Tag: State News

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LA- Mental health providers frustrated with state’s Medicaid managed care organizations

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Results of a recent survey of providers show that they are not happy with the state’s mental health benefit administrators.

 
 

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 recent survey of mental health providers found dissatisfaction with several of the organizations the state uses to manage Medicaid services.

The report, released this month, comes as the state prepares to choose a new set of managed care organizations. The multibillion-dollar contracts account for about 25% of Louisiana’s annual operating budget and cover health care for one-third of Louisiana’s residents, according to The Associated Press. They allow private companies to oversee health care services for about 90% of Louisiana’s Medicaid enrollees, mostly adults covered by Medicaid expansion, pregnant women and children.

Magellan Health, which focuses on behavioral health, received an A- on the Louisiana Rural Mental Health Alliance’s report card, but no other MCO graded higher than a C+, which was the overall grade for Louisiana Healthcare Connections and United Healthcare Community Plan. Aetna and AmeriHealth Caritas Louisiana both received a C- and Healthy Blue received a D. 

The report card is the result of an association-wide provider satisfaction survey seeking to compare how the current Medicaid managed care organizations are performing with their network community mental health providers.

Responses to the Louisiana Department of Health’s request for proposals for MCOs was due Sept. 3, according to the department’s website. Secretary Courtney Phillips announced last year that she would restart the Medicaid managed care contractor search rather than continue a yearlong legal fight over the deals her predecessor approved.

 
 

Clipped from: https://www.businessreport.com/business/mental-health-providers-frustrated-with-states-medicaid-managed-care-organizations

 
 


 

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Home care in Ohio to see federal, state funding increases

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Home health providers will get rate increases for a 2nd 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.

 
 

 
 

For a very long time, as costs and understaffing increased, home and community-based services in Ohio pleaded with state lawmakers and governors to give them more Medicaid money to no avail.

Under Gov. Mike DeWine, the industry – adult day care, assisted living, home care and others offering less intensive alternatives to nursing homes – is finally seeing the needle moved.

“I want to give credit to the administration and to the General Assembly, because finally we have broken that cycle,” said Pete Van Runkle, head of the Ohio Health Care Association. “There was a 10-plus year cycle of no increases in assisted living reimbursement. Same was true with home care.”

Beginning in November, providers will see Medicaid reimbursement rate increases – albeit still not enough – for the second budget cycle in a row.

And with the COVID-19 pandemic worsening existing issues while highlighting more need for home-based care, significant federal COVID-19 relief funding is on its way. 

On the state level

Advocates say that aging in home is significantly less expensive and more accessible for disabled Ohioans, and safer than a skilled nursing facility, despite a history of fraud.

The average cost of care for in-home services can be $1,225 per month, said Beth Kowalczyk, policy officer for the Ohio Association of Area Agencies on Aging. Nursing facility care is estimated to cost $6,361 per month.

Yet for many years, Medicaid reimbursement for home-based care has not come close to meeting the actual costs, groups have said. A nursing visit that costs $95 on average is reimbursed at $54, said Lisa Von Lehmden Zidek, with the Visiting Nurse Association of Ohio.

The gap widened more when the pandemic increased costs and wages.

“The other home care agencies are simply not accepting Medicaid patients. They’re not taking on the financial loss,” Zidek told lawmakers last week. “Only the agencies that will take Medicaid are getting flooded with even more Medicaid referrals.” 

People have to be turned away, leading to more stress on nursing facilities where COVID-19 issues for congregate settings are well known, say home health care advocates. Those on Medicaid, who are low-income or disabled and stand the most to benefit from at-home care, lose out.

Long-term trends estimating a greater share of Medicaid folks to receive in-home care instead of in a facility are only adding to the pressure.

Almost 200,000 Ohioans on Medicaid are enrolled in a home and community-based services program as of June, per state data. Upwards of 60% of individuals with Medicaid coverage are choosing home and community-based settings. 

Increases in reimbursement rates can make a dent into that cycle. In 2019, Ohio committed to giving 3.25% increases for just two home-health programs as well as some more money to the direct care workforce.   

This year, all home and community-based health programs are set to see a 6.1% increase in rates in November. That’s estimated to be more than $57 million coming in, with at least $20 million of that from the state, according to the Legislative Budget Office. 

But to really address the issue, it’ll take more than continually increasing reimbursement rates, said Joe Russell, executive director of the Ohio Council for Home Care and Hospice. He’s advocating that care underMedicaid gets paid more like Medicare is in the state.

