Tag: State News

Posted on by

Maryland passes Adult Dental Care Medicaid Expansion

[MM Curator Summary]: The state will add $80M in adult dental benefits.

 
 

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.

 
 

MARYLAND- A bill to add adults to the dental care portion of Maryland’s Medicaid has passed the state legislature and heads to Governor Hogans’s desk with a veto-proof majority.  SB150, which would add Maryland adults to the list of those who can receive dental services, including diagnostic, preventive, restorative, and periodontal services, for adults whose annual income is at or below 133% of the federal poverty level. 

Speaker Pro Tempore Sheree Sample Hughes tells us that equates to a roughly 800 dollar value per person, where before only children in the foster system and certain pregnant women could take advantage of Medicaid to receive dental work.

“The goal is to get to the root literally of the need for preventative dental care for adults using Medicaid,” she said. 

She tells us the bill will cover both extensive operations and preventative care such as cleanings, with the purpose to prevent poor dental health and expensive outcomes before they happen.

“That’s the problem we wanted to solve with this legislation was to avoid that and to be able to have access to dental care for citizens to see a dentist regularly and have that proper care and not have to look at major extractions or root canals,” Speaker Pro Tempore Hughes said.

Opponents to the bill say they are concerned about the price tag and impact on the state the measure would have.

“Because of bills like this and recurring expenses that we vote on, the budget is now over 60 billion, and this bill alone originally has a fiscal not of 80 million dollars in the first year,” said Delegate Wayne Hartman.

However, Speaker Pro Tempore Hughes says that’s something the measure already accounted for.

“60 percent of this is going to be part of the federal funds we have been able to secure and only 40 percent is state funds,” she said adding “when we are in a position to help the people this is a time we are able to do it, we want a healthy state a healthy community and providing dental care is a part of this process.”

The bill would come into effect in January of 2023.

 
 

Clipped from: https://www.wmdt.com/2022/04/maryland-passes-adult-dental-care-medicaid-expansion/

  • Aa

 
 

 
 

 
 

 
 

 
 

Posted on by

Network adequacy standards vary widely between Medicaid, exchange plans

[MM Curator Summary]: A new study out of Georgetown shows very different network quality requirements being used in different state markets.

 
 

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.

 
 

 
 

A new analysis throws water on the potential benefits of narrow, or “high performance,” networks.

Researchers at Georgetown University’s Center on Insurance Reforms analyzed federal laws, state regulations and regulatory guidance on network adequacy and selected six states for case studies: Florida, Georgia, Kansas, New Mexico, Pennsylvania and Washington.

The study found huge variation between standards for physician networks between states, and volatility between Medicaid and individual market plans. This causes significant differences in access to in-network providers, according to the study.

This is especially true for people who may be enrolling in plans on the individual marketplaces, according to the study, as there is limited oversight for network adequacy. States are required to closely monitor networks for private Medicaid managed care plans.

“Having health insurance should give people the peace of mind that they can get the care they need,” said Andrea Ducas, senior program officer at the Robert Wood Johnson Foundation, which backed the study, in a statement. “One important dimension of that is having enough providers that accept your insurance. Policymakers can bring greater peace of mind to more people by ensuring that provider networks are adequate in size and scope of coverage.” 

Insurers argue narrower networks help manage costs due to a smaller list of provider contracts to manage as well as the ability to ensure plan members are seeking care from high-quality providers. Critics counter plans with narrow networks can make it far more difficult for people to get the care they need in-network.

For example, in Georgia and Kansas, Medicaid managed care plans must meet standards for time and distance to primary care providers, behavioral health providers and OB-GYNs. These standards, however, do not extend to qualified health plans on the states’ exchanges.

The researchers found that state regulations guaranteeing access to primary care and rural health clinics are limited. Federal regulations in this area offer states flexibility, but most states simply enforce baseline requirements, according to the study.

In addition, there are no federal requirements to ensure the care provided is culturally competent, so access there is also lacking, according to the study.

A lack of standards makes it far more difficult for regulators to track and understand how well an insurer is in compliance with requirements, the researchers said. New Mexico is an example of a state that has updated its regulations to more effectively align with MCO standards.

Regulators should roll out additional oversight for provider networks, according to the study, and should embrace greater transparency around network challenges.

