Author: MM_ADMIN

Posted on by

Florida Medicaid, DOH, present FY 2022 budget requests

MM Curator summary

 
 

FL Medicaid is asking to spend more on multiple program areas, including a planned upgrade to its MMIS.

 
 

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

 
 

 
 

 
 

Nicole Pasia | Oct 14, 2021 | Florida

Three agencies — the Agency for Health Care Administration (AHCA), the Florida Department of Health, and the Department of Children and Families — presented their legislative budget requests (LBR) for fiscal year (FY) 2022 to the House Health Care Appropriations Subcommittee for consideration on Monday. 

Recurring requests among the agencies included health care workforce support to address high turnover rates, replacing outdated IT systems, and health quality assurance (MQA) measures. 

 
 

See a list of notable items from each agency below: 

Agency for Health Care Administration

Total legislative budget request (federal and state): $36.5 billion

  • Medicaid rate adjustments: $277.47 million in general revenue

Florida has seen 1.1 million more enrollments in Medicaid during the COVID-19 pandemic, leading to the state’s largest Medicaid population (4.9 million) in history. Rate increases to fit these new parameters were determined at the August 2021 Social Services Estimating Conference (SSEC). 

  • Florida KidCare adjustments: $53.9 million in general revenue

 
 

  • Institutional and Prescribed Drug Providers: $1.16 billion

This reflects cost adjustments for prescribed drug provider operations, such as over-the-counter prescriptions and drugs administered in outpatient settings.

  • Statewide Medicaid Managed Care Procurement Activities: $2.3 million in general revenue

This will support legal and actuary expenses to respond to protests of contract awards as during procurement negotiations. AHCA is required to reprocure contract awards every six years.

  • Medicaid Hospital Direct Provider Payment (DPP) Program: $154,000/2 FTE in general revenue

AHCA will create two positions to oversee this new program, which is expected to bring $1.8 billion in direct payments to hospitals and other providers in its first year. CMS approved this program earlier this year.

  • Florida Medicaid Management Information System: $117.8 million in general revenue

AHCA is set to replace its 20-year-old Florida Medicaid Management Information System.

  • Transfer of PACE from DOEA to AHCA: $37.7 million in general revenue/2 FTE

Revenue, administration, and authority over the Program for All-Inclusive Care for the Elderly, previously under the Department of Elder Affairs, will move to AHCA. AHCA Secretary Simone Marstiller said the move would streamline administrative processes and that AHCA was better suited to oversee PACE, as it is a health care program.

 
 

Department of Children and Families (DCF)

Total legislative budget request (federal and state): $3.8 billion

  • Replacing federal foster care funds: $32.5 million in general revenue

Due to changes in eligibility, Florida may not receive federal matching funds for Title IV-E foster care services and would need to use general revenue instead.

  • Stabilizing Children’s Legal Services Workforce: $4.8 million 

DCF would use funds to increase pay for 600 legal staff that manage court child welfare cases across the state. Staff turnover in this field has increased from 21% in 2017 to 49% this past year, according to Tony Lloyd, DCF assistant secretary for administration.

  • Comprehensive Behavioral Health Services: $109.7 million in trust fund authority

Federal funds from the American Rescue Plan, COVID-19 Relief, and the Substance Abuse and Mental Health Block Grant will expand behavioral health and substance use disorder services within the department, which have waiting lists of 2,000 and 1,000 people, respectively. 

  • State Opioid Response (SOR) Grant Budget Authority: $24.6 million in trust fund authority

Continued funding for this program has provided substance use disorder services for over 15,000 individuals in the last three years.

 
 

Department of Health (DOH)

State legislative budget request (general revenue and trust fund authority): $49.3 million

  • Infant Mortality and Prevention: $2.8 million in general revenue

Services would address the top two causes of infant mortality: sleep-related infant death and drowning. 

  • Office of General Counsel – Litigation: $2 million in general revenue

DOH will contract outside legal counsel due to “additional lawsuits arising from enactment of new laws and adoption of new rules governing the Department.” This request raised concern from Rep. Carlos Guillermo Smith (D – Orange), who filed a lawsuit in August over the department’s refusal to release daily COVID-19 data.

