NAMD President moves to Arkansas; Regulatory News; Hill News
From the NAMD Desk
NAMD President to take reigns in Arkansas.As many of you have heard by now, NAMD President Andy Allison has announced his plans to step down from his position in the Kansas Department of Health and Environment later this month. While this will clearly be a loss to the state of Kansas and everyone who has worked with him in the past, it will also represent an important gain for the state of Arkansas, where Andy will step up to fill the currently vacant Medicaid director slot, effective December 5. We are pleased to confirm that Andy's role as NAMD President will transfer along with him to Arkansas. Please don't hesitate to contact Matt Salo with any questions you may have. For more information on Mr. Allison's transition see: http://arkansasnews.com/2011/11/14/dhs-hires-new-state-medicaid-director/
NAMD announces Spring state-only meeting dates. We are pleased to announce NAMD will hold its annual state-only Spring meeting from May 20-22nd, at the Crystal City Gateway Marriott, Arlington, VA. This meeting is an invitation-only meeting for Medicaid directors and their senior staff.
New at medicaiddirectors.org
Pilot states announced for FMAP and MAGI conversion project. CMS recently notified NAMD of the selections for ten "study states" and ten "alternate study states" for the RAND FMAP and income conversion study, as listed below.
- Study states: Arizona, California, Indiana, Nebraska, New Hampshire, New York, Oregon, Tennessee, Virginia, and West Virginia
- Alternates: Colorado, District of Columbia, Iowa, North Dakota, Michigan, Minnesota, Missouri, South Carolina, Vermont, and Oklahoma
The study is scheduled to occur over a six-month period. Technical assistance to non-study states is scheduled to begin around May 2012. NAMD is planning to assist with sharing key information with other states along the way.
MITA 3.0 draft released. On November 17, CMS released a draft of MITA 3.0. This version involves a number of changes to reflect differences in operations and scope of IT since the release of 2.0 version in 2006. Part I includes a business process crosswalk between 2.0 and 3.0, and CMS also pointed out enhancements to the State Self-Assessment tool.
Comments on the draft must be submitted via an online survey tool, fittingly, by December 16th. Each of the sections has a URL for review and comment, as described below. The various documents can be reviewed online, or downloaded for later review. This online process is the only means of reviewing the draft standards and guidance.
Front Matter: including the Introduction. http://fs21.formsite.com/CMSmita/form24/form_login.html
Part I-Business Architecture: including a maturity model, business capacity matrix and a detailed crosswalk of 3.0 changes from the previous version. http://fs21.formsite.com/CMSmita/form20/form_login.html
Part II- Information Architecture including a new Information Capability Matrix.http://fs21.formsite.com/CMSmita/form21/form_login.html
Part III- Technical Architecture including a new Technical Capability Matrix. http://fs21.formsite.com/CMSmita/form22/form_login.html
State Self-Assessment-including enhanced tools and guidance for the assessment process.http://fs21.formsite.com/CMSmita/form23/form_login.html
CMS delays ICD-10/5010 enforcement. CMS announced a delay in enforcement action for HIPPA covered entities for compliance with ICD-10/5010 standards [the ASC X12 Version 5010, NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards]. Although the effective date of January 1, 2012 has not been changed, CMS’ Office of E-Health Standards and Services (OESS) said it would not take enforcement actions prior to March 31, 2012. The OESS will continue to collect complaints during this discretionary period, and encouraged all HIPPA entities to continue to work with trading partners to move toward compliance. OESS made the decision to delay enforcement action due to industry feedback that the remaining 45 days were inadequate for the majority of trading partners to complete conversion and conduct necessary compliance checks. Many covered entities are still awaiting software upgrades as well. Links to information on Version 5010, NCPDP D.0 and NCPDP 3.0 are available at www.cms.gov/ICD10
VA, TX and TN testify at MACPAC meeting, panel members highlight NAMD paper. Last week the Medicaid and CHIP Payment and Access Committee (MACPAC) convened to discuss some of the major topics of its planned March 2012 report. MACPAC Director Lu Zawistowich has again asked the NAMD Board members to review the chapters of this report, which are likely to be drafted by February.
