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In this weeks newsletter are Fall Meeting materials; Issue Brief on Integrated ACO for Duals; 2017 Medicare Part B Premiums; LTSS Reports.

NAMD Update

November 15, 2016
From the NAMD Desk
NAMD’s 2016 Fall Meeting
Thank you to all who joined us for last week’s 2016 Fall Meeting – our most highly attended conference to date! Your participation fostered informative exploration into some of the most critical components of the Medicaid program. We hope you found great value in the meeting content and networking with your peers.


All presentation materials from the public sessions are available at this link. C-SPAN coverage of two of the meeting’s plenaries (“Future of Medicaid” with Dr. Ian Morrison, and “Changes in Medicaid” with Vikki Wachino) can be found here.


New NAMD Issue Brief Explores Concept of Integrated ACO for Duals
Last week,NAMD released a new issue brief, with support from The Commonwealth Fund, that explores the concept of an integrated Medicare and Medicaid ACO model for dually eligible beneficiaries. The resource underscores how a Medicare/Medicaid ACO for duals could add to the menu of innovative models for states to improve care for this complex population. The issue brief outlines key issues federal policymakers would need to consider should they pursue such a model, including:
  • Importance of state partnership in the design and implementation of an integrated ACO for dually eligible beneficiaries;
  • Availability of close-to-real-time, person-level integrated Medicare and Medicaid data for states;
  • The alignment of quality measures and measure reporting strategies between Medicare and Medicaid;
  • The heterogeneity of the dually eligible population; and
  • State infrastructure and capacity needs to implement and oversee this type of program.
In This Issue

Reg Update


Medicaid Now on Twitter!
As of November 7, CMS is sharing Medicaid information on Twitter. You can view the account and communicate with CMS via this social media platform by viewing or tweeting @MedicaidGov.


2017 Medicare Part B Premiums Announced
On November 10, CMS finalized 2017 premium and deductible increases for Medicare Part B. In making the final determination, HHS exercised its statutory authority to somewhat mitigate the impact on the 30% of Part B beneficiaries not protected by the “hold harmless” provision, which caps increases to the increase in the Social Security cost of living adjustment (COLA). The 2017 Part B premiums for these beneficiaries, including the dually eligible Medicare-Medicaid beneficiaries whose premiums are paid by state Medicaid programs, will be
$134, which is a 10 percent increase from 2016. While these increases are not as severe as those estimated in the 2016 Medicare Trustees Report, states will still be significantly impacted by the 2017 Part B premiums.


CMS Publishes FAQs on Managed Care Rule
On November 10, the Centers for Medicare and Medicaid Services (CMS) published a Frequently Asked Questions (FAQ) document on the final Medicaid managed care rule. The FAQ clarifies certain aspects of the rule related to contract timelines, rate setting in specific rate cells, availability of federal financial participation for external quality review, levels of internal appeal in plans and the state fair hearings process, and other areas.
Notably, the FAQ indicates that states may request rating periods above or below 12 months. States may request a different rating period and provide documentation in support of the altered period as part of their rate certification submissions outlined in Section 438.7 of the rule.


Read the FAQs here.
HHS OIG FY2017 Work Plan Outlines New Medicaid Areas of Focus
The Department of Health and Human Services Office of the Inspector General (HHS OIG) recently released its
work plan for FY 2017. This work plan outlines the oversight activities OIG plans to undertake related to Medicaid in the coming year, including new reviews of the following:
  • States’ MCO Medicaid drug claims
  • Data brief on fraud in Medicaid personal care services
  • Delivery system reform incentive payments
  • Accountable care in Medicaid, including compliance of new models with state and federal requirements
  • Third-party liability payment collections in Medicaid
  • Medicaid overpayment reporting and collections
  • Overview of states’ risk assignments for Medicaid-only provider types
  • Health-care related taxes: Medicaid MCO compliance and hold-harmless requirements
  • Review of Medicaid managed care organizations’ non-payment for hospital-acquired conditions
The work plan also discusses the numerous ongoing Medicaid-related reviews of the OIG, such as around prescription drugs, home health services, and transportation.