  • Group Care Program (GCP) Services: $3.8 million in general revenue

State funds would cover gaps between funding from county health departments and the GCP’s actual expenditures for group homes, schools, and other care services. 

  • Workload Medical Quality Assurance: $1.1 million in trust fund authority/19 FTE

DOH requests 19 positions due to an increase in applicants and high staff turnover rate for the Board of Nursing and the Board of Pharmacy.

  • Office of Medical Marijuana: $24.8 million in trust fund authority

This includes the creation of 85 positions within the department to serve additional patients and licensed Medical Marijuana Treatment Centers, accounting for nearly half of DOH’s budget request. 

Rep. Kelly Skidmore (D – Palm Beach), also expressed concern over DOH’s LBR, and asked why no COVID mitigation requests were included. DOH Deputy Secretary for Operations, Michele Tallent, responded that this was due to the department receiving over $3 billion in federal COVID support funds. 

 
 

Clipped from: https://stateofreform.com/news/florida/2021/10/florida-medicaid-doh-present-fy-2022-budget-requests/

Posted on by

CMS is reviewing Missouri’s new Medicaid licensure policy

MM Curator summary

 
 

CMS has decided to review Missouri’s efforts to increase oversight of safety regulations related to abortion providers.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

The Centers for Medicare and Medicaid Services (CMS) is looking into Missouri’s new Medicaid rule, a spokesperson told The Missouri Times Thursday. 

“CMS evaluates all policies affecting the Medicaid program and is currently reviewing the new policy in Missouri,” the spokesperson said. 

New Medicaid regulations for abortion providers in Missouri took effect Wednesday, enacting requirements some said could potentially jeopardize funding for Planned Parenthood. 

Filed late last month, the emergency regulations tighten reporting requirements, allow state departments to work together to consider licensure, and enact new safety requirements. The rule expires on April 10, 2022. 

Under the new rules, the Department of Health and Senior Services (DHSS) can turn over its inspection records of abortion providers to the Department of Social Services (DSS). 

The Medicaid Audit and Compliance Unit then evaluates Medicaid eligibility for the provider, a change DHSS said would “increase further compliance with state and federal laws and regulations governing abortion facilities.”

“As a result, the Department of Health and Senior Services finds that there is a compelling governmental interest that requires an early effective date,” the notice read. 

The regulations also reinforce standards requiring providers to notify pathology labs of failed abortions within 24 hours, ensure all surgical tools are sterilized, perform pelvic exams on patients 72 hours before the procedure if medically necessary, and participate in yearly fire drills. 

Sen. Bill White, the Republican chair of the Senate Interim Committee on Medicaid Accountability and Taxpayer Protection, said the new regulations were based on recommendations from his committee that would allow DSS to deny or revoke licenses based on DHSS investigations rather than having to conduct their own reviews. 

The emergency rule was filed five days after the recommendation was unveiled.

“We say very general things, and the departments tighten them up and flush them out,” White told The Missouri Times. “The states are given the authority to establish standards for Medicaid providers and decide how to handle those that fail to keep them. These are very good rules.”

White, who also chairs the Joint Committee on Administrative Rules, said he did not believe the regulations put Missouri out of compliance with CMS or jeopardized any federal funding. 

However, representatives from Planned Parenthood of the St. Louis Region and Southwest Missouri (PPSLRSWMO) called on the Biden administration to intervene during a call with reporters Wednesday even though the new regulations will not impact Planned Parenthood’s services at this time. 

 
 

Clipped from: https://themissouritimes.com/cms-is-reviewing-missouris-new-medicaid-licensure-policy/

 
 

Posted on by

Medicaid remains sticking point between GOP, Dems in NC’s budget

MM Curator summary

 
 

The fight over Medicaid expansion may derail the NC state budget again this year.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

RALEIGH, N.C. (WNCN) – Republican House Speaker Tim Moore said this week that the possibility of expanding Medicaid coverage has come up in talks with Gov. Roy Cooper (D), but that there is still not enough support among his party’s members to include that in a final budget agreement.

