Tag: State News

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REFORM- RI Legislators Want to Use Medicaid Waiver Funds to Provide Homeless With Housing

MM Curator summary

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.

 
 

[MM Curator Summary]: The state house is hearing all about designs to pilot a new program to use Medicaid funding to impact homelessness, a la HI, AZ and NY.

 
 

 
 

Clipped from: https://www.golocalprov.com/news/ri-legislators-want-to-use-medicaid-waiver-funds-to-provide-homeless-with-h

 
 

 
 

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The proposal comes after a recent multi-week protest about RI’s homelessness policies at the State House. PHOTO: Sionni

Rhode Island legislators on Tuesday introduced a proposal to create a pilot program testing the effectiveness of using Medicaid waiver funds to provide the chronically homeless with housing.

Rhode Island State Representative David Bennett and State Senator Josh Miller’s proposal (2023 H-5098), modeled after legislation in Hawaii, directs the Executive Office of Health and Human Services (EOHHS) to commission Medicaid waiver funds for a pilot program covering supportive housing services to people suffering from chronic homelessness. 

The program would provide individuals with behavioral health services, case management, personal care and assistance services, home and community-based services and housing support services. Arizona and New York have similar programs, housing thousands of chronically ill individuals and saving taxpayers in both states.

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“As an RN case manager, I’ve worked with a lot of these folks. When they don’t have a roof over their heads, it’s very hard to make sure they’re taking their medications regularly, make sure they’re going to the doctor,” said Bennett (D-Dist. 20, Warwick) who is a registered nurse who has seen the impact of housing first hand. But once they have housing, they can recover and stand on their own two feet again.”

 
 

Modeling Other States

According to the National Alliance to End Homelessness, roughly 20% of homeless individuals are defined as chronically homeless, meaning they have been homeless for at least a year and suffer from chronic and complex health conditions including mental illnesses, substance use disorders, and medical conditions. Without stable housing, they cycle in and out of emergency departments, inpatient hospital stays, psychiatric centers, detoxification programs, and jails, costing taxpayers roughly $35,000 per year as of 2017.

“The acute correlation between homelessness and adverse health conditions is a heinous reality. Unfortunately, issues tend to be aggravated since the tragedy of homelessness brings more attention to shelter than to treatment options,” said Miller (D-Dist. 28, Cranston, Providence). “Getting people into housing removes the burden of finding shelter and allows for the freedom to get connected with programs and employment opportunities, while directly engaging in the most effective preventative care mechanism we have, a roof.”

One of the biggest health costs related to homelessness is emergency room visits, said Miller, who co-chaired a 2013 Senate commission that studied ways to reduce ER visits. Homeless individuals show up to emergency rooms for many reasons. 

According to the legislators’ release, homeless individuals “often struggle to get preventive care, so regular problems may not get treatment until they become critical. Emergency rooms cannot, by law, turn anyone away for inability to pay, so homeless individuals can use them to address more mundane health issues. Sometimes, shelters are full and families just need somewhere warm to sleep.”

 
 

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STATE NEWs- Governor, Ohio Medicaid launch maternal care program

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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.

 
 

[MM Curator Summary]: A new maternal care program will distribute funds to OB practices focused on bending troubling maternal mortality trends.

 
 

 
 

Clipped from: https://www.journal-news.com/community/governor-ohio-medicaid-launch-maternal-care-program/ZMPG3CKRDBHEVDEZWZTLV47HRI/

 
 

A new Comprehensive Maternal Care program has launched in Ohio and is expected to improve health outcomes for mothers, infants and their families by addressing food instability, housing options and more.

“Giving all Ohioans the best possible start at life truly begins before a child is even born and that means ensuring the child’s family has access to the resources they need,” said Ohio Gov. Mike DeWine, who collaborated on the program with Ohio Department of Medicaid Director Maureen Corcoran. “Personalized access to those supports from trusted community partners and high-quality, responsive care that focuses on patients lead to better, healthier outcomes for mothers, babies, and their families,” he said.

‘This is a baseline year’

Ohio Medicaid estimates investing $5 million in the program by the end of its first year, reaching more than 14,000 pregnant and postpartum patients and enrolling 77 medical practices currently caring for pregnant and postpartum patients.

“This is a baseline year,” said Marisa Weisel, Ohio Medicaid’s deputy director of strategic initiatives. The program provides quarterly payments to practices based on the number of Medicaid patients those practices typically serve, according to Weisel.

