Category: Curator

HHS Curator is our free research service published by our team. We read hundreds of Medicaid news items each week and highlight and summarize them for you to save you time.

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Virginia May Have to Foot the Bill for Commonwealth Center’s Mistake

MM Curator summary- an incorrect facility type designation lead to $11M in inappropriate payments for a Virginia behavioral health facility.

 
 

 
 

 
 

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.

 
 

 
 

Clipped from: https://vadogwood.com/2020/12/28/virginia-may-have-to-foot-the-bill-for-commonwealth-centers-mistake/

 
 

State Faces Medical Challenges

Group’s improper accreditation could cost Virginia more than $11 million. 

RICHMOND-A mistake by the Commonwealth Center for Children and Adolescents (CCCA) could cost Virginia more than $11 million. CCCA is a 48-bed mental health facility located in Staunton. Last year, the center served 1,079 children. In 2020, that number was near 1,000.
The Virginia Department of Medical Assistance Services (DMAS) labels CCCA as a psychiatric hospital, and it does provide essential psychiatric services to young Virginians. However, the facility is accredited as a behavioral health organization, and has been since 1990. CCCA officials thought such an accreditation was sufficient to bill Medicaid for the services it provided, but recently discovered their error. 

During its last session, the Virginia General Assembly convened a Children’s Inpatient Services Workgroup that uncovered the incongruity. 

The U.S. Department of Health and Human Services requires that all DMAS facilities be “Medicare certified” or accredited as a psychiatric hospital with The Joint Commission. If the facilities, such as CCCA, are not properly accredited, they can’t be enrolled with DMAS. And that’s important because DMAS administers Medicaid services.

Virginia Department of Behavioral Health and Developmental Services (DBHDS) Commissioner Alison Land explained the problem to the Joint Subcommittee on Mental Health Services in the 21st Century during its meeting Dec. 21. 

The department has a plan to make CCCA compliant with federal regulations. If it fails to do so, however, the state government may be liable for bills it improperly processed. Virginia may also be on the hook for between $11 and 20 million in repayments to the federal government. 

 
 

Who Pays for Medicaid?

In describing the accreditation snafu to the subcommittee on Monday, Land called the situation “pretty critical, because those are the only pediatric beds we have.” In other words, CCCA is located in Central Virginia, but it’s a resource for children struggling with their mental health from around the state. It’s the only resource they have. 

Children must be pre-screened for admission to CCCA by a community health board, which decides whether the child is “in crisis” in their current environment. If so, CCCA can provide support for children who have threatened or attempted suicide; displayed aggressive or assaultive behavior or exhibited a need for evaluation and medication management. 

According to DBHDS Chief Public Relations Officer Meghan McGuire, approximately 60% of CCCA patients are Medicaid-eligible upon admission for a temporary detention order. 

These children come from low-income backgrounds. Medicaid is a program funded jointly by the state and federal government to ensure people without sufficient financial means can still access necessary medical care. 

Since 1990, Virginia has been contributing 50% to the cost-share for Medicaid patients at CCCA. The federal government covered the other 50%. Now, since it appears CCCA was not properly accredited as a Medicaid enrollee, legislators are wondering whether the federal government’s half needs to be paid back. 

According to Land, CCCA stopped billing Medicaid on June 2, 2020. The group notified the Centers for Medicare and Medicaid Services of the issue on Dec. 14. DBHDS has a 12-month plan to address the accreditation issue and potential revenue shortfalls. If needed, DMAS will be working with federal regulators to pay back money owed. That money will be due by Dec. 14, 2021.

 
 

Mental Health Services Budget Already Slashed

Luckily, while DBHDS sorts out the paperwork, there will be no interruption of services at CCCA. “We were doing an inpatient, acute level of care at CCCA and continue to do that, so we just need to get this right from a billing perspective,” Land said during Monday’s subcommittee meeting. 

