Sellers Dorsey Digest

Federal Updates

NEWS

HHS and NGA Announce New Maternal and Child Health Collaboratives

• On February 14, HHS Secretary Xavier Becerra met with state representatives and delegates from the National Governors Association (NGA) to kick off the Postpartum Maternal Health Collaborative. Six states have agreed to participate in the collaborative: Iowa, Maryland, Massachusetts, Michigan, Minnesota, and New Mexico. This initiative encourages collaboration between state experts, local providers, community partners, and federal experts to develop an understanding of the challenges postpartum populations are facing while supporting the development and implementation of new solutions to decrease maternal and infant mortality rates. In tandem with this HHS initiative, the NGA announced its Improving Maternal and Child Health in Rural America State and Territory Policy Learning Collaborative that aims to implement policy changes to improve maternal and child health outcomes in rural areas throughout the country. Additionally, HHS announced the winners of the final phase of its $1.8 million Racial Equity in Postpartum Care Challenge. The grant was introduced to fund initiatives to enhance equity in postpartum care for Black, American Indian, and Alaska Native women enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) (HHS.gov, February 14; Inside Health Policy, February 14).

CMS Makes Changes to Data Request and Access Policies

• On February 12, CMS announced two changes to the current research data request and access policies that would revise the fee structure and restrict access to claims data. Over 300 academics, mainly health economics researchers, have signed a letter opposing the changes, citing the potential “catastrophic impact” on healthcare research. CMS explained that the changes are necessary to protect healthcare records, citing an increase in data breaches. Under the current system, academics can request claims data for a one-time fee and store the data on secure university systems. The proposed changes would require the use of a CMS-controlled platform to analyze data that will likely come with higher costs to researchers and annual renewal fees. CMS aims to implement the data dissemination policy in two phases, the first starting on August 19, 2024, when CMS will no longer allow the physical distribution of data for new research studies. CMS has posted a request for information (RFI) to assist in planning phase two, which would require all projects to use the CMS platform for data (ProPublica, February 15; CMS, February 12).

FTC and HHS Team Up to Investigate GPO’s Possible Involvement in the Drug Shortage

• The Federal Trade Commission (FTC) and HHS have teamed up to investigate the possible role that Group Purchasing Organizations (GPOs) and wholesalers have in the current drug shortage problem. The FTC and HHS issued a RFI seeking public input by mid-April on the contracting methods of GPOs and wholesalers. There have been committee hearings about drug shortages in the past, but many argue that there hasn’t been a focus on GPOs possibly contributing to this issue. The FTC’s involvement began after a letter by major patient advocacy groups was sent to them in late 2022. GPO lobbyists argue that drug shortages are due to manufacturers’ quality issues (Inside Health Policy, February 14).

Federal Litigation

Supreme and District Courts to Hear Arguments About Combating Misinformation on Social Media

• On March 18, the Supreme Court will hear arguments regarding the case of Vivek H. Murthy, Surgeon General, et al., Petitioners v. Missouri, et al.. The case could result in prohibiting federal health officials from communicating with social media platforms, such as X and Instagram, to remove posts the federal health officials identify as false or misleading. Missouri and Louisiana, along with private plaintiffs, filed a brief on February 2 stating, “Defendants would have this Court protect the government’s campaign to constrain private actors. The government can speak freely on any topic it chooses, but it cannot pressure and coerce private companies to censor ordinary Americans.” In a separate matter, a case in the district court for the Fifth Circuit in Texas against the FDA is proceeding to address the issue of whether the FDA exceeded its authority while trying to combat COVID-19 misinformation on social media (Inside Health Policy, February 16).

Federal Regulation

Key ACA-Related Rules to be Finalized

• Patient advocates are hopeful the Biden administration will finalize several key Affordable Care Act (ACA) regulations in the coming months before the Congressional Review Act (CRA) 60-day look back period begins, which would allow a new Congress to potentially overturn policies. The policy priorities include limiting the duration of short-term plans, returning non-discrimination protections for transgender individuals, allowing Deferred Action for Child Arrivals (DACA) recipients to enroll in ACA coverage and rolling back association health plans. The CRA allows Congress to undo an administration’s rule within a certain timeframe and grants a new Congress a 60-day look back period to overturn regulations from a prior administration. The 60-day look back period is based on the legislative calendar, which is unknown at this time but most stakeholders believe it will be up in late May (Inside Health Policy, February 15).