Medicaid reimburses on a “fee for service” model. If a direct care nurse visits a home for just 15 minutes, for instance, the home care agency gets reimbursed lower than if the nurse had visited for 45 minutes.

Under Medicare’s “pay per visit” model, the amount is the same no matter the length of the visit. That gives a lot more flexibility for home care providers, said Russell.

“Tracking the amount of time a nurse is visiting is a regulatory burden,” he said. “It costs the same amount of money to send a nurse no matter the length of the visit.”

Federal help

The federal government, recognizing the importance of home care in light of the COVID-19 pandemic, is also beefing up cash to the sector through the American Rescue Plan Act.

The temporary 10% bump in the federal share of Medicaid funding for home and community-based health care means that Ohio will get a total of $460 million between April of this year and March of 2022.   

The state has until March 2024 to use that additional money to make changes to the home-health system. While one-time, immediate needs from the coronavirus will be considered, the goal is to pinpoint more sustainable, long-term investments, Ohio Department of Medicaid Director Maureen Corcoran told lawmakers.

Providers in home care are eyeing the federal money and have already submitted feedback to the department on how to use that funding.

While most are looking at using money from increased reimbursement rates to help agencies make ends meet, they want to dedicate much of the federal aid to improve wages and work conditions for direct care workers, said Jordan Ballinger, policy director for Disability Rights Ohio, part of the Ohio HCBS Coalition.

“They’re making $12 an hour and Ohio’s estimated $13 an hour is what meets basic needs,” he said. “I think we should go above and beyond basic needs for these direct care workers.”

Workforce development is also another big priority, with issues exacerbated by the pandemic. Videk said since the beginning of 2020, around half of visiting nurses have left.

She told lawmakers she was thinking of hopefully using some of the federal money to create a program targeting students to thinking about becoming at-home providers, paired with tuition reimbursement.

“If we have a stream of employees coming through the organization that are basically raised by our organization, four years out from now I don’t believe we’re going to have the shortage that we have,” she said.

The Medicaid department released a vague, initial plan in June that outlined eight categories for potential projects, from workforce development to telehealth. The agency is in the process of incorporating feedback to create a more detailed plan.

Even with all the anticipated financial help, problems plaguing home health care are likely here to stay for now.

“Over the past 10 years, we have shifted from a crisis in this workforce and provider rates to really an emergency,” said Ballinger. “We’re going to continue to take hits on our HCBS system.” 

Titus Wu is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.

 
 

Clipped from: https://www.cincinnati.com/story/news/healthcare/2021/09/30/home-care-ohio-see-fmap-arpa-medicaid-reimbursement-hcbs-waivers-disability-covid-19/5833726001/

 
 

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CO- Medicaid fails to provide reliable non-emergency medical transportation, state report finds

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The state’s Medicaid agency failed to report 32 incidents related to the safety of elderly Medicaid members during rides Medicaid paid for.

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.

Audit: 32 acts of potential mistreatment of at-risk Colorado adults were never reported

(Getty Images)

The state department that administers Colorado’s Medicaid program failed to provide proper oversight of its contracted transportation service, and didn’t report incidents that could have involved mistreatment of at-risk adults, according to audit results published Monday.

Some of the 32 unreported incidents potentially involved drivers “not safely securing (Medicaid) recipients into vehicles, resulting in recipients falling out of their seats,” Stefanie Winzeler, team leader at the state auditor’s office, told state lawmakers on the Legislative Audit Committee. “This could be caretaker neglect due to the provider not securing or providing adequate physical care to the recipient.”

The Department of Health Care Policy and Financing administers Colorado’s Medicaid program, which provides health care coverage to 1.5 million low-income people and people with disabilities. The state is required to provide non-emergent medical transportation, or NEMT, to Medicaid recipients who need help getting to their scheduled appointments. The federal government reimburses Colorado 50 cents for every $1 the state spends on NEMT services.

From July 2020 to August 2021, the department contracted with the broker IntelliRide to run the NEMT program statewide. This included coordinating transportation for Medicaid recipients, paying transportation providers, and billing the department for reimbursement, according to the audit report released Monday. IntelliRide, which is part of the global public transportation company Transdev, was paid $2.9 million to administer the program.

After each of the 32 instances of potential passenger mistreatment, the health care policy department should have reported what happened to Adult Protective Services or law enforcement, according to the audit report. All of the incidents occurred during the audit period of July 2020 to February 2021 when IntelliRide was the statewide contractor.