The issue was one of the key reasons Cooper and the Republican-controlled legislature never agreed on a budget two years ago, as the governor has pushed for expanding the program to cover hundreds of thousands more lower-income people.

Republican legislative leaders have declined to do that, with Senate leader Phil Berger saying recently he still thinks it’s “bad policy.”

Still no end in sight for NC budget negotiations

Cooper, Berger and Moore are having private discussions about a potential budget compromise and have not made public what aspects of it they’re still trying to resolve with each other.

North Carolina is among 12 states that have not expanded Medicaid, according to the Kaiser Family Foundation.

Chrissy Burk is a working mom of two who lived in Fayetteville for 23 years until she moved to Ohio three weeks ago.

While living in North Carolina, she was uninsured and faced financial hardship.

“I had gotten so comfortable without having (health insurance), I learned how to move around not getting hurt or sick, or if I did using self-remedies, soothing myself,” she said.

She said she moved in with family in Toledo, taking just her clothes and her boys with her. Ohio is among the states that have expanded Medicaid.

“Since I’ve been here in three weeks, me and my kids were covered through Medicaid and I’ve already gotten a job, and I’ve only been here three weeks. And, the only thing I did different was leave the state of North Carolina,” she said.

Democrats in Congress recently tried to entice the remaining states that have not expanded Medicaid by offering to have the federal government pick up even more of the cost for two years. Under the Affordable Care Act, the federal government covers 90 percent of the cost, leaving states responsible for the rest. The American Rescue Plan included a provision to cover a 5 percentage point increase in the match rate for two years.

The Kaiser Family Foundation found that after accounting for the state’s cost for doing that, there would be a net increase of $1.2 billion in funding for North Carolina.

There’s also discussion of including a coverage option for people in states that have not expanded Medicaid in the $3.5 trillion so-called “human infrastructure” bill being debated in Congress.

North Carolina House Speaker Tim Moore said there are still outstanding questions about what that would mean for North Carolina if that passed.

“There’s questions about what impact does that have on the state. And, frankly, a lot of the time has been spent looking into… what would happen. What would it cost the state?” he asked. “A lot of real policy questions along there and we still can’t get them answered because we can’t get a clear answer from DC on them.”

Casey Cooper, CEO of the Cherokee Indian Hospital Authority, has been talking to leaders in Republican-leaning counties in the western part of the state, explaining to them the potential impacts of expanding Medicaid.

He pointed to working people who either don’t have insurance through their employers or can’t afford to purchase it themselves. He said that leads to some people forgoing treatment until they become so sick they have to go to the emergency room, which is much more expensive.

“Medicaid expansion is absolutely essential for small rural hospitals who are already operating on razor-thin margins,” he said.

Commissioners in Clay County adopted a resolution urging state lawmakers to expand Medicaid joining Graham, Jackson, Macon and Swain in the western part of the state, according to Care4Carolina.

“I think that perhaps maybe some of the resistance is just a lack of understanding and not understanding that Medicaid expansion is really the solution to this problem that our friends and families live with every single day,” he said.

Some conservative groups have been urging Republicans not to expand Medicaid.

Americans for Prosperity-North Carolina recently said it’s prepared to “launch a full-scale campaign to combat the effort.”

“As Senator Berger and most legislators who identify as ‘fiscally responsible’ have said for years: Medicaid expansion is— and always has been— bad policy. While some are letting the guise of unreliable federal funding dissuade their principles, our activists are gearing up to remind policymakers that Medicaid expansion will only exacerbate fiscal challenges for our state and North Carolina’s hardworking families,” said AFP-NC state director Chris McCoy in a statement.

It’s not clear how close Republicans and Gov. Cooper are to reaching a budget agreement. Republicans planned to send a counter-proposal to him this week. They haven’t said what the remaining issues are to resolve.