However, CCCA predicts a $2.8 million revenue shortfall from the 12-month suspension in Medicaid billing. The accreditation process itself will also cost nearly $1 million. The facility will spend $718,000 on one-time capital improvements and operational modifications to meet requirements of a psychiatric hospital. It will also hire two staff members at a cost of $170,000 to guide the process. Land said DBHDS will absorb these staffing costs within its existing operating plan. 

All these additional expenses come in a context of funding for mental health services being reduced dramatically in the past year. Multiple departments saw budgets cut due to the pandemic. State Senate Finance Committee Legislative Analyst Mike Tweedy explained these cuts during Monday’s meeting. 

In the governor’s proposed 2021 budget, he removed $442 million from the state’s Department of Health and Human Resources. The General Assembly restored $224 million during the special session, but that still represents a $218 million cut. Specifically, community-based mental health services saw more than $52 million cut, Tweedy said.

Many of the programs that the joint subcommittee listed as top priorities during its last meeting on Dec. 9 were among those facing budget cuts. These included jail diversion programs, pilot programs to discharge geriatric patients with dementia from state mental health hospitals and the STEP-Virginia program.

Future of Deeds Commission in Virginia

The Joint Subcommittee on Mental Health Services in the 21st Century wants to restructure the mental healthcare system in Virginia. It’s been working as part of the Deeds Commission to fulfill that goal for seven years. But next year, the Deeds Commission expires. 

So during the Dec. 21 meeting, legislators on the call also discussed what comes next for the subcommittee. The consensus was that the work needs to continue, but finding funding for staff the subcommittee needs is a primary obstacle. 

“Four years is great, but you know, the work goes on forever. This is not an easy subject, and that’s because it’s complex and the issues constantly have to be considered and reconsidered to get the right approach,” said Sen. Creigh Deeds (D-Charlottesville), for whom the commission is named.

After some discussion, Del. Marcia Price (D-Newport News) made a motion to extend the commission for one year and to revisit the question of sustainable funding in the future. The motion passed. 

Ashley Spinks Dugan is a freelance reporter for Dogwood. You can reach her at info@vadogwood.com.

 
 

 
 

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As relief stalls, restoring Medicaid for Dubuque’s Marshallese is hanging in the balance

MM Curator summary:

Funding for Medicaid services in the Marshall Islands may resume at higher levels under the latest coronavirus relief bill.

 
 

 
 

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.

 
 

Clipped from: https://kwwl.com/2020/12/23/as-relief-stalls-restoring-medicare-for-dubuques-marshallese-is-hanging-in-the-balance/

DUBUQUE, Iowa. (KWWL) —– It’s Wednesday night, December 23rd, 2020. Two days ago, leadership in the U.S. House and Senate passed a coronavirus relief bill. Americans are waiting for details of long-awaited relief to be cemented.

For the Marshallese community, the wait for relief has lasted over 20 years.

Maitha Jolet is a Marshallese man living in Dubuque. He’s been watching national cable news, wishing for the moment the bill passes.

“[The pandemic] is really hard for the Marshallese community,” said Jolet.

Within the federal COVID-19 relief bill text, a proposal: restoring Medicaid eligibility for the roughly 30,000 migrants from the Marshall Islands who now live in the States.

U.S. troops took control of the Islands from the Axis powers near the end of World War II. U.S. nuclear testing started after the war, forcing migrants out.

Doctors think the testing resulted in staggeringly high rates of pre-existing conditions, including diabetes and heart disease.

This puts Islanders at extremely high risk for COVID-19 complications. Marshallese people make up less than 1% of the county’s population. By summertime, more than 20% of the county’s COVID-19 deaths were among Marshallese.

The community reacted, working fast with outreach groups, physicians and translators to get Marshallese connected to the care they needed, according to Kelly Larson, director for Dubuque’s Human Rights department.

“Pre-existing conditions — things that people from the Marshall Islands experience —- come from us having bombed their islands,” Larson said.

A pact between these Pacific islands and the U.S. (called COFA) gave the Marshallese the freedom to live and work in the U.S. In return, the States could sustain military presence there.

In 1986, the U.S. promised migrants eligbility for Medicaid coverage. Then, when Medicaid was reformed in 1996, the promise was broken.

