Tag: State News

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New Hampshire Extends Partnership with Conduent to Maintain, Operate and Enhance Medicaid

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Conduent (nee Xerox, nee ACS) continues its now 16-year contract for the huge MMS contract in NH.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Company will continue to support Medicaid beneficiaries and providers with a range of services including online enrollment, eligibility verification and claims processing

Conduent will also upgrade technical capabilities of the Medicaid system to increase security and processing speed and provide cost efficiencies

FLORHAM PARK, N.J., Sept. 09, 2021 (GLOBE NEWSWIRE) — Conduent Incorporated (Nasdaq: CNDT), a business process services and solutions company, today announced it has extended its partnership with the New Hampshire Department of Health and Human Services (NH DHHS), serving as the exclusive provider of services to modernize the state’s Medicaid Management Information System (MMIS). Conduent will provide maintenance, operations and enhancements that support NH DHHS’s ability to serve approximately 220,000 beneficiaries and process more than 15 million claims annually.

In addition, the company will upgrade the state’s MMIS to a virtualized environment, while increasing system security, reliability, scalability, and performance. 

Since 2005, Conduent has provided solutions to the NH DHHS to enhance the effectiveness, coordination and delivery of numerous initiatives that embody the agency’s mission to facilitate whole-person care. The company will continue to serve as fiscal agent for the state’s Medicaid program, providing online enrollment, eligibility verification and claims processing to help 30,000 providers meet the medical, behavioral and social needs of people across New Hampshire.

“This award demonstrates our strong MMIS expertise, and the trust NH DHHS has placed in us to help the state move its Medicaid program forward for the future,” said Pat Costa, President, Government Healthcare Solutions at Conduent. “Our team is committed to the department’s effort to bring about new technologies and efficiencies that will ultimately benefit providers and beneficiaries across New Hampshire.”

The contract renewal for MMIS maintenance, operations and enhancements, which is valued at approximately $206 million, includes a five-year base term plus a five-year option to extend until 2031.

Earlier this year, Conduent announced a related contract to help the state comply with the federal Interoperability and Patient Access Final Rule. That project provides Medicaid beneficiaries with improved, secure access to their personal health information, enabling them to make more informed healthcare decisions.

With 50 years of experience in the government health and social services industry, Conduent supports more than 41 million customers annually with various government health programs and other eligibility services. For Medicaid, Conduent supports systems in 23 states, Puerto Rico and Washington, D.C., and it has facilitated federal MMIS certifications in 14 states.

About Conduent Conduent delivers mission-critical services and solutions on behalf of businesses and governments – creating exceptional outcomes for its clients and the millions of people who count on them. Through process, technology, and our diverse and dedicated associates, Conduent solutions and services automate workflows, improve efficiencies, reduce costs, and enable revenue growth. It’s why most Fortune 100 companies and over 500 government entities depend on Conduent every day to manage their essential interactions and move their operations forward.

Conduent’s differentiated services and solutions improve experiences for millions of people every day, including three out of every four U.S. insured patients, 10 million employees who use its HR Services, and nearly 18 million benefits recipients. Conduent’s solutions deliver exceptional outcomes for its clients, including $16 billion in savings from medical bill review of workers compensation claims, up to 40% efficiency increase in HR operations, up to 27% reduction in government benefits costs, up to 40% improvement in finance, accounting and procurement expense, and improved customer service interaction times by up to 20% with higher end-user satisfaction. Learn more at https://www.conduent.com.

Media Contacts: Sharon Lakes, Conduent, +1-214-592-7637, sharon.lakes2@conduent.com

Investor Relations Contact: Giles Goodburn, Conduent, +1-203-216-3546, ir@conduent.com

Note: To receive RSS news feeds, visit www.news.conduent.com. For open commentary, industry perspectives, and views, visit http://twitter.com/Conduent, http://www.linkedin.com/company/conduent or http://www.facebook.com/Conduent.

Trademarks Conduent is a trademark of Conduent Incorporated in the United States and/or other countries. Other names may be trademarks of their respective owners.

 
 

Clipped from: https://www.bakersfield.com/ap/news/new-hampshire-extends-partnership-with-conduent-to-maintain-operate-and-enhance-medicaid/article_9e52249b-50c0-586f-b2a2-95a32707b1f8.html

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Governor Lamont Announces Public-Private Initiative to Address Homelessness and Chronic Health Problems

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CT has gotten federal approval to use Medicaid dollars to coordinate services for 150 homeless members, including housing services.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

09/08/2021

Connecticut Among First States to Connect Medicaid and Housing Services

(HARTFORD, CT) – Governor Ned Lamont today announced that his administration has received federal approval to combine Medicaid health coverage with a range of housing services for Connecticut residents struggling with homelessness and chronic health issues.