Some incidents involved injuries, Winzeler told lawmakers, and some involved a driver speeding or running red lights with the Medicaid recipient in the vehicle — which “could also be considered caretaker neglect if the caretaker created a hostile or fearful environment,” Winzeler said.

During the audit period, 35,423 Coloradans covered by Medicaid received approximately 640,500 non-emergency rides to medical appointments, for a monthly average of 80,100 rides.

“Unfortunately, it was not surprising, but really concerning,” Julie Reiskin, executive director of the Colorado Cross-Disability Coalition, said of the unreported incidents of potential mistreatment. Reiskin, who uses a wheelchair and has spent years advocating for people with disabilities, said that most of the transportation-related safety concerns she hears involve cab drivers.

Reiskin believes having more people at the health care policy department help to oversee the NEMT program could have helped with that issue. “Given everything, (the staff member) did a great job, but they had one person doing this for the whole state,” she said. The department has since assigned another full-time equivalent staff member to NEMT, according to the audit report.

For people mistreated by someone driving them to an appointment, Reiskin recommends filing a complaint with Medicaid as well as with the Public Utilities Commission, if the driver worked for a cab company. They should also involve an outside advocate such as the Cross-Disability Coalition or Disability Law Colorado, she said.

The attorney general’s office also takes complaints about abuse, neglect and exploitation through its Medicaid Fraud Control Unit.

Millions paid for ‘noncompliant claims’

The department paid IntelliRide $33.2 million to reimburse it for transportation services provided during the audit period. But auditors found that $291,600 of that money went to pay claims “that did not comply with federal and state requirements.” Some claims that IntelliRide submitted for reimbursement, and which the department paid, did not include details supporting that the rides were actually provided, while other claims were overpaid, and some claims requested reimbursement for rides that didn’t take people to medical appointments.

Another $5.18 million — approximately 16% of what the Department of Health Care Policy and Financing paid IntelliRide for services during the audit period — went to “potentially noncompliant” claims, such as taxi rides that may have been reimbursed at the wrong rates, according to the report.

Meanwhile, many Medicaid recipients who raised concerns about IntelliRide were essentially ignored.

More than two-thirds of the complaints Medicaid recipients filed with IntelliRide about the medical transportation service were not resolved, the audit found, including 75 complaints about health or safety risks that IntelliRide never investigated or reported to the department.

“The report was just released this morning and we are still in the process (of) reviewing all items very carefully,” Mitun Seguin, vice president of marketing and communications for IntelliRide, told Newsline in a Monday email. “From a high level, we agree with the findings and have already been taking corrective actions on many of these items already. We have also been seeing good progress in several areas. We take all feedback very seriously and will be ensuring corrective action in all the areas of concern.”

Changes to non-emergency transportation

As of this month, IntelliRide is no longer the statewide NEMT administrator. The Department of Health Care Policy and Financing moved to have IntelliRide administer NEMT for just nine Front Range counties — Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Jefferson, Larimer and Weld — while Medicaid recipients in the remaining 55 counties must contact transportation providers directly to schedule appointments.

“By moving to this hybrid model, we received some positive initial feedback from advocates and stakeholders,” Kim Bimestefer, director of the department, told lawmakers during the Monday hearing.

Reiskin agreed the new model might be for the best.

“When you build these statewide contracts, they often don’t work well in rural areas,” Reiskin said. She pointed out that coordinating medical transportation in smaller communities requires building relationships with providers, including those that may not necessarily be technologically savvy.

But the real problem, according to Reiskin, is that there are areas of the state that don’t have any transportation providers.

“I think telemedicine is helping to some extent with that,” she said, adding that in-person visits are sometimes necessary.

Medicaid should also make sure that people who need to travel long distances to appointments receive adequate funds to cover food and lodging, Reiskin said.

“So you have a critically ill child and you’re having to already take time off work — you know, most of these folks are paid hourly — it would be nice to at least give them enough to stay somewhere safe and eat while they’re with their child,” she explained.

The department agreed with how auditors said it should improve NEMT services, and said it would make the recommended changes. Those included:

  • Implement information technology to pay medical transportation claims in line with state and federal Medicaid requirements, improve documentation of services, recover payments for claims that did not comply with requirements, and investigate potentially noncompliant claims.
  • Ensure the NEMT contractor meets requirements for reliable transportation and customer service, and establish a process to assess Medicaid recipients’ satisfaction with their transportation services.
  • Ensure the medical transportation contractor pays local providers accurately, and that it “tracks, resolves, and reports complaints and incidents.”
  • Report incidents of potential neglect or mistreatment of at-risk adults to law enforcement and Adult Protective Services.

