News

• On December 12, the Center for Medicaid and CHIP Services (CMCS) released an Informational Bulletin (IB) to remind states and other stakeholders that the use of worker management platforms, commonly referred to as registries, is a key strategy for ensuring that Medicaid beneficiaries utilizing home- and community-based services (HCBS) have access to qualified workers. These HCBS worker registries can serve as an important connection between individuals who need HCBS and those providing them. CMCS took this opportunity to remind states that only workers who have attained the state’s minimum educational and/or training requirements should be included on the registry. States are also required to specify reasons they exclude certain HCBS workers from being listed on the registry, such as state laws that prohibit individuals with certain criminal histories from being included. States are expected to educate HCBS workers about the mandatory or voluntary nature of participation on the registry and the types of information the state requires for internal and external use. CMCS also provides a list of promising practices that states may use when considering the development of a registry. The list will be updated, as necessary. Registries look different depending on the state, but implementation of such registries is expected to support the following functions and promising practices:

1.Helping beneficiaries identify and employ qualified workers who meet their needs.

a. Maintaining an electronic system to help beneficiaries identify and match with appropriate workers.

b. Assisting beneficiaries and their families in navigating the HCBS system, including specific support on self-direction.

c. Integrating financial management service (FMS) functions, such as processing payments to workers and making tax withholdings and other deductions for standard employment benefits on behalf of the beneficiary. In some states, however, these functions are currently performed by independent FMS entities.

2. Facilitating recruitment and retention of workers in the Medicaid program to ensure an adequate supply of workers.

a. Helping workers become HCBS Medicaid providers as well as stay enrolled as a provider.

b. Actively recruiting new workers.

c. Connecting workers to training benefits and opportunities for professional development.

d. Facilitating access to health coverage and other benefits, in addition to training.

e. Ensuring there is a system for communication with and support for workers, particularly in the case of health or other emergencies.

3. Supporting state oversight activities related to program integrity, monitoring access to and quality of care for beneficiaries who receive services and maintaining a system for communication with workers.

a. Providing background checks.

b. Verifying worker qualifications and identifying special skills.

c. Creating a system for communication with workers and beneficiaries in self-directed programs to facilitate communication with HCBS providers in public health and other emergencies and to provide program updates and access to other supports.

There are additional registry functions that would generate useful data for monitoring HCBS quality and access.

CMCS highlighted the availability of enhanced federal match (FMAP) for worker registry development and maintenance along with the ARP funding opportunity. In order to receive approval for the enhanced FMAP, states can submit an Advanced Planning Document (APD) requesting the 90/10 percent enhanced match for the design, development, and implementation of Medicaid Enterprise Systems (MES) initiatives that contribute to the economic and efficient operation of the Medicaid and CHIP programs, including HCBS worker registries. States are also permitted to request a 75/25 percent enhanced FMAP for ongoing operations of CMS-approved systems. Additionally, Section 9817 of the ARP provided states with a temporary 10 percentage point increase to the FMAP for certain Medicaid expenditures for HCBS, from April 1, 2021 through March 31, 2022. CMS expects states to expend such funds by March 31, 2025. States interested in using the state equivalent funds for the development and maintenance of worker registries should reach out to their CMCS contacts or HCBSIncreasedFMAP@cms.hhs.gov

CMS also released the Overview of State Spending under American Rescue Plan Act of 2021 (ARP) Section 9817, and highlights the following items:

1. Across all 50 states and the District of Columbia (D.C.), an additional $4,933 will be spent on activities that enhance, expand, or strengthen HCBS.

2. Across all 50 states and D.C., more than 1,200 activities have been proposed, including workforce recruitment and retainment, workforce training, quality improvement, reducing or eliminating HCBS waiting lists, and expanding use of technology.

3. According to the states’ and D.C.’s submissions to CMS, there is a total of $36.8 billion in planned spending.

a. States and D.C. have reported $1.3 billion in total planned spending on family caregiver training, respite, and support.

b. 43 states have proposed activities addressing social determinants of health or promoting equity.

i. $2.02 billion for housing-related services and supports (24 states).

ii. $393 million to add or expand culturally and linguistically competent services and staff (13 states).

iii. $257 million for community integration and social supports (15 states).

iv. $254 million for non-medical transportation.

v. $250 million for employment.

All 50 states and D.C. are proposing activities to support workforce recruitment and retainment (Medicaid.gov, December 12; Medicaid.gov, December 12; GovDelivery, December 12).

• On December 6, the National Institutes of Health (NIH) issued a statement that the Biden administration will expand its Home Test to Treat pilot program that launched earlier this year into a nationwide program that will continue to cover COVID-19 telehealth sessions and at-home treatments and will add coverage for flu testing and treatment. Any adult with a positive COVID-19 or flu test will receive telehealth care at no cost and if medically necessary and prescribed, will have medication delivered directly to their home. Adult individuals who do not have COVID-19 or the flu can enroll and receive free testing if uninsured or receiving services under Medicare, Medicaid, the Veterans Affairs health system, or Indian Health Services. The NIH stated that “providing these services virtually is intended to expedite the time to treatment and the convenience of accessing services from home.” The LUCIRA by Pfizer COVID-19 and Flu Home Test, the first FDA-authorized test that can detect both viruses in a single test, will be utilized in the Home Test to Treat program (Inside Health Policy, December 6).

