HMA Weekly Roundup

Arizona

Arizona Pauses ALTCS-EPD Procurement Following Judge’s Decision. The Arizona Health Care Cost Containment System announced on August 13, 2024, that it is pausing the transition to new contracts for the Long Term Care System/Elderly & Physically Disabled (ALTCS-EPD) program, scheduled to go live October 1, after an Administrative Law Judge determined that the states ALTCS-EPD procurement was flawed. The judge recommended that a new request for proposals (RFP) be issued and that the Banner-University Family Care, Mercy Care Plan, and Blue Cross Blue Shield of Arizona Health Choice appeals be granted. Arizona must accept, modify, or reject the judge’s decision by September 9, 2024. The ALTCS-EPD program covers 26,000 individuals, representing approximately 38 percent of the ALTCS managed care population. Arizona had awarded the new contracts to Centene/Health Net Access and UnitedHealthcare Community Plan. Read More

Arizona Allocates $2.5 Million to CHCs to Address Rural Maternal Healthcare Access. The Arizona Health Care Cost Containment System (AHCCCS) announced on August 12, 2024, that it has allocated a total of $2.5 million to four community health centers (CHCs) to fund on-call maternity care services in rural communities. The funding recipients are Mariposa Community Health Center, San Luis Walk-in Clinic, Little Colorado Medical Center, and Canyonlands Healthcare. The funds are part of Senate Bill 1720, a rural maternal healthcare initiative, which appropriates a total of $7.5 million toward access expansion through June 30, 2026.

California

California Bill to Strengthen State Oversight of Private Equity Healthcare Investments Gains Public Support. KFF Health News reported on August 13, 2024, that a California bill looking to strengthen oversight of private equity firms and hedge funds investing in healthcare has gained support from the California Medical Association, labor unions, and consumer advocates. Assembly Bill 3129 would require private equity firms wanting to make healthcare investments to propose their purchases to the attorney general who would have to inspect the proposals’ impact on care quality and accessibility. The legislation would apply to for-profit hospitals and other medical facilities such as clinics, nursing homes, and testing labs; nonprofit hospital transactions are already subject to review. Read More

L.A. Care Health Plan Cuts 24 Percent of Prior Authorization Requirements. Modern Healthcare reported on August 7, 2024, that California-based L.A. Care Health Plan has cut 24 percent of its prior authorization requirements for approximately 14,000 billing codes in an effort to reduce administrative burdens. L.A. Care serves 2.5 million beneficiaries, including Medicaid and dual eligible enrollees. Read More

Connecticut

Connecticut Lowers Income Eligibility Threshold For Husky A Beneficiaries Beginning in October. CT Mirror reported on August 8, 2024, that Connecticut’s eligibility threshold for parents and caretaker relatives covered under Husky A will reduce to 138 percent of the federal poverty level from 160 percent beginning October 1, 2024, with an estimated 15,300 individuals expected to lose coverage. People disenrolled from Husky A may be able to maintain coverage under Covered Connecticut, a program that provides free health insurance through the state’s health insurance marketplace program. The new income limits are expected to save the state $2.1 million in fiscal 2025. Read More

Florida

Florida Children’s Medical Services Procurement Expected to Drop Any Day. Florida Politics reported on August 7, 2024, that the Florida Department of Health (DOH) is preparing to release an invitation to negotiate (ITN) for the Children’s Medical Services Health Plan, which provides care for Medicaid and CHIP eligible children with complex medical conditions and expires January 2025. This move follows the DOH’s decision in May to extend its current $12.9 billion with Sunshine Health Plan. The current contract with Centene/Sunshine Health Plan expires January 31, 2025. Read More

Georgia

Georgia Fiscal 2025 Budget Includes 11 Percent Increase for Health Agencies. GBPI reported on August 8, 2024, that Georgia’s fiscal year 2025 budget includes $7.3 billion in state funds for three state health agencies: the Departments of Behavioral Health and Developmental Disabilities (DBHDD), Community Health, and Public Health. General Fund appropriations account for $6.6 billion, which is an 11 percent increase from the original fiscal 2024 budget. Mental health and developmental disabilities services account for approximately 75 percent of DBHDD state funds. Read More

Idaho

Idaho Awards MMIS System Integrator Advisor Contract to NTT Data. State Scoop reported on August 12, 2024, that Idaho has awarded NTT Data with a technical advisory services contract for the state’s new modular solution Medicaid Management Information System (MMIS). NTT Data is expected to develop a framework for MMIS modernization and ensure implementation and integration of the new system. The contract will last for four years, with a maximum term length of eight years. Read More

Kentucky

Kentucky Submits Amendment Requests for All 1915(c) HCBS Demonstrations for New Rates. The Kentucky Department for Medicaid Services announced on August 14, 2024, that it has submitted amendments for all six 1915(c) Comprehensive Home and Community Based Services (HCBS) waiver demonstrations to incorporate new rates based on the 1915(c) HCBS waiver rate study and rate increases funded in the 2024-2026 state budget. Demonstrations being amended include Acquired Brain Injury; Acquired Brain Injury Long Term Care; Home and Community Based; Modell II Waiver; Michelle P. Waiver; and Supports for Community Living. The public comment period will be open through September 13. Read More