 
 

Clipped from: https://www.fiercehealthcare.com/payers/network-adequacy-standards-vary-widely-between-medicaid-exchange-plans-study

Posted on by

Medicaid winds down coverage for PT & OT telehealth

[MM Curator Summary]: NC will stop covering physical and occupational therapy via telehealth starting July 1 in response to CMS policies on not making telehealth changes permanent.

 
 

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.

 
 

Are you a health care worker? We’d love to hear from you. Email editor at northcarolinahealthnews.org

By Clarissa Donnelly-DeRoven

Before the pandemic, Valerie Fox almost never used telehealth — nobody did at the Veterans Affairs Medical Center in Durham, where she works as a behavioral health occupational therapist.

Now, many patients request it. 

“Especially with the VA, a lot of people come from a lot of different parts of the state to here,” Fox said. “When we go to transition to outpatient work, it’s a lot easier.” With telehealth, people can more easily incorporate OT into their daily schedules — an hour here, an hour there. 

“It doesn’t become this big thing,” she said. 

 
 

But that’ll likely be changing soon. By July 1, North Carolina Medicaid will no longer cover occupational and physical therapy services done via telehealth — and getting to and from appointments will become, yet again, a big thing. The change was supposed to take place March 31, but the state extended coverage for 90 more days. 

Kimberly Godwin, the advocacy chair at the state’s occupational therapy association, has been getting a lot of emails over the last few months from therapists such as Fox telling her how telehealth has helped them serve more clients. 

“We’ve heard from a lot of businesses within the pediatric as well as other outpatient settings or specialized care, like mobility clinics, that have been able to just really broadly reach clients,” she said. “There’s been less cancellations, less no shows.” 

Many providers have noted how telehealth increased access for people who can’t afford transportation to and from a clinic, or those who don’t have any transportation to begin with. 

Even the state’s Medicaid program sounds supportive of keeping telehealth for physical and occupational therapy. 

“Over the past two years, telehealth flexibilities helped children and families access valuable PT/OT services during the unprecedented circumstances of the COVID-19 pandemic,” said state health department spokesperson Catie Armstrong. 

But she said that right now, the federal Centers for Medicare & Medicaid Services is not allowing any permanent changes to telehealth services. During the first few months of the public health emergency, the state recorded nearly 60,000 telehealth claims from people on Medicaid. In the months since, that number has declined.

That means, even if it wanted to, North Carolina doesn’t have the authority to permanently authorize the state Medicaid program to cover virtual OT and PT services. The coverage rollback has left many who work in the field worried about the impact it will have on people across the state, especially those in rural areas. 

Unique role telehealth plays in OT and PT

Since the start of the pandemic, researchers at Duke University have been investigating the role telehealth plays in expanding access to care in general. One study is examining the impact virtual care has had for people receiving OT and PT. 

Katherine Norman, a pediatric occupational therapist, is one of the investigators on the study.

“The population we looked at was children and adolescents, so that was anybody from zero to 20, enrolled in Medicaid from April 2020 to March 2021,” she said. The researchers analyzed the Medicaid claims data of about 137,000 children with a musculoskeletal health diagnosis who visited a provider during the time period. 

“The data that we uncovered really suggests that removing access via telehealth could impact as many as one in five kids who were using physical therapy and one in three kids who are using occupational therapy,” Norman said. To add a qualitative dimension to their study, the researchers are also speaking with people on Medicaid, health care providers, and community leaders statewide.

Physical and occupational therapy can be critical for helping kids meet developmental milestones. PT can help children learn how to do critical physical tasks with more ease: walk and run, get on and off the floor, and play, while OT helps kids with the development of fine motor skills, such as brushing their teeth or holding a comb. 

Imagining all those kids missing out on this kind of care deeply worries Norman. 

Also, she says, telehealth holds a unique value within occupational therapy because of the nature of the care. If she’s seeing a patient, rather than just telling her about the stairs they have trouble climbing, or the corner they want to be able to stand behind to surprise their sibling, they can literally bring her into the room.

“They can show me exactly how they do it,” she said, “so that I can see that and be like, ‘OK, so we need to work on your ability to crouch, or your ability to jump, or [whatever] specific movement pattern.'”

Fox agrees. 