The ‘CHESS’ initiative – short for Connecticut Housing Engagement and Support Services – will pool the efforts of state agencies and nonprofit partners to bring coordinated healthcare and housing support to individuals with mental health, substance use, and other serious health conditions.

“For the first time, the resources of Connecticut’s nationally-recognized Medicaid program will reinforce our ongoing initiatives in the areas of housing and homelessness prevention,” said Governor Lamont. “Also known as the HUSKY Health program, Medicaid will add a crucial dimension to our ability to not only stabilize a person’s housing situation, but to really improve the quality of his or her health and life. The CHESS initiative also reflects my direction to find ways to best coordinate expertise and services across our health and human services agencies.”

Connecticut Medicaid’s CHESS benefit is one of the first of its kind to receive federal approval, joining Arkansas, California, Minnesota, and North Dakota. It will combine the Coordinated Access Network and housing subsidy programs administered by the Connecticut Department of Housing; supportive housing programs administered by the Connecticut Department of Mental Health and Addition Services; and the Money Follows the Person program administered by the Connecticut Department of Social Services (the state agency administering Medicaid).

CHESS is aimed at managing the difficulties that are often part of homelessness, including access to health care and handling chronic health issues, with the overall goal of promoting health and well-being by coordinating targeted healthcare with housing.

“Simply put, we know that housing instability and serious health issues are often related,” said Department of Social Services Commissioner Deidre Gifford, who also serves as senior advisor to the governor for health and human services. “The new Medicaid benefit offers a flexible package of services to help people find and maintain housing, and to coordinate medical and behavioral health services, chronic disease management and wellness education. With CHESS, our public-private partnership aims to reduce homelessness and unnecessary hospitalizations, while making lasting improvements in the lives of some of our most vulnerable residents. The COVID-19 pandemic has also taught us more about the close relationship between safe, stable housing and health.”

Housing subsidies for CHESS enrollees, administered by the Department of Housing, will be prioritized for applicants who meet the Medicaid program requirements and are subject to separate eligibility requirements.

“We are proud to participate in this collaborative effort,” said Department of Housing Commissioner Seila Mosquera-Bruno. “Our goal is to reduce and end homelessness in Connecticut. The CHESS program contributes additional resources to our homeless service system, allowing it to provide the necessary supportive services to vulnerable residents and to maintain stable housing in our communities.”

“Nonprofit supportive housing providers across Connecticut have a tremendous amount of knowledge and years of experience serving people with complex needs and long histories of housing instability,” said Department of Mental Health and Addiction Services Acting Commissioner Nancy Navarretta. “I’m confident that the evidence-based supportive housing model that will be available to CHESS participants will contribute to our collaborative efforts to make homelessness rare, brief, and one time.”

“The recent federal approval of Connecticut’s innovative CHESS Medicaid benefit will lay the groundwork for deeper engagement with our healthcare system partners in efforts to end homelessness in our state,” said Sonya Jelks, Connecticut Director for the Corporation for Supportive Housing. “This trailblazing approach, one of the first in the nation, will provide a new and sustainable source of funding for the critical support services that are key to successfully supporting persons who experience chronic homelessness. The Corporation for Supportive Housing is proud to have been a partner in developing and designing the CHESS approach and looks forward to continuing to collaborate to build on Connecticut’s success with supportive housing – linking services, including housing provisions and healthcare, to permanent housing solutions.”

With federal approval to use Medicaid funding for CHESS, the Department of Social Services has opened applications at www.CTCHESSDSS.com. Application information is also available by calling 1-888-992-8637 or 2-1-1.

As a new benefit to be evaluated by the UConn Center on Aging, CHESS is currently estimated to serve 150 participants through next fiscal year. The joint state/federal initiative was designed by a collaborative of the Department of Social Services, the Department of Housing, the Department of Mental Health and Addiction Services, the Department of Developmental Services, the Connecticut Housing Finance Authority, the Corporation for Supportive Housing, the Partnership for Strong Communities, and the Connecticut Coalition to End Homelessness.

CHESS provides supportive housing benefits under Medicaid, coordinated with Medicaid services and non-Medicaid housing subsidies. Medicaid-covered housing engagement and support services include chronic disease management and wellness education, in addition to pre-tenancy supports (help with locating and securing housing); tenancy sustaining supports (help with maintaining successful tenancy); and non-emergency medical transportation. The CHESS staff will help participants apply for housing subsidy vouchers.