 
 

Maitha Jolet

Jolet hopes the decades-long struggle will end soon.

“The government still owes people for what has been done,” Jolet said. “One of my friends’ wife, she died from the COVID. And he showed me the bill. The bill is around $114,000.”

“Something is not right. We are in poverty. We don’t have money.”

Two days before Christmas, Jolet waits with all of us for relief to be certain.

 
 

 
 

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Tennessee Medicaid plan’s vendor mails PHI to wrong members, exposes 3,300 individuals’ info

MM Curator summary:

Tennessee reported a data breach for members that occurred when mailings were sent to the wrong address by Axis Direct.

 
 

 
 

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.

 
 

 
 

 
 

Clipped from: https://www.beckershospitalreview.com/cybersecurity/tennessee-medicaid-plan-s-vendor-mails-phi-to-wrong-members-exposes-3-300-individuals-info.html

 
 

TennCare, Tennessee’s state Medicaid health plan, recently notified 3,300 members that their protected health information may have been exposed due to a misaddressed mailing incident on behalf of its vendor, according to a Dec. 21 WKRN report. 

Gainwell, which runs the state’s Medicaid Management Information System, alerted TennCare of the breach in October. An investigation of the incident found that about 3,300 mailings sent out in late 2019 and 2020 may have been misaddressed and delivered to the wrong person. 

The mailings, managed by the state’s vendor Axis Direct, contained protected health information of TennCare members. In a statement to the network, Gainwell said it is not aware of any members’ personal information having been misused as a result of the incident. The state is now offering free credit monitoring to the impacted members. 

“TennCare is committed to safeguarding the information of our members. We have confidence in Gainwell and the process undertaken to identify the error that impacted certain members and correct it,” said TennCare Director Stephen Smith, according to the report. 

 
 

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Larry Hogan announces that Medicaid reimbursement increases will go into effect January 1

MM Curator summary:

 
 

Maryland will begin paying BH and LTC providers more January 1 via a rate increase of 3.5% and 4%, respectively.

 
 

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.

 
 

 
 

 
 

 
 

 
 

Clipped from: https://stateofreform.com/featured/2020/12/60078/

Behavioral health and long-term care Medicaid reimbursement rate increases are set to go into effect on Jan. 1.. They were initially set to go into effect on July 1. The rate increases were passed through legislation in 2019.

Governor Larry Hogan announced the change on Thursday. Reimbursement rates will affect private health care providers who provide services to Marylanders on Medicaid.

 
 

 
 

Get the latest state-specific policy intelligence for the health care sector delivered to your inbox.

 
 

The changes to long-term care reimbursement will include nursing facilities, Rare and Expensive Case Management (REM), Development Disabilities Administration (DDA) targeted case management for certain individuals and private duty nursing. The Medicaid reimbursement rate for each will increase by 4 percent.

Behavioral health programs included in the bill will see a 3.5 percent increase in reimbursement. This includes behavioral analysis, adult residential and community-based substance use disorder treatment (SUD), mental health services, behavioral health targeted case management for children and adults, the 1915i community-based services program and therapeutic behavioral services.

The costs associated with the changes will be split between the state’s general funds and federal Medicaid funding.

 
 

 
 

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State still waiting to hear word about Medicaid waiver

MM Curator summary:

Tennessee has not given up his efforts to get its first-of-a-kind Medicaid block grants approved by CMS.

 
 

 
 

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.

 
 

 
 

 
 

Clipped from: https://www.johnsoncitypress.com/news/state/state-still-waiting-to-hear-word-about-medicaid-waiver/article_d9f456e2-448a-11eb-b3a2-5bd255df0d79.html

 
 

State Sen. Jon Lundberg, R-Bristol.

Tennessee officials are hoping to get a response soon from the federal government regarding the state’s year-old request for a block grant waiver from the Centers for Medicare and Medicaid Services.

The proposal would amend the way the state distributes its Medicaid dollars through the TennCare program.