In OT, “We think a lot about the environment, and how that impacts function and somebody’s ability to participate,” she said. “When it comes to having somebody leave their natural environment to come to an outpatient clinic, you have to ask a lot of questions: What does your home look like? And how do you move through your home? And what is the environment?

“Telehealth allows you to truly see that in the moment and kind of be there with someone and I think that’s another layer, in addition to accessibility.”

Also, Fox says, it doesn’t have to be all or nothing. In a perfect world, care going forward could be a blend of telehealth and in-person care. 

“I just had that with a veteran,” she said. “He’s 75. He lives about an hour and a half away. So the first visit was that we do a lot of assessments, and now that we kind of know each other and I have more of an idea of his level of function, the next few sessions could be telehealth.”

“What is the harm in keeping it as an option?” 

Fox, who in addition to her full-time job at the VA is also the president of the North Carolina Occupational Therapy Association, said she was unaware of any outreach the state health department had done to ask occupational and physical therapists how virtual coverage was going for them and if they’d want it to continue going forward. 

“This came to our attention when we were informed of the date of the sunset,” Fox said. Medicaid refers to the end of coverage for certain services as ‘sunsetting.’ 

“So, we did not realize that this was coming, and definitely not that it was coming as fast as it was,” she said. “We’ve been told that they did not have the data showing that the telehealth modality was utilized enough. We are unclear on what type of data that was, or how it was collected or what their cutoff is for ‘enough,’ but that was what we’ve been told so far.”

Spokespeople from DHHS did not directly answer the question of if they conducted outreach to providers, but said that they have qualitative data from families showing support for telehealth. Still, they said, the data the department has collected and analyzed “did not demonstrate the use of these services.”

In a public webinar presentation on March 17, the associate director of program evaluations at North Carolina Medicaid, Sam Thompson, presented the data collected by Norman and the other Duke researchers, but came to a different conclusion than the researchers.

“As a proportion of care, telehealth is just substantially lower in this group,” he said. “Because it’s such a small proportion of care, it’s a little bit less meaningful”

But, Fox argues, even if utilization rates were low, if anyone used it, it’s worth keeping. 

“It’s about access,” she said. “And so if five people throughout the year use it, what is the harm in keeping it as an option?” 

The state Medicaid office did worry at first that adding telehealth as an option would increase costs, but that’s not what they’ve seen. 

“We have not found it to be significantly more expensive,” Thompson said. “We have some evidence to suggest that it can help prevent complicating factors that might be more expensive.”

It’s unclear if private insurance plans will continue to cover tele-OT and PT or sunset their coverage as well. But historically, Godwin said, private insurance plans often follow what Medicaid does, meaning there’s a good chance that if telehealth for OT and PT is made permanent by the federally funded health care program, other insurance plans may follow. 

While the state Medicaid office is limited in its ability to make permanent changes to its telehealth coverage policy, providers spoken to for this story want to encourage officials to do everything they can to make sure the coverage remains permanent. 

If it goes away, they argue, fewer people will get the care they need. 

“And that makes me really sad,” Godwin said.

Republish our articles for free, online or in print, under a Creative Commons license.

X

Republish this article

This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

As of late 2019, we’re changing our policy about reprinting our content.

You are free to use NC Health News content under the following conditions:

 

  • You can copy and paste this html tracking code into articles of ours that you use, this little snippet of code allows us to track how many people read our story.
  • Please do not reprint our stories without our bylines, and please include a live link to NC Health News under the byline, like this:

    By Jane Doe

    North Carolina Health News


     
  • Finally, at the bottom of the story (whether web or print), please include the text:

    North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org. (on the web, this can be hyperlinked)

 Providers worry as Medicaid winds down coverage for OT and PT done via telehealth

by Clarissa Donnelly-DeRoven, North Carolina Health News
April 4, 2022

1

 
 

Clipped from: https://www.northcarolinahealthnews.org/2022/04/04/providers-worry-as-medicaid-winds-down-coverage-for-ot-and-pt-done-via-telehealth/

Posted on by

Rewrite of Florida’s Medicaid managed care system signed into law

[MM Curator Summary]: The managed care reform bill has been signed into law, keeping most components; the dental benefit will remain outside of MCO contracts.

 
 

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.

 
 

 
 

 
 

 
 

One of the most heavily lobbied health care bills of the 2022 Session was signed into law by Gov. Ron DeSantis late Wednesday night.