“We are especially proud of the strong and enthusiastic partnership that is bringing the CHESS initiative forward,” Commissioner Gifford said. “It’s built on leading-edge work in both state government and the private, nonprofit community as we focus on the so-called social determinants of health. In this case, the focus is on the vital area of housing and how lack of stability there relates to chronic disease and, alternatively, well-being.”

The Connecticut Behavioral Health Partnership, through Beacon Health Options, will provide eligibility assessment and service authorization. Federal support is provided by the Center for Medicaid and CHIP Services, part of the Department of Health and Human Services’ Centers for Medicare and Medicaid Services.

Twitter: @GovNedLamont Facebook: Office of Governor Ned Lamont

 
 

Clipped from: https://portal.ct.gov/Office-of-the-Governor/News/Press-Releases/2021/09-2021/Governor-Lamont-Announces-Public-Private-Initiative-to-Address-Homelessness

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Ohio fighting Biden’s decision to eliminate work requirement for Medicaid

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Ohio has officially resisted the current CMS effort to break its contract with the state over work requirements.

 
 

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Credit: SEAN GLADWELL/Moment/Getty Images

COLUMBUS, Ohio)—Ohio Governor Mike DeWine is fighting the Biden Administration’s decision to eliminate a work requirement for Medicaid.

DeWine requested on Wednesday that Ohio Attorney General Dave Yost take necessary legal action to reverse the decision.

Yost’s Office filed a notice of appeal with the Centers for Medicare and Medicaid Services (CMS).

Biden requiring federal workers, contractors to get COVID shot with no testing opt-out

“Removing a provision that says a healthy, able-bodied individual should be working, looking for work, participating in job training, or participating in a recovery program in order to receive free taxpayer-funded healthcare is contrary to Ohioans’ values,” said Governor DeWine. “Eliminating reasonable requirements discourages people from becoming self-sufficient and only reinforces government dependency. Ohio’s program would offer assistance when Ohioans need it while providing opportunities for future success.”

The Biden Administration revoked Ohio’s work requirements last month following the 2019 approval by the Trump Administration.

Members of the Ohio legislature passed a bill in 2017 requiring the state to establish work requirements for the Medicaid expansion population.

 
 

Clipped from: https://www.wytv.com/news/local-news/ohio-fighting-bidens-decision-to-eliminate-work-requirement-for-medicaid/

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DC Council hits pause button on Medicaid contract

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DC’s MedStar contract is now off again.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Health care for Medicaid recipients in D.C. is in limbo yet again: The D.C. Council has effectively hit the pause button on a contract with the health care provider that was set to extend benefits to a quarter-million residents.

The complicated twists and turns of the contract process is entirely bureaucratic, and could result in the District’s most-vulnerable residents losing access to their doctors during a pandemic.

As the District’s Medicaid contract was less than a month from expiring, Mayor Muriel Bowser declared a state of emergency, allowing her administration to enter into a contract extension with MedStar Health.

The nine-month extension allowed for D.C. to restart the process of finding its next Medicaid provider. A previous selection process had awarded the contract to MedStar, but a judge last year nullified the award, citing a failure of the health care company to meet the requirements to win the $3 billion bid.

The contract extension would have passively passed the council had it not taken action in 10 days. But four council members co-signed a resolution of disapproval Friday, allowing it to “extend our review period from 10 to 45 days,” the resolution reads.

Four members of the council, Chair Phil Mendelson, Kenyan McDuffie, Elissa Silverman, and Robert White, co-signed the resolution, which questions the legality of the contracts.

“Extending our review period also gives time to the Mayor to re-evaluate the bid
proposals as ordered by the Contract Appeals Board last December 1st (the CAB expressly ordered the District to “re-evaluate the competitive range offerors’ proposals in accordance with District procurement law and regulation, the terms of the solicitation, and the instant decision,” Mendelson wrote in the resolution.

The council wants more time to review but has three options. First, to do nothing, which Mendelson contends given the controversy and legal advice, is “not a positive image for the Council.” The second option would be to disapprove the contracts, and the final option would be to act by emergency legislation and overrule the CAB’s decision and approve the contracts.

Deputy Mayor Wayne Turnage believes the mayor’s move to enter into extended contracts via emergency order was the only way forward.

“The mayor has responsibly submitted these contracts under emergency to avoid any disruption in the health care for over 250,000 people. That is the extent of what she can do at this point. So really, it’s up to the council,” said Turnage.

