House Passes Bills to Address Opioid Epidemic
The House of Representatives during the week of May 10 passed several bills addressing the opioid epidemic that had previously cleared the House Energy & Commerce Committee. The bills were then combined into a single package to be attached to a bill already passed by the Senate. AMCHP continues to monitor these bills as they move and will share any analysis of opportunities for engagement by state Title V programs.
Senators Seek Stronger Pediatric Services in Essential Health Benefits Package
On May 5, U.S. Senators Schatz, Cardin, Casey, Brown, Gillibrand, Murphy, Warren, Blumenthal, Markey, Nelson and Boxer circulated a "dear colleague" letter to Department of Health and Human Services (HHS) Secretary Sylvia Burwell about strengthening the pediatric services category of the Essential Health Benefits (EHB). Under the current law, states are allowed to benchmark their pediatric benefits based on the benefits of a typical private plan. The letter argues that structuring the benefits in this way does not target the specific needs of children and youth and does not ensure that they receive adequate benefits. The letter argues that HHS should create a national standard definition of the pediatric services benefit in an effort to better support children's health and development. The American Academy of Pediatrics has developed a robust set of recommendations to create this national standard.
Health Reform Implementation
Arizona Adds Health Insurance Program for Children
Arizona Gov. Doug Ducey on May 6 signed into law a bill that aims to help working families who earn too much to qualify for Medicaid but who cannot afford private health insurance. Arizona had opted out of the federal Children's Health Insurance Program in 2010 due to budget concerns. To qualify for the new KidsCare program, a family of four must earn between $33,000 and $49,000 annually. It is estimated that this program will serve about 30,000 children.
New Report Finds 47 States and D.C. Reimburse for Telehealth
47 states and the District of Columbia currently provide fee-for-service reimbursement for medical services delivered via some form of live video, according to the fourth edition of the State Telehealth Laws and Reimbursement Policies, recently released by the Public Health Institute. The report, designed for policymakers, health advocates and health care professionals, is the most current summary of telehealth-related policies, laws, and regulations.
Continuity of Care Provision Included in 2017 Benefit and Payment Parameters
The recently finalized 2017 Benefit and Payment Parameters, which apply to health plans sold in Federally Facilitated Marketplaces (FFMs), includes a continuity of care provision allowing consumers undergoing an active course of treatment to continue seeing their provider after the provider is terminated from a health plan network without cause. On-going care with the provider must continue at in-network cost-sharing rates until the course of treatment is complete, or for 90 days, whichever is shorter. For example, the final rule extends the right to continuity of care for pregnant women through the postpartum period, a change that is consistent with the National Association of Insurance Commissioners (AIC) model law, as well as with 29 state laws. More information is available here.
CMS Clarifies Requirements for Managed Care Reimbursement to FQHCs and RHCs
The Centers for Medicare and Medicaid Services (CMS) recently released guidance clarifying the requirements for states to implement alternative payment methodologies (APMs) under which Medicaid and CHIP-managed care entities directly reimburse federally-qualified health centers (FQHCs) and rural health clinics (RHCs) the full amounts payable to them under the prospective payment system. The guidance notes that states are also required, in all managed care contracts starting on or after July 1, 2017, to include access to at least one FQHC, one RHC and one freestanding birth center, when available.
CMS Encourages States to Facilitate Access to Medicaid for Justice-Involved Populations
CMS recently released guidance to ensure that states facilitate Medicaid access for justice-involved populations prior to and after a stay in correctional institutions. For the purposes of claiming Federal Financial Participation (FFP), the guidance clarifies the regulatory definition of an "inmate of a public institution" as an individual who is in custody and held involuntarily in a public institution operated by law enforcement authorities. CMS further clarifies that a state may claim FFP for justice-involved populations on parole or probation; residing in a halfway house, under certain conditions; or on home confinement. Reinforcing long-standing CMS policy, the guidance encourages states to suspend, rather than terminate, Medicaid enrollees entering incarceration in order to ensure better continuity of coverage after their release.
HHS Announces Challenge to Create "A Bill You Can Understand"
Department of Health and Human Services (HHS) Secretary Sylvia Burwell recently announced a new challenge for health care organizations, designers, developers, digital tech companies and other innovators: Design a medical bill that's simpler, cleaner and easier for patients to understand, and improve patients' experience of the overall medical billing process. The Bill You Can Understand design and innovation challenge is intended to solicit new approaches and draw national attention to a common complaint with the health care system: that medical billing is a source of confusion for patients and families. The challenge will issue two awards: one for the innovator who designs the bill that is easiest to understand and another for the innovator who designs the best transformational approach to improve the medical billing system, focusing on what the patient sees and does throughout the process. Get information here.