SB 1950 was one of 42 bills the Governor signed into law, but it wasn’t the only bill related to the Medicaid managed care program that became law. The Governor also approved HB 855, which addresses Medicaid managed care reporting requirements.

Under the new law, Florida will have nine Medicaid managed care regions across the state instead of the existing 11. But the Legislature did not include in the legislation any changes to how Medicaid delivers dental care to beneficiaries.

Indeed, there was an industry fight over the provision of dental care and whether dental services should continue to be delivered through a separately procured Medicaid dental managed care program. The Agency for Health Care Administration (AHCA) wanted the Legislature to change the law to eliminate the separate managed dental care program and to require dental services to be provided by contracted managed medical assistance and long-term care plans.

But, in the end, the Legislature agreed to continue the separate Medicaid managed dental program.

 
 

A large majority of the more than 5 million people enrolled in Medicaid — the state’s safety net health care program — receive their coverage through managed care companies. That’s because the Legislature passed a bill that then Gov. Rick Scott signed into law that requires most Medicaid beneficiaries, from the cradle to the grave, to join a managed care plan.

In 2013, AHCA launched the Medicaid managed long-term care program. The Medicaid managed medical assistance program, which provides services to women and children, followed in 2014.

The law has guided the state as it twice procured lengthy, multi-year contracts with managed care plans. Florida’s existing managed care contracts expire on Dec. 31, 2024, which means AHCA wants to start the process to solicit new contracts.

AHCA Secretary Simone Marstiller advocated for the changes, saying they would make the procurement run more smoothly and eliminate a requirement the state issue separate bids for each Medicaid region.

Meanwhile, under HB 855 signed into law Wednesday, contracted Medicaid managed care plans will be required — beginning in the 2025 calendar year — to start stratifying the data they are required to collect by age, sex, race and ethnicity, among other things.

 
 

The plans must report the stratified data in the 2026 calendar year. The bill also changes statutes to require HMOs to collect and report the Healthcare Effectiveness Health Plan Employer Data and Information Set (HEDIS) measures. Current law requires MMA plans to collect and report only the HEDIS measures identified by AHCA.

HB 855 also adds a statutory requirement for plans to report Centers for Medicare and Medicaid Services Adult and Child Core Set behavioral health measures, which are not currently required by AHCA, beginning in the calendar year 2025.

Post Views: 0

 
 

Clipped from: https://floridapolitics.com/archives/514863-rewrite-of-floridas-medicaid-managed-care-system-signed-into-law/

Posted on by

Colebrook woman charged with filing $148K in fraudulent Medicaid claim

[MM Curator Summary]: Jennifer McGevna was arrested for submitting false claims for mental health services in CT.

 
 

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.

 
 

A Colebrook woman has been charged with fraudulently billing the government’s Medicaid health insurance program, according to state authorities.

Jennifer Lefebre-McGevna, 45, of Flagg Hill Road, Colebrook, was arrested Thursday by inspectors from the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney, and charged with one count each of first-degree larceny by defrauding a public community and health insurance fraud, state authorities. said in a statement.

Between 2017 and 2020, Lefebre-McGevna, a behavioral health clinician, allegedly billed the Connecticut Medicaid Program for “psychotherapy services that were not provided and billed for services rendered by unlicensed individuals,” the statement said, citing an arrest warrant affidavit. “By submitting these bills, Lefebre-McGevna stole $148,102.80 from the Medicaid program.”

Further, the submission of claims to the Department of Social Services “provided by Lefebre-McGevna contained false, incomplete, deceptive or misleading information which constitutes the crime of Health Insurance Fraud,” the statement said.

Lefebre-McGevna was free on a $150,000 non-surety bond, and is scheduled to appear in Harford Superior Court on April 13.

The case will be prosecuted by the Medicaid Fraud Control Unit, the statement said.

The unit noted it “is grateful for the assistance it received in the investigation from the State Department of Social Services Office of Quality Assurance, and the Rocky Hill Police Department.”

Anyone with knowledge of suspected fraud or abuse in the public health care system is asked to contact the Medicaid Fraud Control Unit at the Chief State’s Attorney’s Office at 860-258-5986.

