Fall Conference agenda, New job postings, Right to sue state Medicaid and more

Post date: 
October 11, 2011
From the NAMD Desk
New at NAMD-us.org
Regulatory News
Hill Update
In the News
Other Items of Interest
Mark Your Calendar
From the NAMD Desk [back to top]
  • NAMD Fall Conference agenda details released. On November 7-9, the NAMD Fall Conference will be convened in Washington, DC. All state Medicaid Directors and appropriate agency staff are invited to attend NAMD’s all-state meeting, November 7th. Individuals and organizations interested in the latest operational and policy developments in the Medicaid program are invited to attend the public meeting, which kicks off with a reception the evening of November 7th. A breakfast with current and former Medicaid directors is scheduled for November 8th. In addition to a wealth of state presentations, several officials from the U.S. Department of Health and Human Services will highlight important initiatives underway and congressional staff will discuss the outlook for legislative action. The draft agenda is posted online at: https://custom.cvent.com/7E4FC58CE40643FF9BB17C52411311BB/files/8f951eae21f24e3095578ea025b7eef7.pdf
New at www.NAMD-us.org [back to top]
Regulatory News [back to top]
  • IOM releases EHB report. The Institute of Medicine (IOM) issued its long-awaited report with recommendations to HHS concerning the essential health benefits (EHB) package. The report recommends methodologies to determining the EHB package, not specific benefits themselves. The following are some of the panel’s key recommendations to HHS:
    • The panel stressed the need to ensure affordability of coverage, and recommended setting a cost target based on the projected national average premium of typical small employer plans in 2014.
    • Define “typical employer plan” as the type of coverage commonly provided by small employers and peg the EHB package to this typical plan.
    • Do not require coverage of new treatments unless they show “meaningful improvement in outcomes over current effective services.”
    • State-mandated benefits should not automatically be included in the EHB, but should be subject to review. HHS should encourage state innovation by providing flexibility in defining the contents in the EHB.
    • Update the EHB package annually, beginning in 2016, and establish a National Benefits Advisory Council to help inform this process.
The report includes a section titled “State flexibility” and recommends criteria for approving a state-specific EHB definition. According to the committee, the HHS Secretary has the authority and should approve state-specific EHB definitions that allow states to make their own social value prioritizations and deviate from the federal standard definition of essential health benefits. The panel’s recommendation focuses solely on guidance for when the Secretary should consider such state-specific variations. The panel recommended the following criteria for federal approval of state-specific EHB definitions:
  • Consistency of process and standards between the federal and any state process used to develop the EHB.
  • State-specific EHB definitions should provide coverage that is actuarially equivalent to the national package, and not significantly higher nor lower. The state-based process should allow for a different set of social values to emerge regarding covered benefits, but the overall actuarial make of that coverage locally should be equivalent to that provided under the federal EHB definition. The report suggests that states that can more efficiently offer additional benefits by becoming more evidence-based and value-promoting within the premium target should be encouraged to do so.
  • The state would have to update the package at least every two years, and should focus on becoming more specific, evidence-based, and value-promoting.
  • HHS should have the authority to end any state-specific EHB definitions not compliant with federal law.
  • HHS standards for a state-based process should encourage state-level innovation in the way those standards are met and require an evaluation plan to document outcomes.
The full report is available online at: http://iom.edu/Reports/2011/Essential-Health-Benefits-Balancing-Coverage-and-Cost.aspx
  • HHS discusses release of contracts for federal exchange. Although no official announcement was made, last week Politico reported on HHS’ release of several contracts to support the development of the "federally facilitated insurance exchange."  The contracts are for the production of IT systems or design options for the federal exchange in states opting out of a state-run exchange.
    • CGI Federal Inc., will build and "host" the IT infrastructure for the federal exchange, including consumer website, plan enrollment, and other functions.
    • Booz Allan Hamilton was awarded three policy development contracts to provide HHS with options and design elements for:
      1. Consumer eligibility appeals process;
      2. Plan certification and oversight; and
      3. Design of an eligibility and enrollment strategy.
    • Also announced was the contract for the construction of the federal verification hub (data services for Medicaid/exchange eligibility).  This 5-year contract was awarded to Quality Software Services, Inc., to build and maintain the hub.
It will be important for states, particularly Medicaid programs, to have a say in the IT design and policy approaches developed through these contracts.  NAMD is seeking ways to facilitate state interaction and input with these contractors. 
Hill update [back to top]
  • Supercommittee keeps close hold on deliberations. The supercommittee continued meeting behind closed doors last week though it was unclear what if any progress was being made. Few details have been released about their private meetings aside from committee members reporting that all options remain on the table. However, according to various media outlets, lawmakers, aides and lobbyists are growing increasingly skeptical about the scope and content of the panel’s recommendations. At the moment, the committee appears to remain deadlocked over considering new taxes and a spending-reduction only plan. While the committee must report out its recommendations by November 23rd, Congress is not expected to vote on any of the proposals until after the November deadline. In Washington terms, particularly given the events of earlier this year, this still seems to leave plenty of time to cut a deal or perhaps amend the target.