ExploreOhio Medicaid extends postpartum coverage for new mothers

The Comprehensive Maternal Care program creates a framework for providers and community partners to develop individualized plans to support women and families who’ve historically lacked ready access to high-quality, responsive care before and after pregnancy, according to the governor’s office.

“Ohio Medicaid and our vision for the ‘Next Generation’ of care commits to delivering a personal care experience to every Ohioan served,” Corcoran said, referencing Ohio Medicaid’s Next Generation managed care program. The next stage of implementation will launch on Feb. 1, which will include managed care plans.

“The (Comprehensive Maternal Care program) model builds on that commitment by encouraging providers and communities to partner on building a trustworthy and comprehensive system of care for members,” Corcoran said.

What that care looks like

The practices involved in the program may use the funds to help their patients achieve better health outcomes, as Ohio Medicaid will be monitoring them through measurements to allow those practices to track how they are doing.

“We could have a practice that decides they want to hire a community health worker with their extra resources,” Weisel said. The health worker could help patients sign up for benefits such as WIC, help them work on finding stable housing or help get women connected with the behavioral health system to deal with post-partum depression.

Weisel said post-partum depression can play a big role in the parent’s ability to care for their child. It also points to how mental health impacts maternal mortality rates. In an analysis on pregnancy-related deaths between 2017 and 2019, the Centers for Disease Control found four out of five pregnancy-related deaths could have been avoided, with 23% of those deaths being associated with mental health conditions, including deaths to suicide and overdose/poisoning related to substance use disorder.

The health practices involved in the program also must consider and link patients to resources that address broader factors of health, such as housing, food instability and transportation.

“We know that health care is not the only thing that matters,” Weisel said. “There are often other barriers to them accessing care.”

Additional support

Gina McFarlane-El, CEO of Five Rivers Health Centers, said the Comprehensive Maternal Care program will help them continue to care for their pregnant patients. Five Rivers Health Centers is the 10th largest federally-qualified health center in Ohio, seeing more than 27,000 patients a year. Of their pregnant patients, approximately 22% of them are uninsured.

In addition to health visits, McFarlane-El said Five Rivers Health Centers also supports their pregnant patients through programs like their diaper and bra banks, as well as with group visits for pregnant individuals.

“Diapers are one of those things that are not supported through any of the various funds that our women receive, so we created Montgomery County’s first diaper bank within this area through our Healthy Start program,” McFarlane-El said. “We use those resources to help women not worry about diapers.”

Cost figures vary for diapers, but the National Diaper Bank Network estimates the average monthly supply of diapers costs approximately $80 in Ohio, costing parents approximately $960 a year.

Five Rivers Health Centers also offers group prenatal care visits through the program Centering Pregnancy. Toni Tipton, a certified nurse midwife at Five Rivers Health Centers, said pregnant women can take part in group prenatal visits to allow for them to learn more and connect with other individuals whose delivery dates are similar to theirs.

“We really highly recommend it for first time moms, and it also provides social support,” Tipton said. The program is also aimed at decreasing infant mortality, while also increasing breastfeeding and immunization rates.

McFarlane-El said they will use some of the funds they receive through Ohio Medicaid’s Comprehensive Maternal Care program to support those programs and expand other efforts.

Requirements for providers

Participation in the Comprehensive Maternal Care program requires obstetrical practices to receive feedback from patients and families, such as through advisory councils or other means, which can then be used to improve patient experiences and reduce disparities.

“One thing we’ve heard, sometimes (patients) don’t feel like they’re able to communicate effectively with their provider,” said Weisel. This program then encourages those practices to get regular feedback from patients.

ExploreLocal hospitals recognized as ‘high performing’ in maternity care, per new report

Additionally, Weisel said practices must use the pregnancy risk assessment to identify women in need of a first prenatal appointment and ensure timely access to appointments and services. This assessment also helps Ohio Medicaid track pregnant individuals’ needs and maintain their Medicaid coverage while they’re pregnant and also after their pregnancy. In April of last year, Ohio Medicaid extended its coverage of benefits for new mothers from 60 days to 12 months after the birth of their child.

Additional criteria for participation includes engaging community supports, evaluating the mother’s and family’s experiences throughout the treatment, ensuring patient involvement and care continuity with their providers and assessing the practices’ operations to make sure they are achieving healthier outcomes.

