• National health spending in the U.S. totals over $4 trillion per year and it’s expected that health spending will grow to an estimated 20% of GDP by 2031. This has lawmakers concerned on both sides who are calling for controlling healthcare spending, especially in Medicare. In the Senate, there’s a push for more value-based care to curb cost growth and a push to move to “market-based solutions similar to Part D,” while in the House, there is a desire among lawmakers to create a bipartisan fiscal commission (Inside Health Policy, October 20).

Featured Content

Medicaid Coverage for Violence Prevention Programs

• New York Governor Kathy Hochul has signed legislation allowing Medicaid reimbursement for violence prevention programs provided the federal government approves such coverage. This move aims to enhance access to vital programs for historically underserved communities, particularly those affected by gun violence and other forms of violence. The legislation requires the NY State Department of Health to seek approval from the federal government to allow community violence prevention services to be available for Medicaid beneficiaries, and to establish rates for service providers. In addition, violence specialists will be required to take at least six months of training in providing prevention services or youth development services; complete a training and certification program through NY State Department of Health; and complete four hours of continuing education annually (Finger Lakes Daily News, October 20 and New York State Governor’s Office, October 18).

Waivers

• Section 1115
  • Nebraska
    • On October 12, 2023, Nebraska submitted an application to extend their section 1115(a) demonstration titled, “Nebraska Substance Use Disorder (SUD) Section 1115 Demonstration.” The demonstration authorizes federal Medicaid matching funds for reimbursement of services delivered to beneficiaries residing in IMD with SUD and is currently set to expire June 30, 2024. The application seeks to continue to operate the SUD demonstration as approved by CMS with no changes for an additional five years. The federal public comment period is open from October 20, 2023 through November 19, 2023. Public comments can be submitted here.

SPAs

• On October 19, Governor Whitmer (D-MI) signed legislation that prohibits insurers from denying healthcare based on preexisting conditions and requiring coverage for dependents under their parents’ health insurance through age 26, effectively codifying a portion of the ACA regulations as Michigan state law. Insurers are now required to provide no-cost essential services including, preventative, mental health, and emergency services, and cannot deny or limit coverage based on gender identity, sexual orientation, or cap coverage throughout an individual’s lifetime. The legislation was passed by the House in June, with many Republicans joining Democrats before it was passed by the Senate along party lines (AP News, October 20).
• CenterWell Senior Primary Care, a Humana affiliate, plans to open eight clinics throughout Virginia by the end of 2024. The first of the clinics opened in Chesapeake in September. Two of three clinics will open in Richmond in November, with the remaining openings in Hampton, Tidewater, Portsmouth, and Newport News slated for 2024. Humana launched the CenterWell brand in 2021 to provide whole-person care to its enrollees, the majority of whom are in Medicare Advantage plans. In late 2022, Humana released a statement saying it planned to open additional CenterWell Senior Primary Care centers in 2023 in the three new states of Virginia, Indiana, and Mississippi while expanding in Kentucky, Louisiana, Nevada, North Carolina, South Carolina, Tennessee and Texas. Currently, Humana operates 108 CenterWell Senior Primary Care locations (Health Payer Specialist, October 20).
• The Oregon Health Authority (OHA) has announced that it will release new funding grant opportunities for community-based organizations (CBOs). The funding is part of the Public Health Equity Funding program that will allow CBOs to support culturally and linguistically responsive public health work in the following health equity-focused program areas: climate adaptation, communicable disease prevention, public health emergency preparedness, and domestic wells. OHA has allocated up to $10.25 million for the program. The grant applications are open and will close December 1, 2023. OHA is specifically seeking applicants who serve communities of color, tribal communities, disability communities, immigrant and refugee communities, migrant and seasonal farmworkers, LGBTQ+ communities, faith communities, older adults, rural communities, houseless communities, and others (OHA, October 16).

News

• Walgreens Boot Alliance and Alignment Health have announced a partnership where they will provide co-branded Medicare Advantage plans in 10 counties across Arizona, California, Florida, and Texas. The plans will be available January 1 and offer $0 premiums and $0 copays on medical and prescription drugs coverage. The plans are pending regulatory approval (Health Payer Specialist, October 18).
• On October 20, Blue Cross and Blue Shield of North Carolina negotiated a deal to acquire 55 urgent care centers from FastMed. The nonprofit carrier plans to enhance FastMed operations in the state by increased hiring efforts. FastMed, which has provided preventive, telehealth, occupational health, primary care and urgent care services in Arizona, Florida, North Carolina, and Texas, has recently been divesting its urgent care centers. The acquisition is expected to close early next year (Modern Healthcare, October 23).
• The federal Department of Health and Human Services is working to expedite the delivery of COVID-19 vaccines to long-term care facilities after complaints of delays in receiving the doses for residents. This year, the distribution of vaccines transitioned from the federal government to the commercial market. A change which has resulted in long-term care facilities facing challenges in receiving the vaccine. Some vaccine manufacturers are working to address the issue. Advocates and stakeholders have expressed concerns that the vulnerable long-term care population has not been prioritized this year. Providers such as LifeSpark in the Minneapolis area are experiencing significant barriers to providing vaccines to residents and hope to see improvements soon (Modern Healthcare, October 24).
• A new analysis of behavioral health therapy outcomes conducted by Blueprint found that approximately 67% of patients receiving outpatient therapy will not reach remission. However, the analysis was complemented by the Blueprint Quality Index (BQI), a new framework for communicating, comparing, and improving behavioral health outcomes at a national level. Behavioral health providers can utilize the BQI to track quality improvement over time while assessing the effect of programmatic or other changes on patient outcomes. Blueprint has worked with more than 9,100 clinicians treating more than 200,000 patients and believes they have accumulated a comprehensive data set on outpatient behavioral health therapy outcomes. The data set consists of more than 2 million outcome measure administrations. The BQI is based on Achievable Benchmarks of Care and can provide organizations with 100-point quality composite scores (Fierce Healthcare, October 23).
• ECRI, a patient safety organization, surveyed pharmacists, pharmacy technicians, procurement specialists, and clinicians across a range of healthcare settings and found that nationwide medication, medical supply, and medical equipment shortages are compromising patient care and harming patients. Half of those surveyed said that shortages have delayed patient care and a third noted that they were unable to provide patients with optimally recommended drugs or treatments. 60% of the respondents reported shortages of more than 20 drugs, single-use supplies, or other medical devices during the six month period prior to the survey (Fierce Healthcare, October 23).
• The FDA is currently reviewing a nasal spray vaccine that could be available by next year allowing individuals to self-administer the vaccine at home. The vaccine is called FluMist and its drugmaker AstraZeneca has asked the agency to allow adults ages 18-49 to be able to give themselves the vaccine. Patients would have to go through an online pharmacy system to order the vaccine for home delivery. Researchers are hoping that a self-administered nasal spray vaccine would increase uptake (CNN, October 24).

• Sellers Dorsey worked with a large Georgia safety-net hospital that struggled with managing the cost of care for its uninsured population. The Firm partnered with the hospital to secure funding that is anticipated to improve access to care, quality outcomes, and health equity. Through the delivery of value-based care initiatives, these improvements are designed to transform the healthcare delivery system for vulnerable, at-risk patients and drive systemic change. Click the link here to download the GA AIDE case study!
• The Sellers Dorsey Digest strives to give you what matters most in Medicaid and healthcare each week, and as a dedicated reader, we’d love a chance to hear from you. Tell us how we can improve and what information you would like to see in future Digest editions by completing our quick and easy survey. Plus, be entered for a chance to win $100! Click here to take the survey.