« The Dual Agenda: May 4, 2016 Issue

State Highlights

Alabama

The state’s budget standoff over the future of Alabama’s Medicaid program, including its Medicaid reform program, continues. Governor Robert Bentley’s administration has begun making the case for full Medicaid funding to a skeptical state Legislature. In the meantime, the state’s pediatricians have threatened to stop seeing Medicaid patients if reimbursement rates are cut.  

California

Justice in Aging submitted extensive comments to the California Department of Health Care Services and the Medicare-Medicaid Coordination Office in response to proposed program changes for Cal MediConnect, the state’s dual eligible demonstration project. In its comments, Justice in Aging opposes the state’s proposal to extend passive enrollment of additional beneficiaries into Cal MediConnect while also supporting some proposals such as extension of the deeming period which would help to stabilize enrollment. 

In other news, California’s Department of Insurance held a hearing on the proposed merger of Aetna and Humana in late April. Consumer advocates raised concerns about the mega-merger related to lack of consumer protections, unreasonable rate increases, skepticism about passing savings along to consumers, low consumer satisfaction scores, and unease with Aetna’s lack of attention to diversity and health disparities.

On the legislative front, two bills moving through the California state Legislature would require more transparency around prescription drugs. Senate Bill 1010 would require drug manufacturers to notify health plans if they are going to increase the wholesale cost of a drug by 10 percent or more during any 12- month period. Assembly Bill 2436, which is sponsored by Community Catalyst partner, Health Access California, will increase transparency in drug prices by giving consumers more information about the cost of prescription drugs and how much they will have to pay.

Maryland

An innovative methadone clinic in Baltimore has been given funding by the U.S. Substance Abuse and Mental Health Services Administration to share the details of its unique program with states beyond Maryland. Unlike the vast majority of methadone clinics, the Johns Hopkins Broadway Center for Addiction provides a variety of treatment options to patients other than just methadone, including other medication regimens, addiction counseling and group classes. The Broadway Center also collaborates with local physicians and serves as a hub for the social needs of patients, including housing, transportation and job training.

Massachusetts

On April 29, the Long-Term Services and Supports (LTSS) subcommittee of the One Care Implementation Council held a public meeting to hear about what is working well and what still needs improvement related to enrollees’ access to LTSS. One Care is the state’s dual eligible demonstration project. Participants shared concerns about the Long-Term Services and Supports Coordinator role and ideas for improving it. These comments will be shared with MassHealth and the One Care plans in order to shape amendments to the One Care three-way contract.

The Massachusetts House of Representatives has passed an FY '17 budget that includes a new $250 million tax on the commonwealth’s hospitals to help fund the state’s Medicaid program. The tax is scheduled to be phased out after five years. The  revenue generated by the new tax would be redistributed among the state’s hospitals, with the largest share going to hospitals that serve large numbers of Medicaid patients. Governor Charlie Baker’s administration says the new revenue is important as the state seeks to restructure its Medicaid program to incorporate accountable care models.

Michigan

The Michigan Department of Health and Human Services is hosting two regional forums this week on the MI Health Link dual eligible demonstration project, one in Detroit and the other in Clinton Township. The presentation at the forums will focus on sharing information about the status of the program, answering questions, and receiving feedback from dually eligible individuals, their families, providers and other interested stakeholders.

Minnesota

TakeAction Minnesota will be hosting a facilitated discussion titled Aging Together: A Conversation about Care and Caregiving about the roles, needs and concerns of caregivers and those that they care for.

New Jersey

In its latest newsletter, Health Management Associates (HMA) reports on the most recent quarterly meeting of New Jersey's Medical Assistance Advisory Council. Among the updates was information on the three Medicaid ACOs approved by the Division of Medical Assistance and Health Services (DMAHS) for Medicaid ACO demonstrations: Camden Coalition of Healthcare Providers; Healthy Greater Newark Accountable Care Organization and Trenton Health Team. The meeting also featured a report on the state’s Managed Long-Term Services and Supports program which began in July 2014 and currently serves approximately 24,000 people. Finally, HMA reports that DMAHS will release a renewal for the state’s Comprehensive Medicaid 1115 waiver in mid-May that will be followed by a 30-day public comment period. The state’s current waiver is set to expire on June 30, 2017.

New York

New York began implementing its $8.25 billion Delivery System Reform Incentive Payment (DSRIP) program two years ago and reports on how the program is working are beginning to emerge. Last week, The Commonwealth Fund issued a report on New York’s experience implementing DSRIP, focusing on organization, governance and market transformation; care model and the social determinants of health; analytics; measurement and accountability; and value-based payment arrangements and sustainability. The Commonwealth Fund has scheduled a webinar to review the findings in the report. In addition, New York’s Department of Health has also issued a mid-point assessment of DSRIP.   

The United Hospital Fund has released a report on the performance of New York’s Accountable Care Organizations (ACOs) in Year 2 of the Medicare Shared Savings programs. The Medicare Shared Savings Program is a nationwide ACO program sponsored by the Center for Medicare and Medicaid Innovation. New York has 21 ACOs that have been in the program long enough to have generated results. In year two, New York’s ACOs were comparatively strong on quality measures but less impressive in terms of cost savings. In aggregate, the 21 ACOs generated savings to Medicare of $1.6 million, a savings rate of 0.05 percent of total expenditures.

Finally, the Healthcare Association of  New York State has issued a report on quality measures that urges stakeholders to collaborate on building a measurement system that helps to achieve the Triple Aim. The report urges the streamlining and aligning of measurement metrics and focusing on only those measures that positively impact patient outcomes.

Oregon

The Collaborative for Health Information Technology in Oregon, a multi-stakeholder group, recently released a white paper titled Aligning Health Measurement in Oregon that puts forward recommendations framed around Oregon priority improvement areas. In other news, the Oregon Health Policy Board met last month to discuss the renewal application for the state’s 1115 waiver. Oregon Medicaid Director Lori Coyner shared the overall goals of the renewal which include: building on transformation including integration; more deeply addressing social determinants of health, including housing; maintaining a sustainable rate of growth in expenditures; and expanding the coordinated care model.

Pennsylvania

The Pennsylvania Department of Human Services (DHS) has made available for public review and comment its proposed waiver for Community HealthChoices (CHC), the commonwealth's managed long-term services and supports program. If approved, the program will launch in southwest Pennsylvania in January 2017, the southeast in January 2018, and in the northwest, Lehigh-Capital and northeast regions in January 2019. DHS will accept public comments until May 23. In the meantime, the Office of Long-Term Living will offer two webinars in May for public input and discussion of the proposal: May 12 2 - 3:30 p.m. and May 18 10 - 11:30 a.m.

In other news, DHS announced that eight managed care organizations have been chosen to serve in HealthChoices, the state’s Medicaid managed care program. The new HealthChoices contracts will gradually increase the percentage of value-based or outcome-based provider contracts the plans have with hospitals, doctors and other providers to 30 percent of the funds they receive from DHS. Value-based options may include, for example, bundled payments, patient-centered medical homes or accountable care organizations.

Rhode Island

Rhode Island is finally moving forward with its demonstration for dually eligible individuals. The three-way contract between the Centers for Medicare and Medicaid Services (CMS), the state of Rhode Island and Neighborhood Health Plan was executed last week, and the state is eying July 1 as a first enrollment date. Neighborhood Health Plan is the only plan in Rhode Island participating in the demonstration. The state expects 10,000 to 14,000 people to enroll.

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