Health Policy News – November 2019


We hope many of you were able to join us for our second annual Fall Health Policy Webinar, which focused on innovative approaches to state Accountable Care Organization (ACO) Programs. If you were unable to attend (or would simply like to review Health Policy News’ report, tracking tool, and presentation materials), we have provided a brief overview of our discussion below and updated our blog post from last month with the presentation slide deck. As always, if you have suggestions for topics for us to include in future policy webinars, we would love to hear from you!

In addition to the webinar, this month is shaping up to be a busy one, with late November marking the anticipated release timeframe of the annual Exchange Guidance in the form of the draft Letter to Issuers in the Federally-Facilitated Marketplaces and the annual Notice of Benefit and Payment Parameters proposed rule. Plus, as we note in more detail below, the Centers for Medicare and Medicaid Services (CMS) announced proposed changes related to Medicaid fiscal accountability just last week. In our recap of the annual National Association of Medicaid Directors conference, we share the latest updates and information about the proposed rule that Administrator Seema Verma announced at the event. In alignment with our focus on Medicaid program integrity, this month’s edition also includes a timely recap from the National Association of Medicaid Program Integrity (NAMPI) conference.

Finally, we continue our coverage of the 2018 Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act with an update on how states are implementing telehealth service delivery in response to flexibility included in the legislation. Using recent efforts from New York as an example, our post highlights the benefits of telemedicine as an avenue for states looking to ensure adequate care capacity and expand access to substance abuse treatment services.  

UPDATED: Innovative Approaches to Accountable Care

We were grateful to have diverse perspectives during the discussion portion of our November 14th “Innovative Approaches to Accountable Care” webinar, which delved into topics such as the successes and challenges that such programs face, as well as their likely future direction. Our colleague Michael Joseph highlighted commonalities between successful mature ACO Programs—including flexibility in model design; providing technical assistance to providers and access to clinical cost and utilization data; and building upon existing health care reform efforts. Lisa Kaplan Howe spoke to the use of state and federal regulatory tools to monitor ACOs and ensure consumer protections. If you were unable to attend the webinar and would like to review the presentation deck, as well as our “Innovative Approaches to Accountable Care” report and accompanying ACO Tracking Tool, please visit our updated blog post from last month here.

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Verma Announces Proposed Medicaid Fiscal Accountability Rule at National Association of Medicaid Directors (NAMD) Conference

On November 12th, Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), kicked off the NAMD conference by announcing CMS’s recent issuance of the proposed Medicaid Fiscal Accountability Rule (CMS-2392-P). This proposed rule seeks to improve transparency into Medicaid financing arrangements and supplemental payments, as well as ensure that payments are value driven. Members of the HPN team attended the NAMD conference and heard from many attendees and clients about these proposed changes; we have prepared a short fact sheet that summarizes the main changes in the proposed rule, as well as suggested areas for State comment.  Click here to view both of those items.

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National Association of Medicaid Program Integrity (NAMPI) 2019 Annual Conference

PCG staff members joined over 500 attendees at the 35th Annual NAMPI Conference in August. The NAMPI conference covered a range of topics; there were larger presentations on the Medicaid Fraud Control Unit and smaller breakout sessions on topics such as data solicitation, Electronic Visit Verification (EVV), and the use of artificial intelligence (AI) to ensure program integrity. PCG’s program integrity experts compiled key themes from presentations that may be of interest to readers. To read them—and to learn more about how PCG can help states implement EVV as required under the 21st Century CURES Act, maximize data analytics, and improve program integrity—click here.

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States seek to Expand Substance Abuse Treatment Services via Telehealth

A particularly interesting element of the 2018 SUPPORT Act was its promotion of telemedicine to tackle the growing demand for recovery and substance use disorder (SUD) treatment services. Since its passage, states like New York have issued guidance encouraging both commercial and Medicaid insurance providers to integrate telehealth into their benefit offerings, emphasizing its importance in tackling the opioid epidemic by building capacity to medication-assisted treatment and SUD providers. As an approach that has both federal support and existing implementation guidance in other states, MAT and SUD treatment via telehealth is a compelling avenue for regulators to consider as they attempt to improve enrollee access to these services. To read more about state approaches and guidance related to SUD and telehealth, click here.

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