Archive for: Medicaid

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Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

CMS uploaded new materials to the Quality Payment Program Resource Library.

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Payment Innovation: Other

GAO Report Finds Changes Needed in Order for CMS to Assess the Effectiveness of its Quality Measurement Activities

On Thursday, September 19, 2019, the GAO released a report on quality measurement activities of the Centers for Medicare and Medicaid Services titled, “CMS Could More Effectively Ensure Its Quality Measurement Activities Promote Its Objectives.”

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Insurance Coverage: Waivers

Tennessee 1115 Waiver Application

On September 17th, 2019, Tennessee released its proposal to implement a black grant for Tennessee’s Medicaid program, otherwise known as TennCare.  This 1115 waiver, referred to as “Amendment 42,” would convert the federal share of the state’s Medicaid funding for most services into a block grant.

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Payment Innovation: Other

GAO Releases Report on Managing High Cost Medicaid Beneficiaries

The GAO has released a report on identifying, predicting, and managing high-cost beneficiaries in Medicaid.

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Insurance Coverage: Waivers

Montana 1115 Waiver Application Summary

Montana submitted a new 1115 waiver application to CMS on August 30, 2019. The waiver is pending approval.

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Insurance Coverage: Regulation

Recent State Action Relating to Medicaid Expansion

We have highlighted recent state grassroots, legislative and executive action to expand Medicaid.

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Insurance Coverage: Waivers

Utah Medicaid Waivers

CMS has approved Utah’s 1115 waiver, implementing a “bridge plan” while the state submits additional waivers.

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Insurance Coverage: Waivers

New York 1115 Waiver Application Summary

On August 9, 2019, New York announced it will submit a Section 1115 Medicaid Demonstration waiver application to CMS to provide Medicaid services to certain incarcerated individuals about to be released from county jails and New York State prisons.

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Prescription Drug: Legislation

Summary of Senate Finance Prescription Drug Package

Senate Finance Committee posts description of the Chairman’s mark of its legislation addressing prescription drug pricing.

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Payment Innovation: Other

2020 Medicaid and CHIP Core Set Open for Comments Through August 5

Recommendations for the 2020 Medicaid and CHIP Core Set are open through August 5.

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Payment Innovation: Other

CMS Updates Medicaid and CHIP Scorecard

On July 18, 2019, CMS updated the data within the Medicaid and CHIP Scorecard.

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Prescription Drug: Pricing

Administration Withdraws Rebate Overhaul Proposal

The Administration has announced it is no longer pursuing its drug pricing proposal that would have required pharmacy benefit managers to pass rebates directly on to the patient.

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Payment Innovation: Other

CMS Commits $50 Million to Assist States with Substance Use Disorder Treatment and Recovery

CMS released a Notice of Funding Opportunity for planning grants to address the opioid crisis.

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Insurance Coverage: Waivers

South Carolina 1115 Waiver Application Summary

On May 8, 2019, South Carolina submitted a new 1115 waiver application to the Centers for Medicare and Medicaid Services (CMS). The waiver includes work requirements, expands coverage for children, pregnant women and parents, and expands coverage for certain individuals with substance use disorders, who are chronically homeless or who are involved in the justice…

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Insurance Coverage: Waivers

Utah Per Capita Cap 1115 Waiver Summary

On May 31, 2019, Utah released its 1115 waiver proposal, “Per Capita Cap.” This waiver requests authority to implement the provisions of Senate Bill 96 “Medicaid Expansion Adjustments”, which passed during the 2019 Utah legislative session.  Provisions of the waiver include implementing a per capita cap, seeking enhanced Federal Medical Assistance Percentages (FMAP) for the…

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Payment Innovation: Other

GAO Recommends CMS Improve Transparency Policy for Section 1115 Waivers

On May 17, the GAO released a report recommending an improved transparency policy for Section 1115 waivers.

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Payment Innovation: Innovation Center

Reminder: Applications for the InCK NOFO are due June 10, 2019

The Innovation Center released updated FAQs for the InCK Notice of Funding Opportunity.

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Payment Innovation: Innovation Center

Innovation Center Hosts Webinar on InCK Model on May 15

The Innovation Center will host a webinar on the InCK model on May 15.

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Insurance Coverage: Legislation

Senate Dems Introduce Choose Medicare Act, Public Option

Senators Jeff Merkley (D-OR), Chris Murphy (D-CT), and Dianne Feinstein (D-CA) introduced the Choose Medicare Act, which would allow for any individual who is not already enrolled in Medicare or Medicaid to enroll in Medicare as an individual. This would be known as Medicare Part E and would be offered on all state and federal…

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Insurance Coverage: Legislation

House Dems Introduce Medicare for America Act, Expanding Coverage in Medicare and Medicaid

Representatives Rosa DeLauro (D-CT) and Jan Schakowsky (D-IL) introduced the Medicare for America Act. The bill would expand coverage in Medicare and Medicaid to include prescription drugs, dental, vision, hearing, and long-term support services. Those who are uninsured or do not have employer-sponsored health insurance, including those in the individual marketplace, would be auto-enrolled into…

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Payment Innovation

CMS Issues Letter to State Medicaid Directors

On April 24, 2019, CMS sent a letter to State Medicaid Directors inviting states to partner with CMS to test innovative approaches to better serve those who are dually eligible for Medicare and Medicaid.

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Payment Innovation: Innovation Center

Innovation Center Holds Second Webinar on InCK Funding Opportunity

The Innovation Center is holding its second webinar on the InCK Model Notice of Funding Opportunity.