In response to the council’s resolution, the mayor outlined the potential outcomes of letting the contract expire. Among them, she said, the Department of Health Care Finance will have no legal authority to pay for health care services; District residents will have to navigate the health care system; and health care costs will likely increase.

“To avoid these substantial, unnecessary, and harmful disruptions, I urge Chairman Phil Mendelson to withdraw the disapproval resolution immediately as the Department of Health Care Finance resolicits the procurement over the next few months in order to add additional services for beneficiaries and to address the Council’s concerns,” Bowser said. 

The council is out on recess until Oct. 1, and sources within the council said its rules prohibit council members from voting until it reconvenes. Its next legislative meeting is set for Oct. 5.

“I think you could have made the argument early in his process that this was such a challenging issue, that people of goodwill were legitimately confused as to what should be done. I don’t think you can make that argument anymore. Everybody understands precisely what has happened. And precisely what will happen if the council disapprove these contracts. Or if they just take the entire 45 day review period,” Turnage told WTOP.

Clipped from: https://wtop.com/dc/2021/09/dc-council-hits-pause-button-on-city-contract-to-extend-medicaid-benefits/

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Georgia Eyes New Medicaid Contract. But How Is the State Managing Managed Care?

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GA MCO contracts are expected to be rebid soon and journalists are reporting that current contracts lack financial controls that are standard in other states.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

(Hannah Norman / KHN photo illustration / Getty Images)

Just before Frank Berry left his job as head of Georgia’s Medicaid agency this summer, he said the state “will be looking for the best bang for the buck” in its upcoming contract with private insurers to cover the state’s most vulnerable.

But whether the state — and Medicaid patients — are getting an optimal deal on Medicaid is up for debate.

Georgia pays three insurance companies — CareSource, Peach State Health Plan and Amerigroup — over $4 billion in total each year to run the federal-state health insurance program for low-income residents and people with disabilities. As a group, the state’s insurers averaged $189 million per year in combined profits in 2019 and 2020, according to insurer filings recorded by the National Association of Insurance Commissioners. Yet Georgia lacks some of the financial guardrails used by other states.

“Relative to other states, Georgia’s Medicaid market is an attractive business proposition for managed-care companies,” said Andy Schneider, a professor at Georgetown University’s Center for Children and Families.

Georgia is among more than 40 states that have turned to managed-care companies to control Medicaid costs. These contracts are typically among the biggest in these states, with billions of government dollars going to insurance companies. Insurers assume the financial risk and administrative burden of providing services to members in exchange for a set monthly fee paid for each member.

The health plans, though, have at times drawn questions both on spending and quality of care delivered to Medicaid members.

“The transition to managed care was supposed to save states money, but it’s not clear that it did,” said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation. (KHN receives funding support from the foundation.)

States can require Medicaid insurers to pay back money if they don’t hit a specified patient-spending threshold. That threshold is typically 85% of the amount paid to the insurance companies, with the rest going to administration and profit.

But Georgia does not require its Medicaid insurers to hit a specific target for spending on patient care, a federal inspector general report noted. Though Georgia is trying to “claw back” $500 million paid to its Medicaid insurers, it could have lost out on recoupment dollars, the report indicated.

And state documents show that the Peach State company, which now has the largest Medicaid enrollment of the three insurers, failed to reach the 85% mark from 2018 to 2020.

Overall, Georgia’s Medicaid “medical loss ratio,” which assesses how much was spent on patients’ claims and expenses, was fifth from the bottom nationwide last year, behind only Mississippi; Washington, D.C.; Wisconsin; and Arkansas, according to data from the insurance commissioners association. Spending rates on patient care in the state fell from 82.9% to 80.8% in 2020. (The NAIC uses a different method for calculating the ratio than the state and federal governments do.)

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“Profits for Georgia Medicaid HMOs are very healthy,” said Allan Baumgarten, an independent analyst and consultant.

When asked whether Georgia planned a spending requirement in the new contract, Fiona Roberts, spokesperson for the Department of Community Health, which runs Medicaid, said “a number of considerations are being discussed.” She noted that the state having a low medical loss ratio does not necessarily translate to “unreasonable profit” for the insurers.

The insurers also make money off their management services firms. In 2020, the insurer Peach State paid a subsidiary of its parent company, Centene Management Company, $114.7 million for administrative services. The nonprofit CareSource paid its management services firm $86.5 million in 2020.

“Fees paid to subsidiary companies represent another source of revenues for the parent companies,” said Baumgarten. “And it’s done in a way that does not allow the state to hold the HMOs accountable.”

