Sellers Dorsey Digest

Federal Updates

NEWS

MACPAC HOLDS JANUARY 2024 PUBLIC MEETING

• The Medicaid and CHIP Payment and Access Commission (MACPAC) met on January 24-25 to discuss the following topics:
  • Denials and appeals in Medicaid managed care – MACPAC staff presented the draft chapter for the March 2024 report to Congress with seven recommendations intended to improve the beneficiary experience with the appeals process generally along with the monitoring, oversight, and transparency of denials and appeals. The Commission voted in favor of all seven recommendations.
  • Self-reported disability data collection in Medicaid populations – MACPAC staff discussed findings related to self-reported disability data collection. The Commission reviewed federal priorities for collecting data, how Medicaid disability data are currently collected, and essential considerations for disability data collection.
  • Policy options for improving the transparency of Medicaid financing –- The Commission reviewed policy options for improving transparency of financing methods and amounts. Since Medicaid is jointly financed by states and the federal government, MACPAC considered the policy options using a framework that explored the usefulness, comprehensiveness, and administrative burden for states, providers, and CMS in collecting new data.
  • Interviews with key stakeholders about state Medicaid agency contracts – MACPAC staff reviewed important themes from interviews with state Medicaid officials in five case study states, federal officials at CMS, and health plan representatives for Medicare Advantage dual eligible special needs plans (D-SNPs).
  • Evaluating effectiveness of Medicaid payment changes on access to physician services – MACPAC staff discussed the relationship between Medicaid physician payment rates and beneficiary access. MACPAC partnered with Mathematica to conduct a review of the literature between 2013 and 2023. Mathematica also convened an expert roundtable and MACPAC staff shared themes from the roundtable and focused on certain areas that MACPAC may examine in the future.
  • Medicaid coverage of physician-administered drugs (PADs) – MACPAC staff discussed challenges related to managing PADs through the medical benefit and summarized findings from their analysis on Medicaid utilization and spending on PADs using data from the Transformed Medicaid Statistical Information System.
  • Highlights from the duals data book – MACPAC staff reviewed the Beneficiaries Dually Eligible for Medicare and Medicaid data book, which includes information on individuals who were dually eligible for Medicare and Medicaid in 2021. This edition includes information about the dually eligible community’s demographics and characteristics, eligibility pathways and enrollment, service utilization and spending, and use of long-term services and supports.
  • Enrollment trends in Medicare savings programs (MSPs) – MACPAC staff provided enrollment information from 2010 through 2021 and focused mainly on the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Beneficiary (SLIB) programs since they account for more than 90% of MSP enrollees. (MACPAC, January 24-25).

State Updates

NEWS

PROPOSED CUTS TO NEW YORK MEDICAID IN GOVERNOR HOCHUL’S FY2025 EXECUTIVE BUDGET

• In her budget address, Governor Hochul highlighted the 40% increase in Medicaid spending over the past three fiscal years and announced the need to save more than $1 billion in the Medicaid budget. Her $233 billion executive budget includes $35.50 billion in state funding for the Medicaid program. Governor Hochul plans to partner with the legislature to find appropriate decreases in spending that won’t negatively impact those covered by Medicaid in the state. One option proposed includes ending wage parity for a program that provides services for individuals needing help with everyday activities. Reducing supplemental pay benefits or home care aids could save the state an estimated $200 million alone (MSN, January 27).

SPA and Waiver Approvals

SPAS

• Payment Services
  • Arizona (AZ-21-0011, effective October 1, 2021): Updates the state plan to reflect DSH Pool 5 funding and participating hospitals for the DSH state plan rate year ending 2022.
  • Arizona (AZ-23-0019, effective October 1, 2023): Updates the inpatient hospital differential adjusted payment (DAP) program for contract year ending 2024.
  • Arizona (AZ-23-0020, effective October 1, 2023): Updates the nursing facility DAP program for contract year ending 2024.
  • Arizona (AZ-23-0021, effective October 1, 2023): Updates the outpatient DAP program.
  • District of Columbia (DC-23-0011, effective October 1, 2023): Revises the rate rebasing schedules for Specialty Hospitals.
  • Louisiana (LA-23-0034, effective October 1, 2023): Adjusts payments for well baby and transplant services within the inpatient hospital services program in order to align with current practices.
  • Missouri (MO-23-0031, effective November 8, 2023): Updates provisions related to final DSH redistributions and unspent allotment payments to bankrupt-liquidation and closed hospitals.
  • New York (NY-23-0099, effective October 1, 2023): Provides for the continuation of a zero-trend factor in the Medicaid reimbursement rates for Medicaid residential healthcare facilities caring for non-pediatric populations.
  • Ohio (OH-23-0035, effective January 1, 2024): Provides for Inpatient Hospital Services Cost Coverage add-on.
  • Ohio (OH-23-0032, effective October 1, 2023): Updates nursing facility services case mix reimbursement provisions.
  • Pennsylvania (PA-23-0019, effective November 1, 2023): Authorizes a one-time supplemental payment to eligible public and non-public nursing facilities.
  • South Dakota (SD-23-0012, effective July 1, 2023): Updates the nursing facility services reimbursement model by replacing the Resource Utilization Group III (RUG III) reimbursement model with  the Patient Driven Model (PDPM). In addition, nursing facility reimbursement rates are updated to the provider fiscal year 2021 cost report period and PDPM case mix data.
• Services SPAs
  • Arkansas (AR-24-0004, effective January 1, 2024): Updates to clarify the coordination of triage, treatment, and transport to an alternative destination.
  • District of Columbia (DC-23-0014, effective October 1, 2023): Carves out emergency transportation services from 1932(a) managed care contracts.
  • Iowa (IA-23-0027, effective December 31, 2023): Phases out the Health Home Program as part of the transition plan.
  • Kansas (KS-24-0001, effective January 1, 2024): Updates provisions to indicate compliance with the Electronic Visit Verification System (EVV) requirements for home health services.
  • Missouri (MO-23-0033, effective October 1, 2023): Annual assurance of the pharmacy program’s adherence to the FULs requirement of federal regulation regarding expenditures for multiple source drugs.
  • New Mexico (NM-23-0016, effective November 1, 2023): Provides for Opioid Treatment Center compliance with  provisional certification/accreditation and certification standards specified in 42 CFR part 8, subparts A and B.
  • North Carolina (NC-23-0044, effective October 1, 2023): Adds provisions relating to Early and Periodic Screening Diagnosis and Treatment (EPSDT) to the Private Duty Nursing (PDN) section.
  • North Dakota (ND-23-00029, effective October 1, 2023): Authorizes coverage of adult vaccines and requires updates to vaccine rates on a quarterly basis.
  • South Dakota (SD-23-0019, effective October 1, 2023): Provides coverage for adult vaccinations and their administration without cost sharing.
  • Utah (UT-23-0011, effective July 1, 2023): Provides coverage for services provided by a licensed behavioral analyst.
• Eligibility SPAs
  • Maine (ME-23-0026, effective January 1, 2024): Authorizes the new income standards for the optional state supplement program.
  • Texas (TX-23-0015, effective January 1, 2023): Adopts changes to the eligibility rules for the Former Foster Care Children eligibility group, as enacted by the SUPPORT Act, Pub. L. No. 115-217, section 1002.

Sellers Dorsey Updates

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Sellers Dorsey Welcomes New SVP of Product Development

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