Federal Regulation

• According to the newly released Fall 2023 Unified agenda, the Biden administration expects to finalize a draft rule that limits the duration of short-term health plans in April 2024. The draft rule was announced in July and reverses a Trump administration rule from 2018 that provided for short-term plans to run for up to three years if allowed by states. Short-term plans are not required to adhere to the ACA consumer protections, such as spending limits or coverage mandates. The draft rule proposes to define a short-term, limited duration (STLDI) plan as one that runs for no longer than three months, allows for a one-month renewal, prohibits stacking policies by a single insurer or broker, and increases the required consumer notification requirement. The new STLDI plan limits would go into effect 75 days after the rule is finalized while existing STLDI plan policies would be allowed to run out under the Trump-era regulations (Inside Health Policy, December 8).

Federal Legislation

• On December 7, bipartisan lawmakers unveiled a bill that would let Medicaid pay for behavioral health treatment in criminal justice settings. This would reform the Medicaid Inmate Exclusion policy to allow for Medicaid coverage and payment for mental health and substance use services for eligible inmates in order to lower the risk of overdose and prepare recipients for community re-entry. Additionally, it would require states to reinvest any additional funds into technology and data sharing amongst the state Medicaid program, jails and prisons, and community-based providers and organizations (Inside Health Policy, December 7).
• On December 6, a new bipartisan piece of legislation, The Protecting Rural Seniors’ Access to Care Act, was introduced in the Senate to potentially block CMS from implementing its proposed nursing home staffing minimums. Lawmakers cite staffing shortages and high costs as reasons the proposed rule would be detrimental to nursing facilities. In November, a letter from a group of House Democrats pushed CMS to have stronger minimum nursing standards for facilities. This was then quickly followed by a House GOP proposal attempting to block the CMS proposed staffing minimums. The legislation introduced on the 6^th would establish an advisory panel on nursing home staffing that includes experts from both urban and rural communities. The panel would then submit a report to Congress making recommendations to bolster the workforce. The legislation is currently endorsed by over 90 organizations, including LeadingAge (Inside Health Policy, December 8).

New Hampshire Announces Medicaid Managed Care Contract Awards

• Three incumbents, Centene’s NH Healthy Families, AmeriHealth Caritas New Hampshire, and WellSense, formerly Boston Medical Center HealthNet Plan, were awarded New Hampshire’s $2.4 billion Medicaid contract. According to the New Hampshire Department of Health and Human Services (DHHS) scoresheet released last week, the payers scored totals of 1,533, 1,469, and 1,292 points, respectively. The state did not receive any additional bids outside of the three incumbents. Contract winners will be required to “promote optimal health and equitable access to services by better integrating physical and behavioral health through a holistic role of providers in the delivery of care” and focus on social determinants of health and promote care for priority populations, such as infants with neonatal abstinence syndrome (Health Payer Specialist, December 11).

News

• On December 10, The Wall Street Journal reported that Cigna and Humana called off their potential stock-and-cash deal valued at an estimated $140 billion, stating that the two companies were unable to agree on price and other financial terms. Cigna and Humana never confirmed that they were discussing a potential merger, but Cigna released a statement on Sunday saying that the company plans to buy back $10 billion worth of stock, in addition to a previously authorized $1.3 billion stock buy back. Humana declined to comment and Cigna did not answer any questions about merger talks (Modern Healthcare, December 10; Health Payer Specialist, December 11).
• On December 6, Oregon’s Medicaid Advisory Committee issued a memo advising the Oregon Health Authority to disapprove of the merger between SCAN Group and CareOregon unless more information about the deal is obtained. In late 2022, SCAN Group and CareOregon announced plans to merge under a firm named HealthRight Group by the end of 2023. The new organization would be worth $6.8 billion in revenue with nearly 800,000 members in Medicare Advantage and Medicaid plans. The Medicaid Advisory Committee stated it had serious concerns over the impact to the coordinated care organization system, access to care, and the state’s control of Medicaid spending. Oregon has a rigorous Health Care Market Oversight program that requires comprehensive reviews of mergers and acquisitions (Health Payer Specialist, December 11).

• With ample evidence of how transportation issues impact health, Medicaid is becoming a solution for more states looking to cover transportation for non-emergency medical needs. Companies like MTM, Inc., a non-emergency medical transportation company that partners with health plans to provide rides for members, ensure individuals can attend treatment for opioid abuse, among other needs. In this engaging Q&A, MTM shares their insights on the intersection of transportation and health and how Medicaid can help. Click here to read the full Q&A!