In November 2019, Tennessee became the first state to submit a block grant waiver to the federal authority under a new law approved by the state General Assembly.

State Sen. Rusty Crowe, R-Johnson City, said under this amendment, Tennessee is asking to convert the federal share of its Medicaid funding, which totals more than $7.9 billion annually, into a block grant to “provide core medical” services under TennCare.

“The goal is to provide the state an opportunity to address the specific health care needs of all Tennesseans, while lowering costs and increasing access to patient-centered care,” said Crowe, who presides as chairman of the state Senate Health and Welfare Committee.

If an agreement is reached between the state and federal governments on the waiver, Crowe said the plan will come back to Tennessee lawmakers for a final vote during the 2021 legislative session. The 112th session of the state General Assembly is scheduled to convene on Jan. 12.

Repub-licans, who hold a supermajority in the General Assembly, say the waiver gives Tennessee more flexibility to supervise its Medicaid programs while also providing the state with an opportunity to rein in spending.

“Tennessee has completely different health care needs across its nearly 500-mile span,” state Sen. Jon Lundberg, R-Bristol, said Tuesday. “This will give us a better opportunity to disperse those Medicaid dollars to meet those needs.”

Lundberg said the state officials are hoping to hear word of the waiver before President Donald Trump leaves office.

“We really don’t know how the new administration will react,” Lundberg said.

Officials say approval of the Medicaid waiver has been delayed as federal authorities have asked the state for more details to clarify the proposal.

In the meantime, recommendations from a legislative panel appointed to study possible changes to the state’s Temporary Assistance to Needy Families Program is expected to be considered by the General Assembly in 2021. Tennessee has $741 million in unspent funds from the federal block grant program that supports Tennessee’s Families First program.

Families First provides support to Tennessee families in need of child care assistance, temporary cash assistance, transportation and job training.

“Discussions on how to best allocate the unspent funds were interrupted by COVID-19 last session,” Crowe said.

The Johnson City senator said he will sponsor legislation to require the state’s Department of Human Services submit an annual report to the General Assembly that includes information pertaining to TANF program. Crowe said that report would give details of organizations receiving TANF funds, and how recipients are spending those dollars.

 
 

 
 

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Work Requirements Can Preserve Medicaid For Those Who Need It Most

MM Curator summary:

The author of this Forbes op-ed argues that ACA underprojections and the rich FMAP for expansion enrollees has created a moral hazard for state programs that results in disadvantaging disabled Medicaid enrollees.

 
 

 
 

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.

 
 

 
 

 
 

Clipped from: https://www.forbes.com/sites/sallypipes/2020/12/21/work-requirements-can-preserve-medicaid-for-those-who-need-it-most/?sh=127720f841ca

 
 

A view of the front portico of the United States Supreme Court building in Washington, DC.

 
 

This month, the U.S. Supreme Court agreed to hear a case early next year that will decide whether states have the power to impose work requirements as a condition of receiving Medicaid benefits.

The question before the high court is a legal one. But as a matter of policy, work requirements are a great way to rein in Medicaid’s out-of-control spending and preserve the program’s scarce resources for the truly needy.

Several states—including Kentucky, Arkansas, and New Hampshire—have pondered work requirements in hopes of limiting Medicaid enrollment, which has exploded in recent years. The program was created more than a half-century ago to provide health insurance to the poor, disabled, and pregnant women. But as of July, it covered nearly 69 million people. That’s roughly one in five Americans.

About 12.4 million of those enrollees signed up through Obamacare’s expansion of the program to everyone with income below 138% of the federal poverty line, or roughly $17,600. That includes the able-bodied. To date, 38 states and District of Columbia have signed onto the expansion.

Many states thought expanding Medicaid would be a great deal. After all, Obamacare bound the federal government to pay 90% of the cost of covering the expansion population.

Even with that hefty assist, several states are struggling with their Medicaid tab.

For starters, many more people have signed up than the states projected. In 2017, the Foundation for Government Accountability investigated enrollment of the expansion population in 24 states as of 2015 and 2016—and found that it was more than double what the states expected.

