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This week we take a look at Medicaid-Housing agency partnerships; 1332 waivers; substance abuse and mental health; happenings on the hill.

Update
May 23, 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

 

State Medicaid-Housing Agency Partnerships Technical Support Opportunity for States; Expressions of Interest Due June 8, 2017
 
CMS’s IAP is launching a new technical support opportunity for state Medicaid agencies to develop partnerships between state Medicaid agencies and their local housing systems to foster additional community living opportunities for Medicaid beneficiaries. Open to up to eight states and lasting for nine months, the 2017 State Medicaid-Housing Agency Partnerships Track is designed to offer intensive and hands-on technical support to move selected states towards building sustained collaborations with housing partners and with partners from other service agencies. IAP is working closely with its federal partners, the US Department of Housing and Urban Development, the Substance Abuse and Mental Health Services Administration, the Office of the Assistant Secretary for Planning and Evaluation and the US Interagency Council on Homelessness on planning and coordination of the program support.
Additional information, including the Program Overview, Expression of Interest form, and Informational Session (5/18/17) slides can be found here. Interested states are asked to complete and email an Expression of Interest form to MedicaidIAP@cms.hhs.gov  subject line ” Medicaid-Housing Partnerships,” by June 8, 2017, Midnight ET.

CMS Issued Section 1332 State Innovation Waiver Checklist
 
Last Tuesday, CMS released a new checklist tool to help states seek waivers from requirements in the Affordable Care Act (ACA). The new tool is intended to help states pursue solutions to help lower costs and increase coverage choices for Americans struggling with unaffordable premiums and reduced competition in the insurance market brought on by the ACA (Section 1332 waiver generally can be used by states to opt-out of some mandated provisions under ACA). The guidance, said CMS Administrator Seema Verma, “will help lower premiums, stabilize the health insurance exchange, and meet the unique needs of each state.”
Back in March, HHS Secretary Price sent a letter to all states encouraging them to use innovative strategies to strengthen their health insurance markets, including 1332 State Innovation Waivers. Please click here to read the letter. More information on section 1332 State Innovation Waivers is also available here.

Comprehensive Primary Care Plus (CPC+) Round 2 Region Announcement
 
CMS is offering a second round of solicitations for payers to partner with CMS and practices to participate in
Comprehensive Primary Care Plus (CPC+) from 2018 to 2022. The following four locations have been selected:
 
  1. Louisiana: Statewide
  2. Nebraska: Statewide
  3. North Dakota: Statewide
  4. New York: Greater Buffalo Region (Erie and Niagara Counties)
The regions were selected based on payer alignment and market density to ensure that CPC+ practices have sufficient payer supports to make fundamental changes in their primary care delivery. Depending on their care delivery and health IT capabilities, practices may apply to participate in either Track 1 or Track 2. Track 1 is intended for practices that have the health information technology and other basic infrastructure necessary to deliver comprehensive primary care, while Track 2 is intended for practices proficient in comprehensive primary care that are prepared to increase the depth, breadth, and scope of medical care delivered to their patients, particularly those with complex needs. CMS expects to select up to 1,000 practices across the new Round 2 regions. The model requirements ensure that practices in each track will be able to build capabilities and care processes that provide more opportunities for patients to improve their health.
For eligible practices located in these regions, applications will be open from 18, 2017 to July 13, 2017. For more information about the model or the application process, visit here or email CPCplus@cms.hhs.gov.

HRSA Delays Effective Date of 340B Ceiling Price, CMPs Rule
 
On May 19, the Health Resources and Services Administration (HRSA) issued a final rule delaying the effective date of its 340B drug pricing program ceiling price and civil monetary penalties rule to October 1, 2017. The previous effective date was set to be May 22, 2017.
As a reminder, this rule would set the 340B ceiling price as Average Manufacturer Price minus the Unit Rebate Amount, and would set the 340B price at one cent when this calculation would result in a ceiling price below that amount. The rule would also set a maximum civil monetary penalty of $5,000 for each instance of a manufacturer overcharging a 340B covered entity.
Read the rule announcing the delay on the Federal Register here.