The state’s latest performance data, which covers 2019, shows the plans did as well or better than the national median on many measures, including on access to a primary care provider.

But low birthweight rates appear to be on the rise despite the state’s goal of bringing them down to 8.6% or less. The companies hovered at an average of about 9.8% in 2019, the latest available data.

“We continue to hear stories from families and health care providers about children in Medicaid managed care who have considerable trouble getting the services they need — whether it’s medication to control their asthma, getting connected to behavioral health care after a mental health crisis lands them in the emergency room, or any number of health challenges,” said Melissa Haberlen DeWolf, who directs research and policy at the Voices for Georgia’s Children advocacy group.

Compared with other states, Georgia has a stunningly low rate of referring poor children to specialty services under Medicaid, according to a recently released National Health Law Program report. DCH said recently it’s investigating why the rate is so low.

And, currently, the state is reporting low covid vaccination rates for those 12 and older covered by the Medicaid managed-care companies. A state posting shows the rates for the three companies are each below 10%, far lower than Georgia’s overall rate.

The companies, when asked about profitability, quality of care and administrative costs, directed a reporter to Jesse Weathington, executive director of the Georgia Quality Healthcare Association trade group. He said he could not comment on individual companies’ financial performance.

“Our goal is to continue to drive quality improvement, and successful patient outcomes, in the most cost-efficient manner for taxpayers who fund Georgia Medicaid,” Weathington said.

Georgia is expected to open the high-stakes bidding process on a new Medicaid contract next year. The bid process typically is fierce and the results often contested.

It’s not clear, though, when Georgia’s new contract process will be completed as the timelines have hit snags in several other states. North Carolina rolled out its managed-care system July 1 after two years of delays. It will spend $6 billion annually, the largest contract in the state health agency’s history.

Last year, Louisiana’s contract process fell apart after insurers that lost out disputed the results. And Centene and other companies are protesting Pennsylvania’s decision not to award them contracts, delaying implementation.

St. Louis-based Centene has more Medicaid managed-care business nationally than any other company. Centene last year acquired WellCare, a Medicaid insurer in Georgia, then closed down that operation in May.

Centene has also faced questions about overbilling. Ohio settled an $88 million pharmacy fraud lawsuit it filed against Centene months before awarding it a contract, while Mississippi settled with it for nearly $56 million. Now Georgia is expected to get money back under the $1 billion that Centene set aside to settle with other states affected by the pharmacy overbilling.

Consumer groups want the state to take stronger steps to advance the health of those who rely on Medicaid and to make the deals with the insurers more transparent.

“Medicaid members are best served when they have ready access to providers, insurers are eager to resolve their health care needs, and policymakers exercise strong oversight to ensure members’ health and well-being are prioritized over profits,” said Laura Colbert, executive director of Georgians for a Healthy Future, a consumer advocacy group.

A bill that aimed to bring more transparency and accountability to the state’s health care plans was vetoed last year by Republican Gov. Brian Kemp. The legislation would have allowed a committee to examine records of health care contractors and compel the state to respond to questions about them. Kemp said the bill would have violated the separation of powers doctrine between the executive and legislative branches of government.

 
 

Clipped from: https://khn.org/news/article/georgia-medicaid-contract-managed-care/

 
 

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FL- County throws lifeline to hospitals drowning in Medicaid