2017 Medicare Part D Clawback to be Largest to Date; Cost States Over $11 Billion
On October 28, the Centers for Medicare and Medicaid Services (CMS) announced the Medicare Part D cost-sharing payments states must make in 2017. The 2017 payments total over $11 billion, an increase of $1.1 billion from last year and a 11.93% increase overall. This is the second consecutive year of double-digit Part D clawback growth and the largest clawback payment required since Part D’s inception in 2006. Federal Funds Information for States (FFIS) estimates state-specific increases ranging from 5% to over 15%.


CMS Issues Update to MDRP Rebate Agreement
On November 9, the Centers for Medicare and Medicaid Services (CMS) issued a program notice updating the drug rebate agreement between the U.S. Department of Health and Human Services (HHS) and drug manufacturers which governs participation in the Medicaid drug rebate program (MDRP). This notice is the first time the MDRP agreement has been updated since 1991, and thus reflects a variety of legislative, regulatory, and technical changes instituted over the past 25 years.


Comments on the updated rebate agreement are required by February 7, 2017. Once finalized, all current manufacturers participating in the MDRP will be required to sign updated agreements.


View the notice here.
CMS Announces $66 Million Funding Opportunity for Zika-Affected Areas
On November 9, the Centers for Medicare and Medicaid Services (CMS) announced the availability of $66.1 million in federal funds to support Zika virus prevention and treatment activities. This funding is available to states and territories that the Centers for Disease Control and Prevention has confirmed as having active Zika transmission. The U.S. Virgin Islands, Puerto Rico, American Samoa, and Florida are eligible for these funds, which were made available under the Zika Response and Preparedness Act passed by Congress earlier this year.


CMS Acting Administrator Comments on Drug Pricing
Addressing the Biopharma Congress last week in Washington, D.C., CMS Acting Administrator Andy Slavitt laid out a path to address pharmaceutical innovation, access, and affordability for the those covered through Medicare, Medicaid, CHIP, and the Marketplaces. He offered five strategies through which CMS and innovators could collaborate to develop new products, facilitate market access, and expedite the affordability of drugs for patients as quickly as possible:
  1. Simplify the path to market for new discoveries in the areas of prevention, diagnosis, and treatment while also taking steps to leverage existing clinical research;
  2. Support clinical trials by covering costs for Medicare beneficiaries;
  3. Shorten the wait for innovative products by creating a single front door to research safety, efficacy, coverage, and pricing – with appropriate firewalls and safeguards;
  4. Maintain affordability while pushing for innovation; and
  5. Release data whenever possible to help develop real-world evidence to show improved health outcomes from pharmaceutical products.
Read the remarks  here.
CMS Publishes Series of Long-Term Services and Supports (LTSS) Reports
Recently, CMS published three reports exploring various aspects of Medicaid long-term services and supports.
They include:
  • Medicaid Long-Term Services and Supports Beneficiaries in 2012: Now in its third iteration, this report reveals that over 4.8 million people received Medicaid-funded LTSS during calendar year 2012, the vast majority of whom (70%) received home and community-based services (HCBS), including people who also received institutional services during the year. Most beneficiaries were under age 65, including both children and youth under age 21 (16%) and people age 21 through 64 (39%). Sixteen states provided LTSS through managed care programs (link).
  • Medicaid Expenditures for Section 1915(c) Waiver Programs in FY 2014: In FY 2014, $41.5 billion in federal and state dollars was spent on Section 1915(c) waivers, a critical financing source for HCBS. Encompassing an array of services (i.e., case management, residential and day habilitation, supported employment, personal care, etc.), HCBS target people with developmental disabilities, people with brain injuries, medically fragile children, people living with HIV/AIDS, and people with serious mental illness or serious emotional disturbance. The percentage of total waiver spending for these target groups remained virtually unchanged from FY 2013 to FY 2014 (link).
  • Medicaid 1915(c) Waiver Data based on the CMS 372 Report, 2012 – 2013: Presenting information from the CMS 372 reports, this assessment shows that over 1.53 million people received Section 1915(c) waiver services in 2013, a 3.8% increase from 2012. On average, $26,478 in waiver expenditures was spent per person, a slight increase from 2012, for a little over 10 months of the year. People with developmental disabilities collectively accounted for $28.5 billion (70%) of all 1915(c) waiver expenditures, reflecting higher average costs per participant for this population. Most of the remaining spending (28%) was for older adults and/or people with physical disabilities ($11.3 billion) (link).
CMS Publishes Medicare Outpatient Payment Rule, Addresses Opioid Issues
On November 1, CMS issued a rule finalizing its annual Medicare outpatient prospective payment system (OPPS) update for calendar year 2017. Certain provisions of the final rule related to opioid prescribing and addiction may be of interest for Medicaid Directors, particularly:
  • A modification to the Medicare hospital value-based purchasing (VBP) program. This update  removes the Pain Management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for purposes of the VBP program. This change is intended to remove a potential incentive for the overprescribing of opioid pain medications. CMS is continuing to develop alternative questions around the relationship between provider communications to patients and pain management. Until the alternative measures are developed, the existing pain management measure will continue to be publicly reported.
  • Electronic clinical quality measure on opioid overdose risk. In the rule, CMS indicates that it is continuing its work, informed by public comment, to develop an electronic clinical quality measure to identify patients at high risk for opioid overdose due to other health conditions.
View the rule here.
CMS Interim Final Rule Delays Application of Outpatient Drug Rule to Territories
On November 14, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule modifying provisions of the covered outpatient drug rule affecting its applicability to the territories. Specifically, CMS is modifying the definition of “the states” and “United States” in the rule to delay the inclusion of the territories in the definition until April 1, 2020, rather than April 1, 2017 as initially finalized. This change takes effect on November 15, 2016 and will be open for comment for 60 days.