Trump Administration Selects Psychiatrist Specializing in Opioid Abuse to Lead SAMHSA
President Donald Trump’s administration has nominated Elinore McCance-Katz, MD, a psychiatrist specializing in opioid abuse, to lead the Substance Abuse and Mental Health Services Administration (SAMHSA). Dr. McCance-Katz will be the first person to take the title of Assistant Secretary for Mental Health and Substance Abuse; she will report to HHS Secretary Tom Price. The Senate must confirm Dr. McCance-Katz’s nomination. Read more here

SAMHSA has announced two new Comprehensive Addiction and Recovery Act (CARA) Grant Opportunities
 
The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced two new Comprehensive Addiction and Recovery Act (CARA) Grant Opportunities:
 
  • The Building Communities of Recovery (BCOR) Grant seeks Recovery Community Organizations (RCOs) applicants to mobilize resources within and outside of the recovery community to increase the prevalence and quality of long-term recovery support from substance abuse and addiction. These awards are intended to support the development, enhancement, expansion, and delivery of recovery support services (RSS) as well as promotion of and education about recovery (More information here).
  • The State Pilot Grant for Treatment for Pregnant and Postpartum Women (PPW-PLT) Grant is looking for Single State Agencies for Substance Abuse (SSA) to: 1) support family-based services for pregnant and postpartum women with a primary diagnosis of a substance use disorder, including opioid disorders; 2) help state substance abuse agencies address the continuum of care, including services provided to women in nonresidential-based settings; and 3) promote a coordinated, effective and efficient state system managed by state substance abuse agencies by encouraging new approaches and models of service delivery (More information here).
Applications for both grant opportunities are due July 3, 2017, and a combined 16 awards are available.

Solicitation for Nominations to Advisory Council on Alzheimer’s Disease and Related Dementias
 
In 2011, the Secretary of the Department of Health and Human Services established an Advisory Council to provide advice and consultation on how to prevent or reduce the burden of Alzheimer’s disease and related dementias on people with the disease and their caregivers. HHS is soliciting nominations for seven new non-Federal members of the Advisory Council to replace the seven members whose terms will end September 30th, 2017.
The link to the Federal Register Notice with detailed instructions is available here.

Mathematica Policy Research Seeking Public Comment re Quality Measure for Non-Dual Medicaid Beneficiaries with Serious Mental Illness (SMI); Comment Period Closes June 9, 2017
On behalf of CMS’s Center for Medicaid and CHIP Services, Mathematica Policy Research is seeking public comment on the measure specification and justification for stratified reporting of an existing quality measure (NQF 0541: Proportion of Days Covered: 3 Rates by Therapeutic Category) for non-dual Medicaid beneficiaries with SMI. Mathematica’s questions, as well as the measure information form (MIF) and measure justification form (MJF), are available in a zip file in the Downloads section  here. Please look for the zip file titled, “Quality Measure Development and Maintenance for CMS Programs Serving Medicare-Medicaid Enrollees and Medicaid-Only Enrollee.”
Please submit your comments by close of business June 9, 2017 to PMHQualMeasures@mathematica-mpr.com. You may also send any questions to this email address.

Hill Update

 

The Next Step for the American Health Care Act (AHCA)
The Senate has spent the past week discussing possible paths forward for healthcare reform. A 13-member working group comprised of Senate leadership and other leadership is exploring ways to tweak the American Health Care Act (AHCA) while gaining the support from 50 Senators, while another faction of Senators, led by Sen. Cassidy and Sen. Collins, is exploring the development of a proposal based off their bill, the Patient Freedom Act. Sen. Cassidy and Sen. Collins also convened a bipartisan group of Senators to discuss working together outside of reconciliation to reform health care.
Senate action, however, will be stalled until the Congressional Budget Office (CBO) releases a score of AHCA, expected for this week.  There is also concern that the House bill will not comply with Senate budget rules requiring at least $2 billion in savings from both the Finance Committee and HELP Committee jurisdiction.

Senate Finance Committee Unanimously Votes to Advance CHRONIC Care Act of 2017
 
Last Thursday, the Senate Finance Committee (SFC) unanimously voted (26-0) to send the CHRONIC Care Act of 2017 to the Senate floor. The legislation would introduce a series of reforms to the Medicare program to allow plans and providers to better address the needs of beneficiaries with chronic conditions.
Please find a summary of the legislation here.

Senate Finance Committee Adopts Amendment re Medicare Parts A/B Claims Data
 
The SFC last week adopted by voice vote a single amendment brought forward by Sens. Tom Carper (D-DE) and Pat Roberts (R-KS) which would allow Part D plans to get Medicare Parts A/B claims data from CMS. The amendment has the goals of “optimizing therapeutic outcomes through improved medication use, improving care coordination as to prevent adverse health outcomes such as preventable emergency department visits and hospital readmissions, and other purposes.”
A list of amendments may be found here.

