HMA Weekly Roundup

Colorado

Dentists Collect Signatures for Ballot Initiative on Increasing Medicaid Reimbursements. 9 News reported on June 11, 2022, that Colorado dentists have begun collecting signatures in support of a ballot initiative that would increase Medicaid dental reimbursement rates from 45 percent of the procedure cost to 73 percent. The initiative needs 125,000 signatures by registered voters to earn a spot on the November ballot. Read More

Delaware

Delaware Delays Medicaid Managed Care Contract Awards to July. Health Payer Specialist reported on June 8, 2022, that Delaware has delayed awards for its Medicaid managed care procurement until July 1. Incumbent plans are AmeriHealth Caritas Delaware and Highmark Health Options. Both incumbents submitted proposals, as did Centene and UPMC Health Plan. According to the request for proposals released in December 2021, Delaware intends to award contracts to two or three bidders. Contracts will be effective January 1, 2023, and run for five years with three optional one-year extensions. Read More

Florida

Florida Names Bidders In Modular MMIS Procurement. Florida Politics reported on June 8, 2022, that the Florida Agency for Health Care Administration (AHCA) received five responses to an invitation to negotiate for the provider service component of the state’s modular Medicaid management information system (MMIS). Bidders included Gainwell Technologies, Optum, HHS Tech Group, FEI Systems, and Digital Harbor. AHCA also received bids for the unified operations center module from Conduent State Healthcare, Gainwell Technologies, Deloitte, Automated Health Systems TTEC, Cognosante, and Maximus. Contracts are set to be awarded on June 30. The modular MMIS initiative is called Florida Health Care Connections. Read More

Louisiana

Louisiana Names Additional Medicaid Managed Care Contract Winner. The Louisiana Department of Health announced on June 9, 2022, its intent to award a Medicaid managed care organization contract to incumbent UnitedHealthcare in addition to the five other health plans named in February 2022. Contract implementation has been delayed six months to January 2023, and the contracts will run for three years with an option to extend up to two more years. The other contract winners are AmeriHealth Caritas, Anthem/Healthy Blue, Centene/Louisiana Healthcare Connections, CVS/Aetna Better Health, and Humana. Read More

Maine

Governor Creates Cabinet on Aging to Address Needs of Older Residents. The Associated Press reported on June 13, 2022, that Maine Governor Janet Mills created a Cabinet on Aging to ensure older residents have access to health care and other supports as they age. Maine has the oldest median age in the country, with tens of thousands of residents planning on retiring. Cabinet members include the commissioners of several state departments, including the Maine Department of Health and Human Services. The cabinet will meet at least four times per year, starting in July. Read More

Maryland

Maryland Releases Draft Medicaid 1115 Waiver Amendment to Cover Ambulance Transport, Dental Services. State of Reform reported on June 10, 2022, that the Maryland Department of Health (MDH) released a draft 1115 waiver amendment to extend Medicaid coverage to the Alternative Destination Pilot (ADP) and Adult Dental Pilot in accordance with a recently passed state law. The ADP allows ambulance providers to transport patients to destinations other than emergency departments, if appropriate. The Adult Dental Pilot program provides dental coverage to dual eligibles aged 21 to 64. Recently enacted legislation would remove the $800 cost cap and expand coverage to all Medicaid-eligible adults, effective January 1, 2023. MDH is accepting public comments through June 25, 2022. Read More

Maryland Announces $81 Million in Federal EMS Funding. State of Reform reported on June 14, 2022, that the Maryland Department of Health announced $81 million in federal funding toward the cost of emergency medical services (EMS) for Medicaid participants between October 1, 2020, through June 30, 2021. The funding, from the Centers for Medicare & Medicaid Services, will be distributed through the state’s Emergency Service Transporter Supplemental Payment Program to Jurisdictional Emergency Medical Services Operational Programs. Read More

Michigan

Michigan Dentists Call for Increase in Medicaid Reimbursement Rates. Michigan Radio reported on June 15, 2022, that Michigan dentists are urging the state to increase Medicaid reimbursement rates for dentists to improve access to care for beneficiaries. Dentists argue that low fees are limiting access to dental care for Medicaid beneficiaries in the state. Read More

Montana

Montana Does Not Consistently Verify Eligibility for Medicaid, CHIP, Audit Finds. The Great Falls Tribune/The Daily Montanan reported on June 10, 2022, that the Montana Department of Public Health and Human Services has not consistently verified eligibility for Medicaid and the Children’s Health Insurance Program (CHIP), according to an audit from the Legislative Audit Division for fiscals 2020 and 2021. The audit also found that the state does not have a system in place to stop individuals convicted of Medicaid fraud from receiving benefits, and it may have overpaid some foster care subcontractors tens of thousands of dollars. Read More