Medicaid has long been the 800-pound gorilla in state budgets. States cover a little over one-third of the more than $600 billion the country spends on the program each year. Together, Medicaid and the related Children’s Health Insurance Program account for nearly 30% of state spending. They’re the second-largest line item in state budgets.

Every dollar that goes toward a new, able-bodied Medicaid beneficiary is a dollar that can’t go toward other state responsibilities like public safety or infrastructure.

And thanks to the pandemic-induced economic downturn, those tax dollars are harder to come by. According to a Kaiser Family Foundation survey, 17 of 19 states with budget projections for 2021 reported a Medicaid budget shortfall was “nearly certain” or “likely.”

Work requirements can help states preserve their Medicaid resources for the program’s original beneficiaries—the impoverished and disabled—by nudging the able-bodied on the path to self-sufficiency. Research from the Buckeye Institute has found that work requirements can increase lifetime earnings close to $1 million for individuals who eventually transition off Medicaid.

It’s far better for taxpayers—and would-be Medicaid beneficiaries themselves—to get insurance through their jobs or to accumulate enough income to pay for coverage on their own.

Further, by tightening eligibility for the program, work requirements can make it easy for the program’s legacy beneficiaries to secure care.

Medicaid pays doctors and hospitals less than Medicare or private insurance. So healthcare providers often limit the number of Medicaid patients they’ll see. About 70% of providers accept Medicaid, according to a national survey from 2015. Eighty-five percent accept Medicare, and 90% private insurance.

Expanding Medicaid has created additional competition for scarce appointments. That can mean legacy beneficiaries have to wait longer than they would have pre-Obamacare.

States’ limited resources—and the higher payments they receive from the federal government for expansion enrollees—can cause them to de-emphasize the needs of disabled enrollees, for whom they bear more of the cost. A study from the Foundation for Government Accountability found that nearly 250,000 disabled individuals were on waiting lists for Medicaid care as of 2016 in states that had expanded the program to able-bodied people.

Other government programs for the poor, like the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families, have employed work requirements with great success. When the Clinton administration required single parents to work or seek work to receive TANF, childhood poverty plummeted, and employment soared in the years that followed.

Medicaid was created to help the needy, not those who should be able to take care of themselves. Requiring able-bodied adults to seek employment in exchange for taxpayer-funded health insurance shouldn’t be controversial. It should be common sense.

 
 

 
 

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DHHS childhood reading program gains $3 million in federal Medicaid funding

MM Curator summary:

The NC Reach and Read program just got more funding to partner with pediatricians to encourage early childhood reading.

 
 

 
 

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.

 
 

 
 

Clipped from: https://journalnow.com/news/local/dhhs-childhood-reading-program-gains-3-million-in-federal-medicaid-funding/article_dfc922b2-4527-11eb-86d9-13970d4be00e.html

 

 
 

Richard Craver

A federal Medicaid program is providing just more than $3 million in funding for the state’s early childhood program known as Reach Out and Read.

The program will be conducted by the N.C. Department of Health and Human Services with matching funds.

DHHS said the reading initiative is one of the first in the country among state Medicaid programs.

The goal is improving literacy and language comprehension through participation from low-income children who would be eligible for Medicaid or the federal Children’s Health Insurance Program 

Meanwhile, the federal Centers for Medicare and Medicaid Services said the program has proven in other states to have improved patient-clinician relationships and well-child visit attendance.

“Expanding Reach Out and Read recognizes that children’s healthy development and early literacy are intertwined,” Dr. Mandy Cohen, the state’s health secretary, said in a statement.

“This program meets families where they are and through people they trust.”

Reach Out and Read partners with pediatric primary care locations to deliver training for medical providers, literacy tools for families, and to encourage healthy routines and relationships through shared stories.

 
 

 
 

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CMS finalizes rule for greater pricing flexibility for Medicaid drug purchases

MM Curator summary:

CMS has begun the process to define value based purchasing arrangements for drugs in the Medicaid program, with a focus on the value delivered by a drug to the individual patient. One key change to regs is to allow manufacturers the ability to report multiple best prices.