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MCOS; STATE NEWS- State dodges questions about Medicaid procurement during latest update

MM Curator summary

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.

 
 

[MM Curator Summary]: A reporter doesn’t understand why an official wasn’t giving MCOs ammunition for protest later.

 
 

 
 

Clipped from: https://floridapolitics.com/archives/583312-state-gives-update-on-medicaid-procurement-dodges-answering-questions/

 
 

The Agency for Health Care Administration (AHCA) is getting poised to post an invitation to negotiate six-year Medicaid managed care contracts that are worth more than $100 billion in the aggregate and tens of billions of dollars for health plans that submit winning bids.

But Florida Medicaid Director Tom Wallace avoided answering some of the questions members of the Senate Health Policy Committee had for him Monday, saying that “we are in a blackout-type period.”

The agency, which houses the state’s Medicaid program, has been working on a new invitation to negotiate (ITN) the state’s Medicaid managed medical assistance and Medicaid long-term care programs. 

The ITN is at least 27 days away from being published. Once published, there is a statutory blackout period where respondents to the ITN or individuals acting on their behalf cannot contact the agency or any state official about the ITN.

Sen. Gayle Harrell pressed Wallace about the minimum number of Medicaid managed care plans the state is required to contract with in each region. 

 
 

The Legislature last year passed SB 1950, which trimmed the number of regions from 11 to nine and increased the minimum number of plans in each region the state is required to contract with.

Then Harrell asked Wallace about minimum contract requirements for Medicaid specialty populations, such as children with complex medical issues and children in the child welfare program. 

“How are you going to address that statewide?” Harrell asked. “Are you going to have one plan as we do with Sunshine or are you going to have a number of plans?”

“You are starting to ask a lot of detailed questions,” Wallace replied. “We are in a blackout-type period, almost, here. I know the ITN has not been released, but we are just trying to be cautious on exactly how I respond to some of these questions.”

That wasn’t the only question Wallace dodged.

 
 

Sen. Bryan Ávila asked Wallace about possible hurdles or challenges with the procurement and executing new six-year contracts.

“We are going through the process. I hate to come out there and say too much about what I am thinking right now related to the process,” Wallace told Avila.

Avila, who said he was “sensitive” to Wallace’s predicament, encouraged the Medicaid director to “brush around the details,” and let them know whether there will be vast differences when the state transitions from the current six-year contracts to new contracts.

“We are looking for improvement. … We’ve seen gains in each of the procurement cycles we’ve gone through,” Wallace said. “We have (SB) 1950 out there. Respective entities can look at that and see what the statutory requirements are to meet. That’s pretty much all I feel comfortable responding to right now.”

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EXPANSION- Georgia won’t take up full Medicaid expansion anytime soon, lawmakers say

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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.

 
 

[MM Curator Summary]: Talk to the hand, expansioners (says GA rep).

 
 

Clipped from: https://www.beckerspayer.com/payer/georgia-wont-take-up-full-medicaid-expansion-anytime-soon-lawmakers-say.html

Georgia will not consider a full expansion of Medicaid in the near future, The Atlanta Journal-Constitution reported Jan. 19. 

Georgia House Speaker Jon Burns said the state instead needs to focus on Georgia Governor Brian Kemp’s proposal to expand the program, which would require adults to work at least 80 hours a month to qualify for Medicaid coverage. 

The more limited expansion is slated to begin this summer. State officials estimate it will insure around 50,000 adults. If the state fully expanded Medicaid, it would insure around 400,000 adults, The Atlanta Journal-Constitution reported. 

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MH/BH; STATE NEWS- Human Services Department announces Behavioral Health Day at New Mexico Legislature on January 25

MM Curator summary

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.

 
 

[MM Curator Summary]: NM Medicaid will probably get about $90M for BH programs if the Good Guvnr Grisham has her way.

 
 

 
 

Clipped from: https://www.hsd.state.nm.us/2023/01/24/human-services-department-announces-behavioral-health-day-at-new-mexico-legislature-on-january-25-strong/

Star Award Celebration will recognize behavioral health care professionals on January 24 

SANTA FE – The New Mexico Human Services Department (HSD) today announced the 18th Annual Behavioral Health Day at the New Mexico State Legislature. The New Mexico Behavioral Health Planning Council is sponsoring two days of events to recognize the need for improved behavioral health care and celebrate individuals for their hard work and dedication to their local communities. Behavioral Health Day activities will run from 9 a.m. to 12 p.m. in the Capitol Rotunda on Jan. 25, 2023. 