Clipped from: https://coloradonewsline.com/2021/09/29/medicaid-audit-non-emergency-medical-transportation/

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Oregon Health Authority Wants Millions From Feds For Equity Spending

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The state has submitted a waiver to address SDH, and is asking for a shared-savings component from 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.

 
 

 
 

Oregon Health Authority officials plan to ask the federal government for millions in funding that will allow communities to determine their unique needs and priorities related to health equity, as part of their next Medicaid application. 

 Potential areas of investment include workforce needs, green spaces or programs to help people obtain housing, but could vary after community input.

The Medicaid application, called a waiver, reflects the authority’s overall goal to make health care equitable for all Oregonians by 2030. As part of that focus, the state wants to address social determinants that can influence a person’s overall health, such as their access to housing, food and social programs.

To accomplish those goals, Oregon hopes the federal government will recognize the state’s efforts to rein-in growth of its health care costs. Oregon officials will ask federal Centers for Medicare & Medicaid Services to calculate the federal government’s estimated savings due to Oregon’s 2019 law that caps the per capita growth of health care at 3.4% annually. 

At this point, it’s unclear how much money that may generate for Oregon. State and federal officials would need to negotiate those terms. However, Oregon officials project $16 billion in state, federal and private savings during the next six years due to the state’s Sustainable Health Care Cost Growth Target Program, which started due to the passage of Senate Bill 889 in 2019.

“Oregon plans to ask the federal government to share those savings back with us so that the state can invest it into communities affected by health inequities,” the concept paper says, though the potential negotiated amount is unknown.

Lori Coyner, the authority’s senior Medicaid policy advisor, said: “We plan to ask for shared savings from the federal government to further invest in addressing health equity, but the exact amount has not been determined. We anticipate a significant ask, but it would not run into the billions of dollars.”

That’s a key piece of the concepts behind Oregon’s Medicaid waiver application, which is essentially a five-year plan. The waiver application process lets states seek flexibility from the federal government for how they tailor Medicaid. To succeed, Oregon’s waiver application must  win approval from the Centers for Medicare & Medicaid Services before its current waiver expires on June 30, 2022.

The waiver system establishes health care policy for the more than 30% of Oregonians who are covered by Medicaid, or about 1.4 million people. Oregon’s past Medicaid waiver applications have led to substantial changes. In 2012, Oregon’s waiver allowed the state to set up coordinated care organizations.

Oregon Health Authority officials plan to send the application to federal officials in early 2022. That’s a little later than the state’s earlier target of December. But it’s still enough time for state and federal officials to negotiate the details. 

In early November, the state will release its final concept papers and accept more public input. The authority released draft concepts earlier this year.

The state will release a more detailed draft application in December and accept feedback for a 30-day comment period before sending the document to the federal government.

“While this new timeline is slightly delayed from our original ambitious plan, it reflects the reality of incorporating the important feedback we’ve received so far, as well as our commitment to ensuring non-waiver feedback is routed to right programs for consideration,” Jeremy Vandehey, Health Policy and Analytics director, and Coyner, the senior Medicaid policy advisor, wrote in an email about the timeline. 

Coordinated care organizations, which contract with Oregon as Medicaid insurers, are part of the plan. Oregon officials want CCOs to have more flexibility to spend money on equity-related health measures that may not necessarily be direct health care a patient receives in a clinic or hospital. This means that CCOs would be able to spend 3% of their global budgets on equity-related items. Currently, CCOs have less flexibility and can only spend on those items out of administrative budgets.

“The goal is to give CCOs the ability to continue meeting members’ needs around social determinants of health,” Coyner said in an interview, adding that community voice and input would be key. 

That means there would be a lead entity from the community and a strong community input in the process, Coyner said.

 “Those could be things like building green space for folks to have access to outdoors,” Coyner said. “It could be developing clinics or some kind of social programs that happen right in the community.”

There are limits to the funding, however. While housing support programs could be one option, the health authority will not build new housing complexes. 

If more funding comes Oregon’s way through the waiver, it will be awhile before Oregon communities will see it. Most likely, that wouldn’t happen until at least 2023. 

It could also require changes to CCO contracts, a separate process that would spell out the funding process.

Other preliminary concepts in the waiver application include increasing the number of Oregonians with health insurance, which is currently about 94% and boosting access to care. 