New Mexico

New Mexico Settles with Medicaid Plan Over PBM Fraud Allegations. Modern Healthcare reported on June 14, 2022, that Centene will pay New Mexico $13.7 million in a settlement over allegations that its former pharmacy benefit management operation (PBM) overcharged the state’s Medicaid program for prescription drugs. Other states settling with Centene over PBM-related allegations are Arkansas, Illinois, Kansas, Mississippi, and Ohio. Read More

North Carolina

North Carolina Foundation to Study Whether State Should Transition Medicaid Oral Health to Managed Care. North Carolina Health News reported on June 14, 2022, that the North Carolina Oral Health Collaborative will study and potentially make recommendations on whether the state should transition Medicaid oral health services from fee-for-service to managed care. The goal is to have recommendations completed before the state begins its next Medicaid managed care procurement process in 2024. Read More

Senate Committee Considers Bill to Carve-Out Foster Care Services from Managed Care. The Winston-Salem Journal reported on June 12, 2022, that the North Carolina Senate Health Care committee is considering a bill (House Bill 144) that would carve-out foster care services from Medicaid behavioral managed care plans. Instead, the Department of Health and Human Services (DHHS) would seek proposals from prepaid health plans operated by health insurers who already have contracts with DHHS to procure a single statewide children and families specialty plan. The bill advanced out of the Senate Rules and Operations committee and was placed on the floor agenda, but it was then withdrawn and added to the Health Care committee agenda. The bill passed in the state House in May 2021. If the bill passes, the plan would launch by December 1, 2023. Read More

Senate Passes Medicaid Expansion Bill. Insurance News Net reported on June 9, 2022, that the North Carolina Senate passed a bill (HB 149) to expand Medicaid to approximately 600,000 adults. The bill includes a provision for work requirements, which has been struck down in other states. The bill also includes changes to certificate of need statutes and increased telehealth options, allowing advanced practice nurses to practice without physician supervision. The House will most likely not take up the bill during the current session. Read More

Hospitals Raise Concerns Over Certificate of Need Changes in Medicaid Expansion Bill. North Carolina Public Radio reported on June 3, 2022, that the North Carolina Healthcare Association (NCHA) does not support modifications to certificate of need laws outlined in a Medicaid expansion bill passed by the state Senate, according to an NCHA statement. However, NCHA supports Medicaid expansion to reduce the amount of charity care provided by member hospitals. Read More

South Dakota

Secretary of State Validates Second Medicaid Expansion Ballot Measure. The Yankton Daily Press & Dakotan reported on June 10, 2022, that a second ballot measure to expand Medicaid in South Dakota was validated by Secretary of State Steve Barnett. The measure, Initiated Measure 28, will appear on the November ballot alongside Constitutional Amendment D, which also seeks to expand Medicaid. Read More

Texas

Texas Health Plan Did Not Meet Fraud, Abuse Detection Requirements, State Report Says. The Texas Health and Human Services Commission Office of the Inspector General (OIG) reported on June 14, 2022, that Medicaid plan Community First Health Plans did not meet state requirements related to preventing, detecting, and investigating fraud, waste, and abuse between September 1, 2019, and August 31, 2020, according to an OIG audit. Community First plans to implement corrective actions outlined in the audit by June 2022. Read More

Texas Seeks to Extend Medicaid Postpartum Coverage to Six Months. The Centers for Medicare & Medicaid Services announced on June 10, 2022, that the Texas Health and Human Services Commission submitted a Section 1115 waiver amendment request to extend Medicaid postpartum coverage for eligible women to six months, a four month increase from current coverage. If approved, the extension will be effective September 22, 2022. Public comments will be accepted through July 10, 2022. Read More

West Virginia

West Virginia Submits SUD Continuum of Care 1115 Waiver Renewal for Federal Approval. The Centers for Medicare & Medicaid Services announced on June 10, 2022, that West Virginia is seeking federal approval to renew its “creating a continuum of care” Section 1115 waiver for Medicaid enrollees with substance use disorder (SUD) for another five years. The renewal would continue current programs, reimburse short-term inpatient treatment services, expand services for high-risk individuals, and implement recovery housing options. Comments will be accepted until July 10, 2022. Read More