As many New Mexicans cope with the disabling effects of behavioral health disorders, Gov. Michelle Lujan Grisham has recommended increased funding for behavioral health services in her FY 2024 budget. The budget recommendations include:  

  • $3.5M expansion of community-based behavioral health services for children,  

 
 

  • $2.7M increase for behavioral health services for children in custody,  
  • $1.2M increase in non-Medicaid behavioral health reimbursement rates from 85% to 100% of Medicaid, 
  • $6.6M increase for the 988 statewide crisis line, 
  • $6.5M for Behavioral health supports, 
  • Over $70M for the New Mexico Behavioral Health Institute forensics facility. 

“Behavioral Health Day is a great way we can recognize the important work being done to improve the lives of many New Mexicans,” said David. R. Scrase, MD, cabinet secretary for the New Mexico Human Services Department. “Governor Michelle Lujan Grisham’s budget recommendations mark the next steps toward providing better behavioral health services in New Mexico.” 

The Behavioral Health Star Award Celebration will be held on Jan. 24, 2023, from 9 a.m. to 5 p.m. at the Hilton Buffalo Thunder – Tewa Ballroom. The highlight of the 2023 Behavioral Health Award Celebration is the awards presentation. These individuals will be honored for their hard work and dedication to their local communities. 

2023 Behavioral Health Star Award Winners 

  • Albuquerque Community Safety Department – Albuquerque Metro Area/ Bernalillo County  
  • Barry Ore – The Four Corners Region 

 
 

  • Cathi Valdes – Statewide 
  • Janna Rae Vallo – Tribal communities in New Mexico  
  • Jess Spohn – Dona Ana County 
  • Jodie Jepson and Jennifer Martinez – Heading Home – Albuquerque Street Connect 
  • Lara Yoder – Santa Fe 

 
 

  • Lawrence A. Medina – Taos, Colfax, and San Miguel Counties 
  • Local Collaborative 18 – Eight Northern Indian Pueblos and surrounding Northern New Mexico communities 
  • Lee Roy L. Lucero, Licensed Master Social Worker – Albuquerque  
  • Liliana Spurgeon – Albuquerque  
  • Mary (Martinez) White – Las Cruces and Dona Ana County 

 
 

  • Michael Aguirre -Northeast NM Colfax, Taos, Union 
  • Patsy Romero – Santa Maria El Mirador 
  • Roman Sanchez, Child Protection Service Worker. Espanola and Taos 
  • Sindy Bolanos-Sacoman – New Mexico Tribal populations in McKinley County 
  • 2023 Carol Luna Anderson Award: Russel Liles  

 
 

  • 2023 Lifetime Achievement Award: Paul Tucker  
  • 2023 John Henry Award: Zachy – Service Dog (owner David Padilla) 

The Governor’s Proclamation for Behavioral Health Day can be found here and the 2023 Behavioral Health Star Award Celebration flyer can be found here. 

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We talk, interpret and smile in all languages.  We provide written information to our customers in both English and Spanish and interpretation services are available in 58 languages through our provider, CTS Language Link. For our hearing, and speech impaired customers, we utilize Relay New Mexico, a free 24-hour service that ensures equal communication access via the telephone to individuals who are deaf, hard of hearing, deaf-blind or speech disabled. 

The Human Services Department provides services and benefits to 1,076,746 New Mexicans through several programs including: the Medicaid Program, Temporary Assistance for Needy Families (TANF) Program, Supplemental Nutrition Assistance Program (SNAP), Child Support Program, and several Behavioral Health Services. 

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MH/BH; RX- California Medi-Cal Contracts With Pear to Treat Stimulant Use Disorder

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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.

 
 

[MM Curator Summary]: The CA deal will be a huge lift for the startup towards its goal in monetizing its CBT app.

 
 

Clipped from: https://www.managedhealthcareexecutive.com/view/akili-laying-off-30-of-workforce

California Medi-Cal Contracts With Pear to Treat Stimulant Use Disorder

Medi-Cal, California’s Medicaid program, has contracted with Pear Therapeutics for members in 24 counties to participate in an outpatient program for stimulant use disorder.