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Miami is now operating a “provider tax” program to maximize federal dollars for hospital Medicaid revenues.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Miami-Dade County now has a Medicaid Hospital Directed Payment Program (DPP) to give local hospitals financial relief made necessary by unreimbursed Medicaid costs.
The ordinance by Commissioner René García, unanimously approved Sept. 1, would take effect in ten days. The program would provide financial relief to Miami-Dade hospitals, which incur $524 million in unreimbursed Medicaid costs each year. Currently, Miami-Dade has nearly 17% of the state’s Medicaid enrollees, a memo from Chief Financial Officer Edward Marquez says.
The DPP is a Medicaid matching program funded through local non-ad valorem special assessments on local hospitals. The revenue generated through this special assessment is placed in a local provider participation trust fund and is matched with federal funds to provide hospitals with supplemental Medicaid reimbursement.
“The passage of this ordinance will ensure that our community’s low-income patients benefit from enhanced healthcare services, and hospitals are able to improve their facilities and patient care through the creation of this program, which ensures Miami-Dade County and its residents receive their fair share of federal Medicaid funding,” said Commissioner García in a press note.
Commissioner Rebeca Sosa expressed similar sentiments at the meeting. “When hospitals face staggering losses, they cannot provide the care necessary for the population, those losses prevent or delay upgrades to facilities and staff, and they can create pressure on public facilities. So, it’s a pleasure to join our senator Rene García and all my other colleagues in this item.”
At the July 8 commission meeting, four representatives from local hospitals spoke in favor of the now-approved ordinance. Gino Santorini, CEO of Mount Sinai, said Medicaid comes at a loss in terms of covering the costs, so “this is an opportunity to unlock some federal funds, which would bring about $300 million down to offset that which will really help to benefit all the hospitals, the employers and the county health in general.”
Dawn Javersack, chief financial officer (CFO) of Nicklaus Children’s Health System, said “seven out of every 10 patients that we see are Medicaid beneficiaries and they represent some of the most vulnerable population… This is really important in terms of the care that’s provided to those patients.”
Sanjay Shetty, president of Steward Health Care North America, and Dawn White, vice president of Government and Community Relations for Baptist Health, also expressed support for the creation of the program.
“I am so pleased that the county commission unanimously supported this innovative mechanism for drawing down more funding to cover the costs of care for our low-income residents,” said Mayor Daniella Levine Cava in a press release. “Our local hospitals treat patients with professionalism and compassion. They deserve our support so they can meet the healthcare needs of Miami-Dade families.”

 
 

Clipped from: https://www.miamitodaynews.com/2021/09/07/county-throws-lifeline-to-hospitals-drowning-in-medicaid/

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Physicians booted from board after blocking Stitt Medicaid plan

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Doctors appointed by the Governor who thwarted his major health initiative have been removed from their appointments.

 
 

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

OKLAHOMA CITY — Gov. Kevin Stitt fired the only two physicians who serve on the state’s Health Care Authority governing board after they opposed his plan to outsource Medicaid.

Dr. Jean Hausheer said when a Stitt staffer called Saturday to give her and Dr. Laura Shamblin the news, he was unable to provide a reason why the governor was kicking two of his own appointees off the nine-member board. The governor appoints five of the board members, to the panel, who serve as volunteers and which oversees more than $2 billion in taxpayer funds for state healthcare programs, including Medicaid.

The Legislature appoints the remaining four members.

Hausheer said the axe fell after the two doctors stymied Stitt’s latest effort to outsource the state’s Medicaid program using a backdoor administrative rules process instead of working with the Legislature and health care community.

Stitt has argued that outsourcing Medicaid could save money and improve health outcomes.

“He didn’t get his way, so he’s just getting rid of those of us that don’t see eye-to-eye with him,” Hausheer said.

She said as of Tuesday, Stitt had filled the posts with non-physicians.

Hausheer, an ophthalmologist with the Dean McGee Eye Institute, which is based in Lawton, said Stitt had previously tried a similar unsuccessful strategy to outsource the program to managed care providers. Earlier this year, the state’s highest court rejected that plan, ruling that it was pushed forward without proper legislative approval.

Hausheer said Stitt’s administration now is attempting to create administrative rules under Senate Bill 131, which put guardrails on the governor’s plan. She said lawmakers, though, told her the Senate bill never took effect because of the Oklahoma Supreme Court ruling.

Hausheer, a practicing physician for more than 40 years, said Stitt appointed her to the board in 2019 with the understanding that she’d serve for four years. She and Shamblin were two of three women who served on the board and the only two licensed physicians. She said the timing was odd because the dismissal came during the month that honors women in medicine.

Hausheer said instead of attempting to outsource Medicaid through administrative rules, Stitt should put together a team that includes legislative leadership, Health Care Authority staffers and members of the state’s health care community.

“We would meet with him gladly and find a pathway forward,” Hausheer said. “(Managed care organizations) by themselves are not necessarily evil for all things. They’re not. It’s just that they would work better for some things and would work terrible for other things.”

She said that strategy would result in a more meaningful partnership as opposed to Stitt’s methods right now of getting rid of people who don’t agree with him.

In an email Tuesday, Carly Atchison, a Stitt spokeswoman, did not comment on why Stitt decided to boot Hausheer and Shamblin from the board.

“The governor is grateful for Dr. Hausheer and Dr. Shamblin’s service to the state of Oklahoma,” Atchison said.

She also said Stitt welcomes Susan Dell’Osso and Gino DeMarco to the board “to help make Oklahoma a Top 10 state for health outcomes.”

Atchison said Dell’Osso served as former chief innovation officer for Integris Health, has experience across the state’s different health systems, and a passion for serving Oklahoma communities.