Wyoming

Legislators Consider Extending Medicaid Postpartum Coverage to One Year. WyoFile reported on June 9, 2022, that the Wyoming Joint Health, Labor, and Social Services Committee is considering extending postpartum Medicaid coverage for pregnant women from 60 days to one year through a state plan amendment. The Committee will consider outcomes and a sample bill at its next meeting in August. Read More

National

CMS Variation of Reimbursement Rates for 340B Hospitals is Unlawful, Supreme Court Rules. Modern Healthcare reported on June 15, 2022, that the Centers for Medicare & Medicaid Services (CMS) does not have authority to change 340B reimbursement rates without surveying hospital acquisition costs, according to a unanimous ruling by the U.S. Supreme Court. The ruling concludes that CMS’ variation of reimbursement rates for 340B hospitals in 2018 and 2019 were unlawful. Read More

MACPAC Recommends New System for Monitoring Access to Medicaid Care Across States, Delivery Systems. The Medicaid and CHIP Payment and Access Commission (MACPAC) released on June 15, 2022, its report to Congress on Medicaid and Children’s Health Insurance Program for June 2022, which recommends creating a new system for monitoring access to Medicaid care across states and delivery systems. The report also focuses on transparency of Medicaid managed care directed payments, improved access to vaccines, integrated care standards for dual eligibles, advancing health equity in Medicaid, and how the adoption of information technology among behavioral health providers can better integrate care for Medicaid beneficiaries. Read More

AMA Looks to Block Expansion of Non-Physician Scope of Practice. Modern Healthcare reported on June 14, 2022, that the American Medical Association (AMA) will help craft state legislation that opposes expanding the scope of practice for non-physicians and reversing laws that have already done so. AMA will also conduct research on cost and quality of care under nurse practitioners, physician assistants, and other advanced practice practitioners without a doctor’s supervision. Read More

Medicaid Managed Care Enrollment Approaches 68 Million in 2020, CMS Reports. The Centers for Medicare & Medicaid Services (CMS) announced on June 13, 2022, that 67.8 million individuals were enrolled in some form of Medicaid managed care as of July 1, 2020. Total Medicaid enrollment exceeded 80 million in 2020. California had the highest total Medicaid enrollment of any state at 13 million. Read More

U.S. Senators Include Funds for Expanded Mental Health Resources in Bipartisan Agreement on Guns. NPR reported on June 12, 2022, that a bipartisan group of U.S. Senators developed a framework for gun-related legislation that would include funding for expanded mental health resources for schools and a national expansion of community behavioral health centers. The proposal would also provide funds for “red flag” laws, school safety, and expanded background checks. The Senate is not expected to vote soon on the legislation, but Senators are optimistic that it will eventually pass with at least 60 votes. Read More

Biden Administration Considers Requirement for Nursing Homes to Spend Majority of Medicaid Dollars on Direct Care. Kaiser Health News reported on June 10, 2022, that the Biden administration is considering a proposal to require nursing homes to spend most of their Medicaid payments on direct care for residents and limit the amount going to operations, maintenance, capital improvements, or profits. Medicaid covers 62 percent of long-term care nursing home residents. Read More

MACPAC Encourages CMS to Use Health Equity Lens For Minimum Nursing Home Staffing Standards. The Medicaid and CHIP Payment and Access Commission (MACPAC) issued on June 10, 2022, a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure that encourages CMS to apply a health equity lens when developing new minimum staffing standards for nursing facilities. This is based on a recently conducted review of pre-pandemic staffing data, which found that nursing facilities that serve a higher share of Medicaid-covered residents were much more likely to have lower staffing rates and more racial and ethnic minorities compared to other facilities. The letter was in response to a request for information from CMS on revising requirements for long-term care facilities to establish mandatory minimum staffing levels. Read More

U.S. Representative Introduces Bill to Implement Medicaid Work Requirements. WIBW reported on June 9, 2022, that U.S. Representative Jake LaTurner (R-KS) introduced a bill that would require all able-bodied adults to work or volunteer for no less than 20 hours per week to remain eligible for Medicaid. Read More

CMS Issues First Hospital Pricing Regulation Penalties. Fierce Healthcare reported on June 9, 2022, that the Centers for Medicare & Medicaid Services (CMS) issued civil penalties to two Northside Hospital facilities in Georgia for violating hospital price transparency regulations. Northside Hospital Atlanta was penalized $880,000, and Northside Hospital Cherokee was penalized $214,000. The regulations, which require hospitals to publish accessible pricing information online, went into effect on January 1, 2021. Read More