Read the interim final rule here.

Hill Update


Republicans Retain Control of Congress; Lame Duck Session Focused on Funding and Drug Innovation
Election Day delivered a largely unexpected result, as Donald Trump defeated Hillary Clinton for the presidency. Republicans also maintained control of the House and Senate. As Washington prepares for the change in Administration, Congress remains focused on two key issues in the lame duck session:  first, continued funding of the federal government, currently set to expire in early December; and second, advancing drug innovation legislation. The House-passed 21st Century Cures legislation has yet to be reconciled with the Senate’s own drug innovation efforts, though both Speaker of the House Paul Ryan and Senate Majority Leader Mitch McConnell have indicated they remain committed to passing legislation this year.

In the News


National Public Radio Reports on Mississippi Court Blocking CMS Nursing Home Rule
A federal district court in Mississippi has issued an injunction blocking CMS’s new Nursing Home Rule, which would preserve the right of patients and their families to sue nursing homes over quality-of-care disputes, thereby banning pre-dispute binding-arbitration clauses in nursing home contracts. In doing so, the Mississippi court has ruled in favor of the American Health Care Association (AHCA), which filed a lawsuit in October to block the rule, calling it “arbitrary and capricious.” The court argued that the CMS rule constitutes an “incremental creep of federal agency authority,” exceeding “that envisioned by the U.S. Constitution.”


Please find the article here.


Modern Healthcare Covers CMS approval of Massachusetts’s New 1115 Waiver
Last week, CMS approved a waiver that will enable Massachusetts to place its entire Medicaid population into accountable care organizations (ACOs). Starting in July 2017, the five-year waiver authorizes $52.4 billion and will generate $29.2 billion of federal revenue for the state. With a focus on complex populations, it will enable the state to use federal funds to expand residential rehabilitation service programs, as well as care-coordination and services for beneficiaries with substance abuse disorders (SUDs). The waiver will also continue Massachusetts’s hospital pool for uninsured individuals, totaling $4.8 billion over five years. As it promotes coordinated care, provider accountability, and expanded access for SUD services, the waiver, in the words of Republican Governor Charlie Baker, “is the first major overhaul of the MassHealth program in 20 years.”


Please find the article here.