CMS Updates Instructions for Medicare Savings Programs

• On February 9, CMS released updated instructions for states to follow when implementing strategies for Medicare Savings Programs (MSPs). The updated instructions have been released prior to forthcoming compliance dates as identified in the Streamlining Medicaid; Medicare Savings Program Eligibility Determination and Enrollment final rule. This regulation streamlines MSP eligibility and enrollment processes by:
  • Automatically enrolling most Medicare-enrolled SSI recipients into the Qualified Medicare Beneficiary (QMB) group, covering Medicare premiums and cost-sharing. The compliance deadline is no later than October 1, 2024.
  • Leveraging the Medicare Part D Low Income Subsidy (LIS) program to enroll eligible individuals in the MSPs, including use of LIS “leads” data and applying the definition of family size in the LIS program as the definition for “family of the size involved.” The compliance deadline is no later than April 1, 2026.
  • Reducing documentation requirements for MSP applicants prior to enrollment. The compliance deadline is no later than April 1, 2026 (Medicaid.gov, February 15: Federal Register, September 21, 2023).

Federal Studies & Reports

Report Finds Doula Access Improves Maternal Health Outcomes

• The Elevance Health public policy institute has released a new report with findings that doula access through Medicaid managed care improves maternal health outcomes. The report compares the health outcomes of 869 women enrolled in Medicaid who received doula care before, during, or after a pregnancy with 1,094,005 women who did not involve a doula during their pregnancy. The findings show that women who received doula care had low rates of C-sections and postpartum depression and anxiety. However, only 13 states and the District of Columbia offer reimbursed doula care through Medicaid. According to data from the National Health Law Program, another 30 states are either implementing some Medicaid coverage of doula services or considering doing so (MSN, February 16).

State Updates

NEWS

Utah to Become Second State to Cover Traditional Native Healing Services under Medicaid

• Historically, traditional Native healing services have been specifically excluded from Utah’s Medicaid program, and not covered by other health insurance programs. This has caused a gap in care for Native residents, as many rely on Medicaid to cover necessary health services. Senate Bill 181 could potentially change this, by allowing Native healing services to be eligible for reimbursement through Medicaid. Following suit with New Mexico, which is currently the only state that has federal approval for making these services billable, Utah will have to submit a waiver to the federal government for approval if Senate Bill 181 is passed. Arizona and California recently submitted waiver requests to CMS to allow Native healing services to be reimbursed through the Medicaid program. Native Americans currently make up about 3% of Utah’s Medicaid enrollees, approximately 15,000 people. An estimated 1,100 Native Americans in Utah will use their Medicaid coverage for these services (Salt Lake Tribune, February 19).

Iowa Senate Passes Bill to Expand Medicaid Postpartum Coverage

• The Iowa Senate has advanced a bill to extend Medicaid postpartum coverage from 60 days to a full year. Senate File (SF) 2251, proposed by Governor Kim Reynolds, would also make changes to Medicaid eligibility. Currently, the eligibility limits for postpartum coverage are set at 315% of the federal poverty level. SF 2251 would lower these limits. Under the new bill, a pregnant person in a household of four making more than $64,500 a year would no longer qualify for coverage (KCCI, February 20).

Illinois Senators Urge CMS to Approve State’s 1115 Waiver

• Illinois Senators Dick Durbin and Tammy Duckworth sent a letter to CMS on February 13 to urge the agency to approve the State’s 1115 demonstration waiver. The waiver aims to help Illinois Medicaid address the opioid epidemic, maternal mortality, violence prevention, mental health, homelessness, and other health-related social needs. Approximately 3.5 million people in the state are covered through Medicaid. The Senators highlighted the importance of housing and wraparound care in the 1115 waiver that would support beneficiaries experiencing homelessness (Inside Health Policy, February 13).

Florida Awards Contracts for Medicaid Managed Care Pilot Program for Individuals with IDD

• Elevance Health subsidiary Simply Healthcare Plans and Florida Community Care, owned by Independent Living Systems, have secured contracts to provide care to Florida Medicaid recipients with intellectual and developmental disabilities (IDD). This is part of the state’s efforts to explore the use of managed care to assist individuals with IDD. The contract terms are for six years in specified counties, including Miami-Dade and Monroe. Last year, Florida lawmakers passed legislation allowing up to 600 waitlisted volunteers from the Medicaid iBudget Waiver program to enroll in a new pilot program assessing the ability of managed care to address the needs of individuals with IDD (Health Payer Specialist, February 14).