 
 

 
 

Clipped from: https://www.courant.com/breaking-news/hc-br-colebrook-woman-arrested-fraud-20220405-73f7xuytsvfgbhncpcobulpzne-story.html

Posted on by

Woman charged with Medicaid fraud

[MM Curator Summary]: Pamela Bell falsified claims to make it look like her mental health company was using licensed therapists.

 
 

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.

 
 

 
 

 
 

LITTLE ROCK, Ark. (KAIT) – A White County woman faces two counts of Medicaid fraud after authorities said she turned in over 300 fraudulent claims to the system over a three-year period.

Pamela Townsend-Bell of Judsonia was arrested earlier this month after an investigation by the Arkansas Attorney General’s office.

A statement posted Tuesday said the allegations centered around Townsend-Bell fraudulently billing Medicaid while owning the mental health agency, “I’m a 10 Wellness Center, LLC”, in Searcy.

“Townsend-Bell billed Medicaid for one-on-one individual counseling services provided by unlicensed staff, listing herself as the performing provider,” Attorney General Leslie Rutledge said. “The unlicensed staff included non-paid interns and office staff. Medicaid requires these types of outpatient mental health services to be provided by licensed therapists.”

The fraudulent claims made by Townsend-Bell were about $18,600, according to Rutledge.

She added Townsend-Bell purposely made false statements for payments that violated state Medicaid rules, plus made false entries in medical records “indicating she provided services to Medicaid recipients.”

Townsend-Bell appeared in Pulaski County District Court on March 18 and was released, pending further proceedings on the issue, Rutledge said.

 
 

Clipped from: https://www.kait8.com/2022/03/31/woman-charged-with-medicaid-fraud/

Posted on by

Las Vegas woman sentenced in Medicaid fraud case

[MM Curator Summary]: Jessica Brown and Shonna Marshall have been convicted of using a ghost company to steal NV Medicaid dollars.

 
 

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.

 
 

 
 

LAS VEGAS (KLAS) — A Las Vegas woman has been sentenced to prison for submitting false claims in a Medicaid fraud case.

On Tuesday, a judge sentenced Jessica Celeste Brown, 33, of Las Vegas to 18 – 48 months in prison.

The fraud case also names Brown as failing to maintain adequate records to substantiate claims submitted to Nevada Medicaid. The incidents occurred between October 2017 to February 2018.

The investigation revealed that Brown and her co-defendant, Shonna Nicole Marshall created a ghost company for the sole purpose of fleecing as much money as possible as quickly as possible.

In February, Marshall was sentenced in another case for committing 27 felony counts of Medicaid fraud and money laundering using a similar scheme where she formed a ghost company solely to fraudulently bill Medicaid.

Marshall is currently imprisoned for her repeated efforts to defraud Nevada Medicaid.  

Along with the prison sentence, Brown is also being placed on probation and is ordered to pay more than $150,000 in restitution, penalties, and costs. She is also prohibited from employment with any Medicaid-contracted companies.

 
 

Clipped from: https://www.8newsnow.com/news/local-news/las-vegas-woman-sentenced-in-medicaid-fraud-case-2/

Posted on by

Controversial freeze on Medicaid contracts approved by legislature

[MM Curator Summary]: Kansas has officially moved the MCO renewal effort past the next election cycle.

 
 

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 Kansas Senate approved language early Saturday morning to delay re-negotiation of $4 billion worth of contracts with private firms that serve as managed care organizations after a heated debate.

The move came hours after a member of the negotiation team hashing out an agreement on the bill claimed the provision was part of a “pay-to-play” corruption scandal involving members of the legislature and lobbyists, an accusation flatly denied by Republicans.

In a surreal speech, Rep. John Carmichael, D-Wichita, said he “has reason to believe that the federal authorities are already aware of the proposed legislation introduced today” based on “strong circumstantial evidence.”

He invoked a 2014 scandal where associates of then Gov. Sam Brownback were probed by the FBI in connection with the privatization of the state’s Medicaid program.

“If somebody can come to me and give me a legitimate and good reason that we ought to extend these contracts in a no-bid fashion, that there’s a logical and a good policy reason, I’ll feel a lot better about what we’re doing,” Carmichael said. “But in the absence of such an explanation, I have to conclude that we’re back to pay-for-play politics here.” 

More:Kansas refuses to enforce federal COVID vaccine mandate. CMS will take over, cut $350K

The comments quickly drew a rebuke from other legislators.