 
 

Clipped from: https://www.cbs17.com/news/capitol-report/medicaid-remains-sticking-point-between-gop-dems-in-ncs-budget/

Posted on by

Adding SNAP Benefits for Older Adults in Medicare, Medicaid Can Reduce Hospital Visits, Healthcare Costs

MM Curator summary

 
 

A new study suggests that SNAP benefits reduces hospitalizations, but the design is limited.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

A study published in Annals of Internal Medicine led by UNC School of Medicine’s Seth A. Berkowitz, MD, MPH, shows that participation in the Supplemental Nutrition Assistance Program (SNAP) by older adults dually enrolled in Medicare and Medicaid is associated with fewer hospital visits and lower healthcare costs. But millions of Americans do not take advantage of the program.

 
 

Seth Berkowitz, MD, MPH

CHAPEL HILL, NC – Food insecurity among older adults takes a toll on the nutrition and health of those affected. According to data from 2019, 5.2 million people age 60 and above in the U.S. were food insecure – equaling 7.1% of that population – and that number has likely grown during the COVID-19 pandemic.

Older adults facing food insecurity are more likely to have chronic health conditions like depression, asthma, diabetes, congestive heart failure and heart attack. Only 48% of older adults who qualify for the Supplemental Nutrition Assistance Program (SNAP), which provides benefits to supplement budgets to purchase healthy and nutritious foods, are enrolled in the program.

A study published in the Annals of Internal Medicine shows the importance of older adults taking advantage of this nutrition benefit, as it is associated with fewer hospital visits and lower healthcare costs.

“Providing income support for older adults is incredibly important for health,” said study lead author Seth A. Berkowitz, MD, MPH, assistant professor of general medicine and epidemiology at the UNC School of Medicine. “Along with affecting the foods they have access to, food insecurity can force people to choose between food and medications or other basic needs, and worsen mental health. All of this takes a toll on what is already a group at high risk for poor health outcomes.”

The study used a unique circumstance to better evaluate the association between SNAP participation and healthcare use and cost. In 2017, Benefits Data Trust – a national nonprofit dedicated to helping people access essential public benefits and services – was contracted by the North Carolina Department of Health and Human Services to help people age 65 and over who were dually eligible for Medicare and Medicaid enroll in SNAP. BDT provided outreach to these individuals by mail, a telephone-based screening, and – if the person chose to enroll in SNAP – the nonprofit would aid in filing an application. This circumstance allowed for previously unavailable linkages among data sets related to SNAP outreach, SNAP participation, and health care use and cost.

Researchers used data from BDT’s outreach to more than 115,000 people age 65 and older in North Carolina between 2016 and 2020 who were dually eligible for Medicare and Medicaid, and were eligible for SNAP but not enrolled. Almost 5,100 of those who received outreach about SNAP benefits enrolled in the program. SNAP enrollment was associated with a decrease in inpatient hospitalizations, emergency department visits, long-term care admissions, as well as fewer dollars in Medicaid payments per person per year.

“Billions of dollars in food and healthcare assistance go untapped every year, often because people aren’t aware they are eligible or they are not sure how to access them,” said Pauline Abernathy, chief strategy officer at BDT. “These research findings show that data-driven outreach and application assistance significantly increase SNAP participation, which in turn markedly improves health and lowers Medicaid costs. With millions of people 65 and older eligible but not participating in SNAP, this research underscores the urgent need to increase outreach and streamline enrollment.”

Study co-authors include Deepak Palakshappa, MD, MSHP, and Joseph Rigdon, PhD, of Wake Forest School of Medicine; Hilary K. Seligman, MD, MAS, of University of California San Francisco; and Sanjay Basu, MD, PhD, of the Center for Primary Care, Harvard Medical School.

This study was primarily funded by the National Institutes of Health.

 
 

Clipped from: https://news.unchealthcare.org/2021/10/adding-snap-benefits-for-older-adults-in-medicare-medicaid-can-reduce-hospital-visits-healthcare-costs/

Posted on by

Six companies vying for latest $21B state Medicaid deal

MM Curator summary

 
 

CMS is expected to release guidance on its new vaccine mandates for nursing homes and hospitals receiving federal funds.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

The Centers for Medicare & Medicaid Services (CMS) revealed last week that it was in the rulemaking stage of a collaboration with the Occupational Safety and Health Administration (OSHA) on the establishment of a federal vaccine mandate.

