Federal Regulation

• On September 1, CMS released a proposed nursing home staffing mandate that omitted licensed practical nurses (LPNs). The proposed mandate would require nursing homes to provide three hours of care per resident, per day, with 0.55 hours of care coming from registered nurses and 2.45 hours of care coming from certified nursing assistants. LPNs make up approximately 13% of nursing home staff and as much as 75% of clinical staff at some facilities. LPNs provide most of the hands-on care within skilled nursing facilities and their absence from the proposed mandate concerns many stakeholders, especially with the growing staffing challenges in the healthcare sector (Modern Healthcare, September 11).

Federal Studies and Reports

• According to a June 2022 report released by ATI Advisory, dual eligible beneficiaries are more likely to experience mental health diagnoses, serious mental illness, and depression that require integrated and individualized healthcare. The lack of care coordination tends to lead to poorer health outcomes and barriers to access, resulting in higher spending across both the Medicare and Medicaid programs. Accessibility to services can vary depending on geographical location, with mental health services also being one of the most underpaid services across the country. Plans have started including services from therapists, counselors, psychiatrists, psychologists, and other behavioral health providers in-person and through telehealth (Health Payer Specialist, September 11).

• Hawaii’s Medicaid program, Med-QUEST, has paused all Medicaid disenrollments until 2024, ensuring that coverage is maintained in nearly all cases. This comes after Hawaii paused redeterminations in Maui County following the deadly fire in August and the CMS mandate that states review ex-parte renewal processes for disenrollment errors and make any necessary changes. Med-QUEST enrollment increased by 43% during the pandemic and since the beginning of the unwinding period they have disenrolled 20,822 beneficiaries. Some states have not paused their redeterminations, despite high rates of procedural disenrollments. According to Georgetown University’s Center for Children and Families, various states, including, Utah, Georgia, Nevada, Kansas, Indiana, New Hampshire, and Arkansas all have high rates of procedural disenrollments. Utah and Georgia both have procedural disenrollment rates above 90% and Arkansas has disenrolled more than 300,000 beneficiaries since April (Inside Health Policy, Sept 12).
• Legislators in Kentucky are expected to finalize regulations that expanded dental, vision, and hearing benefits for Medicaid beneficiaries this year. Advocates believe that making these benefits permanent will result in healthier Medicaid enrollees. Since the updated regulations went into effect earlier this year, Kentuckians have used their benefits for almost 3,000 crowns, 2,000 root canals, and 6,000 partial or complete dentures (MSN, September 9).
• Oregon could become the first state in the country to offer rental assistance as a Medicaid benefit if CMS approves its recent request. The Oregon Health Authority (OHA), working with the Oregon Housing and Community Services, has submitted an 1115 waiver to offer six months of rental assistance for those at risk of losing their current housing, beginning November 1, 2024. Currently, about 125,000 Medicaid beneficiaries in the state would be eligible for this benefit due to the shortage of affordable housing. This is part of a broader effort by OHA to expand benefits to include health-related social needs within the Medicaid program (Health Payer Specialist, September 11).
• An audit by the U.S. DHHS Office of Inspector General (OIG) found the state of Florida owes $106 million in unpaid Medicaid managed care rebates to the federal government. The money is specifically from savings the state Medicaid program realized from 2015 to 2019. The federal government is supposed to get a share of the savings but the state claims that the federal rules did not explicitly spell out the requirements until 2021;thus, Florida is not required to share its savings from 2015-2019 with the federal government (Health Payer Specialist, September 11).
• CMS has approved North Dakota’s requested changes to the state essential health benefit benchmark plan that affect all ACA-complaint plans in the state, including ACA marketplace exchange plans, plans offered under the individual market through licensed agents, and small group plans offered by small employers. The changes include adding benefits such as insulin, hearing aids, nutritional benefits, and weight loss drugs as well as PET scans and limited opioid coverage (for acute or chronic periodontal disease). The plans will begin providing these benefits starting January 1, 2025. Grandfathered plans and large-group plans are not affected by this CMS approval (Health Payer Specialist, September 8).

News

• On September 7, Eastern Kentucky University (EKU) announced the expansion of their Anthem Rural Medicine Scholarship Program, making it the third year the university has worked with Anthem Medicaid to recognize students pursuing healthcare careers. Leaders from the university and health plan believe this scholarship gives students the opportunity to pursue their education in healthcare without having to worry about financial components. EKU leadership hopes to continue this partnership well into the future (MSN, September 7).
• Blue Cross Blue Shield of Michigan will eliminate 20% of prior authorization requirements in response to provider complaints about excessive burden. Medicare and commercial enrollees will see fewer precertification requirements for procedures like bariatric surgery, breast biopsy, and cardiac rehab services. The company also plans to expand the “gold card” program to reduce prior authorizations for physicians with high approval rates. Nearly 3% of the 87 million claims processed each year by the company require prior authorization. Blue Cross holds a 68% commercial plan market share in Michigan. Also noteworthy is that multiple insurance companies including UnitedHealth Group, Cigna, and other Blue Cross Blue Shield companies are revisiting prior authorization requirements (Modern Healthcare, September 8).
• Walmart is exploring the acquisition of ChenMed, a value-based care provider that operates in over 125 medical centers aimed at seniors in 15 states. ChenMed focuses on affordable care for underserved patients across the country. If successful, this deal would mark the largest inroad for Walmart in healthcare. This news comes as other retail giants, such as Walgreens and CVS Health, continue to move into the healthcare industry (Health Payer Specialist, September 11).

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