chief Financial Officer

 

 

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