In the News [back to top]
  • Stateline article focuses on provider tax proposals. A Stateline story, “Medicaid explained: How would lower provider taxes affect state budgets?” offered insights into health care provider taxes and recent proposals to limit their use in funding the state share of Medicaid: http://stateline.org/live/details/story?contentId=604805
  • NAMD contests claims in new report on duals. Last week, the Robert Wood Johnson Foundation released a report prepared by the Urban Institute that suggests that states lack experience in managing dual eligibles’ medical care, and face continued incentives to substitute federal Medicare for state Medicaid spending, in order to control their expenditures. The authors recommend Medicare take greater responsibility for care of the duals. In an interview with Inside Health Policy, NAMD’s Director Matt Salo said there are a lot of opportunities for Medicare to change what it is doing but the notion that increasing state responsibilities would risk duals' care is one that “frankly, I find offensive,” especially because Medicaid programs have been trying to provide better care to duals against Medicare's “vehement opposition.” He went on to say, “We've been trying to improve the care for this group for decades,” and added that while states do not necessarily have to take the lead in improving duals' care, both programs need to be at the table.
NAMD comments on Medicaid case before the Supreme Court. On October 3rd, the Supreme Court heard oral arguments in Douglas v. Independent Living Center of Southern California. The case rests on whether patients and providers have standing in federal court when a state cuts its Medicaid reimbursement rates. NAMD’s Director Matt Salo told National Public Radio’s Marketplace Morning Reporter Nancy Marshall Genzer that if Medicaid providers are allowed to sue, they will choke the courts with lawsuits, “[and] it will drag every state into prolonged litigation that they can't afford to fight.” See: http://marketplace.publicradio.org/display/web/2011/10/03/am-medicaid-issue-reaches-supreme-court/#.TopE_8cfxAM.facebook
Similarly, NAMD’s Andrea Maresca told Inside Health Policy that every state is closely watching the lawsuit because if states lose it will major consequences for their budgets, “There are enormous stakes for the decision. Maybe it’s time to evaluate the processes for determining what states need to obtain federal approval for.”


Other Items of Interest [back to top]


  • AHIP releases paper with proposals for dually eligible population. AHIP, the trade association for health plans, recently released a proposed roadmap to care improvement for dual eligibles. In “AHIP Proposal: Achieving Medicare/Medicaid Integration for Dually Eligible Beneficiaries,” AHIP groups six models into three alternative approaches suited to states with varying readiness for integration, which they believe will promote widespread progress toward integrating the Medicare/Medicaid programs for dually eligible beneficiaries. In order to accelerate integration, AHIP called on CMS to create templates for the models, provide flexibility for states to design building blocks that respond to their unique circumstances within a specified framework, establish an expedited process for states to implement the options reflected in the templates.
  • Supreme Court hears case on individuals’ right to sue state Medicaid. On October 3rd, the Supreme Court heard oral arguments in the case Douglas v. Independent Living Center of Southern California, Inc., et al. According to the account from the Associated Press, Chief Justice John Roberts appeared skeptical of the providers’ claims, stating that the legislature “intended to deprive [providers] of the right to sue under the statute.” The AP reported that Justice Elena Kagan took the other side, accusing California of evading federal law. Documents for the case are posted at: http://www.supremecourt.gov/Search.aspx?FileName=/docketfiles/09-958.htm
Mark Your Calendar [back to top]
  • NAMD Fall Conference, November 7 (state-only day) and November 8-9 (open meeting): http://www.cvent.com/d/9dqhpx
    • November 7th: Welcome Reception
    • November 8th: Medicaid Director Breakfast with Alumni Directors

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