A pilot program with the state of California’s Medicaid program, Medi-Cal, will allow eligible members to participate in a 24-week outpatient program to treat stimulant use disorder. The Recovery Incentives: California’s Contingency Management Program will utilize Pear Therapeutics to track and distribute incentives.

The program uses evidence-based treatment to provide motivational incentives to treat stimulant use disorder. The goal is to recognize and reinforce positive behavioral change. California has received federal approval for the use of contingency management (CM) as a benefit in the Medicaid program.

 
 

Julia Strandberg, MBA, chief commercial officer, Pear Therapeutics, praises California Medi-Cal decision.

“We applaud California’s DHCS for taking this important step to expand access to behavioral treatment to address the stimulant use disorder crisis that persists in California,” Julia Strandberg, chief commercial officer of Pear Therapeutics, said in a statement. “By working together, we will implement an innovative program that will reinforce individual positive behavioral change consistent with meeting treatment goals.”

The program is launching in 24 California counties in the first quarter of 2023. The 24-week outpatient program is also followed by six or more months of additional recovery support services. Motivational incentives will be in the form of low-denomination gift cards and the retail value will be determined per treatment episode.

Pear will deliver, implement, and manage the program through the electronic tracking and distribution of incentives to Medi-Cal members who participate in the program. The pilot program will inform the design and implementation of a statewide CM benefit through the Drug Medi-Cal Organized Delivery System.

California is not the first state to partner with Pear to fight addiction. In November, the Wisconsin Department of Health Services awarded the company funding to provide residents with access to Pear’s reSET and reSET-O, which treat substance use disorder and opioid use disorder, respectively.

Both reSET and reSET-O are FDA-authorized prescription digital therapeutics (PDTs) delivering cognitive behavioral therapy and indicated to improve outpatient treatment for substance use and opioid use disorders. PDTs use software to treat serious disease and once they are evaluated and authorized by regulators, they are used under the supervision of a prescribing clinician.

In Wisconsin, synthetic opioids, such as fentanyl, were identified in 91% of opioid overdose deaths and 74% of all drug overdose deaths, with fentanyl overdose deaths growing by 97% from 2019 to 2021.

The state is making reSET and reSET-O available in a variety of outpatient treatment settings.

“The state of Wisconsin is making a difference for those struggling with addiction by expanding access to evidence-based treatment and recovery services,” said Strandberg. “We have a shared goal to ensure that people living with substance and opioid use disorders have every opportunity for favorable outcomes for recovery.”

Earlier, Pear had partnered with the South Carolina Department of Corrections to provide both PDTs to women incarcerated at the Camille Griffin Graham Correctional Institution.

“Pear and the South Carolina Department of Corrections intend to integrate innovative clinically validated technologies into the treatment paradigm to combat addiction and support those at-risk,” Strandberg said. “Our prescription digital therapeutics are designed to help patients on the path to recovery while our clinician dashboard allows counselors to monitor patient progress.”

Both reSET and reSET-O have been studied in randomized controlled trials with the findings published in peer-reviewed medical journals. The studies found the PDTs have the potential to improve real-world health outcomes and decrease treatment costs.

A recent study in The American Journal of Addictions presented findings of a real-world observational analysis that demonstrated high rates of engagement, retention, and abstinence from substances for patients using the reSET treatment through 12 weeks.

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PROVIDERS; LTC- ‘A ticking time bomb’: NY nursing homes push for Medicaid rate increase

MM Curator summary

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.

 
 

[MM Curator Summary]: NY NH providers say they have a 42% inflation factor that they are stuck dealing with, and if the state doesn’t give them a 20% raise like right now several of them will shut down.

 
 

Clipped from: https://www.northcountrypublicradio.org/news/story/47197/20230118/a-ticking-time-bomb-ny-nursing-homes-push-for-medicaid-rate-increase

Jan 18, 2023 —

A coalition of nursing homes says, if the state doesn’t increase its Medicaid reimbursement rates, the eldercare facilities may have to reduce the number of beds — or even shut down all together.

 
 

 
 

03:12

00:00

Cara Chapman’A ticking time bomb’: NY nursing homes push for Medicaid rate increase

 
 

United Helpers Rehabilitation and Senior Care in Canton is one of a couple dozen skilled nursing facilities formally advocating for Gov. Kathy Hochul to increase the Medicaid reimbursement rates for long-term care by 20% in this year’s budget. Photo provided

According to the state’s health insurance assistance program, most nursing home residents use Medicaid to pay for their care. New York State sets the reimbursement rates the facilities get paid for those residents.