 
 

 
 

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.

 
 

 
 

Clipped from: https://www.benefitspro.com/2020/12/23/cms-finalizes-rule-for-greater-pricing-flexibility-for-medicaid-drug-purchases/

New value-based pricing approaches could save up to $228 million in federal and state dollars through 2025.

 
 

 
 

The final rule codifies a broad definition of VBP, which can better align pricing and payment to observed or expected evidence and/or outcomes-based measures in a targeted population. (Image: Shutterstock)

States, private payers and manufacturers now have more flexibility to enter into value-based purchasing (VBP) arrangements for prescription drugs under Medicaid. The Centers for Medicare & Medicaid Services on Monday finalized regulatory changes to modernize Medicaid prescription drug purchasing and drive payment innovation.

“Rules on prescription drug rebates and related reporting requirements have not been updated in thirty years and are thwarting innovative payment models in the private sector,” CMS Administrator Seema Verma said. “Medicaid’s outdated rules have consistently stymied the ability of payers and manufacturers to negotiate drug reimbursement methods based on the actual outcome of the treatment. A new generation of approaches to payment methods is needed to allow the market the room to adapt to these types of curative treatments while ensuring that public programs like Medicaid remain sustainable and continue to receive their statutorily required discounts.”

Related: Drug pricing legislation and the impact on self-insurers’ pharmacy spend

Under current regulations, prescription drug manufacturers face challenges accounting for VBP arrangements in their Medicaid best price reporting to CMS. This has the unintended consequence of hindering providers, insurers and prescription drug manufacturers in their efforts to develop innovative payment models for new drug therapies and other innovative treatments. Current regulations also discourage payers and manufacturers from designing new payment arrangements based on the value their product may provide.

With the new flexibilities under this final rule, manufacturers are expected to be more willing to negotiate with payers, including Medicaid, with
drug pricing being driven by the value of their drug to the individual patient.
New genetic-based treatments initially may be expensive but in the long run offer significant value to the patient and payer.

Payers will be able to negotiate prices with manufacturers for these genetic-based treatments based upon outcomes and evidence-based measures such as reduced hospitalizations, lab visits and physician office visits, ensuring that if such measures fail to support the value of a drug, the payer is not held accountable for the full price.

The final rule codifies a broad definition of VBP, which can better align pricing and payment to observed or expected evidence and/or outcomes-based measures in a targeted population. The final rule also allows manufacturers to report multiple best prices instead of a single best price when offering their VBP arrangements to all states. By making these changes, effective in January 2022, CMS hopes to encourage VBP arrangements and negotiations to help make new, innovative therapies more available to all patients. As a result, it is estimated that these new

VBP approaches could save up to $228 million in federal and state dollars through 2025. Basing payment on the effectiveness of a given therapy can foster innovation in the treatments that are most beneficial to patients, while reducing overall health-care spending and hospital visits. When payers are positioned to be stronger negotiators with drug manufacturers, Medicaid beneficiaries will benefit from better access to prescription medications.

 
 

 
 

 
 

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D.C. Medicaid contract awards violated procurement rules, judge says

MM Curator summary

A judge has ruled that the latest round of DC MCO contract awards must be re-evaluated.

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.

Clipped from: https://www.washingtonpost.com/local/dc-politics/judge-says-dc-violated-law-in-awarding-three-lucrative-medicaid-contracts/2020/12/16/4000ba38-3f41-11eb-9453-fc36ba051781_story.html

D.C. Mayor Muriel E. Bowser (D) speaks at a ceremony in November. (Bill O’Leary/The Washington Post)

The D.C. government violated procurement laws when it awarded three of its largest contracts this summer — totaling $1.5 billion for three companies to manage health care for Medicaid recipients, a D.C. Contract Appeals Board judge ruled.

The city must reassess the contracts that govern which insurance plans are available to hundreds of thousands of poor Washingtonians, Judge Nicholas A. Majett said in his order. The decision could mean tens of thousands are forced to change health plans, some for the second time in a year.

