Click here to read the 1/5/2017 CMS guidance on State Medicaid agency managed care plan arrangements’ responsibility to ensure that Medicaid enrollees under 21 years old have access to the full scope of federally mandated EPSDT services. The memo notes that states may opt to “carve out” certain EPSDT services and reimburse them, separately from managed care arrangements, on a fee-for-service basis – which some states do with IEP-required services provided by schools.
This fact sheet from the Kaiser Family Foundation examines key questions around the potential changes President-elect Donald Trump and the next Congress may seek to make in Medicaid. It considers multiple forms a repeal of the ACA could assume and potential structural changes to Medicaid, including through a block grant or a per capita cap. It also reflects on the impact such a repeal could have on coverage, financing, delivery system and payment reform, and access to care, particularly for complex and vulnerable populations. The fact sheet also discusses how executive powers can be used to make changes to Medicaid without congressional action, including new regulations and Medicaid waivers.
Please find link to fact sheet here.
Click this link to read an article by The Center on Budget and Policy Priorities about the anticipated impact of Per Capita or Block Grant funding on State Medicaid Programs: http://www.cbpp.org/research/health/per-capita-caps-or-block-grants-would-lead-to-large-and-growing-cuts-in-state
The National Health Law Program reviewed each State Medicaid Plan and created an issue brief on “Free-Care.” To view the brief and related information online, click here
Click <here> for a look at the latest OIG (Office of Inspector General, U.S. Department of Health and Human Services) audit findings on “State Use of Express Lane Eligibility for Medicaid and CHIP Enrollment.”
For children to have the best chance of becoming productive and healthy adults, child-serving systems need to coordinate their care and services. Two sectors in particular, education and health, play critical roles in promoting better outcomes for child wellbeing and long-term success. Excluding the home, schools and child health systems have the most direct influence on a child’s development. Yet, these two sectors often operate in silos, failing to leverage the resources accessible to each other, and so limiting their impact.
For the complete story, go to: https://www.brookings.edu/wp-content/uploads/2016/07/Price-Layout2.pdf
The Centers for Medicare and Medicaid Services (CMS) proposed a rule change to the Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) programs that have to do with changes as a result of the Affordable Care Act to the way states decide eligibility for Medicaid and Children's Health Insurance Program (CHIP). More information about the proposed change as well as the proposed rule can be found here.
The Chicago Department of Public Health collaborated with the Partnership for Healthy Chicago develop of Health Plan for the city of Chicago. This was the work of many stakeholders from both public and private stakeholders. The strategies are outlined in the Healthy Chicago 2.0 Plan. The detailed plan outlines all areas for a healthy community including health and education which can be found starting on page 24.
The National Association of State Boards of Education (NASBE) hosted a webinar on December 15, 2015 regarding Promoting Access to School Health Services for Improved Student Health and Achievement.
The presenters included Paula Hall from the National Association for School Nurses (NASN) and John Hill from the National Alliance Medicaid in Education (NAME).
To watch the webinar <Click Here>.
The Centers for Medicaid and CHIP Services (CMCS) finalized “CMS-2390-P” on Monday April 25, 2016, which is a set of rules that will be published in the Federal Register soon.
The rule applies to health insurers operating Medicaid managed care plans for the states and it is the first major update to Medicaid and CHIP managed care regulations in more than a decade. It aligns key rules with those of other health insurance coverage programs; modernizes how states purchase Medicaid managed care services; and strengthens the consumer experience and key consumer protections.
As Families USA says in their news email, “The new rule is a big deal in part because it affects so many people: There are more than 72 million people enrolled in Medicaid. Three quarters of them are in managed care plans across 39 states. States can—and many already have—gone above and beyond these new standards in many areas. For other states, it will require substantial work to come into compliance. For many provisions (of the rule), CMS has given states (and managed care plans) a long implementation timeline.”
The final rule, when published, will be posted in the Federal Register: https://www.federalregister.gov/ It is currently available in PDF only, here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-09581.pdf
For more information on CMS-2390-P, a summary of its key provisions, guidance documents, technical assistance documents, and information about state managed care programs, visit the federal Medicaid Agency’s Managed Care website: https://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/managed-care/managed-care-site.html
Statements from the Centers for Medicare and Medicaid Services (CMS) and national organizations on CMS-2390-P
From the CMS Blog of April 25, 2016:
From the National Association of Medicaid Directors (NAMD):
Press Release April 26, 2016
NAMD Statement on Medicaid Managed Care Final Rule
From Families USA:
Families USA’s take on New Medicaid Managed Care Rules