United Helpers COO Stacey Cannizzo said the state hasn’t adjusted those rates for inflation since 2007. 

“There is approximately a 42% inflationary factor that we have not been able to manage because our rates have been stagnant for so long,” she said.

United Helpers — which operates the United Helpers Rehabilitation and Senior Care facility in Canton — and a couple dozen other skilled nursing facilities say they collectively lost more than $81 million last year. Cannizzo said the Medicaid rates led to those losses; United Helpers actually closed its Ogdensburg facility in 2021 due to financial difficulties. 

The nursing homes, all of whom are nonprofits located throughout Upstate, formed a coalition in November. They want the governor to include a 20% increase to the Medicaid rates in this year’s budget, as well as a process put in place to ensure the state routinely looks at and adjusts reimbursement levels. 

Republican Assemblyman Matt Simpson — whose district covers all of Warren County and parts of Essex, Washington, Saratoga and Fulton counties — said raising the Medicaid rates for long-term care is one of his top priorities this session. He said both the rates and nursing home staffing have been at crisis levels for several years.

“It’s a ticking time bomb right now,” Simpson said, “and if we lose these facilities because we’re not correctly supporting them, it’s going to be devastating for those that need those services.”

Cannizzo said the stagnant Medicaid rates hinder efforts to attract and keep staff. Since nursing homes have to meet minimum staffing levels, lack of staff means facilities across the state are leaving beds empty. She said that can mean individuals are unable to access the care they need and hospitals don’t have a place to send patients who need post-acute care. 

Republican Assemblyman Scott Gray represents the St. Lawrence “River District” that comprises parts of St. Lawrence and Jefferson County. He said there’s “no question” the rates are overdue for an adjustment, but that the biggest objective is to keep people in their homes and make sure they can afford to age in place. Gray said that’ll help reduce the cost of Medicaid for long-term care.

“Essentially, if we can address and help and assist with aging in place and keep the Medicaid costs down, then we can pay for these adjustments that are necessary — providing we don’t wait 15 years to do it again.”

 
 

Stacey Cannizzo is the COO of United Helpers, which operates United Helpers Rehabilitation and Senior Care in Canton. Photo provided

Cannizzo said she thinks raising the Medicaid rates is an issue that affects every New Yorker. She said it could be the individual themselves, or a family member, friend or someone in their community who needs long-term care.

“These are people that have worked and paid taxes their entire lives, and we are committed to making sure that their needs are met — but we need the help and we need the support of the governor to make sure that we can afford to provide that care.”

Cannizzo said she’s “cautiously optimistic” that the rates will go up with this budget. Regardless, the coalition plans to take a long-game approach to keep the issue on people’s minds.

Gov. Kathy Hochul’s State of the State book, which outlines her priorities for the year, does not specifically mention Medicaid reimbursement rates for long-term care. But, similar to what Assemblyman Gray said, the plan proposes investing in teams to provide care for low-income adults in their homes and allow them to age in place. 

Hochul spokesperson Justin Mason said in a statement that the governor is “committed to ensuring that all New Yorkers can age with dignity and independence in the community of their choosing.” On whether she’s considering an increase to the Medicaid rates for long-term care, he said more information would be shared when she releases her executive budget later this month.

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PROVIDERS (OP-ED); FINANCE- 72% of Private Practice Dentists Plan to Raise Fees This Year, Will Texas Do the Same for Medicaid Dentists With $32.7 Billion Extra in the Kitty?

MM Curator summary

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.

 
 

[MM Curator Summary]: TX dentists look upon the current state budget surplus with optimism for raising their own rates.

 
 

Clipped from: https://www.tdmr.org/72-percent-of-private-practice-dentists-plan-to-raise-fees-this-year/


The American Dental Association’s Health Policy Institute last month published the results of an ongoing survey it has been conducting since January 2022, quizzing some 3,000 participating private practice dentists each month to measure the impact of COVID-19 and other issues affecting the profession.

The report includes breakdowns by “ownership status, DSO affiliation, practice size, geographic location, sex, age group, and race/ethnicity.”  A PDF of the report is below.

