AUGUST 21, 2012

Welcome to the Medicaid Update eNewsletter
Editor: Philip L. Ronning -- philronning@ronninghcs.com
This issue sponsored by the
Conference on Reaching, Retaining, and
Servicing Dual Eligible Beneficiaries

CCTP Partners: Round 3 Site Summaries
CMS announced an additional 17 sites have been selected to participate in the Community-based Care Transitions Program (CCTP). CCTP is a five year program created by the Affordable Care Act. Added to the first 30 participants, the CCTP now includes 200 acute care hospitals in 21 states who partner with community-based organizations (CBOs) in providing care transitions services for an estimated 185,800 Medicare beneficiaries. CMS continues to accept applications and approve participants on a rolling basis as long as funds remain available. (CMS, August 17, 2012)

Advancing Accountable Care Organizations in Medicaid
The socio-economic status of many Medicaid recipients (e.g., lack of primary care, unmet mental health needs, unstable housing, etc.) results in poor patient care, poor outcomes and wasteful spending. Many states are developing accountable care organizations (ACOs) for their Medicaid populations that alter the financial incentives to encourage coordinated care. The Center for Health Care Strategies (CHCS) with support from the Commonwealth Fund and the Massachusetts Medicaid Policy Institute is launching Advancing Medicaid ACOs: A Learning Collaborative to facilitate the implementation of Medicaid ACOs. The initiative will help these states develop and launch ACO models: Maine, Massachusetts, Minnesota, New Jersey, Oregon, Texas, and Vermont. Efforts will focus on 1) designing the essential building blocks for an ACO program; 2) building robust financing, data-sharing, and measurement approaches; 3) obtaining federal approval; and 4) implementing the ACO program. (Commonwealth Fund, August 15, 2012)

Coming Wave of Medicaid Patients Will Test Quality at Safety-net Hospitals
The addition of 30 million new insured patients entering the delivery system during the next decade as the result of the Affordable Care Act (ACA) will produce a variety of problems including a shortage of 160,000 physicians by 2025 projected by The Association of American Medical Colleges and more than 11 million new Medicaid patients according to the Congressional Budget Office. The broader question is where these new patients will seek care and the ongoing viability of these providers. An Archives of Internal Medicine study found that the 25% of hospitals with the highest proportion of Medicaid patients score nearly 6 percentage points worse in patient satisfaction measures when compared with non-safety-net hospitals. "Only 11% of the safety-net hospitals met a key benchmark for avoiding Medicare [Value-Based Purchasing] pay cuts, and they were 60% less likely to meet it than the hospitals that treated the fewest low-income patients," the study said. Similar financial results are expected from the Hospital Readmissions Reduction Program. These payment reductions combined with 50% cuts in Disproportionate Share Hospital funding put safety net hospitals in harms way as they can expect severe financial strain in the next decade. (amednews.com, August 6, 2012)

Technology to Help CMS Revamp Medicaid
States are taking their time in deciding on Medicaid expansion following the SCOTUS ruling. "There is no particular time deadline for a state to declare its intentions, unlike the need for a state to determine by later this fall whether or not they will build a state-based health insurance exchange or do a partnership model or a federally facilitated exchange," said Cindy Mann, Director of the Center for Medicaid and Children's Health Insurance Program (CHIP) Services. "The importance of states' decisions going forward about whether to take up the Affordable Care Act Medicaid expansion can't be overstated," she said. To ease the transition, for example, CMS is developing templates, available soon, to streamline the process of seeking waiver authority for changes or flexibility in the Medicaid program. CMS is also moving online its business processes with states, including waivers and state plans, "which will not only make it simpler but also will create a database so other states and interested parties can see what's going on in the world of eligibility, waivers, delivery system reforms, and move forward from that in their own ways," Mann said. (HealthCare IT News, August 1, 2012)

Almost 1 in 3 Physicians Turn Away New Medicaid Patients
A government survey published in the August issue of Health Affairs shows that nearly a third of office-based physicians declined to accept new Medicaid patients last year. New patients covered by Medicare and private insurance faced rejection rates of 17% and 18%, respectively. Medicaid acceptance rates varied widely when compared state-by-state ranging from 40.4% in New Jersey to 99.3% in Wyoming. These variations followed variations in professional fees paid by Medicaid -- states with higher Medicaid fee-for-service rates as a percentage of Medicare rates had higher acceptance rates: Wyoming's Medicaid fees are close to 150% of Medicare's rates while New Jersey's are dead last at 37%. (Medscape, August 7, 2012)

Medicare/Medicaid Dual Eligibles May Be In for Health Plan Change
Tests in 26 states have begun to move as many as 3 million dual eligibles into managed health plans to save the government money and to improve healthcare. These changes are likely to involve "passive enrollment," meaning beneficiaries would have to take the initiative to opt out. This concerns the Senior Citizens League (TSCL) who cautions seniors to be vigilant in the coming months. "Without a strong notification and education process, many of the affected dual eligibles may not be aware, or understand, that they have new health coverage," says Larry Hyland, TSCL's Chairman. "A new health plan can mean a change of doctor if their former providers don't participate," he adds. (Insurancenewsnet.com, August 11, 2012)

Florida: A Bellwether for Medicaid Expansion
This story from The Atlantic provides a picture of Florida's overt opposition to the Affordable Care Act (Governor Scott, refused millions of dollars in federal ACA planning aid and has not allowed any preparations to take place for the ACA) and its refusal to expand Medicaid. The picture of a "rickety" system is painted through patients' experiences, including one of the author's. Florida's Medicaid system is fourth from the bottom in terms of amount spent per enrollee. (The Atlantic, August 6, 2012)

Medicaid Health-care Providers Still Paid by U.S. Despite Tax Debts
A legal technicality is making it difficult for the IRS to collect back taxes from payments made to thousands of Medicaid providers who owe hundreds of millions of dollars in federal taxes. As a result, the federal government continues to pay them in spite of their debt. The Government Accountability Office said in a recent report that Medicaid payments are not technically considered federal funds because they are channeled through state healthcare programs. (Washington Post, August 2, 2012)

Medicaid Directors Seek More Efficient Managed Long-Term Care Waiver Reviews
CMS should set deadlines for reviewing state waiver applications for managed long-term care programs and the agency should speed reviews, in some cases skipping the approval process, said the National Association of Medicaid Directors (NAMD) in a recent letter. The letter also suggests that CMS' current State Plan Amendment (SPA) and waiver application and amendment processes lack mechanisms to ensure accountability between the partners. NAMD also asks that states be able to tailor readiness reviews and to design their own categories for review. (Health Policy News, August 17, 2012)

Child Friendly Medicaid

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New Tools for Medicaid Program Integrity

Angela Brice-Smith, MPA
Medicaid Integrity Group, Baltimore, MD