The Dual Agenda: September 1, 2016

State Highlights

Alabama

The Alabama state Legislature, meeting in a special session, failed to approve Gov. Robert Bentley’s lottery proposal to resolve the state’s long-term budget crisis and, specifically, to address funding shortfalls for the state’s Medicaid program. The Legislature will continue to meet in special session next week to consider using money paid to the state after the BP oil spill to resolve the budget crisis for 2017. If agreement on that were to be reached, it would solve the state’s funding gap for next year, but not represent a long-term solution to the state’s budget problems. 

California

The California Department of Health Care Services (DHCS) recently provided several updates to the Coordinated Care Initiative (CCI):

  • DHCS started streamlined enrollment on Aug. 22 for the Cal MediConnect program, the state’s dual eligible demonstration project. Streamlined enrollment, which is part of the state’s comprehensive strategy, will allow Cal MediConnect health plans to submit enrollment changes to DHCS on behalf of their members. This is intended to be a simpler method for beneficiaries whereby they will not have to take the extra step of enrolling via an enrollment broker. Beneficiaries will be able to enroll in the plan associated with their current Medi-Cal managed long-term services and supports health plan.
  • The UCSF Community Living Policy Center and the UC Berkeley Health Research for Action Center released findings from a telephone survey conducted with 2,139 dually eligible beneficiaries to examine their experiences with Cal MediConnect. Survey findings and additional information about the evaluation can be found here.
  • DHCS has developed the Cal MediConnect Beneficiary Toolkit to support beneficiaries, their caregivers and options counselors in helping choose the best health plan option.
  • DHCS has updated the Cal MediConnect Physician Toolkit to provide physicians with information about how the CCI is changing health care for dually eligible patients. The updated toolkit outlines the new coverage options for patients and how these changes could affect the billing process, care coordination and other aspects of a physician’s practice.
  • DHCS is soliciting proposals from qualified entities to provide services, including consumer assistance, education, training and outreach, to California's dually eligible beneficiaries in CCI counties.

In other news, advocates in California are engaged in ongoing efforts to pass legislation that would increase transparency in prescription drug prices. Because the most recent bill, SB 1010, was heavily amended and now exempts up to 99 percent of drug price hikes, advocates are no longer supporting that legislation. The original bill, which was vigorously opposed by the pharmaceutical industry, would have provided 30-day advance notice of prescription drug price hikes for both public and private purchasers, as well as greater disclosure of prescription drug cost trends. Health Access California and their partners plan to continue their efforts to win meaningful reforms to help consumers afford prescription drugs. 

Massachusetts

MassHealth, the state’s Medicaid program, posted the August enrollment numbers for One Care, the state’s dual eligible demonstration project.

The Medicare-Medicaid Coordination Office posted a summary of amendments to the three-way contract for One Care , the state’s dual eligible demonstration project.

In other news, MassHealth has released an FAQ document regarding the state’s 1115 waiver, which was recently submitted to the Center for Medicare and Medicaid Services (CMS) for approval. The waiver would create Accountable Care Organizations for Medicaid beneficiaries. Public comment on the proposal is due to CMS by Sept. 3.

Michigan

The Michigan Department of Health and Human Services posted the latest enrollment numbers for the MI Health Link dual eligible demonstration project.

New York

The New York State Department of Health (DOH) released information about how the 25 Performing Provider Systems (PPS) participating in the Delivery System Reform Incentive Payment program are spending funds. Most notable is how little of the funds awarded to date have been spent – only $200 million out of $842 million. Spending thus far has been on project management functions and on financially shoring up hospitals which anticipate funding losses due to reductions in hospital use, which is the key goal of DSRIP. Only 4.2 percent of overall PPS spending went to community-based primary care providers. Community-based organizations (CBOs), viewed as critical partners in addressing social determinants of health, received only 3.2 percent of total expenditures and ten of the 25 PPSs have not shared any funding with a CBO. DOH has also started publishing DSRIP Digest, a new monthly newsletter about the DSRIP program.

In other news, the New York City Department of Health and Mental Hygiene, along with other partners, released a plan that outlines five strategies to expand the impact of the medical home model of primary care across New York City. The five strategies highlighted by the plan include:

  • Prioritizing medical home adoption in communities with the greatest health inequities.
  • Ensuring medical home adoption is accessible and sustainable for small practices.
  • Supporting the integration of behavioral health care as part of the medical home.
  • Coordinating various medical home initiatives underway across New York state.
  • Achieving multi-payer support to sustain the medical home model.

