Archive for October 2018
The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. The October 2018 MACPAC meeting covered a range of front-line issues in Medicaid, leading off with an analysis of disproportionate share hospital (DSH) allotments on Thursday morning. Following the analysis, the Commission discussed options for March recommendations on how to structure DSH allotment reductions that are scheduled to begin in fiscal year 2020. The Commission later resumed the discussion it began in September on work and community engagement requirements, presenting new data from Arkansas on compliance and disenrollments, as well as information gathered since that meeting about Arkansas’s approach to implementation. On Thursday afternoon, … Read More
If a regulation proposed by the Department of Homeland Security to redefine what constitutes a “public charge” is adopted, millions of people currently enrolled in the Medicaid and Children’s Health Insurance Program might choose to disenroll from those programs rather than risk losing their opportunity to obtain legal permanent resident status in the U.S. The proposed regulation seeks to filter out of possible residency status individuals who might become public charges, or dependent on government programs, over time. A new analysis published by the Kaiser Family Foundation concluded that Under the proposed rule, individuals with lower incomes, a health condition, less education, and/or who are enrolled or likely to enroll in certain health, nutrition, and housing programs would face increased … Read More
Seven of the largest health insurers serving Pennsylvanians have agreed to end pre-authorization requirements for patients needing medication-assisted treatmen for opioid addictions. As explained in a news release issued by the governor’s office, These guidelines apply to individual, small group, and large group fully insured plans. Self-funded plans, where employers provide health care coverage administered by a third party, are regulated by the federal government and are not included in this agreement. In addition, The guidelines implement thresholds for prior authorization for long- and short-acting opioids, morphine milligram equivalents (MME) and exceptions for active cancer, sickle cell crisis, and palliative care/hospice patients. Generally, commercial insurers are requiring prior authorization for all long-acting opioid prescriptions and short-acting opioid prescriptions after seven … Read More
Centers for Medicare & Medicaid Services administrator Seema Verma intends to increase federal use of data reported by the states to improve the performance of state Medicaid programs. In an article published on the CMS blog, Verma wrote that Through strong data and systems, CMS and states can drive toward better health outcomes and improve program integrity, performance, and financial management in Medicaid and CHIP. Verma pointed to two core sets of data she considers vital: Medicaid and CHIP child and adult core sets, which are reported only voluntarily by states, and administrative data submitted through the relatively new Transformed-MIS system. The latter, according to Verma. …modernizes and enhances the way states submit operational data about beneficiaries, providers, claims and … Read More
Centers for Medicare & Medicaid Services administrator Seema Verma recently addressed the Medicaid Managed Care Summit, which was held in Washington, D.C. Ms. Verma’s speech focused on four major areas: Empowering states to function as laboratories for innovation by giving them the flexibility to introduce changes that work best for their own citizens. Developing Medicaid and CHIP scorecards that present data on health outcomes, quality metrics, and CMS’s administrative performance. Improving Medicaid program integrity, including through “…targeted audits to ensure that provider claims for actual health care spending match what the [Medicaid managed care] health plans are reporting financially.” Strengthening CMS’s use of data in Medicaid oversight. See Ms. Verma’s complete remarks here.