Raising fees

The one remarkable statistic is that 72% of 1041 dentists across the country, representing a cross-section of private practice dentistry,  responded that they are planning to raise their patient fees in 2023.

Unfortunately, there are no survey results on why these dentists are raising their fees. But one can only conclude that the recent inflationary spiral which has hit dentistry hard plus the difficulties in staff recruitment are the reasons.

Bounty in the state budget

A few months ago, the Texas Comptroller of Public Accounts Glenn Hager estimated there would be a budget windfall for Texas of some $27 billion, thanks to high oil prices.  It was announced this week that the budget surplus is actually $32.7 billion.

Adverse effect on providers

As we have repeated in several stories, the situation is desperate for Medicaid dentists who have to cope with the same costs as private practice dentists but get fees substantially less.  The Medicaid dental fee schedule has only gone down since 2007.

The situation is becoming untenable for many who also have to put up with the erroneous behavior of DMOs, scrutiny of the OIG and the potential pitfalls and penalties of the Texas Medicaid Fraud Prevention Act and whistleblowers such as Joshua Lafountain.

We hope the legislature will look at raising Medicaid dental fees before the situation worsens.

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MH/SUD- How State Medicaid Programs Address the Behavioral Health Workforce Shortage

MM Curator summary

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.

 
 

[MM Curator Summary]: Nearly all states are trying things like increasing rates and expanding scope of practice to help deal with the BH workforce shortage.

 
 

Clipped from: https://healthpayerintelligence.com/news/how-state-medicaid-programs-address-the-behavioral-health-workforce-shortage

Over 70 percent of state Medicaid programs reported at least one strategy to incentivize provider participation in Medicaid, helping to alleviate the behavioral health workforce shortage.

 
 

 
 

By Victoria Bailey

January 16, 2023 – State Medicaid programs have implemented or plan to implement strategies to address the behavioral health workforce shortage, including increasing reimbursement rates and reducing administrative burden, according to an issue brief from the Kaiser Family Foundation (KFF).

The COVID-19 pandemic exacerbated mental health issues and increased the need for behavioral healthcare. However, workforce challenges have made it difficult for people to access care.

Data from 2020 revealed that around 39 percent of Medicaid beneficiaries were living with a mental health or substance use disorder. Meanwhile, only 36 percent of psychiatrists accept new Medicaid patients.

KFF surveyed state Medicaid officials about their strategies that addressed the behavioral health workforce shortage in fiscal year (FY) 2022 and the strategies they plan to implement in FY 2023. Forty-three states and the District of Columbia responded to the survey, with response rates varying by question.

State strategies fell into four areas: increasing reimbursement rates, extending the behavioral health workforce, reducing administrative burden, and incentivizing provider participation in Medicaid.

Reimbursement gaps often limit access to care, especially for Medicaid beneficiaries. Psychiatrists receive lower Medicaid reimbursement than primary care providers. In addition, overall Medicaid payment rates may be lower than other payers.

States have opportunities to increase reimbursement rates in fee-for-service (FFS) Medicaid and managed care organizations (MCOs).

Nearly two-thirds of responding states (28 of 44) implemented FFS payment rate increases in FY 2022 or plan to in FY 2023.

Many states used the temporary funding provided through the American Rescue Plan Act (ARPA) that boosted the Medicaid match rate for home and community-based services (HCBS) to increase behavioral health provider rates.

In some states, specific provider types received payment rate increases, such as applied behavioral analysis or those providing residential-level care for substance use disorders.

Other states implemented broader increases. For example, Oregon instructed its Medicaid coordinated care organizations to raise rates by 30 percent for providers who receive 50 percent or more of their revenue from Medicaid and 15 percent for those who receive less than 50 percent of their revenue from Medicaid.

Strategies to expand the workforce were common, with 33 out of 38 responding states reporting they had at least one strategy in place or planned for FY 2023. The top strategy reported was adding peer or family specialists as providers who can bill without a supervising practitioner.

States also reported extending direct reimbursement privileges to other types of mental health practitioners, such as clinical social workers. In addition, almost two-thirds of states reimbursed services delivered by license-eligible individuals practicing under supervision in FY 2022.

Providers can experience significant administrative burden when managing prior authorization, documentation requirements, and lengthy credentialing processes.

