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With 2018 transitioning to 2019, MHPA would like to wish its members, partners and other industry professionals a safe and happy holiday season. The last edition gave readers a glance at how MHPA has defended Medicaid in the news this year. Here are some additional articles that received a lot of attention from you, our valued readers. Our regular publication will resume Wednesday, Jan. 2.
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The Washington Post
From June 5: Call it a beauty pageant for state Medicaid programs. Except that it's extremely difficult to judge. On Monday, the Trump administration released what it's calling a Medicaid "scorecard" that compares states side-by-side on 17 measures indicating the timeliness and quality of medical care received by enrollees and how well they're faring under the insurance program for low-income Americans. Medicaid Health Plans of America chief executive Jeff Myers, whose group represents Medicaid managed-care plans, called the scorecard a "good first step."
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The Hill
From May 22: Earlier this month, the Centers for Medicare and Medicaid Services (CMS) rejected a request from Kansas to limit Medicaid eligibility to just three years. CMS Administrator Seema Verma followed up on the Kansas decision by saying the administration will not allow any states to impose lifetime limits on Medicaid.
Verma never promised automatic approvals of conservative ideas, though some might have interpreted it that way, according to Jeff Myers, president and CEO of the Medicaid Health Plans of America. He said it's becoming clear that what the Trump administration wants is to construct policies that will make Medicaid beneficiaries self-sufficient, but that will not take away their benefits entirely.
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HealthLeaders Media
From March 27: A proposed rule change by the Centers for Medicare & Medicaid Services would exempt state Medicaid programs from some access-to-care reporting requirements. Specifically, the proposal would exempt states with a Medicaid managed care penetration of 85 percent or more from some monitoring requirements, and provide similar flexibility to states when they make nominal rate reductions to fee-for-service payment rates. Jeff M. Myers, president and CEO of Medicaid Health Plans of America, said the existing rules are not needed in states with a high penetration of Medicaid managed care plans because they already have robust provider networks.
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HFI’s mission is to partner with healthcare clients to improve their fiscal health by advocating for their most vulnerable members. HFI helps members get necessary benefits and income affording them access to important social determinants of health.
We effectively identify and reclassify eligible super-utilizers from TANF/ACA to ABD.
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MHPA
From March 13: In addition to revisiting Affordable Care Act repeal-and-replace efforts and changes to Medicaid financing, the president's proposed fiscal year 2019 budget contains several reforms aimed at restructuring drug benefits in both Medicare and Medicaid. And while critics of the budget released Feb. 12 say the drug-related proposals do very little to address rising pharmaceutical prices, the document at the very least has some positive indications that policymakers are ready to revamp an outdated drug purchasing system in Medicaid, suggests one industry expert.
"I think it is a signal that policymakers are frustrated that pharmaceutical companies are still raising prices at 12 percent a year and that their publicly paid program can no longer afford the price escalation," remarks Jeff Myers, president and CEO of MHPA.
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STAT (Subscription required)
From Nov. 13: Thanks to a combination of falling prices and litigation, more state Medicaid programs have eased restrictions on hepatitis C medications, according to a new analysis by the Center for Health Law and Policy Innovation. But the group, which is funded by drug industry money, also leveled criticism that "far too many states have retained their discriminatory insurance practices."
Francis Rienzo, who heads Medicaid Health Plans of America, explained that "unsustainable prices ... should change with the entry of multiple generics, but until then, offering unrestricted access to hepatitis C drugs will decimate Medicaid budgets in many states. This evolution of the hepatitis C market is Exhibit A in the argument for much-needed reform of the Medicaid Drug Rebate Program which perpetuates misaligned incentives."
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MHPA via AIS Health
From June 26: Congress at press time was considering comprehensive legislation to combat the opioid crisis, including provisions addressing a growing area of concern for Medicaid beneficiary advocates and insurers — treatment for opioid-addicted pregnant women and infants born with Neonatal Abstinence Syndrome (NAS). CMS in new guidance also recognized this issue and highlighted options for states, although advocates say a shortage of clinicians available to provide medication-assisted treatment (MAT) to the mothers must also be addressed.
