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Brief & Report

50-state Medicaid director survey released: states focus on quality and outcomes amid waiver changes


Results of the 18th annual Medicaid Budget Survey were released Oct. 24, 2018 and examine changes taking place in Medicaid in all 50 states and the District of Columbia. The Kaiser Family Foundation (KFF) and HMA conduct the survey in partnership with the National Association of Medicaid Directors.

Key findings of the study include:

  • A growing number of states are implementing or planning to implement Section 1115 waivers
  • Risk-based managed care continues to be the predominant deliver system for Medicaid services
  • States are working to address social determinants of health
  • Expansion of people served in in-home and community-based settings
  • States are planning provider rate increases, increase in benefits for mental health and substance use disorder treatment and efforts to address rising prescription drug costs and management strategies to address the opioid crisis.

The report was prepared by Kathleen Giff­ord, Eileen Ellis, Barbara Coulter Edwards, and Aimee Lashbrook from HMA, and by Elizabeth Hinton, Larisa Antonisse, and Robin Rudowitz from the Kaiser Family Foundation.

Brief & Report

HMA Denver office evaluates jail-based behavioral health services program in Colorado


HMA partnered with the Colorado Office of Behavioral Health and Correctional Treatment Board to conduct a statewide program evaluation report for The Jail Based Behavioral Health Services (JBBS) program. The JBBS program is administered by the Office of Behavioral Health and is funded through Colorado House Bill 10-1352 and was expanded through Colorado Senate Bill 12-163 creating the Correctional Treatment Cash Fund.  The JBBS program provides resources for the county jails to address the needs of individuals with substance use disorders and co-occurring mental health disorders. Initiated in 2011 with twenty- four counties, the program is in its seventh year and has grown to 46 counties across the State.  This initial JBBS program evaluation examined both process elements of how the program is implemented across the counties as well as the outcomes and impact of the services provided.

Brief & Report

MACPAC contracted with HMA to better understand how states develop their hospital payment policies


Health Management Associates was contracted by MACPAC to better understand how states develop their hospital payment policies. State, hospital, and managed care representatives from five states that vary in their use of supplemental payments and financing approaches (Arizona, Louisiana, Michigan, Mississippi, and Virginia) were interviewed. The three key findings from the study include:

  1. The availability of financing for the non-federal share of Medicaid payments has affected states’ use of base and supplemental payments;
  2. The use of Medicaid managed care has not substantially affected Medicaid payments to hospitals; and,
  3. The adoption of prospective payment systems and value-based payment models is slow.

MACPAC presented this information at its September 2018 Commission meeting.

Brief & Report

HMA reviews state assisted living licensing regulations and statutes for 2018 NCAL state regulatory review


From March 2017 through April 2017, HMA reviewed each state and the District of Columbia’s assisted living licensing regulations and statutes, relying on the resources published on state licensure agency web pages.  According to the NCAL’s 2018 edition of “Assisted Living State Regulatory Review,” assisted living regulations, statutes, and policies in 29 states were updated between June 2017 and June 2018. The report found that the most common changes to state regulations were in the area of staffing, such as additional training requirements and expanded background check requirements.

Brief & Report

HMA Report Examines Needs Assessment for Denver Residents with Intellectual and Developmental Disabilities


The City and County of Denver’s Department of Human Services (DHS) contracted with HMA, between March and August 2018, to conduct a needs assessment of services and supports for individuals with intellectual and/or developmental disabilities (IDD). Denver will use findings from this assessment to inform decisions regarding the governance and distribution of a Denver property tax (mill levy) dedicated to funding services for residents with IDD.

The primary goals of the needs assessment were:

  1. Inventory current services for Denver County residents with IDD and the existing capacity in and around Denver to provide these services.
  2. Identify service gaps and potential ways to address these gaps by engaging stakeholders ‐ including clients, families, caregivers, service providers, city and state agencies, employers, and the public, with the intent to form the basis of how dedicated mill levy funding is programmed going forward.
  3. Research possible governance models for determining/overseeing the disbursement of dedicated revenue, gathering stakeholder feedback on the governance models, and evaluating pros and cons of preferred models to form the basis of the process through which dedicated funding is allocated going forward.

The report summarizes the findings in the three areas identified above, including recommendations on the most pressing service gaps to address and features of the governance model.