Deputy Mayor for Health and Human Services Wayne Turnage said in an interview Wednesday that he would seek a solution that would allow as many beneficiaries to keep their current health plans as possible: “The goal of the administration is to make sure that we do not have to move the beneficiaries yet again. We will do all that we can to prevent that from happening, and I believe we will be successful.”

Majett ruled that all beneficiaries may stay on their current plans through the end of September 2021.

The administration of D.C. Mayor Muriel E. Bowser (D) decided earlier this year to move a larger number of Medicaid recipients in the city onto what is known as a managed-care plan, where a private insurance company provides health insurance to Medicaid recipients.

Three providers won contracts to offer those plans: MedStar, AmeriHealth and CareFirst. Amerigroup, a company that previously provided managed-care plans for the city but lost out on this bid, challenged the decision.

Majett ruled in Amerigroup’s favor this month, with Chief Administrative Judge Marc D. Loud Sr. concurring. The Dec. 1 ruling was unsealed Tuesday.

Under District procurement law, companies that bid on city contracts are scored on a point system. Of the seven companies that bid on the Medicaid contract, according to Majett’s ruling, the three contract recipients scored the highest, followed by Amerigroup.

But Majett found that MedStar did not include information about its leadership that was supposed to be in its bid, and that the company submitted performance evaluations pertaining to two previous contracts when it should have submitted three.

MedStar should have scored lower under the law, and Amerigroup should have scored higher, Majett wrote, concluding that Amerigroup was judged more harshly than MedStar for weaknesses in its responses.

Turnage said Wednesday that the Department of Health Care Finance would respond to the ruling. Asked whether he would consider keeping just two providers, AmeriHealth and CareFirst, given the judge’s finding that MedStar was unfairly ranked, Turnage said, “I don’t want to speak in hypotheticals.”

The lucrative Medicaid contracts have been overturned in similar fashion before, most recently in 2017.

 
 

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2020 MACStats Released by MACPAC

MM Curator summary

   
 

The first MacPac data book with T-MSIS data is now available.

   
 

   
 

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.

   
 

   
 

   
 

Clipped from: https://www.jdsupra.com/legalnews/2020-macstats-released-by-macpac-51897/

   
 

On December 16, 2020, the Medicaid and CHIP Payment and Access Commission (MACPAC) released its annual MACStats: Medicaid and CHIP Data Book for 2020.  This document contains a wealth of information about the Medicaid and CHIP programs and it is the primary source of information about these two important public health insurance programs.  You can access MACStats here.

This is the first MACStats to derive information from the Transformed Medicaid Statistical Information System (T-MSIS).  CMS has worked with states for many years to transform the prior Medicaid Statistical Information System.  The new data set contains enhanced information about Medicaid eligibility; beneficiary and provider enrollment; service utilization; claims and managed care data; and expenditure data for the two programs.  As CMS noted in March of 2019, “access to high-quality, timely data is essential for ensuring robust monitoring and oversight of the Medicaid and CHIP programs.”  The T-MSIS data set contains that quality and timely data.

Want to know how many people were ever enrolled in Medicaid or CHIP in 2018?  The answer is 96.1 million, or 29.3% of the U.S. population (see Exhibit 1, page 3).  Want to know how much Florida Medicaid spent on disproportionate share hospital payments in 2019?  The answer is $236.8 million (see Exhibit 24, page 63).  Want to know how much the state of Maine spent on Medicaid benefits in 2019?  The answer is $2.9 billion (See Exhibit 23, page 60).  Want to know how much Massachusetts received in § 1115 waiver payments in 2019?  The answer is $831.2 million (see Exhibit 24, page 63).  Ever wondered what percentage of Wyoming residents receive their Medicaid benefits through managed care?  The answer is a minuscule 0.2%, as opposed to Tennessee’s 91.8%.  (see Exhibit 29, page 78).

All this and more is available in MACPAC’s helpful, detailed and thoughtful analysis of the Medicaid an CHIP programs.  The MACStats guidebook is a key data source for those who care about these important public health programs.