Jennifer Moore, Ph.D., executive director of the Institute for Medicaid Innovation (IMI), says the CMS guidance is significant. "NAS is finally getting the attention it deserves," she tells AIS Health. "National initiatives like this will help strengthen efforts that address opioid use disorder among pregnant women and babies, especially in the Medicaid populations. We hope that the guidance will continue to spark the momentum and conversations for other initiatives such as those focused on [MAT]."
Meanwhile, the House on June 13 introduced the SUPPORT for Patients and Communities Act (H.R. 6), comprised of multiple opioid-related House-passed bills to move over to the Senate. This included a provision directing the HHS secretary to issue guidance to improve care for infants with NAS and their families. "While there have been a few hundred opioid-related bills introduced this Congress, only a handful address opioid addiction in pregnant women and NAS babies,” remarks Francis Rienzo, vice president of government relations and advocacy at Medicaid Health Plans of America. “Given that Medicaid covers more than 80 percent of NAS births, whatever legislation ends up addressing the opioid crisis and NAS will be best implemented via the program and their health plan partners."
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Kern Health Systems (Kern) is overcoming numerous care management challenges using Jiva, the industry’s leading PHM platform. Learn how the powerful end-to-end platform is helping Kern consolidate data, streamline workflow, manage compliance, create holistic assessments, improve overall health outcomes, and plan for future expansion into new lines of business.
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The Washington Post
From Feb. 13: Many parts of President Donald Trump's budget proposal are just pie-in-the-sky wishes. But the proposal unveiled yesterday does contain this: some strong hints about how the administration might tackle the burgeoning opioid epidemic with $6 billion in new funding that is already in hand. The budget's mention of medication-assisted treatment was especially pleasing to Medicaid plans and health advocates, who have long fretted that drugs proved to be extremely helpful in treating addiction aren't used nearly often enough by providers or covered by insurers.
"We are happy to see the White House and HHS address the opioids crisis, especially calling out medication-assisted therapy as an important tool to help those who are addicted, and that they enlist the help of Medicaid health plans to tackle these issues at the state level," said Jeff Myers, president of Medicaid Health Plans of America. But these advocates are still ambivalent about the budget proposal. That's because it also incorporates a rollback of the Affordable Care Act's Medicaid expansion, as well as suggests block-granting Medicaid and placing a per-person spending cap on it. Those are all moves that would sharply reduce future Medicaid spending and almost certainly reduce health coverage for many low-income Americans.
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Forbes
From Oct. 23: The move away from fee-for-service medicine is moving beyond the experimental stage for private health plans that contract with state Medicaid programs, a new study shows.
The Institute for Medicaid Innovation's 2018 annual Medicaid managed care survey said half of Medicaid managed care plans are "piloting population specific" value-based payment models, and 15 percent are "expanding successful pilots." The report was released during Medicaid Health Plans of America's annual conference, which runs through Tuesday in Washington. MHPA's members include Aetna, Centene, UnitedHealth Group and WellCare Health Plans.
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AIS Health's Health Plan Weekly
From Oct. 9: A national collaborative of 17 major health systems recently unveiled a two-year initiative that it anticipates will transform the Medicaid program by leveraging shared digital solutions and innovative care models to improve care for complex, costly, vulnerable populations. The broadly defined approach somewhat baffles a Medicaid health plan association, which says the health systems' initiative seems to be taking a page from managed care's playbook — basically, focusing on what plans already do.
"Andy Slavitt is incredibly smart. He's visionary, the kind of leader CMS needed to move forward ... and we're all for Medicaid transformation. That's what plans do," said Jeff Myers, president and CEO of Medicaid Health Plans of America.
"But to do Medicaid transformation is more than cool ideas. It's actually implementing things on the ground," Myers told AIS Health. "I'm not sure what 'secret sauce' they have that isn't being explored already."
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Modern Healthcare (Subscription required)
From Oct. 30: The Democrats' predicted blue wave looks poised to hit the Republicans' red seawall, which means a big swath of the country could crash purple this midterm election cycle. For the healthcare industry, where stakes are higher at the state level over the next two years, that could mean the states will carry out the kind of bipartisan work that stymies Washington.
"Keep in mind how Washington under the Democrats and Republicans has been increasingly unable to get things done in a whole lot of areas,” Charlie Cook, editor of Cook Political Report, told the Medicaid Health Plans of America conference in Washington last week. "That has left a power vacuum that has devolved power out to state governments."
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