You can reach Ben Botkin at ben@thelundreport.org or via Twitter @BenBotkin1.

Clipped from: https://www.thelundreport.org/content/oregon-health-authority-wants-millions-feds-equity-spending

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FL- Medicaid waitlist remains long after $95 million infusion

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The DD HCBS waiting list will remain after a near-$100M cash infusion 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.

 
 

 
 

More than 22,000 people with intellectual and developmental disabilities are on a waiting list for Medicaid services, budget documents show. That’s despite lawmakers targeting $95 million in additional funding this past spring to reduce the backlog.

Florida Agency for Persons with Disabilities Director of Budget Planning and Administration Rose Salinas told members of a House health care spending panel Monday the agency has sent 621 “offers” to people on the waitlist for the Medicaid waiver program called IBudget. An additional 252 offers to people on the waitlist will be sent Oct. 8.

Salinas could not say how many of the 621 people the state notified were enrolled in the iBudget waiver program.

In addition to those offers, Salinas also said the agency, on average, enrolls about 100 people with intellectual or developmental disabilities who are considered “at-risk” in the iBudget program.

iBudget is a Medicaid waiver program that allows people with intellectual and developmental disabilities to receive home and community-based services they require to keep them out of institutions and in the community.

 
 

Medicaid doesn’t traditionally cover home and community-based services people with intellectual and developmental disabilities might require, such as assistance with daily living activities like bathing, dressing and eating. Medicaid does cover more expensive institutional care, though.

Several of the committee members pressed Salinas about reimbursement rates the state pays iBudget support coordinators.

APD was one of three agencies to appear before the committee to discuss legislative budget requests. Governors consider legislative budget requests, or LBRs, as they develop the proposed budget to submit to the Florida Legislature for consideration.

The House Health Care Appropriations Committee panel also heard from Department of Elder Affairs Secretary Richard Prudom, who outlined an austere LBR that includes a $1.4 million request to upgrade information technology and another nearly $505,000 to enhance its Office of Professional Guardians.

The Department of Elder Affairs also proposes in its LBR to transfer the $33.8 million Program for All Care for the Elderly to the state Agency for Health Care Administration.

 
 

Prudom noted the “modest” LBR request was made possible by a $235 million-plus bump in federal funding from the American Rescue Plan.

Prudom said his department is getting $106.7 million to invest in nutrition programs and develop strategies to improve access to mental health services. The department will get another $128 million from the federal government after Congress agreed to increase federal Medicaid funding for home- and community-based services, also from the American Rescue Plan.

Prudom noted the agency is asking the Legislature for authority to hire a Deputy Secretary. Asked by Committee Chair Rep. Bryan Avila whether the agency could spread the work a deputy secretary would take across existing positions, Prudom said no.

“We’re a pretty lean agency,” Prudom said.

The panel also heard from the Department of Veterans Affairs. Among other things, that department is requesting $1.4 million in general revenue to beef up pay for nurses at veteran facilities and another $13.8 million to increase its contracting budget.

The panel will hear from other health-care-related agencies next month, including the Agency for Health Care Administration, the Department of Health, and the Department of Children and Families.

Clipped from: https://floridapolitics.com/archives/458900-medicaid-waitlist-remains-long-after-95-million-infusion/

 
 

 
 

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Indiana Medicaid Announces New Reimbursement for COVID-19 Ready Nursing Facilities

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Nursing homes will be paid more to keep COVID-positive residents at their own facilities.

 
 

 
 

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.

 
 

Sept. 21 Update:  This article has been updated with new information about the effective date of the reimbursement for COVID-19 Ready Nursing Facilities.

 
 

On the afternoon of September 20, 2021, Indiana Medicaid released a new policy increasing reimbursement for COVID-19 Ready nursing facilities.  The policy is in response to the need to ease the growing stresses on the state’s hospital capacity by helping nursing facilities offset the growing and large costs for operating COVID-19 units.  The effective dates for qualifying providers are dates of services between September 20, 2021 and October 16, 2021.  Facilities submitting an attestation form in the month of September will have reimbursements begin back to September 20, 2021.  Facilities that submit attestations on October 1, 2021 or after will have reimbursements start the date of the submission of the attestation.

The temporary increases are 4% per patient day (all Medicaid patients in the facility) for facilities that attest to being COVID-19 Ready and an additional $230 per COVID-19 positive resident.

