HMA Weekly Roundup

Colorado

Colorado Hospital Transparency Reports Reveal Increased Operating Expenses, Reimbursements. The Colorado Department of Health Care Policy & Financing released on February 5, 2024, mandatory reports analyzing hospital financials and pricing transparency. Some findings from the 2024 reports include that net patient revenues in the state are returning to pre-pandemic levels, tax exempt hospitals’ community investments rose by 13 percent in fiscal year 2021 and 55 percent of funding was directed to addressing social determinants of health, and the hospital assessment provided an additional $464 million in reimbursement to hospital providers and funding for Medicaid coverage without increasing Colorado’s General Fund expenditures. Read More

Florida

Florida House, Senate Consider Bills to Establish Rural Emergency Hospitals. Health News Florida reported on February 4, 2024, that the Florida House Select Committee on Health Innovation approved a bill, sponsored by Representative Jason Shoaf (R-Port St. Joe), that would establish a category of rural emergency hospitals in the state that could receive Medicare payments to provide emergency services, observation care, and outpatient services. The bill, intended to increase health access in rural areas, awaits further House review. Senator Corey Simon (R-Tallahassee) sponsored a Senate version of the bill which has been approved by the Senate Health Policy Committee. Read More

Florida Files Lawsuit Over CMS Ban on Disenrolling CHIP Beneficiaries. POLITICO Pro reported on February 1, 2024, that Florida Governor Ron DeSantis has filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS), which prohibited the state from removing children from the Children’s Health Insurance Program (CHIP) funded program, KidCare, if parents stopped paying the required premiums. Specifically, the state is seeking a preliminary injunction and stated that CMS has violated the federal Administrative Procedure Act. KidCare serves more than 119,000 children from families with incomes above the maximum threshold for Medicaid eligibility. Read More

Florida Advocacy Group Pushes to Include Medicaid Expansion on 2026 Ballot. The Tallahassee Democrat reported on February 1, 2024, that advocacy group Florida Decides Healthcare has launched an effort to raise a minimum of $12 million and collect nearly 1 million signatures to place Medicaid expansion on the 2026 ballot. If the measure is approved and passed by a minimum of 60 percent of voters, the state’s constitution would be amended to include Medicaid expansion. Medicaid expansion would expand coverage to approximately 1.4 million individuals. Read More

Georgia

Georgia Sues Federal Government to Extend Limited Expansion with Work Requirements. The Georgia Recorder reported February 2, 2024, that Georgia has sued the federal government in an effort to keep the Georgia Pathways to Coverage limited Medicaid expansion with work requirements running until 2028. The suit, filed in U.S. District Court, claims that the Biden administration’s attempt to try to revoke the program’s work requirement delayed implementation, which reduced the approved five-year term to just over two years. The state is asking the Centers for Medicare & Medicaid Services to extend its Georgia Pathways to Coverage existing agreement; however, the state has not yet submitted a formal extension. The program is set to expire at the end of September 2025. Read More

Georgia Releases PBM RFP in Partnership with Alaska, Montana, and Vermont. The Georgia Department of Administrative Services released on February 1, 2024, a request for proposals (RFP), in partnership with NASPO ValuePoint cooperative purchasing program, for one or more pharmacy benefit manager (PBM) vendors to serve Georgia, Alaska, Montana, and Vermont’s fee-for-service Medicaid pharmacy program. Georgia, the lead state, will evaluate responses, and establish master agreements with the support and assistance of a multistate sourcing team composed of individuals from other member states. The initial contract term will run for one year and the lead state will have nine, one-year options to renew the master agreement. Proposals are due by March 28. Read More

Hawaii

Hawaii Requests Five-year Extension of Hawaii QUEST Integration Waiver. The Centers for Medicare & Medicaid Services announced on February 5, 2024, that the Hawaii Department of Human Services has applied for a five-year extension of its Section 1115 Hawaii QUEST Integration waiver through July 31, 2029. The demonstration extension proposal includes continuous eligibility for children ages 0 through 5, continuous two-year eligibility for children ages 6 through 18, pre-release services for justice-involved individuals, nutrition supports, contingency management, rental assistance expansion, and medical respite to the state’s Community Integration Services program. Public comments will be accepted through March 6. Read More