Nevada

Nevada Lawmakers Propose Legislation to Improve Behavioral Healthcare, Medicaid School-based Health Services. Nevada Current reported on August 13, 2024, that the state’s interim Committee on Health and Human Services approved 15 proposals focused on behavioral and children’s health, including proposals to establish an office of children’s mental and behavioral health within the Nevada Department of Health and Human Services. The committee also approved a proposal that would expand Medicaid-covered school-based services. The Legislature reconvenes in February. Read More

New Mexico

New Mexico Seeks Public Input on Proposed Medicaid Forward Expansion Program. Source NM reported on August 9, 2024, that the New Mexico Health Care Authority is seeking public feedback on its proposed Medicaid Forward expansion program, which would build on the state’s existing Medicaid expansion for adults. Specific areas of interest cited in the request include provider reimbursement rates, access to health care, premiums and cost sharing, and possible employer and employee impacts. By October 1, 2024, the New Mexico Health Care Authority is required to provide state legislators a report addressing how the Medicaid Forward program could extend program eligibility to all nonelderly residents to create another affordable coverage option for the uninsured. The report is expected to address establishment of premiums and out-of-pocket costs on a sliding scale. Read More

New York

New York Faces Lawsuit Over CDPAP Fiscal Intermediary Services Procurement. Crain’s New York Business reported on August 14, 2024, that a group of companies have sued the New York State Department of Health and its Commissioner over a procurement seeking a single statewide fiscal intermediary services vendor for the Consumer Directed Personal Assistance Program (CDPAP). The lawsuit, filed in the state Supreme Court, alleges the request for proposals is anticompetitive, will close companies, and will jeopardize services for individuals enrolled in the program. There are currently over 600 companies in New York that serve as fiscal intermediaries for caregivers and the state. The new sole statewide contract is slated to be awarded October 1. Read More

North Carolina

North Carolina Hospitals Agree to Participate in Medical Debt Relief Initiative. The Associated Press reported on August 12, 2024, that all 99 qualifying North Carolina hospitals will participate in an initiative to forgive medical debt for low and middle-income patients. The initiative—which the Centers for Medicare & Medicaid Services approved in July and is set to begin in 2025—will relieve $4 billion in medical debt dating back to 2014 for Medicaid enrollees, and debt dating back two years for non-Medicaid members who meet certain criteria. It will also require hospitals to start programs to help discourage future debt. Hospitals will receive higher Medicaid payments for participating in the initiative. Read More

Oklahoma

Oklahoma Approves $29 Million Medicaid Budget Increase for Nursing Homes. KGOU reported on August 13, 2024, that the Oklahoma Health Care Authority Board approved a $29 million increase in Medicaid funding to raise reimbursement rates for nursing home facilities, 70 percent of which will go to direct care costs and 30 percent toward other costs. This approval, along with $30 million the legislature appropriated toward improving long-term provider care rates in the last legislative session, will direct more than $100 million to direct care providers and facilities. Read More

Oregon

Oregon Announces First Round of CCBF Awards Totaling $31 Million. The Oregon Health Authority (OHA) announced on August 8, 2024, that $31 million in grant funding will be distributed in the first round of Community Capacity Building Funds (CCBF) awards, which aim to connect Medicaid beneficiaries with new health-related social needs services, including housing and nutrition supports. Awardees, which include 157 organizations representing housing and nutrition providers across the state, will use the grants to upgrade technology, invest in educational trainings, develop their workforce and prepare to deliver the new services. Award notices for the remaining $7 million of 2024 CCBF grants will be released later in the year. Read More

Oregon CCO’s Improved on Several Statewide Performance Measures in Annual Report. Oregon Health Authority (OHA) released on August 8, 2024, its 2023 annual report on the performance of coordinated care organizations (CCOs), which found that CCOs increased capacity to address social determinants of health and generally improved their performance in most categories compared to 2022. The report found that dental and oral health services rose above pre-pandemic rates for children preparing for kindergarten; CCOs mostly improved on behavioral health care measures; and immunization measures for children and adolescents have not yet recovered from the pandemic. Read More

Pennsylvania

Pennsylvania Joint Venture Creates New I-SNP for Medicare Advantage Nursing Home Residents. McKnights Business Daily reported on August 8, 2024, that a joint venture between American Health Plans, Lake Erie College of Osteopathic Medicine, HCF Management, CHR Consulting Services, and Highmark Health created an institutional special needs plan (I-SNP) called American Health Advantage of Pennsylvania. The I-SNP will partner with TruHealth of Pennsylvania to provide specialized care to Medicare Advantage residents of long-term nursing homes. Read More