“Gino DeMarco has voluntarily left retirement to once again serve the state, bringing a unique entrepreneurial talent for innovation, growth and development” including years as a senior executive at a Medicaid consulting and software company, she said. DeMarco previously served as the state’s “PPE czar” during the COVID-19 pandemic where he was tasked with obtaining personal protective equipment during a nationwide shortage. He also served as deputy director of the state’s Tourism and Recreation Department.

State Rep. Marcus McEntire, R-Duncan, said it’s disappointing that Stitt chose to dismiss the only two physicians who served on the board.

“Those people care deeply about our state and the direction it’s going with health care,” McEntire said. “I have an idea why he did it. But, I don’t think it bodes well for people who are willing to serve the state on these boards that if they make a decision that somebody higher above them doesn’t like, then they get axed. We’re all trying to pull the state in the right direction.”

McEntire, House author of Senate Bill 131, said the measure was intended to put limitations on the same policy that the Oklahoma Supreme Court voided. He said the measure didn’t take effect given the ruling.

He also said he’s disappointed Stitt is attempting to press forward with outsourcing managed care through administrative rules.

McEntire said the Health Care Authority governing board is comprised of medical experts, yet the majority continues to be against managed care.

Now the board is void of the expertise of practicing physicians, he said.

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Clipped from: https://www.enidnews.com/news/state/physicians-booted-from-board-after-blocking-stitt-medicaid-plan/article_f4a411ca-1028-11ec-9e1b-6f751872d9b5.html

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CO: Centers for Medicare and Medicaid offer funding for Colorado’s Reinsurance Program

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CMS has approved 12 states 1332 waivers to use expanded subsidies to drive down premium costs.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

(AP Photo/Alex Brandon, File)

DENVER – On Tuesday, Sept. 7, the Centers for Medicare and Medicaid Services announced that it is now offering funding to Colorado and 12 other states to support the Affordable Care Act Section 1332 reinsurance waivers. This nearly $50 million for Colorado’s Reinsurance Program comes from expanded subsidies of individuals buying health insurance from the individual market, instead of an employer, as part of the American Rescue Plan.

“$50 million of new federal funds will save Coloradans even more money on health care through the bipartisan Colorado Reinsurance Program,” said Governor Jared Polis. “By slashing health care premiums, Coloradans will have more money in their pockets for groceries or gas while also ensuring quality, affordable health care is available to every Coloradan. This $50 million in additional funds for Colorado’s Reinsurance Program will be used to further reduce insurance premiums.”

The Colorado Division of Insurance administers the Reinsurance Program, lowering premiums and offering affordable coverage by reducing the financial impact of high-cost health insurance claims. 

“The work of the Polis-Primavera administration and the work of the Division of Insurance continue to help Coloradans by making health insurance more affordable. This additional funding will not only help to decrease premiums and get more people covered, but it also helps to strengthen the reinsurance program,” said Colorado Insurance Commissioner Michael Conway.

The funding doled out by CMS ranges from $2.5 million to $139 million per state – varying on factors such as the size of a state’s reinsurance program. The exact amount Colorado will receive in additional pass-through funding will be $49,827,328. The 1332 waiver gives Colorado the ability to fund a substantial amount of the Reinsurance Program with federal funds—dollars that would not have otherwise come to the State. The additional pass-through dollars adds to that funding.

In 2020, the first year of reinsurance, the program saved people 20% on their health insurance. In 2021, it saved Coloradans nearly 21%.

Find more information about the Colorado Reinsurance Program at the DOI’s Reinsurance website.

 
 

Clipped from: https://www.fox21news.com/news/centers-for-medicare-and-medicaid-offer-funding-for-colorados-reinsurance-program/

 
 

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Ohio looking at appealing federal government decision on banning Medicaid work requirements

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Ohio is considering fighting the CMS reneging on its approved work-requirements waiver.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

The State of Ohio is considering filing a lawsuit that will appeal the Biden administration ending proposed work requirements for some Medicaid recipients.

 
 

Under the Trump administration, Ohio was able to get a waiver that would require able-bodied people, who don’t have any children, to either work twenty hours a week or get job training for their Medicaid health benefits. The work requirements were supposed to start on January 1, 2021, but with the pandemic, the start date was delayed. In August, the federal government told Ohio they cannot go ahead with this plan because it goes outside the bounds of how Medicaid was set up. Lt. Gov. Jon Husted believes that having work requirements is beneficial to everyone involved.