Idaho

Idaho House Committee Kills Bill that Could Repeal Medicaid Expansion. The Idaho Capital Sun reported on February 1, 2024, that the Idaho House Health and Welfare Committee voted to hold a bill that could have repealed Medicaid expansion by October 2025 in committee, preventing its advancement to the House floor. The bill, sponsored by Representative Jordan Redman (R-Coeur d’Alene), would have repealed expansion if 11 new requirements had not been met by July 2025 and would have capped Medicaid expansion enrollment at 50,000 people or the total number of enrollees classified as disabled or aged 65 and above. Read More

Indiana

Indiana Lieutenant Governor Calls for Audit of Family, Social Services Administration Following $1 Billion Medicaid Shortfall. The Indiana Capital Chronicle reported on February 6, 2024, that Indiana Lieutenant Governor Suzanne Crouch called for an independent, outside audit of the Family and Social Services Administration (FSSA) following the organization’s announcement of a $1 billion Medicaid spending shortfall. The shortfall led FSSA to push for $300 million in program cuts, including removing compensation for parents serving as caregivers of medically complex children. The state’s General Assembly and Governor Eric Holcomb rejected Crouch’s previous request for a pause to the proposed cuts. Read More

Indiana Legislature Kills Bills that Would Clarify Medicaid HCBS Waivers, Eliminate Prior Authorization. The Indiana Capital Chronicle reported on February 2, 2024, that the Indiana legislature killed bills that would have clarified Medicaid home and community-based services waivers and eliminated most prior authorization requests. HB 1386, sponsored by Representative Bradford Barrett (R-Richmond), died in the House following the addition of amendments seeking transparency and accountability regarding the state’s $1 billion Medicaid funding shortfall. SB 3, sponsored by Senators Tyler Johnson (R-Leo), Ed Charbonneau (R-Valparaiso), and Chris Garten (R-Charlestown), died in the Senate after legislators raised concerns about its potential to raise health care costs by eliminating the majority of prior authorizations. Read More

Iowa

Iowa Lawmakers Advance Bill to Extend Postpartum Medicaid Coverage to 12 Months. The Iowa Capital Dispatch reported on February 5, 2024, that the Iowa Senate Health and Human Services Subcommittee has advanced a bill to extend postpartum Medicaid coverage from 60 days to one year. The bill proposes to limit eligibility for Medicaid coverage of birth and postpartum care to 215 percent of the federal poverty level from 380 percent under current law. The bill would also include coverage for newborns at 302 percent of the federal poverty level through the Healthy and Well Kids in Iowa (Hawki) program. Read More

Iowa House Subcommittee Passes Bill Requiring Additional Oversight of Temporary Medical Staffing Agencies. Iowa Public Radio reported on February 1, 2024, that the Iowa House Health and Human Services subcommittee advanced a bill that would require additional oversight of staffing agencies that supply temporary healthcare workers, aiming to improve the state’s staffing shortages within nursing homes and hospitals. The bill would require agencies to register with the Iowa Department of Health and Human Services, which would oversee new regulations such as wage caps that limit the amount temporary workers can make. Read More

Kentucky

Kentucky Senate Committee Advances Bill to Cover Midwife Services Under Medicaid. WKMS reported on January 31, 2024, that the Kentucky Senate Committee on Families and Children advanced legislation that would allow Medicaid coverage for midwife services. Licensed midwives would be able to offer prenatal, postpartum, and labor and delivery services. Read More

Maine

Maine to Increase Hospital Medicaid Reimbursement. The Portland Press Herald reported on February 6, 2024, that the Maine Department of Health and Human Services has agreed to increase Medicaid reimbursement rates for all in-state hospitals, with the exception of four psychiatric hospitals. Under the agreement, funding will come from $90.3 million allocated to the upcoming state supplemental budget on July 1. The agreement is subject to approval by the Centers for Medicare & Medicaid Services. Read More

Maryland

Maryland Disenrolls 58,000 Medicaid Beneficiaries During December Redeterminations. DCist reported on February 5, 2024, that Maryland disenrolled a total of more than 245,000 Medicaid beneficiaries in 2023. In December, the state disenrolled 58,016, including 51,249 for procedural reasons and 6,767 for ineligibility. Read More