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Insurance Coverage: Waivers

Utah Medicaid 1115 Waiver Summary

On June 22, 2018, Utah submitted an 1115 waiver amendment to CMS seeking to implement a partial and capped Medicaid expansion, as well as Medicaid work requirements for certain populations. Following that waiver amendment, on February 6, 2019, Utah submitted an additional 1115 waiver amendment lifting the Medicaid Institution for Mental Disease (IMD) exclusion for…

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Payment Innovation: Innovation Center

Innovation Center Hosts Webinar on MOM Model Application Process

The Innovation Center will hold a webinar on the MOM Model application process on April 4, 2019.

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Insurance Coverage: Waivers

Ohio Section 1115 Waiver Approval

On March 15, 2019, CMS approved Ohio’s Medicaid 1115 waiver, allowing the state to implement work requirements for certain Medicaid recipients.

ORIGINAL ANALYSIS

Payment Innovation: Other

CMS Publishes Guidance on 1115 Waiver Evaluations

CMS published guidance for states on 1115 waiver evaluations.

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Payment Innovation: Other

CMS Updates Drug Spending Dashboards

CMS updated its drug spending dashboards with 2017 data.

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Insurance Coverage: Stakeholder Engagement

Actuaries Weigh in on Expanding Public Insurance

An American Academy of Actuaries report out today breaks down criteria and implications for “Medicare for All” and less sweeping approaches, including Medicare and Medicaid buy-ins.

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Payment Innovation: Other

CMS Approves Drug Price Negotiations for Colorado Medicaid

Colorado has become the latest state to receive approval from CMS for negotiating drug prices for Medicaid recipients using value-based contracting arrangements.

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Payment Innovation: Innovation Center

Innovation Center Hosts Webinar on MOM Model Application Process

CMMI is holding a webinar on February 21 from 2:00 to 3:15 pm ET to review the Maternal Opioid Misuse (MOM) model Notice of Funding Opportunity and Grants.gov application process.

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Insurance Coverage: Legislation

Medicaid Expansion Bill Introduced

On February 14, 2019, Senator Brian Schatz (D-HI) introduced the State Public Option Act (S. 489) which allows states to provide a public option through Medicaid for individuals not otherwise covered under Medicaid or enrolled in other insurance.

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Payment Innovation: Innovation Center

InCK Model: Notice of Funding Opportunity and Webinar on February 19

The CMS Innovation Center has announced a funding opportunity for the Integrated Care for Kids model and a webinar on Feb. 19.

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Payment Innovation: Innovation Center

Maternal Opioid Misuse Model Funding Opportunity Announced

The CMS Innovation Center will execute up to 12 cooperative agreements with states whose Medicaid agencies will implement the Maternal Opioid Misuse model with one or more “care-delivery partners” in their communities. The Notice of Funding Opportunity is now available.

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Payment Innovation: Other

HHS and OIG Releases Proposal Targeting PBMs

HHS and OIG release proposed rule targeting pharmacy benefits managers.

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Payment Innovation: Innovation Center

McDermottPlus Launches 2019 CMS/CMMI Payment Model Tracker

This handy CMMI payment model tracker will allow you to easily follow changes and help you better understand the evolution of value-based payment in the Medicare and Medicaid program.

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Insurance Coverage: Legislation

Medicaid Extenders Act of 2019

On January 24, 2019, the Medicaid Extenders Act of 2019 (H.R. 259) was signed into law. This law extends the Money Follows the Person program, among other things.

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Payment Innovation: Other

Institute for Medicaid Innovation Survey Finds Medicaid MCOs Are Increasingly Using Value-based Payment Models

Survey results released by the Institute for Medicaid Innovation find that around half of Medicaid managed care organizations launched population-specific value-based purchasing models last year, and around 10 percent of plans had extensive value-based purchasing arrangements in place.

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Payment Innovation: Innovation Center

CMS Announces MOM Model

CMS announces the Material Opioid Misuse (MOM) model as part of the agency’s strategy for combating the opioid crisis.

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Payment Innovation: Other

LAN Releases Updated Report on APM Adoption

Health Care Payment Learning and Action Network released a new report on alternative payment model adoption.

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Payment Innovation: Innovation Center

CMS Announces Integrated Care for Kids Model to Address the Opioid Crisis

On August 23, 2018, CMS announced a new model that is intended to address the opioid crisis for children.

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Insurance Coverage: Budget Information

House GOP Proposes 2019 Budget Plan

The Republican House Budget Committee released a FY 2019 budget roadmap, The Budget for A Brighter American Future, on June 19.

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Insurance Coverage: Stakeholder Engagement

Republican Governors Criticize American Health Care Act

On March 16, 2017, four Republican governors (John Kasich of Ohio, Rick Snyder of Michigan, Brian Sandoval of Nevada and Asa Hutchison of Arkansas) sent congressional leaders a letter criticizing the American Health Care Act and proposing an alternative framework for reforming the Medicaid program. The four governors endorse per capita caps and block grants,…

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Insurance Coverage: Stakeholder Engagement

The Commonwealth Fund: Medicaid’s Future: What Might ACA Repeal Mean?

January 12, 2017 report examining how repeal legislation could affect Medicaid.

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Insurance Coverage: Congress

Senate Finance Committee Letter to RGA on Jan 2017 Medicaid Roundtable

In a letter to the Republican Governors Association dated December 13, 2016, the Senate Finance Committee announced that it will convene a Governor Roundtable in January 2017 to discuss the sustainability and future of the Medicaid program.

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Insurance Coverage: Stakeholder Engagement

What Would Block Grants or Limits on Per Capita Spending Mean for Medicaid?

November 18, 2016 report from the Commonwealth Fund examining the President-elect Trump and some congressional leaders’ calls for absolute limits on the federal government’s spending on Medicaid.  This report explores the two most common proposals for reengineering federal funding of Medicaid: block grants that set limits on total annual spending, regardless of enrollment; and caps…

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