 
 

“We believe it is ultimately valuable for them because an adult who is abled bodied and is not working is probably not doing a lot of constructive things in life,” says Husted. “We want them to do constructive things. We want to help them do constructive things and we want to help give them purpose and opportunity so they can live a better version of the American dream.”

Husted and Governor Mike DeWine have asked Ohio Attorney General David Yost to proceed with the lawsuit, but it hasn’t been filed yet.

 
 

Clipped from: https://www.hometownstations.com/news/ohio-looking-at-appealing-federal-government-decision-on-banning-medicaid-work-requirements/article_0ba7fbb8-0f19-11ec-8cda-834c9b5cc34d.html

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CMS, TX Dispute Over Medicaid Pay Programs Could Affect Provider Pay

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The CMS reneging on the approved TX DSRIP waiver will gut provider payment rates in a month.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Texas providers worry they could face pay cuts if Texas Medicaid officials and CMS don’t promptly hash out an agreement on a state-directed payment proposal that CMS earlier said it wouldn’t approve.

CMS’ notice that it wouldn’t okay the plan as proposed came after a judge ordered the agency to tell Texas it either planned or did not plan to approve the payment programs. Though the payment programs require CMS approval separate from the state’s 1115 waiver, Texas said CMS was violating the terms and conditions of the waiver by dragging its feet on the payment programs.

The judge’s order is part of an ongoing lawsuit Texas filed over the Biden CMS’ decision to revoke a 10-year extension of the state’s 1115 uncompensated care waiver that was granted in January in the final days of the Trump administration. The judge has since placed a temporary injunction on CMS’ rescission of the waiver extension, though CMS previously maintained that it has been acting as though the January waiver was still in effect since May due to Texas also having filed an appeal with the HHS Departmental Appeals Board.

The 1115 waiver as extended in January includes a transition program for Texas’ Delivery System Reform Incentive Program (DSRIP), which rewards performance bonuses to safety net providers that improved health metrics and is set to expire Sept. 30. The transition program, known as the Public Health Providers Charity Care Pool, would still provide incentives but from a smaller pool of money than DSRIP. Texas designed state-directed payment programs to recoup about 80% of the remaining funds that will be lost when DSRIP expires.

John Hawkins, senior vice president of government relations at the Texas Hospital Association, said that not having the state-directed payment programs would hurt provider payments, since some of the payment programs were created as a substitute for a hospital rate increase program in the state. Authority to operate the rate increase program, made possible through the budget neutrality savings from the 1115 waiver, is set to run out at the end of the month, Hawkins said.

The situation also presents challenges for the state’s mental health safety net providers. DSRIP funding was instrumental in building out state mental health capacity. State-directed payment programs — and specifically the behavioral health directed payment program — need to be approved because Medicaid rates alone are not enough to support the level of service delivery Texas wants it providers to sustain, said Danette Castle, CEO of the Texas Council of UHC Community Centers, which represents behavioral health centers across the state.

CMS, in an Aug. 13 letter to Texas, listed areas where the payment programs needed to be altered and offered to extend for one year the DSRIP program. Texas has known since 2017 that funding for the DSRIP program would be phased out by this year. The program is would expire Sept. 30 if not extended for a year.

In an Aug. 16 response to CMS, Texas indicated it believed a one-year DSRIP extension was inconsistent with the Jan. 15 waiver extension.

The Texas Hospital Association hasn’t taken a formal position on whether it would support extending DSRIP for a year, but Hawkins said it is pushing for whichever solution keeps the most capacity in the system with the least amount of disruption. Given that goal, trying to get the state-directed payment programs approved is preferable to a DSRIP extension, he said.

Castle, whose organization petitioned prior to the January extension approval for a DSRIP extension, said if it were between no funding and a DSRIP extension, continuing DSRIP would be the right move. But she doesn’t think the state will have to make that choice.

“We remain confident that the Health and Human Services Commission or state leadership and CMS will be able to come to agreement, whether that is through direction of the court, whether that is through the extension that has been in essence resubmitted, whether it’s through the negotiations going on right now,” she said. “It’s too important not to and I think all parties understand how important it is to do that.”

Hawkins also said he thinks the state is still hopeful that the state-directed payment programs can be approved soon because extending DSRIP isn’t a long-term solution.

The Texas Health and Human Services Commission said it was unable to comment on whether discussion between the state and CMS have begun on the state-directed payment programs because of ongoing litigation. CMS also did not respond to an inquiry by publication. — Maya Goldman (mgoldman@iwpnews.com)

Clipped from: https://insidehealthpolicy.com/daily-news/cms-tx-dispute-over-medicaid-pay-programs-could-affect-provider-pay