Minnesota

Minnesota Seeks Section 1115 Medicaid Waiver Amendments to Expand Eligibility for Children. The Centers for Medicare & Medicaid Services announced on February 5, 2024, that the Minnesota Department of Human Services has requested two amendments to its Section 1115 Prepaid Medical Assistance Project Plus Medicaid waiver aimed at expanding eligibility for children. The first amendment would provide Medicaid eligibility for former foster care youth who turned 18 prior to January 1, 2023, and are under the age of 26. A separate amendment would allow 12-months of continuous Medicaid eligibility for 19 and 20-year-olds; and continuous eligibility for eligible children up to age six. Public comments will be accepted through March 6. Read More

Report Examines Public Option Cost, Funding in 2027. MPR News reported on February 1, 2024, that the Minnesota Department of Human Services released a report on projected public option cost and funding in 2027, predicting that this expansion of the Medicaid program would cost the state up to $364 million annually and would expand services to an additional 151,000 individuals. The report also outlined a second model which would be a three tiered plan available through the state’s health insurance marketplace, costing the state between $86-187 million annually. Read More

Mississippi

Mississippi Democrats To File Multi-component Medicaid Expansion Bill. Mississippi Today reported on February 5, 2024, that Mississippi Democratic representatives plan to file a bill that would expand Medicaid eligibility to all adults and offer a private insurance option for adults with no children who make up to 200 percent of the federal poverty level. Additionally, individuals employed and making between 96 percent and 200 percent of the federal poverty level could have their insurance premiums covered at varying degrees. It is estimated that Medicaid expansion would cover an additional 250,000 individuals. Read More

Mississippi Senate Passes Bill to Streamline Prior Authorization Requests. Mississippi Today reported on February 2, 2024, that the Mississippi Senate passed a bill requiring insurance companies to create a portal or website by January 2025 for doctors to submit prior authorization applications. Insurance companies would have 24 hours to process authorizations related to urgent services or procedures that can help treat someone in intense pain and five days for non-urgent services. Read More

House Passes Bill to Allow 60-days of Prenatal Presumptive Medicaid Eligibility. The Associated Press reported on January 31, 2024, that the Mississippi House passed a bill to allow up to 60 days of prenatal presumptive Medicaid eligibility, making it easier for expectant mothers to access timely prenatal care. If enacted, the bill would take effect on July 1, 2024. Read More

Montana

Montana Awards Maximus Contract for Employment and Training Services. The Montana Department of Public Health and Human Services announced on January 31, 2024, that Maximus US Services has been awarded to provide statewide Employment and Training Services to participants in the state’s Supplemental Nutrition Assistance Program and the Temporary Assistance for Needy Families cash assistance program. The contract is set to begin on July 1, and public comments can be made through February 7. Read More

Montana Releases Medicaid NEMT Program RFI. The Montana Department of Public Health and Human Services released on January 31, 2024, a request for information (RFI) regarding the state’s Medicaid non-emergency medical transportation (NEMT) program. The program covers about 292,000 Medicaid members. Responses must be submitted by February 9. Read More

Nevada

Nevada Medicaid Managed Care RFP Release Expected by January 2025. The Nevada Division of Health Care Financing and Policy announced on January 18, 2024, in a stakeholder presentation that the statewide Medicaid managed care request for proposals (RFP) is expected by January 2025 and contract implementation will begin January 1, 2026. Read More

New Mexico

New Mexico Receives Federal Approval for Use of Mobile Crisis Intervention Teams. The Centers for Medicare & Medicaid Services announced on February 6, 2024, that it has approved a proposal from New Mexico to provide Medicaid crisis services using community-based mobile crisis intervention teams. There are now 15 states that have expanded access to community-based mental health and substance use crisis care through the American Rescue Plan. Read More

New York

Cityblock, Fidelis Care Form Partnership to Increase Health Services for Medicaid Members. Cityblock Health announced on February 7, 2024, that it will be partnering with Centene/Fidelis Care to provide community-based care to Medicaid members in New York City and Long Island living with complex medical and behavioral health conditions. Fidelis Care’s Medicaid and HealthierLife – Health and Recovery Plan members with complex needs will have access to Cityblock’s integrated primary care, behavioral health, and social care services. Read More