Last Monday, Dr. Lee Fleisher, CMS’ chief medical officer and director of the Center for Clinical Standards and Quality (CCSQ), confirmed that the agency is slated to release its guidelines in late October. Fleisher did so while appearing at the National Association for the Support of Long-Term Care’s (NASL) annual meeting.

This means that Medicare-certified home health providers should expect CMS to release guidance any day now.

 
 

“CMS will soon issue the emergency regulation requiring staff vaccinations within the nation’s more than 15,000 Medicare and Medicaid-participating nursing homes and Medicare and Medicaid-certified health care providers that are regulated under CMS regulations, but we cannot comment on the specifics of the pending regulations as we are in the active rulemaking process,” a CMS spokesperson told Home Health Care News in an email. “There will be a 60-day comment period that will begin when the regulation is published in the Federal Register for the public to share their feedback with CMS.”

The journey to a federal vaccine mandate officially began last month after President Joe Biden announced a six-pronged approach to his administration’s COVID-19 strategy, with plans explicitly mentioning home health providers. The approach also pushed for American workers to get vaccinated and called for increased COVID-19 testing.

At the time, CMS confirmed that vaccinations would be a condition for participating in the Medicare and Medicaid programs.

 
 

“The staff vaccination requirement would only apply to Medicare and Medicaid-certified provider and supplier types that are regulated under the Conditions of Participation,” the agency said. “If an entity is not regulated under the CoPs, then this requirement would not apply.”

For now, providers can only speculate on the potential details of the mandate and if any exceptions will be taken into consideration. When one comes out, CMS will need to keep several considerations in mind, according to National Association for Home Care & Hospice (NAHC) President William A. Dombi.

“First, any mandate must provide sufficient time for reasonable compliance,” Dombi told HHCN in an email. “That matters primarily because there is a high risk of interruption of patient services resulting from lost clinical staff. The vaccine mandates in health care settings that already have occurred have demonstrated that some staff leave their jobs. In home care and hospice, there is a current staff shortage such that even the loss of one staff member can cause difficulties in continuing to serve existing patients as well as taking on new patients.”

Secondly, a CMS mandate must provide for exceptions with clear standards for applying those exceptions, he noted.

Additionally, “to the extent possible,” a CMS vaccine mandate should be evenly applied across the health care sector, NAHC’s leader advised. On top of that, CMS should also consider the costs of a vaccine mandate, especially on newer home health and home care agencies.

“A vaccine mandate presents a variety of new costs for home care companies,” Dombi said. “Appropriate compensation for such costs is a reasonable expectation as these costs are not built into today’s payment rates.”

On the state level, New York rolled out its own vaccine mandate back in August. The regulation mandates the vaccination of home health and personal care workers in the state, with the requirement that the first dose be administered by Oct. 7.

Since then, the rate for New York home-based care workers checked in at about 86% partially vaccinated and 71% fully vaccinated. About 34,000 caregivers have not begun the process at all, according to reports from The New York Times.

The state has received pushback from organizations such as the Home Care Association of New York State (HCA-NYS).

“We have been saying to our governor and our state health department, from the beginning, if you’re going to apply the mandate … you need to do it in a way that doesn’t cause a dislocation of care service for patients and a loss of workforce,” Al Cardillo, president of HCA-NYS, previously told HHCN.

Another East Coast state, Massachusetts, announced plans to require vaccinations for all staff at rest homes, assisted living residences, hospice programs, as well as home-based care workers.

Along these lines, individual home-based care providers have also taken a leap and implemented vaccine mandates within their organizations.

In August, Empath Health announced a policy that requires its staff, volunteers and vendors to be fully vaccinated against COVID-19 by Nov. 1.

“This was not a decision that was made lightly or quickly,” Dr. Neville Sarkari, chief medical officer at Tidewell Hospice, previously told HHCN. “We spent a great deal of time debating this internally. The vaccines are effective and safe, so we felt it was the right thing to do to protect our patients and our colleagues.”

Tidewell Hospice is one of Empath Health’s hospice subsidiaries.

CommonSpirit Health and its home-based care arm, CommonSpirit Health at Home, also announced that it would require its employees to be fully vaccinated by Nov. 1.