Brief & Report

Hospital Charges and Reimbursement for Medicines: Analysis of Cost-to-Charge Ratios


This report is an update to a previous report examining hospital markups for separately paid drugs. Our prior analysis examined hospital charges and reimbursement for 20 drugs and found that hospitals marked up charges for those drugs, on average, 487 percent of their acquisition cost. We also found that hospitals receive 252 percent of estimated hospital acquisition cost from commercial payers. Hospital reimbursement data was obtained from the Magellan Rx Management Medical Pharmacy Trend Report™: 2016 Seventh Edition (the Magellan report) and charges were calculated from Medicare claims data. For more information, please refer to our prior analysis.

Brief & Report

HMA Contributes to CPEHN Report on California’s Mental Health Equity Act


Principal Jeff Ring and Senior Consultant Helena Whitney recently coordinated and facilitated an advisory committee which provided recommendations for the implementation of California’s Mental Health Equity Act (AB 470, 2017). Using the Advisory Committee recommendations, they developed the California Pan-Ethnic Health Network (CPEHN) report, “Measuring Mental Health Disparities.”

AB 470 was proposed to mandate the Department of Health Care Services (DHCS) update the performance and outcome reporting system on mental health outcomes and utilization for beneficiaries receiving Specialist Mental Health Services in order to focus the Performance Outcomes System (POS) on disparities. Following the passage of the statute, CPEHN created an Advisory Committee of behavioral health and healthcare experts to develop recommendations for the DHCS to consider during its stakeholder engagement process.

After reviewing DHCS’ existing data and quality measures, the Advisory Committee identified data elements that the state performance outcome reporting system on mental health should include to further the work of tracking mental health disparities and achieving health equality.

Also considered was information obtained through interviews with selected subject matter experts who directed the Advisory Committee to additional performance measures and datasets, such as those currently in use by health plans that are participating in state and national pilot programs such as the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) Program, the Health Homes for Patients with Complex Needs Initiative, and the Whole Person Care Program.

Special consideration was given to measures that were (1) developed by nationally-recognized organizations such as the National Committee for Quality Assurance and the Consumer Assessment of Healthcare Providers and Systems Consortium, (2) are endorsed by the National Quality Forum, (3) are widely used by other states, (4) and/or are cited in the literature as “disparity-sensitive,” meaning that the measurements help identify inequities in health outcomes and access to services.

Per the requirements of the statute, the Advisory Committee organized its measure recommendations into two phases:

  1. Those that are currently available from county mental health plans or the state and should be included in the initial POS reports (“Phase I”).
  2. Those that could be added to county reporting systems and/or may be available from Medi-Cal managed care plans and should be included in future POS reports (“Phase II”).
Brief & Report

Report Examines the Models and Issues of Behavioral Heath Crisis Services


In a report prepared for the Michigan Health Endowment Fund, HMA Principal Steve Fitton and Senior Consultant Esther Reagan examine the models and issues of behavioral health crisis services.

Many people with behavioral health (mental illness and/or substance use disorder [SUD]) issues are arriving in hospital emergency departments (EDs) and not being well served in that setting. The ED is the wrong place at the wrong time for many patients – and for many reasons. These include being discharged prematurely, long waits in noisy EDs may exacerbate symptoms, the EDs may not have the professional staff best suited to provide services, and the ED itself is an expensive setting and can result in unnecessary and costly admissions for public and private insurers.

A number of models have been developed with the goal of improving the behavioral health emergency response environment. This report explores several models, including mobile crisis teams, co-located and dedicated behavioral health crisis emergency services units, behavioral health staffing in hospital EDs, and standalone behavioral health crisis centers. Strategies for moving forward, including addressing challenges in multiple areas are outlined as well.

Brief & Report

HMA Prepares Report Describing Strategies to Increase MAT Prescribing


Senior Consultant Julia ElitzerManaging Principal Jonathan FreedmanSenior Consultant Mary Russell, and Managing Principal Margaret Tatar recently prepared the report “Strategies to Increase MAT Prescribing,” for the Association of Community Affiliated Plans through a grant from the Open Society Foundations.

The report examines how to address opioid use disorder through the promotion of medication-assisted treatment (MAT). MAT is an approach that combines behavioral therapy and the administration of three medications – methadone, buprenorphine, and naltrexone – to treat addiction.

Brief & Report

HMA Contributes MLTSS Research to MACPAC Report


Principal Sarah Barth, Principal Karen Brodsky, Principal Sharon Lewis and Senior Consultant Rachel Patterson and other HMA colleagues contributed research under contract to MACPAC on standards for home and community-based services network adequacy in managed care for long-term services and supports (MLTSS) programs and on tailoring MLTSS programs for individuals with intellectual or developmental disabilities.