Colorado Medicaid Reports on State’s Accountable Care Collaborative (ACC) Savings
Colorado’s Department of Health Care Policy and Financing has announced that its Accountable Care Collaborative (ACC) program has accounted for $490 million in gross savings and $139 million in net savings since FY 2011-2012, saving $205 million in avoided medical costs during state FY 2015-2016 alone. The ACC makes incentive payments to providers for meeting enhanced primary care standards, such as co-locating physical and behavioral health services or offering care after hours. In doing so, it seeks to promote preventive care. The report found that ACC members who were enrolled for 7-11 months, for example, had a lower rate of emergency room visits than those in the program for 6 months or less. These reforms, says Colorado Medicaid Director Gretchen Hammer, make Colorado “a national example of reform” for other states. In her words, “The program makes smarter use of every dollar spent while strengthening health care and community services across the state.”


Please find the press release here.

Take Note


Virginia Launches Addiction Recovery Website
Borne from its Task Force on Prescription Drug and Heroin Abuse, convened by Governor Terry McAuliffe in 2014, Virginia’s newly launched online tool,
VaAware, provides information on treatment for those struggling with addiction, access to resources, and the opioid crisis more generally. It also includes information for providers on prescribing, pain management, addiction, and continuing education opportunities, as well a section on the role of law enforcement agencies in responding to overdoses.


Please find link to the online tool here.


New ICRC Brief on State Contracting with Medicare Advantage D-SNPs
In this brief, the Integrated Care Resource Center (ICRC) analyzes Dual Eligible Special Needs Plan (D-SNP) contracts in 13 states, including states that have made the most extensive use of D-SNP contracting by linking D-SNPs to Medicaid managed long-term services and supports (LTSS) programs. In doing so, it explores how these states have developed these D-SNP-LTSS linkages, describing the specific care coordination and information-sharing requirements that the states have included in their D-SNP contracts. Going forward, this brief can provide guidance for states that have varying opportunities and resources for D-SNP contracting.


Read the issue brief here.

NAMD has Opening for Deputy Executive Director 
The Deputy Executive Director is a new position that consolidates the responsibilities of previously separate state and federal policy positions. The new position is responsible for managing workflow across a broad spectrum of association activity and ensuring that both traditional and emerging priorities are being appropriately supported. Successful applicants will be able to effectively translate the association’s policy, operational and strategic goals into action. State Medicaid agency and/or state-based association experience a plus. This position supervises direct reports on the policy staff.

To see full posting and to apply, click here.


Vermont Seeking Medicaid Medical Director
The Department of Vermont Health Access (DVHA) is currently recruiting for a Medicaid Medical Director to report directly to the Deputy Commissioner for the Health Services and Managed Care Unit.


This position will be responsible for clinical aspects of benefit administration and health care improvement, providing medical expertise to the health system, quality improvement and provider relations.  The MMD provides leadership and oversight for the Drug Utilization Review Board and Medicaid Pharmacy benefit in partnership with board members and the Pharmacy Director.  The MMD has the capacity to collaborate with and oversee clinical activities within Medicaid and work collaboratively across the Agency of Human Services Departments in the interest of improving clinical programs while identifying effective and efficient ways to continually improve services and focus on the Triple Aim; Improving the patient experience of care, including quality and satisfaction, Improving the health of populations, and reducing the per capita cost of health care.


Qualified candidates must possess an M.D. or a D.O. with an active Vermont medical license in good standing.  Position requires at least five (5) years of clinical experience, three (3) of which must have involved leadership and management experience in the health care industry.


This position is open until filled. All letters of interest and accompanying resume/cv should be sent to: For questions or to receive a copy of the full job description please call Amy directly at (802) 241-0147.


Associate Director of Medicaid & Medicare at UI
The University of Illinois seeks an Associate Director of Medicaid & Medicare Policy Coordination. this position is responsible for directing policy analysis and compliance requirements for the Office of Medicaid Innovation (OMI). This includes coordinating the policy, administrative and research needs of the Department of Healthcare and Family Services (HFS) and staying on top of changes in federal and state Medicaid and Medicare policy, legislation and rulemaking; assisting HFS in responding to federal rulemaking and advising on state rulemaking and legislation as needed; and acting as a central resource for advising University of Illinois staff regarding the federal policy and legal requirements applicable to Medicaid and Medicare.


See full posting  here.


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