“In this particular setting and with these folks, I believe it was completely inappropriate to cast aspersions within this room,” said Rep. Bradley Ralph, R-Dodge City. “I took offense to it.”

House Speaker Ron Ryckman, R-Olathe, told reporters the accusations were baseless.

“Absolutely not,” Ryckman said when asked if Carmichael’s comments had merit. “I haven’t heard anything on the MCOs. Our reasons for that have been very clear.”

Carmichael doubled down on his comments when asked by reporters.

“There is no justification as a matter of policy as to why this is necessary,” he said.

More:Lawmakers eye raft of proposed constitutional amendments. Here’s what it means for voters.

Contracts to be renegotiated after 2022 election

The fiery back-and-forth underscored the controversy of the language, which was initially considered as a standalone bill before being added and then removed from the state budget. It eventually found a home in an unrelated bill as legislators negotiated a package of potential legislation.

The Kelly administration was set to launch a request-for-proposal for the three MCO contracts in the fall ahead of a 2023 deadline to select the new vendors. After Brownback ushered in privatization in 2013, a new round of contractors were selected under his successor, Gov. Jeff Colyer, in 2018.

Kansas currently has three MCOs: Aetna, Sunflower Health Plan and United Healthcare.

Now, the contracts won’t be renegotiated until after the November general election, when Kelly is set to stand for a second term, likely against GOP Attorney General Derek Schmidt.

Kelly has panned the idea as “absurd.”

“It’s political, you know,” she told reporters last week. “They want to tie my hands around Medicaid entirely.”

More:Kansas attorney general, advocates at odds over move to ban sanctuary cities

Schmidt became involved in the dispute in his role as attorney general after Democratic legislators asked for advice on whether lawmakers could interfere so directly with the procurement process.

In an opinion released Friday, Schmidt said the proposal was allowable but said he was unable to say whether the state could be sued over the move or even whether it would be approved by federal regulators.

“The Legislature may lawfully alter the procurement process for a state agency through new legislation,” Schmidt said. “This includes modifying, delaying or eliminating the competitive bid process and directing the (state agency) secretary in its management of the KanCare system.”

In a response, Kelly’s chief-of-staff Will Lawrence called Schmidt’s opinion “cavalier-at-best.”

But Ryckman said the move came about because legislators “are not pleased” with how Kelly’s administration has handled procurement for other major projects, notably a deal to modernize the state’s outdated unemployment backend system.

“The governor is trying to carve out a very important piece of the work the state does for its citizens for particular companies,” Ryckman said. “I want to make sure (companies), for-profit and not-for-profit, both have the opportunity to serve our citizens.”

Andrew Bahl is a senior statehouse reporter for the Topeka Capital-Journal. He can be reached at abahl@gannett.com or by phone at 443-979-6100.

 
 

Clipped from: https://www.cjonline.com/story/news/state/2022/04/02/controversial-freeze-medicaid-contracts-approved-legislature/7240487001/

Posted on by

New Medicaid benefit aims to provide Washington’s homeless with housing

[MM Curator Summary]: Washington state Medicaid will start providing medically necessary housing to Medicaid members Jan 1 of 2023.

 
 

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.

 
 

 
 

Shane Ersland | Apr 6, 2022 | Washington

The recently-signed Apple Health and Homes Act aims to provide individuals experiencing homelessness with housing under a new Medicaid benefit.

 
 

 
 

Get the latest state-specific policy intelligence for the health care sector delivered to your inbox.

Subscribe

 
 

Washington Gov. Jay Inslee signed the act into law on March 30. The initiative will provide housing throughout the state by utilizing the newly-created Office of Health and Homes to acquire housing to meet the homeless demand. The office will work with several stakeholders on the initiative–including the state’s Health Care Authority (HCA) and the Department of Commerce–to coordinate a plan for acquiring housing.

“The Office of Health and Homes will be part of the Department of Commerce, and is newly-established to work on this initiative,” HCA Acting Medicaid Director Charissa Fotinos said. “At this point, we do not know how the office will go about building and acquiring new housing. A coordinating entity contracted to HCA will be contracting with a provider network, which would be working with eligible individuals to then connect them to appropriate housing.”

