Weekly Health Care Wrap-Up
Stakeholders Await Details on Medicaid Primary Care Rate Increase
The Affordable Care Act (ACA) includes a federally-funded increase in Medicaid payment rates for primary care services for two years. The change, which will bring Medicaid primary care rates to Medicare rates, is slated to take effect on January 1, 2013. Yet, states, vendors, physicians, managed care organizations and other stakeholders await further guidance from the Centers for Medicare and Medicaid Services (CMS) on the final specifics of the change. In particular, there remains some uncertainty about the final list of providers eligible for the rate increase and how the increase will be administered through Medicaid managed care plans, among other issues. A proposed rule on the shift was published in the Federal Register on May 11. More information is available here.
Tim Hill Leaving CCIIO, Staying at CMS
Tim Hill, deputy director overseeing health insurance exchanges for the Center for Consumer Information and Insurance Oversight (CCIIO), will be leaving his position to work on other issues within CMS. In a statement, CMS commented, “CMS acting Administrator Marilyn Tavenner has asked Tim Hill to assist CMS with strategic planning as we continue to implement the work of the health care law into the Medicare, Medicaid and CHIP programs as well as private insurance market reforms.” Hill’s announcement comes on the heels of recent departures by former CCIIO exchange lead Joel Ario and CCIIO head Steve Larsen.
House Republicans Issue Subpoena, Seek Details on ACA PR Efforts
House Oversight and Government Reform (OGR) Committee Chairman Darrell Issa (R-CA) sent a subpoena to the Department of Health and Human Services (HHS) this week after failing to receive requested details surrounding the Medicare Advantage Quality Bonus Payment Demonstration. OGR Republicans are citing a recent Government Accountability Office (GAO) report that outlines the demo’s “shortcomings” as evidence that the program merits investigation. Secretary Sebelius has until 5pm today (Friday) to comply with the document requests. Read more here.
Meanwhile, House Ways and Means Committee Chairman Dave Camp and Oversight Subcommittee Chairman Charles Boustany wrote a letter to HHS Secretary Kathleen Sebelius asking for the details of the public relations campaign being used “to drive Internet traffic to pro-Obamacare websites and produce television commercials promoting the Administration’s positions.” The subcommittee requested the documents in May 2012, but received no response. The letter “demands” the documents by October 31, 2012.
From the States
A complete roundup of this week’s action in the states is available through ourState of the States: Health Insurance Exchanges publication here.
Tennessee. In a presentation at the National Academy of State Health Policy conference last week, Brian Haile, director of Tennessee’s exchange initiative, profiled the state’s work to design a “one family, one card,” policy to combat churn and family division among Medicaid and exchange products. Under the proposal, Medicaid managed care companies would also offer a product on the exchange with the same network of providers that would be available to families with at least one family member in Medicaid. Several states are looking at ways to combat churn among subsidized exchange and Medicaid customers. More information on Tennessee’s proposal is available here.
Washington. CMS has posted a memorandum of understanding (MOU) regarding Washington’s plans to realign how care for dual eligibles is financed. While approximately half of states have expressed interest in the duals demos, Massachusetts is the only other state to reach the MOU phase of development. The MOU can be found here.
Health Insurance Exchanges: State of the States update
With a significant number of states waiting for the outcome of the November 6 election before making an exchange decision, it was a slow week for exchange developments. However, there was some notable reshuffling within CMS and today the Idaho Health Insurance Exchange Working Group is scheduled to have their final meeting before issuing their exchange recommendation to the Governor. Let’s start at the federal level.
This week, the Center for Consumer Information and Insurance Oversight (CCIIO) announced that Tim Hill, deputy director overseeing health insurance exchanges, would be leaving his position for another assignment within CMS. The move comes weeks before states are expected to begin submitting their exchange Blueprints to CMS and just months after the departure of Steve Larsen, former Director of CCIIO. It is unclear who will replace Hill at CCIIO.
Moving to the states, last week Illinois Governor Pat Quinn (D) sent a letter to CCIIO declaring that it was Illinois’ intention to participate in a federal-state partnership exchange. In his letter, Governor Quinn wrote that he hopes Illinois will pass legislation in the near future that would allow the state to operate a state-based exchange by 2015. Illinois is the third state, along with Arkansas and Delaware, to publicly declare its intent to pursue a federal-state partnership exchange. Other states are still examining the partnership option and there could be additional declarations before the November 16 HHS Blueprint deadline.
Meanwhile, a week earlier Governor Dannell Malloy (D-CT) sent HHS a letterrequesting “the timely issuance” of regulations “regarding the implementation and operation of a Basic Health Program.” Connecticut has been examining the feasibility of developing a Basic Health Program, but lacks the specific regulations needed to make a formal analysis. In his letter, Governor Malloy points out that the decision to implement a Basic Health Program could impact other health reform efforts in the state, including the state’s health insurance exchange and Medicaid program.
Moving west to Minnesota, during a meeting of the Legislative Advisory Commission to review Minnesota’s previous $42.5 million Level One grant award from HHS, Exchange Director April Todd-Malmlov revealed that the exchange anticipated applying for two additional grants in 2013. The total estimated amount of additional grant funding is expected to range between $60 and $80 million. Also this week in Minnesota, the Health Insurance Exchange Advisory Task Force met to discuss recommendations from the Finance Work Group for the Minnesota Exchange on long-term funding options.
In Idaho, the Idaho Health Insurance Exchange Working Group is scheduled to have their final meeting before releasing their exchange recommendation to the Governor. The working group was created earlier this year by Governor C.L. “Butch” Otter (R) to study the exchange issue and determine what would be the best option for Idaho.
Finally, according to the minutes of a September 25 meeting with stakeholders in West Virginia, the state is exploring “regional exchanges.” West Virginia is working with the National Academy of State Health Policy (NASHP) to “research potential regional exchanges, develop reciprocal agreements with other states, potentially share risk pools, develop ways to help bring down administrative costs, and explore potential for shared IT systems.” This is not the first time West Virginia has looked to collaborate with other government entities on complex health IT systems. Two weeks ago, it was announced that the Virgin Islands (VI) will be joining West Virginia’s Medicaid Management Information System by July 2013.