Trump Administration Approves Kentucky Work Requirements for Second Time
The Centers for Medicare and Medicaid Services (CMS) re-approved Kentucky’s request to add work requirements to the state’s Medicaid program last week, following a federal judge’s ruling earlier this year that overturned the first iteration of these requirements. These changes would require the population covered by Kentucky’s Medicaid expansion to report 80 hours of work or “work-related activities” each month, or face losing their coverage for a six-month lockout period. The approved 1115 waiver, which takes effect April 1, 2019, is almost identical to the state’s previously overturned application, and has been projected to result in at least 95,000 Kentuckians losing Medicaid coverage over the next five years.
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CMS Releases Medicare Part D and MA Drug Pricing Proposal
The Centers for Medicare and Medicaid Services (CMS) has released a new proposed rule on prescription drug pricing in Medicare Part D and Medicare Advantage (MA). Most notably, the proposal would provide new exceptions to Medicare’s “six protected classes” policy, a policy that ensures beneficiaries with complex health conditions, including mental illness, have access to a full range of medication treatment options. The Partnership for Part D Access, a coalition headed by the National Council, immediately spoke out against these changes as harmful to patients’ health. Additionally, the proposal would permit Medicare Advantage plans to use step therapy for Part B drugs, provide physicians with real-time estimates of drug prices and alternatives and require the Part D Explanation of Benefits to include new drug pricing information.
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CMS Proposes Overhaul of Medicaid Managed Care Rules
The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule to update the regulations governing Medicaid and Children’s Health Insurance Program (CHIP) managed care plans. The proposed rule would rollback many of the managed care standards established by the Obama Administration in 2016 that help ensure Medicaid beneficiaries have timely access to comprehensive health care. Now CMS intends to “increase state flexibility” by relaxing requirements that support network adequacy and provider pay. CMS is accepting comments on the proposed rule through January 14, 2019.
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CMS Announces New Opportunities to Expand Mental Health Services
This week the Centers for Medicare and Medicaid Services (CMS) announced a new opportunity for states to expand Medicaid coverage for mental health services, including treatment delivered in inpatient facilities with more than 16 beds known as institutions for mental disease (IMDs). In a letter, CMS explains how states can use Section 1115 waivers to “support innovative service delivery systems” for adults with serious mental illness (SMI) and children with serious emotional disturbance (SED). CMS emphasized the need for states to bolster early identification services, better integrate mental health and primary care, increase access to crisis services and expand the use of Certified Community Behavioral Health Clinics (CCBHCs).
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BHECON’s 2018 Themes Show Key Issues Faced by State Behavioral Health Associations
The Behavioral Health + Economics Network (BHECON), an initiative led by the National Council, is winding down on its second year of activities. BHECON partners with National Council state provider associations to transform the behavioral health delivery system by increasing their advocacy capacity and breaking down silos that create barriers to services for individuals with serious mental illness and co-occurring conditions. In its second year, BHECON translated the key state issues identified by stakeholders in year one, including mental health parity, workforce and increasing access to behavioral health services, into specific policy solutions in each of the nine states currently participating in the program.
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Health Care Emerges as Top Issue in Midterms
With historic levels of voter turnout, Tuesday’s midterm election results saw Democrats regain control of the House of Representatives, while Republicans strengthened their majority in the Senate. Health care emerged as a clear priority for voters and Medicaid expansion proved to be a big winner on election night. With power now divided in Congress, the next two years could feature intense political gridlock or force bipartisan compromise. Right now, one thing is clear – the 2018 midterms will send one of the largest classes of freshmen Members to Washington in recent history – and with them come new advocacy opportunities for the National Council and its members.
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CMS Finalizes Changes to Medicare Physician Payment and Quality Policies
Last week, the Centers for Medicare and Medicaid Services (CMS) released its final rule for the 2019 payment year under Medicare. The rule finalizes policies around reducing provider burden, increasing electronic health record (EHR) interoperability, coverage expansions for telehealth, virtual care, and substance use disorder treatment. Notably, CMS decided to modify its original proposal to significantly change the payment and documentation requirements for traditional outpatient, office-based visits by modifying some elements to address concerns raised by provider groups like the National Council and other stakeholders.
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Wisconsin Waiver Adds Medicaid Work Requirements, Drug Screens
On Wednesday, the Centers for Medicare and Medicaid Services (CMS) approved Wisconsin’s request to enact a series of restrictions that would limit Medicaid eligibility and restrict enrollees’ use of Medicaid benefits. The newly-approved Section 1115 waiver will require certain adult beneficiaries to work 80 hours per month to maintain health coverage, institute premiums and subject applicants to drug use screening questions. This decision is the latest in a series of work requirement approvals, however, Wisconsin is the first non-Medicaid expansion state to receive permission from CMS to impose work requirements.
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Trump Administration Loosens Requirements for ACA 1332 Waivers
The Trump Administration has issued new guidance to states that would relax requirements around 1332 waivers, the Affordable Care Act’s (ACA) vehicle for states to make changes to their individual insurance markets. The guidance tracks closely with the Administration’s stated goal of providing flexibility for states to offer cheaper insurance options outside of the ACA marketplaces. In short, the new guidance encourages states to utilize association health plans (AHPs) and short-term health plans as alternatives to current ACA marketplace plans.
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Kaiser Family Foundation Survey Outlines Medicaid’s Future
Results from a new survey suggest that state Medicaid programs have seen stagnant enrollment over the past year while combined federal and state spending continued to grow similarly to the previous year. Additionally, states have reported a shifting focus toward prioritizing improvements in outcomes and value through delivery system changes and managed care requirements. The Kaiser Family Foundation (KFF) and Health Management Associates (HMA) included these results from their 18th annual survey of state Medicaid directors in two reports, released last week.
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