During the first day of MACPAC’s November meeting, several Commissioners publicly referenced NAMD’s latest paper, “Creating a Climate for Innovation.” Commissioners sought to use some of the issues raised in NAMD’s paper to frame the panel’s work. Commissioner Sara Rosenbaum seemed to reiterate NAMD’s call for the Center for Medicare and Medicaid Innovation (CMMI) to focus more on rapid cycle improvements with duals and Medicaid and diffuse this information. Throughout the day, however, commissioners also struggled at times with the appropriate recommendations for what data CMS should require states to submit and request – what data was valuable at a national level – versus what data is more valuable for state-level analysis only.
Dr. William Hazel, Secretary of Virginia’s Department of Health and Human Services, testified on a panel about program integrity. He noted that while the Payment Error Rate Measurement Program (PERM) has value, the current PERM approach for identifying errors in the eligibility determination process raises many concerns for states. Dr. Hazel discussed challenges with the Medicaid Integrity Contractor (MIC) program, which utilizes contractors that are not typically familiar with each state’s Medicaid program, Recovery Audit Contractors (RACs), and different program integrity challenges that occur in managed care programs. He also sang the praises of the Medicaid Integrity Institute. Dr. Hazel told Commission members that there was no “pot of gold” with fraud and abuse initiatives. Testimony by Angel Brice-Smith, CMS’ Director of the Medicaid Integrity Group, focused on the work of the MIG division, the intent to increase utilization of predictive analytics in partnership with states, and MIG’s relative lack of resources given the size of the Medicaid program.
As part of the MACPAC panels on Medicaid financing issues, Texas Medicaid Director Billy Millwee discussed his state’s pending waiver submission, which would shift more of the state’s Medicaid enrollees into a managed care program. In addition, Mr. Millwee focused on Upper Payment Limits (UPL) in managed care and the distribution of the state’s Disproportionate Share Hospital (DSH) funding and how it proposes to make UPLs and DSH more rational funding mechanisms under the proposed waiver program. Mr. Millwee stated that a decision is expected on the state’s waiver by Thanksgiving.
Tennessee’s Medicaid Director Darin Gordon and the state’s Chief of Long Term Care, Patti Killingsworth, testified about the state’s experience serving the Medicaid population in managed care. State officials provided a historical account of the state’s storied program. In fact, Tennessee officials garnered praise for the significant shift that has made the program a model other states seek to emulate in many ways, including in TennCare’s relatively rapid “rebalancing” of its long-term care program and high satisfaction marks from enrollees. State officials stressed that other Medicaid programs embarking on managed care initiatives should allow for meaningful stakeholder input, sufficient time for implementation phase-in, clear and specific expectations of managed care organization, and monitoring that allows for relatively rapid adjustment if problems are identified. In addition, they cautioned Commissioners that states need the flexibility to adapt successful models to reflect unique state characteristics and needs. Mr. Gordon and Ms. Killingsworth also urged caution as some states move rapidly to implement managed care, saying they want to make sure that any potential problems with managed care in one state do not undermine the fact that managed care has proven to be a successful model.
Presentations from the MACPAC meeting are available at: http://www.macpac.gov/home/meetings
HRSA-CMS 340B webinar for Medicaid agencies. On December 8, 2011 from 2:00 – 3:00 ET, the Health Resources and Services Administration (HRSA) and the Centers for Medicare & Medicaid Services (CMS) will host a webinar to provide information to state Medicaid agencies regarding the 340B Drug Pricing Program. The intended audience is Medicaid pharmacy administrators. The webinar will include a focus on preventing duplicate discounts under the 340B and Medicaid programs. The invitation will also be extended to covered entities and drug manufacturers participating in the 340B Program.