“As health care providers, we have a responsibility to help end this pandemic and protect our patients, our colleagues, and those in our communities – including the most vulnerable among us,” Lloyd H. Dean, CEO of CommonSpirit, said in a press statement. “An abundance of evidence shows that the vaccines are safe and highly effective. Throughout the pandemic, we have made data-driven decisions that will help us best fulfill our healing mission, and requiring vaccination is critical to maintaining a safe care environment.”

OSHA has already submitted its rulemaking on COVID-19 vaccination and testing requirements for private sector businesses of more than 100 employees.

“NAHC remains highly supportive of vaccinations,” Dombi continued. “We appreciate the efforts of the administration to get as many people vaccinated as possible and as quickly as possible. However, we must proceed with plans to address all the likely consequences of a mandate in order to ensure continuity in patient care and access to health care at home.”

Additional reporting by Jordyn Reiland

 
 

Clipped from: https://homehealthcarenews.com/2021/10/cms-getting-closer-to-vaccination-guidance-for-home-health-agencies-other-medicare-medicaid-providers/

Posted on by

False Claims Act Complaint Against “Sophisticated” Medicaid Plan Allowed To Proceed

MM Curator summary

 
 

Molina dropped a vendor whose service was included in its cap rate, and the lawsuit has been allowed to proceed.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

20 October 2021

by Shannon Britton Hartsfield

 
 

 

Molina Healthcare of Illinois (Molina) was a Managed Care Organization (MCO) that received a per-patient capitated payment from the Illinois Medicaid program to provide certain services. These services included, among other things, certain professional services delivered within a skilled nursing facility to Molina’s Medicaid beneficiaries receiving nursing facility services. The services were supposed by be rendered by “SNFists,” who are medical professionals focused on providing and coordinating medical care for individuals residing in a nursing facility. Molina provided SNFist services through a subcontract with GenMed. GenMed eventually terminated its contract with Molina due to a payment dispute, yet Molina continued to receive capitation payments from the state without providing SNFist services, either directly or through another subcontractor.

As an MCO, Molina had a risk-based contract in which it agreed to receive a per-enrollee fee, and in exchange, Molina assumed the risk that its cost of providing services could exceed those fees. For a two-year period after the termination of the GenMed agreement, Molina did not deliver SNFist services, yet it continued to receive the full capitation amount for those SNFist services from the Illinois Medicaid program.

GenMed’s founder, Thomas Prose, was aware of this situation and filed a qui tam complaint under the False Claims Act (FCA) and its state law corollary. The lower court dismissed the case for failure to state a claim because it found that the relator’s complaint failed to sufficiently allege that Molina knew that the failure to provide SNFist services was material. On Aug. 19, 2021, the U.S. Court of Appeals for the Seventh Circuit, in United States ex rel. Prose v. Molina Healthcare of Ill., Inc., 10 F. 4th 765 (7th Cir. 2021), reversed and remanded for further proceedings based on the finding that “as a sophisticated player in the medical-services industry, Molina was aware that these kinds of services play a material role in the delivery of Medicaid benefits.”

The court noted that a complaint in a suit brought under the FCA must include particular information regarding the fraud in order to survive. The court found that Prose’s detailed allegations were adequate to state a claim under the FCA and sufficiently alerted Molina regarding the details of a false claim. The fact that Prose did not have details that would be available only in Molina’s files did not defeat the complaint. The lower court found that Prose’s allegations were inadequate to allege that Molina knew that the SNFist services were material to the government’s payment. The appellate court determined that, as a “highly sophisticated member of the medical-services industry,” Molina knew that capitation rates were designed to reimburse providers for services rendered and that the SNFist services were the reason why the capitation rate was as high as it was. Because the complaint contained sufficient allegations that Molina was aware that its higher capitation rate hinged, in large part, on the provision of SNFist services, the court held that the relator could proceed with the complaint.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.Clipped from: https://www.mondaq.com/unitedstates/healthcare/1123040/false-claims-act-complaint-against-sophisticated-medicaid-plan-allowed-to-proceed