New York Caucus Requests Reimposition of Medicaid Quality Incentive Program Funding. Spectrum Local News reported on February 5, 2024, that New York members of the Black, Puerto Rican, Hispanic and Asian Legislative Caucus are asking that Medicaid Quality Incentive Program (QIP) funding be restored in the state budget proposal, after being cut by Governor Kathy Hochul. Caucus members are requesting $268 million in funding for fiscal 2025, after it was previously funded at $111 million last year. The QIP program serves as a deferred payment program for health providers when they take action to close gaps in care for patients and improve access. Read More

Senate Passes Legislation Allowing State to Manufacture Generic Drugs, Lowering Spending. Crain’s New York Business reported on January 31, 2024, that the New York Senate advanced legislation that would authorize the state Department of Health (DOH) to contract with private companies to manufacture generic drugs in an effort to lower prescription drug prices. Under the New York State Affordable Drug Manufacturing Act, DOH and the health commissioner would assess which drugs make good candidates for state manufacturing based on Medicaid population usage and how much a state-manufactured alternative could reduce spending. Read More

North Carolina

North Carolina Releases Foster Care Specialty Plan RFP. The North Carolina Department of Health and Human Services released on February 7, 2024, a request for proposals (RFP) for the new Children and Families Specialty Plan (CFSP), a single, statewide plan for children, youth, and families served by the child welfare system. The CFSP is one of four types of integrated Medicaid managed care plans developed to transition North Carolina’s Medicaid program from fee-for-service to managed care. The plan will provide physical health, behavioral health, intellectual and developmental disability, long-term care, and pharmacy services. Proposals are due May 1 and awards are expected August 15. Contracts will run December 1, 2024, through June 30, 2028, with one additional one-year renewal option. Read More.

North Carolina Medicaid to Launch Behavioral Health IDD Tailored Plans on July 1. NC Newsline reported on February 6, 2024, that North Carolina will begin implementation of Behavioral Health and Intellectual/Developmental Disabilities (BH IDD) Tailored Plans on July 1. Tailored plans will be provided through the awarded Local Management Entity-Managed Care Organizations (LME-MCOs) Alliance Health, Partners Health Management, Trillium Health Resources, and Vaya Health. Implementation has been delayed multiple times since 2022, most recently from October 2023. As a result, the state issued a directive last year to dissolve the Sandhills Center and consolidate Eastpointe and Trillium Health Resources to hasten the delayed rollout. The tailored plans are expected to cover about 160,000 beneficiaries. Read More

Texas

Texas Advocates File Federal Complaint Over Deloitte Medicaid Eligibility Software Errors. The Texas Tribune reported on January 31, 2024, that health care advocates filed a complaint with the Federal Trade Commission, claiming that Deloitte Consulting LLP caused wrongful Medicaid disenrollments in Texas due to errors in their Medicaid eligibility system. Deloitte stated that the complaint is without merit. Read More

Vermont

Vermont House Considers Bill to Expand Medicaid for Pregnant People, Young Adults. Vermont Public reported on February 1, 2024, that the Vermont House is considering a bill sponsored by Representative Lori Houghton (D-Essex Junction) and several co-sponsors, that would expand Medicaid coverage for pregnant people and individuals between the ages of 19 and 26 who earn up to 312 percent of the federal poverty level beginning in 2025. The bill also calls for an analysis to determine how Medicaid could be expanded for all adults and increase Medicaid reimbursement rates for health care providers. The bill has been referred to the House Committee on Health Care. Read More

West Virignia

West Virginia Bureau of Medical Services Selects New Financial Management Services Vendor. WV News reported on February 1, 2024, that the West Virginia Department of Human Services’ Bureau for Medical Services has selected Palco to provide financial management services effective April 1. Specifically, Palco will serve more than 4,900 Medicaid beneficiaries receiving home and community-based services via three waiver programs in the Personal Options program. Palco will replace the current vendor, Public Partnerships, and is working with the department to launch an informational campaign to inform participants and employers about the transition. Read More

House Finance Committee Passes Bill to Increase Tax Rates on Select Hospitals. ABC 4 WOAY reported on January 31, 2024, that the West Virginia House of Delegates Finance Committee passed a bill, sponsored by Representative Matthew Rohrbach (R-Cabell), that would increase tax rates on certain hospitals to the maximum amount permitted by the Centers for Medicare & Medicaid Services. The bill aims to address the state’s $114 million Medicaid budget shortfall and will next receive a second reading in the House. Read More

