CMS Finalizes Medicaid/CHIP Managed Care Regulations

CMS published a final rule overhauling the regulations governing Medicaid and CHIP managed care, which represents the most significant revisions in nearly two decades. The final rule substantially aligns Medicaid managed care rules with those that apply to Medicare Advantage plans and qualified health plans under the ACA, and seeks to enable managed care to drive delivery system reforms and quality improvement throughout the healthcare system. CMS incorporated many of the proposed rule provisions with relatively modest changes but dispensed with proposals that would have required states to provide 14 days of fee-for-service (FFS) coverage as an "enrollment choice period" for beneficiaries and to adopt a comprehensive quality strategy that includes Medicaid FFS, and plans to be accredited as a condition of contracting with a state. CMS also phased the implementation timeframesfor many of the provisions.

Alabama: Legislature Convenes Medicaid Hearings Amid Pending Service Cuts

The Legislature's Joint Medicaid Study Group began hearings last week in response to Medicaid's $85 million budget shortfall, though panel chairman Senator Trip Pittman (R) said he does not expect the hearings to produce a funding solution. The goal of the hearings remains unclear since legislators have not indicated a willingness to revisit the budget after overriding Governor Robert Bentley's (R) budget veto. Medicaid Commissioner Stephanie Azar testified in one of the panel's first meetings, explaining how average patient costs have been level since 2008 but that enrollment has increased 28% during that time, to more than one million enrollees. She further stressed that provider reimbursement rates or services like dialysis and hospice would need to be cut under the current budget. The panel will meet over the next several weeks, past the end of the current legislative session.

Alaska: Legislature Approves Medicaid Reform Bill

The Legislature approved a Medicaid reform bill that will save the State an estimated $365 million over six years by requiring the Department of Health and Social Services (DHSS) to adopt new approaches to care coordination, payment reform, and behavioral healthcare. The bill's approval comes several months after reports commissioned by Governor Bill Walker (I) and the Legislature called for changes to the State's Medicaid program. The bill, which Governor Walker is expected to sign, also includes new initiatives to identify Medicaid fraud and to develop a new eligibility verification system. DHSS will have significant latitude in designing and implementing the bill's reforms.

Nebraska: Plans Selected for Integrated Medicaid Managed Care Program

The State Department of Health and Human Services (DHHS) selected Nebraska Total Care, UnitedHealthcare Community Plan and WellCare to administer "Heritage Health," the State's newly integrated Medicaid managed care program. Heritage Health aims to streamline the delivery model for Medicaid beneficiaries by providing them with a benefit package that includes physical, behavioral and pharmacy services. DHHS currently works with three insurance companies that manage enrollees' physical health and two separate entities for behavioral health and pharmacy services. Approximately 230,000 enrollees will be served by Heritage Health, which is scheduled to launch on January 1, 2017. All three plans will be offered statewide.

New York: Report Examines State's DSRIP Implementation

A new report from The Commonwealth Fund and Manatt Health examines New York's early experiences implementing its Delivery System Reform Incentive Payment (DSRIP) waiver. The report reviews the State's approach to governance, care models, analytics, measurement, and value-based payment arrangements, flagging emerging issues that enable or impede Medicaid transformation and assessing how other states and CMS might draw upon these experiences. Findings were drawn from two rounds of stakeholder interviews that included federal and State officials, thought leaders from national healthcare organizations, and on-the-ground implementation leaders from provider and health plan entities.