Duals data information. CMS’ Medicare and Medicaid Coordination recently shared information regarding Medicare data sharing activities with Medicaid agencies. To date, 22 states have expressed interest in obtaining timely Medicare data. Of those 22 states, CMS reports that:
11 states were/are actively seeking timely Medicare Parts A/B data
14 states were/are actively seeking timely Medicare Part D data
Heads up Express Lane states. HHS’ Assistant Secretary for Planning and Evaluation (ASPE) has contracted with Mathematica to perform the congressionally-mandated evaluation of the Express Lane Eligibility (ELE) provision of CHIPRA. The first task is for Mathematica to collect ELE enrollment and cost data from the six ELE states with an approved SPA as of December 2010: LA, AL, IA, MD, NJ, OR.
Let the blame games begin. Tonight is essentially the deadline for the Joint Select Committee on Deficit Reduction to make its recommendations to the full Congress. The Supercommittee must submit its recommendations by midnight tonight to meet its 48-hour public notice requirement. It is now widely expected that the panel will fail to issue any recommendations, thereby missing an opportunity to advance legislation by a simple majority vote and without amendments.
According to the Budget Control Act, the failure to report at least $1.2 trillion will result in across-the-board spending cuts sufficient to bring total savings to $1.2 trillion, beginning on January 1st, 2013. The cuts are supposed to be split equally between defense and non-defense and would exempt Social Security and low-income programs, Medicaid, and limit Medicare cuts to two percent. However, evidence of the Supercommittee gridlock has been accompanied by speculation that the January 1, 2013, date still leaves plenty of time for Congress to reverse course and alter some or all of how the cuts would be structured.
SSI glitch bill passes. Last week, the House approved (422-0) a bill to reverse certain rules for determing Medicaid eligibility that are scheduled to take effect in 2014. Changes made by the Affordable Care Act call for calculating eligibility for Medicaid without counting the Social Security benefits of early retirees as income. This is a change from the current eligibility criteria for Medicaid, which does consider Social Security benefits when determining if people qualify. The so-call SSI "glitch fix" was included as part of a bill to repeal an unpopular 3 percent withholding requirement for government contractors, which the Senate passed last week. The Congressional Budget Office (CBO) analysis that accompanied H.R. 674 estimated 10-year savings for the federal government at approximately $7 billion but did not address state savings. The CBO estimate is posted at: http://www.cbo.gov/ftpdocs/125xx/doc12549/SA927toHR674.pdf
In the News
WV director alerts state officials to upcoming costs. West Virginia's Register-Herald, quoted the state's Medicaid Director Nancy Atkins during a recent legislative hearing. According to reporter Mannix Orterfield, West Virginia lawmakers should expect a request for a major influx of cash when they meet in January to keep Medicaid operating with more residents coming under its coverage. Ms. Atkins told legislators that one difficulty lies in a reduced match rate in federal money, noting it was 82 percent last year and now has dropped to 70 percent. She reportedly said that as more people come under the Medicaid umbrella, costs naturally go up and went on to say, "Most growth is in the aged and disabled population, which is our most expensive population." See: http://www.register-herald.com/todaysfrontpage/x1938315545/Commissioner-says-rise-in-Medicaid-costs-projected-for-state
CMS raises concerns about TN's "bridge" proposal. The trade publication InsideHealthPolicy reports that federal officials are expressing resistance to Tennessee's proposal to allow Medicaid managed care plans to offer certain people limited-enrollment plans in the state's exchange. According to the article, Tennessee Medicaid Director Darin Gordon reportedly said that the state is not trying to seek a Medicaid waiver to pursue the so-called Medicaid bridge option. Instead, the state wants CMS' Center for Consumer Information and Insurance Oversight to clarify that within the health reform law the state has the authority to have such a plan option. The proposal is intended to address "churn" between Medicaid and the Exchange. ("Tennessee Crafts 'Bridge' To Address Churn Between Medicaid, Exchange" November 21, 2011)