The act was sponsored by Rep. Frank Chopp during the 2022 legislative session, and received strong bipartisan support. It was endorsed by 80 organizations throughout the state. Five significant goals of the act include:

  • Treating chronic homelessness as a medical condition
  • Investing in preventative services and reducing costs to local emergency systems
  • Creating more supportive housing statewide
  • Expanding the capacity of supportive housing providers
  • Ensuring oversight and accountability through the Office of Health and Homes

The new housing program is a Foundational Community Supports (FCS) Medicaid benefit. Each resident who qualifies for the program will have a medical necessity for housing.

“The initiative was led by Rep. Chopp as a means to provide housing for the chronically homeless,” Fotinos said. “The group of bill writers consisted of community providers, stakeholders, advocates, and other county and state staff. HCA and FCS staff were consulted to provide technical assistance and information related to the FCS program, and how to best align this legislation with ongoing efforts focused on behavioral health and housing.”

Housing should be available for those in need sometime after the start of next year.

“The implementation of the new housing benefit will start Jan. 1, 2023,” Fotinos said. “The housing will be subject to availability. HCA, the Department of Commerce, and the Department of Social and Health Services will be working toward program readiness leading up to January. More [housing] information will be available as we get a better understanding of what the capacity looks like.”

 
 

Clipped from: https://stateofreform.com/featured/2022/04/medicaid-benefit-to-provide-housing-for-homeless/

Posted on by

Watchdog finds Medicaid-Legislature disconnect

[MM Curator Summary]: An ID auditor calls attention to the strained relationship between the Medicaid agency and legislature.

 
 

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.

 
 

Distrust. Fear. Unrealistic expectations. Bureaucratic delays.

Those are both the causes and symptoms of a strained relationship between the Idaho Legislature and the state’s Medicaid division — a problem that has thwarted efforts for more than a decade to change how Idaho Medicaid pays for health care.

Because of this vicious cycle, lawmakers who have financial control over Idaho Medicaid don’t “fully understand the impact of their decisions,” according to a report released this month.

The report was written by the Office of Performance Evaluations — Idaho’s independent watchdog agency that conducts evaluations at the request of the Joint Legislative Oversight Committee.

The Legislature does not trust division administration, and division administration is afraid to ask for what it needs.

– Idaho Office of Performance Evaluations 2022 report on Idaho Medicaid rate setting

Medicaid is one of Idaho’s largest health insurers. It provides health care coverage to more than 1 in 5 Idahoans. Its $4 billion budget — coming mostly from the federal government, not directly from Idaho taxpayers — pays for everything from childbirth to nursing home care.

Medicaid’s budget has more than doubled in the past decade as more Idahoans gained health insurance, a pandemic put thousands of Idahoans in the hospital, and Idaho’s cost of living surged. But the state’s Medicaid rates have remained, for the most part, stagnant.

Medicaid’s payments for adult day care and home delivered meals have not changed since 2006, the report said.

At the same time, Medicaid’s large budget makes it an easy target for spending cuts — and political fights.

“It is clear to us that Medicaid does not have the management capacity it needs to do everything that is asked of it, to manage a $4 billion program that serves 400,000 of the most vulnerable Idahoans,” OPE Principal Evaluator Ryan Langrill told the oversight committee in a hearing this month, while presenting the OPE’s findings. “The consequences of this lack of capacity are that the Legislature does not trust Medicaid administration, the Medicaid program does not serve as a good steward of the services that rely on Medicaid, and the division cannot effectively control costs.”

Idaho Health and Welfare Director Dave Jeppesen told the oversight committee he agreed with the OPE’s findings. He said that, in his own review of Medicaid rates, he found one that was unchanged since 1999.

Previous O.P.E. evaluations found similar problems

Langrill said that problem isn’t new. It’s the same problem OPE identified in three other evaluations over the past decade.

“While the division is competent to establish a rate review process, the process will likely not succeed because management has too many competing priorities,” wrote OPE Director Rakesh Mohan in a letter to the committee. “Division management has moved from crisis to crisis while neglecting critical but less urgent work.”

In essence, Idaho Medicaid’s leadership is so occupied with putting out fires, it hasn’t built a fireproof structure. The Idaho Legislature demands the state’s Medicaid agency build that fireproof structure, but doesn’t give its administrators the right blueprints or construction budget, the report suggested.