Ohio

Ohio’s Department of Medicaid released the second annual Medicaid managed care report card, which shows that all five Medicaid plans in the state scored average or better on patient satisfaction and communication. The state used plan data and patient surveys to rate plans on access to care, provider communication, children’s health, management of chronic illnesses and women’s health care. CareSource ranked highest among the plans, receiving 13 of 15 possible stars.

Rhode Island

The Medicare-Medicaid Coordination Office posted a summary of amendments to the three-way contract for the Integrated Care Initiative, the state’s dual eligible demonstration project.

Oregon

The Oregon Health Policy Board is hosting a series of stakeholder and community meetings across the state to gather public input about Oregon’s coordinated care organizations (CCOs). The input will be used to help shape recommendations for a report to Oregon’s state Legislature and the Oregon Health Authority about the future of the state’s CCOs.

In other news, a recent article by the CEO of CareOregon, which owns or supports four of Oregon’s CCOs, highlights the importance of addressing housing and health together. The article calls for support for a bond issue to fund 1,300 affordable housing units in Oregon as a way to provide safe, stable homes, build healthier communities and lower health costs.

Pennsylvania

Pennsylvania's Department of Human Services has announced the selection of three managed care organizations (MCOs) for Community HealthChoices, the Commonwealth’s new managed long-term services and supports initiative. The three selected MCOs are:

  • AmeriHealth Caritas
  • Pennsylvania Health and Wellness (Centene)
  • UPMC for You

Community HealthChoices will provide a broad range of health care and supportive services to more than 420,000 individuals who are dually eligible for Medicare and Medicaid, older Pennsylvanians and individuals with disabilities. The initiative will formally launch in three phases: July 2017 in the Southwest region, January 2018 in the Southeast region and January 2019 in the Northwest, Lehigh-Capital and Northeast regions.

South Carolina

The South Carolina Department of Health and Human Services (DHHS) is transitioning key Home and Community-Based Services (HCBS) responsibilities to the Medicare-Medicaid Plans (MMPs) participating in the Healthy Connections Prime dual eligible demonstration project. DHHS posted a Frequently Asked Questions document for HCBS providers to explain this transition.

Virginia

The Virginia Department of Medical Assistance Services posted the latest enrollment numbers for Commonwealth Coordinated Care , the state’s dual eligible demonstration project.

Washington

Washington’s Medicaid program is moving forward with value-based payments to hospitals and health care providers by tying financial incentives to quality, cost-effective care in its 1115 Medicaid waiver application, presently being reviewed by the Centers for Medicare and Medicaid Services. Specifically, the state is seeking to tie 30 percent of its health care purchases to value-based payment arrangements by 2017, and 90 percent by 2019. The state has selected seven performance measures and will withhold one percent of managed care plan premiums pending an assessment of their performance based on these measures.

In other news, the Centers for Medicare and Medicaid Services MMCO released the first annual evaluation report containing early results of the Washington Health Home managed fee-for-service model demonstration under the Medicare-Medicaid Financial Alignment Initiative. The Washington demonstration leverages Medicaid health homes to test new mechanisms to coordinate Medicare and Medicaid services for Medicare-Medicaid enrollees, and allows the State and the Federal governments to share in savings resulting from quality improvements. 

The results in this report are based on experience during the first demonstration performance period, from July 2013 - December 2014. The report includes qualitative and limited quantitative reporting related to demonstration implementation, enrollment data, beneficiary experience, and Medicare utilization and costs for the eligible population.

Noteworthy News

In this section:

  • CMS Proposes New Rule on PACE Program
  • CMS Proposes Mandatory Bundled Payment Program for Cardiac Care
  • Innovative Approaches Multiplying for Improved Care for Older Adults
  • Action Needed to Support Continued Funding for the Money Follows the Person Program
Featured Resources

In this section:

  • New National Profile of Dually Eligible Beneficiaries
  • New Report on the State of Older Americans in the U.S.
  • Webinar Resources: Preparing Community-Based Organizations for Successful Health Care Partnerships Webinar Resources
  • New Report on Value-Based Payment Models for Medicaid Child Health Services

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