Health Policy News – September 2019


Since publishing our summer edition, the Health Policy News team has attended various conferences. We were thrilled to see many subscribers in person at the National Conference of State Legislatures Legislative Summit, as well as the National Academy of State Health Policy annual conference. In this edition, we share our insights (and relevant fact sheets) from these events for readers who were unable to attend.

As we resume our regular cadence of newsletters this month, we also feature two pieces related to hot-button themes identified in recent Office of the Inspector General (OIG) reviews. The first, from a new Health Policy News contributor, highlights best practices for critical incident management—including insights to assist states in preventing, reporting, and investigating incidents among the long-term care population. The second piece analyzes recent developments related to state claiming and reporting of Medicaid waiver administrative costs, providing recommendations for states looking to update their cost allocation plans accordingly.

Finally, as is typical, we briefly report on breaking news: within the last few weeks, Tennessee made progress on its Medicaid block grant plan, and CMS released a final rule aimed at implementing program integrity enhancements to the Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) provider enrollment processes. Our pieces are brief analyses of these policy developments, with more likely to come on these developing topics in future editions.

Stay tuned next month for a report and tracking tool that will address various state approaches to Accountable Care Organizations. We will host a webinar to present and delve into the details of our report; keep an eye out for invite information! We hope you can join us for what is sure to be a lively discussion of innovative state approaches to care delivery.

National Conference of State Legislatures (NCSL) Conference Brings Policy Makers from Across the Country Together

Members of the Health Policy News team attended the NCSL Legislative Summit in Nashville, TN from August 5th-8th, 2019, learning and sharing our work with legislators and staff from across the country. The health policy-related trending topics this year were the impact of recent court cases at both the state and federal level; prescription drug pricing; and surprise balance billing. To read our takeaways from the event and view our fact sheets on mental health parity review and uniform prior authorization, click here.

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Dishing from the 32nd National Academy of State Health Policy Annual Conference (#NASHPCONF19)

The Health Policy News team continued our summer conference travels with the 32nd Annual #NASHPCONF19, which took place in Chicago, IL from August 21st-23rd, 2019. The theme for this year’s conference was “The Deep Dish on State Health Policy,” featuring in-depth dives into recurring topics like prescription drug pricing reform and surprise billing. The agenda also included interesting updates on market stabilization efforts, public option programs, mental health parity, and hospital consolidation. Click here to view our brief summary of these topics.

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Critical Incident Management Solutions in Medicaid Long-Term Care

Medicaid agencies must assure the health and safety of their Home & Community-Based Services waiver program recipients by managing the reporting, investigation, and prevention of incidents involving these beneficiaries. Failure to do so poses a host of risks around compliance, fraud, and the safety of members. To meet CMS requirements, states must demonstrate that they have systems in place to effectively monitor the adequacy of service plans, the qualifications of providers, and the health and welfare of patients. To learn more about best practices for critical incident management, as well as lessons learned by PCG and others in this field, click here.

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Recent Trends with OIG and CMS Related to Reporting Costs Associated with Waivers

Claiming and reporting of administrative costs to Medicaid waivers has become a targeted area of review by the Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS).  A number of State Medicaid agencies in various regions are facing potential disallowances or deferral of Medicaid administrative claims for failing to claim administrative costs to Medicaid waivers on the CMS-64.10 report. The target of the challenges varies. In some states, the cost allocation plan (CAP) methodology did not identify cost allocation at the individual waiver level (costs were identified as Medicaid administration at the appropriate Federal Financial Participation (FFP) rate level only). In others, methodologies outlined in waiver applications were not implemented in the CAP.  To learn more about claiming and reporting waiver administrative cost and for recommendations for states, click here.

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Tennessee Releases its Block Grant Plan

Tennessee continues to move forward in pursuit of a Medicaid block grant—a plan which seems aligned with the current federal administration’s interest in these types of proposals (with guidance expected to be released, but still under review by the Office of Management and Budget). To read more about the approach Tennessee is taking, including the details of its recently-released draft waiver amendment application, click here.

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CMS Issues New Regulations to Enhance Program Integrity

On September 10th, The U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) published a final rule in the Federal Register aimed at implementing program integrity enhancements to the Medicare, Medicaid, and CHIP provider enrollment processes. The new rule will require greater disclosure from providers under CMS programs as part of the enrollment and re-enrollment process. To learn more about the requirements and how this new information will be used, as well as considerations for providers, click here.

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