CMS Further Clarifies Policy on Medicaid Pass-Through Payments

In an effort to phase out Medicaid managed care “pass-through” payments, CMS is aiming to prohibit states from increasing existing or adding new pass-through payments into Medicaid managed care contracts, according to a CMCS Bulletin. This announcement comes in addition to the phase-out of current pass-through payments described in the recent final Medicaid managed care rules, which provided 5-10 years for all pass-through payments to be transitioned into arrangements based on the delivery of services, utilization, and outcomes. States will now be required to submit detailed descriptions of existing pass-through payments so CMS can closely monitor the arrangements and ensure that capitation rates are actuarially sound and consistent with regulations. CMS will review whether pass-through payments are reasonable, do not exceed the maximum amount allowed and that they are not conditioned on the provider entering into or adhering to intergovernmental transfer agreements.

Medicaid Expansion Enrollees Report Increased Access and Reduced Costs, Study Finds

Medicaid expansion is associated with significant increases in outpatient and primary care utilization, improved self-reported health, and reduced emergency department use, according to a new study published by JAMA Internal Medicine. The study evaluated expansion’s impact on low-income adults in Kentucky and Arkansas compared to their counterparts in Texas, which did not expand Medicaid. While Kentucky enrolled the expansion population in managed care plans and Arkansas used private Marketplace plans (the “private option”), both states experienced comparable healthcare improvements, though Kentucky had higher diabetic glucose testing rates. Both states’ expansions were associated with a nearly 30% reduction in out-of-pocket spending, a significant increase in screenings and treatments for chronic diseases, and significant improvements in quality of care ratings. The authors, who based their findings on statistical analysis of survey results from nearly 9,000 respondents, note that Kentucky’s and Arkansas’s coverage expansions took more than one year to mature, suggesting that early evaluations of expansion likely underestimate its long-term impacts.

Medicaid Agencies Will Cover Mosquito Repellent to Combat Zika Transmissions

State officials in Texas, Louisiana, and Delaware have approved Medicaid coverage of insect repellant in response to increasing concerns over the Zika virus. In Texas, women between ages 10 and 45 years or who are pregnant are eligible; Louisiana extended coverage to pregnant women as well as men and women between ages 14 and 44 who are trying to conceive; and Delaware will cover over-the-counter mosquito repellants for Medicaid enrollees. CMS authorized a federal match for EPA-registered repellants when prescribed by a healthcare provider, among other Zika-related services, on June 1.

Ohio: New Statewide Multi-Payer Primary Care Program Incentivizes Value Over Volume

Governor John Kasich (R) announced the Ohio Comprehensive Primary Care (CPC) Program, which will increase patient access to patient-centered medical homes (PCMHs) by rewarding physicians participating in Medicaid and commercial insurance for joining PCMHs and providing high-value and high-quality—rather than high-volume—care. The multi-payer program, which is part of Ohio’s State Innovation Model Test grant, is a collaboration between the Ohio Department of Medicaid, the Governor's Office of Health Transformation, Ohio's Medicaid managed care organizations, and commercial healthcare payers. CPC physicians will receive incentive payments averaging approximately $4 per patient per month beginning in January 2017. Ohio's new initiative is closely aligned by design with the CMS' Comprehensive Primary Care Plus (CPC+) initiative, which will provide increased Medicare payments to selected primary care practices beginning in 2018.