GOP Leaders May Push Medicare And Medicaid Reforms In 2018 Budget
 
House Budget Committee Chairwoman Rep. Diane Black (R-TN) says she hopes to incorporate changes to Medicaid payments into next year’s budget, claiming that states wrongly receive more federal dollars “to cover able-bodied adults above the poverty line who are on Medicaid than they do to support children and the disabled who are well below the poverty line.” Additionally, House Speaker Paul Ryan (R-WI) has noted he believes Medicare reform will be a part of the fiscal 2018 budget. In a recent interview with a Wisconsin radio station, Ryan noted he has included Medicare reforms in previous House budgets — notably premium support — and believes Medicare changes will come up again in the House GOP’s 2018 budget resolution.

Bipartisan Senate Push for Substance Abuse Care
 
Last Wednesday, six senators (Sens. Dick Durbin (D-Ill.), Rob Portman (R-Ohio), Sherrod Brown (D-Ohio), Shelley Moore Capito (R-W.V.), Angus King (I-Maine), and Susan Collins (R-Maine)) introduced legislation that they say will ease longstanding federal restrictions on Medicaid reimbursement for substance abuse treatment centers. The bill would allow substance abuse treatment centers with as many as 40 beds to be reimbursed by Medicaid for up to 60 consecutive days. It would dial back a decades-old law – known as the Institutes for Mental Disease exclusion – prohibiting Medicaid from paying for patient care at facilities with more than 16 beds.

In the News

 

The FDA and CDC warn that blood tests significantly underestimated lead levels, reports The Washington Post
 
The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) are warning that some blood tests conducted Massachusetts-based Magellan Diagnostics may have “significantly” underestimated lead levels as far back as 2014. In response, the agencies have recommended that children younger than 6 be rechecked if their Magellan venous tests showed lead levels of less than 10 micrograms per deciliter. They also said women who are pregnant or nursing should get retested, while other adults worried about lead exposure should talk to their doctors about possible repeat tests. While serious, FDA and CDC officials say that most people probably won’t be affected by this under-estimation: Patrick Breysse, director of the CDC’s National Center for Environmental Health, for example, predicts that “less than 1 percent” of children in Flint might be at risk for having lead levels that were inaccurately reported.
Please read article here.

Morning Consult reports: “Zika Prevention Must Remain a Priority”
 
According to a new report from the CDC, nearly 1 in 10 pregnant women infected with Zika in the U.S. had a fetus or a baby with serious birth defects. The findings reflect the serious threat that Zika still poses, and the critical need for pregnant women to continue taking measures to prevent Zika virus exposure through mosquito bites and sexual transmission. Recognizing the continued severity of the Zika virus and its broader implications for pregnant women and their babies, Morning Consult highlights and lauds the work of the National Association of Chain Drug Stores Foundation (NACDS), a foundation that uses radio and digital messaging in Puerto Rico to educate and empower women and their families, urging them to talk with their physician or pharmacist about Zika prevention measures. While many assume that Zika is no longer a threat, NACDS’s work amplifies CDC’s cautions that as warmer weather and a new mosquito season approach, pregnant women and their babies are put in grave risk, especially in warmer climates.
Please read article here.

 

Take Note

 

Commonwealth Fund Brief: AHCA Would Affect Medicare, Too
 
In this brief, the Commonwealth Fund explores that even though the American Health Care Act (AHCA) does not include explicit changes to Medicare, there are several ways in which the legislation could have a profound impact on the 11 million Medicare beneficiaries who also rely on Medicaid for key components of their care.
 
  • First, while “dual eligibles” account for one-third of current Medicaid spending, much of this spending is “optional.” This means that states can drop optional dually eligible services/enrollees (i.e., behavioral health services as well as most of their long-term services and supports, such as nursing home and home and community-based services).
  • Second, AHCA’s funding formula, while very generous, is unlikely to keep pace with most states’ spending on high-need, high-cost elderly and disabled populations. In addition, federal Medicaid spending under AHCA would no longer adjust for new costs associated with breakthrough drugs and therapies, rising labor market costs, or changing demographics. This could potentially lead to pressure to constrain care for low-income Medicare beneficiaries.
  • Third, locking states into a lower federal cap could force states to discontinue critical services that are currently available to dual eligibles, such as home and community-based services.
  • Fourth and finally, capping Medicaid could force costs to be shifted to Medicare; as the availability of Medicaid-financed home care services is reduced, for example, more dually eligible individuals could wind up in the hospital more often.
To read the full brief, please click  here.

Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey
In their early release of estimates from the National Health Interview Survey (2016), the National Center for Health Statistics provides health insurance information for 45 selected states. It finds that at the time of the interview, 28.6 million (9.0%) persons of all ages were uninsured -20.0 million fewer persons than in 2010 and no change from 2015. Among adults aged 18-64, 12.4% were uninsured at the time of interview, 20.0% had public coverage, and 69.2% had private health insurance coverage.
For the full report, please click here.

McKinsey Looks at State Options to Control Medicaid Spending, Improve Program Performance
 
Earlier this month, McKinsey’s Center for U.S. Health System Reform published an article titled “Looking ahead in Medicaid: Options for states and the implications for payors and providers.” The article analyzes some of the drivers of recent Medicaid spending growth at the state and federal level, noting in particular that overall Medicaid spending growth from 2010 to 2015, which was 6.5%, outpaced the consumer price index – medical (CPI-U), which was 2.9% over the same period. The report projects several scenarios for future spending growth, detailing the variable impact such growth will have on states, and details a variety of state options to target drivers of that growth.
Read the article here.

Avalere Report Analyzes Impact of Capped Medicaid Funding on Children
 
On May 18, Avalere Health, on behalf of the Children’s Hospital Association, released a report titled “The Impact of Medicaid Capped Funding on Children.” The report assesses, on both a nationwide and a state-by-state basis, the potential effects of AHCA’s per capita allotment for traditional, non-disabled Medicaid children. The analysis found that AHCA would reduce federal spending for these children by $3 billion in 2020, and reduce federal spending on this population by a cumulative $43 billion by 2026. This finding is based on the Congressional Budget Office’s estimation that spending for traditional Medicaid children would grow at a rate of 4.8% over the next decade, which exceeds the CPI-M growth factor AHCA assigns for this group. On a state basis, federal spending would be reduced from a range of $59 million to $5.1 billion.
Read the analysis here.

Kaiser Family Foundation Issue Brief: Gaps in Coverage Among People with Pre-Existing Conditions
 
In this brief, the Kaiser Family Foundation estimates the number of people with pre-existing conditions who might be affected by AHCA’s provision that would allow states to waive community rating in the individual insurance market. Kaiser estimates that 27% of non-elderly adults (6.3 million individuals) have a condition that would have led to a decline in coverage in the pre-ACA market. Some people with such a gap would have gained coverage through an employer-based plan or Medicaid, and are subject to premium surcharges based on their health. Yet, as Kaiser makes clear, anyone who has been uninsured for 63 days or more who tries to buy individual market insurance in a state with a community rating waiver would likely face very large premium surcharges under an AHCA waiver.
Please find full brief here.

 

Jobs
DC Supervisory Policy Analyst
The DC Department of Health Care Finance is seeking a Supervisory Policy Analyst who will serve as the Associate Director for the Division of Regulations and Policy Management within the Health Care Policy and Research Administration at DC’s Medicaid agency, the DC Department of Health Care Finance.  We are seeking an attorney with Medicaid work experience who has some background in rulemaking (and ideally State Plan work) and some supervisory experience.  This person will supervise a team of 5 to manage our SPA and rule work.
Application here.

South Carolina Director of Program Integrity
The South Carolina Department of Health and Human Services is seeking qualified candidates for the position of Director of Program Integrity and Surveillance Utilization Review System (SUR) programs. The program director will oversee the management of provider and beneficiary investigations and reviews to identify areas of misuse, fraud, abuse, and incorrect payments.
For more information and to apply, please visit:
jobs.sc.gov.

 

Virginia Director of Eligibility and Enrollment
Exciting opportunity to provide executive leadership and direction for the Division of Eligibility and Enrollment Services within the state Medicaid agency. This position directs all operations, programs, policy, and staff within the division, including oversight of Eligibility Policy, Eligibility Operations and Performance Management. This position also serves as the Commonwealth’s Children’s Health Insurance Program (CHIP) Director with primary responsibility for oversight of the FAMIS and FAMIS Moms programs.

Click here to apply.

 

 

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