“The Legislature should not expect dynamic management from a division with fewer staff than it had in 2009,” the report said.

But the division hasn’t necessarily used its resources in the best way, either, the OPE found.

The evaluation found “that lawsuits, crises and external pressure drive the division’s strategic priorities, rather than a strong internal vision,” Langrill told the committee. “The division prioritizes new projects over the successful implementation of existing projects, in order to be responsive. There’s a sense that they cannot say no to something new, even when taking on that project would compromise existing work.”

The Idaho Legislature last week approved a new budget for Idaho Medicaid that includes provider rate increases in several categories, and funding for employee pay raises. It also incorporates one of the OPE’s key recommendations: a $113,000 line item for Medicaid provider rate review.

Recommendations from the report

The OPE report said a few things might help the Medicaid rate review process.

The Idaho Medicaid division should identify its key management needs and submit a budget request for those needs.

The Legislature should consider what it wants to control and what it wants to delegate to the division, and invest accordingly.

The Legislature could consider options such as additional reporting or the establishment of an oversight committee.

To improve collaboration, the division and the Legislature need to understand each other’s needs and commit to long-term investment. “In other states, the Medical Care Advisory Committee is a useful forum for oversight and communication,” the report said. But Idaho’s committee “has been chronically understaffed and has not produced its required annual report.”

Medicaid rates can ratchet up or down based on rate revisions passed by Medicare, a federally run program.

But some of the services covered by Idaho Medicaid don’t have a Medicare equivalent. State laws make it hard for Idaho to independently change what it pays for things like children’s developmental disability services — an example OPE gave, wherein it took three years for Medicaid rate revisions to go through the review process, be approved by the Idaho Legislature and take effect.

“State law requires the Legislature to approve changes to the fee schedule by approving a line item in the budget request for the Department of Health and Welfare,” the OPE report said. “The result is a minimum delay of 13 months between the (Medicaid) division calculating the impact of rate adjustments, developing the budget request for a new rate, and that rate going into effect.”

Changes to Medicaid payments, funding don’t come easy

This disconnect was evident in a committee hearing this session, on a bill that was pitched as a way to address a colossal spike in costs for health care staffing.

Steve LaForte, the attorney for Cascadia Healthcare, which owns more than 20 long-term care facilities in Idaho, told legislators that before the pandemic, Cascadia spent $5,000 per month on temporary nursing staff to fill labor gaps. But in December 2021 alone, it spent $1 million on temporary staffing, he said.

Steve LaForte, attorney for Cascadia Healthcare, speaks in the Idaho Legislature on the fast-rising costs for nursing homes and care facilities that rely on Medicaid for much of their revenues

Steve LaForte, attorney for Cascadia Healthcare, speaks in the Idaho Legislature on the astronomical pandemic-era staffing costs for nursing homes and care facilities, which rely on Medicaid for much of their revenues. (Screenshot via Idaho Public Television)

Many of the facilities’ residents have Medicaid and Medicare health insurance, he said. But those government insurance plans’ reimbursements are static, unable to keep up with staffing costs.

Sen. Mary Souza, R-Coeur d’Alene, asked why Medicare and Medicaid hasn’t begun to pay more for those services.

Souza’s remark went to the heart of OPE’s report: Medicaid isn’t nimble. It cannot overhaul reimbursement rates because the Legislature hasn’t given it enough support, and Medicaid officials haven’t really asked the Legislature for the support they need to make that happen.

Jeppesen responded to the report after seeing it in February. In a letter to OPE, Jeppesen said Health and Welfare agrees that Idaho Medicaid “lacks the appropriate management capacity” to create a robust rate review process.

“While we have worked to the best of our capacity to respond to provider rate reimbursement needs over the years, we acknowledge that there are opportunities for the division to improve our review processes and better communicate provider needs to the legislature,” Jeppesen wrote. “The Medicaid Division is at a critical juncture where we are finding it incredibly difficult to successfully bring up new projects and update processes with the resources available to us at this time.”

Jeppesen said the division “is strained to successfully manage the day-to-day operations of the (Medicaid) program, innovate towards more efficient operations, and clearly communicate the needs of Medicaid providers.”

 
 

Clipped from: https://cdapress.com/news/2022/mar/31/watchdog-finds-medicaid-legislature-disconnect/