Around 75 percent of responding states reported at least one strategy to reduce provider administration burden in FFS and MCOs. Many states said they had sought behavioral health provider feedback on administrative processes, while multiple states reported plans to implement centralized or standardized provider credentialing in FY 2023.

Certain state Medicaid programs have more flexibility than others regarding reducing administrative burden. For example, one state shared how their behavioral health authority regulates documentation, meaning streamlining the process would require collaboration between the Medicaid agency and the authority.

Provider participation in Medicaid programs may be slim due to reimbursement gaps and delays, but implementing prompt payment policies could help incentivize participation.

Two-thirds of reporting states had prompt payment policies in FFS and MCOs in FY 2022. However, less than one-fifth of states reported providing financial incentives to encourage providers to participate in physical and behavioral health integration.

The brief found that state Medicaid programs’ efforts to support the behavioral health workforce are on par with federal efforts. The Consolidated Appropriations Act passed in December 2022 authorized funding for new psychiatry residency positions and included provisions to boost the number of providers authorized to prescribe medications for opioid use disorder.

 
 

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TECH- Chances of State Medicaid Programs Bringing Telehealth Services Into ‘23 are High

MM Curator summary

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.

 
 

[MM Curator Summary]: Telehealth for BH remains the most likely contender for survival of any post-pandemic clawback.

 
 

Clipped from: https://www.managedhealthcareexecutive.com/view/chances-of-state-medicaid-programs-bringing-telehealth-services-into-23-are-high

Medicaid officials of 44 states (including the District of Columbia) responded to a KFF survey about policies and trends relating to telehealth delivery of behavioral health services. Officials reported high utilization rates of telehealth services for behavioral health purposes since the beginning of the pandemic and plan to continue telehealth expansion permanently.

Telehealth seems to be a necessity when accessing behavioral health services for Medicaid users.

In 2022, behavioral health, especially mental health, remained a top service category with high telehealth utilization among Medicaid enrollees.

In a recent KFF survey, state Medicaid officials were asked about their telehealth delivery policies and trends when it came to behavioral health. Out of all U.S. states only 44 (including the District of Columbia) participated. Responses resulted in many seeking permanent adoption of pandemic-era telehealth policy expansions.

Early in the pandemic, all 50 states expanded coverage and/or access to telehealth services in Medicaid. Respondents of the survey stated they took at least one specified Medicaid policy action to expand access to behavioral healthcare through telehealth. For example, states expanded behavioral health provider types eligible to provide Medicaid services through telehealth. States also expanded categories of Medicaid behavioral health services eligible for telehealth delivery. Lastly, states newly allowed or expanded their audio-only services.

As of July 1, 2022, states were more likely to offer this audio-only services.

Audio-only coverage was reported to help facilitate access to care, especially in rural areas with broadband access challenges and for older populations who may struggle to use audiovisual technology.

While, many states reported high utilization of telehealth for behavioral healthcare after, some noted utilization trends among certain subgroups of Medicaid enrollees.

These trend subgroups include:

  • Geographic: With states most commonly reporting particularly high behavioral health telehealth utilization in rural areas compared to urban areas.
  • Demographic: These trends indicate behavioral health conditions are most prevalent among young adults and White people. In particular, some states reported younger enrollees (including children and non-elderly adults) were most likely to utilize telehealth for behavioral health care.
  • Temporal: States have frequently reported behavioral health telehealth use has declined from its peak earlier in the pandemic, but remains high compared to the pre-pandemic period. Future policy changes, such as to further expand or to limit telehealth flexibilities, may impact ongoing utilization.

Nearly all responding states found some of these trends by monitoring utilization in 2022. Many plan to begin doing so in 2023, which is important for the future of Medicaid telehealth policy for behavioral health as it relies on continued analysis of utilization and other data, as well as federal guidance.

As states continue and expand their monitoring, the results of these analyses may provide information that can inform policy decisions.

For example, the Bipartisan Safer Communities Act signed into law in June 2022 directs CMS to issue guidance to states on options and best practices for expanding access to telehealth in Medicaid, including strategies for evaluating the impact of telehealth on quality and outcomes, KFF said. CMS must then issue this guidance by the end of 2023.

The Consolidated Appropriations Act passed in December 2022 authorized additional telehealth provisions, such as requirements for Medicaid provider directories to include information on telehealth coverage and for CMS to issue guidance on how states can use telehealth to deliver crisis response services.