National

CMS Outlines Guidelines for Use of Artificial Intelligence in Medicare Advantage. Modern Healthcare reported on February 6, 2024, that the Centers for Medicare & Medicaid Services (CMS) informed Medicare Advantage (MA) insurers that artificial intelligence (AI) may be utilized to make coverage decisions but may not override benefits rules and medical necessity standards. CMS specified that patient-specific factors must still be considered in coverage decisions and that insurers should ensure that the use of AI does not exacerbate health inequities. Several MA insurers, including UnitedHealth Group, Humana, and Cigna, are currently involved in lawsuits alleging that they used AI to decline coverage. Read More

Medicaid Enrollment Is Down 9.5 Million Halfway Through Unwinding Period, KFF Finds. KFF Health News reported on February 7, 2024, that total Medicaid enrollment has decreased by a net total of approximately 9.5 million since the beginning of the Medicaid eligibility redeterminations process. By the end of the process, Medicaid and Children’s Health Insurance Program enrollment is expected to return to pre-pandemic levels, totaling approximately 71 million. Thus far, states have disenrolled more than 16 million beneficiaries, while simultaneously re-enrolling and granting first-time coverage to millions. Read More

Centene Loses Appeal to Keep Tricare West Region Contract. Health Payer Specialist reported on February 7, 2024, that Centene’s appeal of the $65 billion Tricare western region contract award to TriWest Healthcare Alliance was rejected by the U.S. Court of Federal Claims. The Government Accountability Office previously upheld the decision in August. Read More

Increased Medicaid Drug Spending Was Driven by Specialty Drugs in 2021, MACPAC Finds. The Medicaid and CHIP Payment and Access Commission (MACPAC) released in February 2024, an issue brief that demonstrated that Medicaid drug spending grew in 2021, mainly due to high-cost specialty drugs, and totaled $38.1 billion in net drug spending. High-cost specialty medications include cell and gene therapies and generally have low rebates and high launch prices. MACPAC recommended increasing Medicaid rebates for drugs until their clinical benefit is verified and permitting states to require evidence on a drug’s benefits for Medicaid populations when granting Medicare coverage. Read More

Several States Direct Medicaid Funding to Provide Housing Aid Amidst Disenrollments. KFF Health News reported on February 6, 2024, that at least 19 states are utilizing Medicaid funding to provide housing services to address the homelessness epidemic. Rates of homelessness have increased and a recent Health Affairs study found that Medicaid disenrollments, which have similarly increased, may result in more evictions. Read More

HHS Issues Final Rule Permitting Use of Telehealth for Opioid Treatment Programs. Modern Healthcare reported on February 1, 2024, that the U.S. Department of Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) released a final rule that allows opioid treatment programs to initiate buprenorphine and methadone treatment via telehealth. Following telehealth evaluations, practitioners may order treatment medications as indicated. The rule, which makes permanent temporary flexibilities first issued by SAMHSA in spring 2020, will go into effect on April 2. Read More

Biden Administration Initiates Medicare Prescription Drug Price Negotiations for 10 Drugs. USA Today reported on February 1, 2024, that the Biden Administration initiated Medicare drug price negotiations with manufacturers of 10 widely prescribed drugs – Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and the insulins Fiasp and NovoLog. Negotiations are expected to continue through the spring and summer. Final prices will be announced September 1 and take effect January 2026. Price negotiations for the 10 drugs, which comprised approximately 20 percent of Medicare Part D prescription drug spending in the last year, are expected to result in $98.5 billion in savings over a decade. Read More

OIG to Audit CMS Oversight of Third-party Nursing Home Surveyors. JD Supra reported on January 31, 2024, that the U.S. Department of Health and Human Services Office of Inspector General (OIG) will audit the Centers for Medicare & Medicaid Services’ (CMS) nursing home survey practices and release findings in 2025. Specifically, OIG will examine whether CMS effectively monitors the third-party contractors that states utilize to conduct federally mandated routine surveys of skilled nursing facilities at least every 15 months. Previous reviews of nursing homes have found that several routine surveys were backlogged. Read More