Vermont

Vermont Medicaid Claims Vendor Overpaid Nurse Practitioners; State Seeks Refund. Seven Days Vermont reported on August 7, 2024, that Vermont Medicaid claims vendor Gainwell Technologies overpaid around 180 nurse practitioners, according to a state internal audit. The audit found that Gainwell began reimbursing nurse practitioners at the same rate as doctors after conducting a payment systems update. Vermont’s fee schedule shows nurse practitioners should be paid 10 percent less. The Department of Vermont Health Access began withholding weekly Medicaid payments this month to start recollecting the money. Some healthcare organizations will cover the overpayments for their providers, but practitioners in private practice will be responsible for all repayment unless the state accepts their debt forgiveness applications. Because of the halted income, some practitioners have stopped accepting new Medicaid patients, and others have dropped Medicaid patients entirely. Read More

West Virginia

Highmark Begins Offering Medicaid Managed Care Coverage in West Virginia. The Marietta Times reported on August 10, 2024, that Highmark Inc. has launched a new Medicaid managed care organization named Highmark Health Options West Virginia, with coverage for Medicaid beneficiaries beginning in August. The statewide contract with Highmark Health Options West Virginia runs for four years. The West Virginia Department of Human Services announced in January 2024 that Highmark was approved to contract as the fourth MCO after a law was passed that ended competitive procuring for the Medicaid managed care program. The insurer is working with 10 local social care networks, including local frontline nonprofits and community-based organizations, to address key health-related social needs in member communities. Read More

West Virginia Considers Rate Increase for Home Care Workers in October. West Virginia Watch reported on August 12, 2024, that the West Virginia Department of Human Services is considering a rate increase for home care workers in October 2024, as the agency appears to have $130 million in carryover funds for fiscal 2025. Senior centers in West Virginia are facing caregiver shortages due to the state’s low Medicaid reimbursement rate. Some senior centers have tried to find it in their own budgets to pay workers more, or retain staff through the Aged and Disabled Waiver Program, but many face high turnover rates and layoffs. A state-funded study found that West Virginia needs to increase caregiver rates to fall between $15.50 and $18.60 per hour. Read More

National

MACPAC Releases Issue Brief Assessing Health Needs and Access to Care for CYSHCN. The Medicaid and CHIP Payment Access Commission (MACPAC) released in August 2024 an issue brief examining care quality, care access, adequacy of insurance, and transition planning for children and youth with special health care needs (CYSHCN) across different insurance types. The brief found similarities in transition planning across payers but differences in care access and delivery across others. For example, Medicaid-covered CYSHCN were more likely to have their medical needs met and receive better care coordination than children with other types of insurance, but less likely than privately-covered CYSHCN to have a personal doctor or nurse. The brief also compared CYSHCN and non-CYSHCN health characteristics. Read More

CMS Releases Guidelines Regarding Best Practices and Requirements For Assuring Access to Family Planning. The Centers for Medicare & Medicaid Services (CMS) released on August 8, 2024, an informational bulletin reminding states and Medicaid managed care organizations of requirements and best practices for providing family planning services and supplies. The required family planning benefit covers services and supplies to prevent or delay pregnancy, and in some states, includes infertility treatment. CMS encourages states to follow best practices for family planning services—such as providing six to 12 months of contraceptive coverage at a time, or implementing state policies to improve access to over-the-counter contraceptive medications—as well as prenatal/postpartum care. Read More

CMS to Provide Subsidies for Medicare Drug Plans to Offset Premium Increases. Politico reported on August 13, 2024, that the Centers for Medicare & Medicaid Services (CMS) will implement a three-year demonstration to provide participating Medicare prescription drug plans $15 per member per month subsidies and restrict annual premium rate increases. The plan is an effort to offset higher Medicare premiums, which will be released in mid-to-late September. The three-year project is estimated to cost about $5 billion if all standalone plan sponsors participate. Read More

Most States Failed to Meet Federal Renewal Requirements During Unwinding. Georgetown University McCourt School of Public Policy reported on August 8, 2024, that almost all states did not comply with federal renewal regulations, according to a report by the U.S. Government Accountability Office (GAO). Compliance issues included not conducting ex parte reviews at the individual level for 29 states which affected about 420,000 beneficiaries; 26 states were not prepared to conduct ex parte reviews for certain groups of beneficiaries; and 19 states did not allow enrollees to submit renewal forms through all modalities. The GAO has recommended that the Centers for Medicare and Medicaid Services (CMS) document and implement oversight practices to prevent compliance issues with renewals. Read More

Republican State Attorneys General Sue CMS Over Rule Extending Medicaid to DACA Recipients. Fierce Healthcare August 12, 2024, that 15 republican state attorneys general have filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) over a rule which allows Deferred Action for Childhood Arrivals (DACA) recipients to enroll in Medicaid or Exchange plans. The lawsuit alleges that the rule, which is estimated to cover more than 100,000 DACA recipients, violates the Administrative Procedure Act and the Affordable Care Act. States involved in the lawsuit include Alabama, Idaho, Indiana, Iowa, Kansas, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, and Virginia. Read More