Missouri Supreme Court Strikes Down Denying Medicaid Funds to Planned Parenthood

• For the second time in four years, Missouri’s Supreme Court has denied lawmakers’ efforts to ban abortion providers and their affiliates from receiving Medicaid reimbursements. In a February 14 decision, the court determined that the legislature’s attempt to defund Planned Parenthood through the budget process was unconstitutional. Medicaid has reimbursed Planned Parenthood for reproductive health services including sexually transmitted infections, cancer screenings and contraceptives. However, Planned Parenthood has not received any state funds for almost two years because of the court proceedings, though the organization’s clinics have continued to treat all patients regardless of insurance (Insurance News, February 19).

SPA and Waiver Approvals

Waivers

• Pennsylvania
  • The Commonwealth of Pennsylvania has submitted an 1115 demonstration request titled “Bridges to Success: Keystones of Health for Pennsylvania.” The proposed demonstration seeks authority to implement a set of services and benefits coordinated through case management in four focus areas: reentry services; housing services; food and nutrition benefits; and continuous coverage for children under 6 years of age. The federal public comment period will be open from February 15, 2024, through March 16, 2024.

SPAs

• Payment Services
  • Georgia (GA-23-0008, effective October 1, 2023): Revises the methodology utilized to reimburse Psychiatric Residential Treatment Facilities (PRTF).
  • Illinois (IL-23-0035, effective January 1, 2024): Updates the rates for Mental Health Rehabilitative Services.
  • Indiana (IN-23-0022, effective January 1, 2024): Revises Medicaid reimbursement rates for physician and other practitioner services, including reimbursement rates for physician, anesthesiology, and dental services.
  • North Carolina (NC-23-0041, effective October 4, 2023): Increases reimbursement to Ambulatory Surgical Centers (ASC) for dental procedures.
  • Oregon (OR-23-0040, effective January 1, 2024): Changes the methods and standards for swing bed hospital reimbursement.
  • Texas (TX-22-0007, effective October 1, 2022): Allows certain non-drug products to be added to the pharmacy formulary.
• Services SPAs
  • Illinois (IL-23-0049, effective October 1, 2023): Implements coverage of the Advisory Committee on Immunization Practices’ recommended vaccines for adult Medicaid beneficiaries without cost sharing in compliance with Section 11405 of the Inflation Reduction Act of 2022.
  • Indiana (IN-24-0001, effective January 1, 2024): Assures Indiana Medicaid is in compliance with the 21^st Century Cures Act Electronic Visit Verification (EVV) requirements for home health services.
  • Iowa (IA-23-0012, effective July 1, 2023): Eliminates the Dental Healthy Behaviors requirement and removes the basic dental benefit package from the Iowa Dental Wellness Plan.
  • Louisiana (LA-23-0014, effective March 11, 2021): Adds mandatory coverage of COVID-19 vaccine and administration, testing, and treatment benefits as required by Section 9811 of the American Rescue Plan Act.

Private Sector Updates

NEWS

What Medicare Advantage Rate Cuts Could Mean Going Forward

• Last month, CMS released a proposed rule to decrease the Medicare Advantage (MA) benchmark rate by .16% in 2025. Both insurance companies and physicians are encountering rate reductions, with insurance companies experiencing high utilization rates and medical costs and CMS finalizing a 3.4% decrease for physicians last November. Providers are concerned about what the insurer’s rate cut could mean for them, including operational issues and patient care. Insurance company executives are discussing possible benefit cuts. Researchers believe that supplemental benefits, like dental, hearing and vision coverage could be at risk. Other possibilities include increased premiums and reducing reimbursements to providers. The finalized rule is set to be released by April 1 (Modern Healthcare, February 16).

Sellers Dorsey Updates

Meet Our Team: Managing Director, Jen Swails

• In case you missed it last week, explore this engaging Q&A with our Managing Director, Jen Swails, as she discusses her 20+ years of policy experience with the Commonwealth of Pennsylvania.

Uncovering Solutions at the Intersection of Housing and Health with Jami Snyder

• Click here to explore how housing and health are deeply intertwined and the solutions in Medicaid that states, providers, and managed care plans are utilizing to help secure housing and care for vulnerable populations.