CA reaches agreement on ADHC cuts. Last week, California officials and lawyers for some Medi-Cal beneficiaries reached agreement that will mitigate planned closer of the state's Adult Day Health Care centers. Lawyers had filed a federal class-action lawsuit in 2009 on behalf of 35,000 benefit recipients that alleged that many would have nowhere else to go for care, except to hospitals and nursing homes. According to the L.A. Times, the settlement allows the adult day healthcare program to operate in its current form until Feb. 29 and creates a new program that will provide similar, center-based services for many benefit recipients after that date. The new program will be called Community-Based Adult Services. The other half of benefit recipients would receive intensive case management to help them remain in their homes. Toby Douglas, director of California's Department of Health Care Services, told the Times' Anna Gorman, "We are very pleased with the settlement." It ensures that there is a program for "the most vulnerable participants." See: http://www.latimes.com/health/la-me-adult-daycare-20111118,0,3138702.story
Other Items of Interest
Public comment on inappropriate rx use in older adults. The American Geriatrics Society (AGS) is seeking public feedback until5pm on November 28, 2011, on the draft AGS Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.The Beers list catalogues medications that cause side effects in the elderly due to the physiologic changes of aging. AGS convened an expert panel, to update the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The updated Criteria address three primary areas:
- Criteria for Potentially Inappropriate Medication Use in Older Persons: Independent of Diagnoses or Conditions
- Criteria for Potentially Inappropriate Medication Use in Older Persons Due To Drug - Disease/ Syndrome Interaction
- Criteria for Potentially Inappropriate Medication Use in Older Persons: Drugs to be used with caution.
The draft criteria and more information on submitting comments is posted at: http://www.americangeriatrics.org/health_care_professionals/ags_beers_criteria
NGA asks HHS for SDW follow-up. On November 16, the National Governors Association sent a follow-up letter to Health and Human Services Secretary Kathleen Sebelius regarding its decision about a resolution to the federal liability to states for the Special Disability Workload (SDW) issue. The Chair and Vice Chair of NGA's Health and Human Services committee requested additional detail about the specific barriers preventing an administrative solution to the SDW liability.
Projected timeline for Supreme Court case.On November 14th, the Supreme Court announced it has combined three cases pertinent to the lawsuit against the Affordable Care Act - National Federation of Business (NFIB) v. Sebelius, Florida et al v. HHS, and Dept. of HHS v. Florida. The Court will allow for five and a half hours of oral arguments total over two days. It will look at the whole slate of challenges brought forward by the 26 GOP-led states and NFIB. As part of the Supreme Court's announcement, health policy and legal scholars were somewhat shocked to learn that the Court plans to consider the constitutionality of issues surrounding the expansion of the Medicaid program along with the constitutionality of the individual mandate and severability of the rest of the law. The Supreme Court is expected to announce a hearing schedule in the coming weeks. Oral arguments are likely to occur in March, which means decisions could come next summer. Also, the court asked to be briefed on how the case relates to the Anti-Injunction Act, which holds that court challenges against a tax cannot come forward until the tax is actually collected. The Fourth Circuit Court of Appeals dismissed a lawsuit against the mandate on this basis. This could potentially call into question the timing for a ruling about the constitutionality of the mandate.
GAO report on Countercyclical FMAP formula. Last week the Government Accountability Office (GAO) released its report on a prototype formula for a temporary increased FMAP and evaluates its effects on the allocation of assistance to states. The report was mandated by the American Recovery and Reinvestment Act (ARRA) and required GAO to make recommendations for modifying the increased FMAP formula to make it more responsive to state Medicaid program needs during future economic downturns. "Prototype Formula Would Provide Automatic, Targeted Assistance to States during Economic Downturns" http://www.gao.gov/highlights/d1238high.pdf
Mark Your Calendar
MITA v 3.0 comments due: December 16, 2011.
Save the date for NAMD's 2012 Fall meeting: October 28-30, 2012.