Qualifying as a COVID-19 Ready Facility

Each nursing facility desiring to become COVID-19 Ready must follow and attest to the below Indiana Department of Health (IDOH) COVID-19 Ready requirements.  The COVID-19 Ready Attestation Statement is linked below.

  • Follow IDOH COVID-19 Long-Term Care (LTC) Standard Operating Procedures and IDOH COVID-19 Infection Prevention (IP) Toolkit, located on the Professional Resources page at coronavirus.in.gov.
  • Follow IDOH LTC hospital transfer guidance or have developed a mutually agreed upon plan with local hospitals for admission and readmission of COVID-19 patients.
  • Follow IDOH, Centers for Medicare & Medicaid Services (CMS), and Centers for Disease Control and Prevention (CDC) communication guidelines.
  • Accept COVID-19 new admissions, readmissions and transfers.
  • Share complete COVID-19 status information with transportation providers serving residents.
  • Follow IDOH, CMS and CDC reporting requirements for new COVID-19 cases and deaths involving residents and staff.
  • Provide daily updates of COVID-19 bed capacity and changes in admission status (for example, admissions hold) in the EMResource system at emresource.juvare.com.

 
 

  • When making the first entry, enter the facility’s current admissions status and capacity.

Attestation Process

  • Facilities must complete the COVID-19 Ready Attestation Statement to Derris Harrison at Derris.Harrison@fssa.in.gov
    and
  • Update their COVID-19 Ready status in EMResource.  The facility must enter “yes” in the LTC COVID Ready Facility Status Column.

 COVID-19 Resident Reimbursement

To obtain the temporary $230 per resident daily add-on, up to 21 days, a facility must:

  • Submit the COVID-19 Ready Attestation Statement to Derris Harrison at Derris.Harrison@fssa.in.gov; and
  • Bill claims for COVID-19 positive residents with the primary diagnosis code of U07.1 – COVID-19 positive.

Nursing facilities will be paid the temporary add-on for the full 21-days when the following are true:

  • The resident is in a COVID-19 Ready facility.
  • The resident is COVID-19 positive between Sept. 20, 2021, and Oct. 16, 2021.
  • Claims had U07.1 as the primary diagnosis.
  • The resident was not discharged prior to the 21 days for any reason, including death, transfer to another facility or being sent home.

 
 

 
 

Clipped from: https://www.ihca.org/resource/indiana-medicaid-announces-new-reimbursement-for-covid-19-ready-nursing-facilities/

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Civil rights groups file complaint over DC Medicaid dispute

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Advocates are framing MedStar’s tactics as a health equity issue.

 
 

 
 

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.

 
 

Advocates for D.C.’s Medicaid recipients have filed a complaint with the U.S. Department of Health and Human Services over threatened changes to the D.C. Medicaid program.

The groups, including the D.C. branch of the NAACP and the Health Alliance Network, a community organization devoted to health equity, have written to the HHS Office for Civil Rights, complaining that the health of the city’s Medicaid recipients is imperiled by MedStar Health’s dispute with the District government over its Medicaid contract.

The groups pointed to an Aug. 20 letter penned by the D.C. Department of Health Care Finance to the D.C. Council Committee on Health, which said that MedStar Health intends to terminate its contracts with AmeriHealth Caritas DC and CareFirst Blue Cross Blue Shield, two Medicaid managed health care programs operating in the District.

MedStar, which operates two of the city’s largest hospitals, MedStar Washington Hospital Center and MedStar Georgetown University Hospital, has been in a long-standing dispute with the D.C. government over the Medicaid managed care contract of its subsidiary, MedStar Family Choice.

The D.C. Contract Appeals Board ruled last December against MedStar Family Choice’s Medicaid contract with the city. Mayor Muriel Bowser issued an emergency order this month extending that contract and the other two, despite the CAB ruling. But with contracts set to expire at the end of the month, the D.C. Council passed a resolution disapproving of the mayor’s emergency order extending the contracts.

The civil rights and advocacy groups speaking out against MedStar’s threat to end Medicaid contracts with the two insurance companies that provide Medicaid health coverage to the city’s poor.

“MedStar’s actions jeopardize the lives, the health and the safety of over 200 thousand vulnerable DC residents on Medicaid, A majority of whom are “Black and Brown people,” said NAACP D.C. branch president Ali Akosua.

The D.C. Department of Health Care Finance said the action would threaten access to care for as many as 230,000 District residents.

“MedStar Health is using its market share leverage to bully the District into contract renegotiations and threatened to raise the discount pricing they have made to other managed care organizations, jeopardizing the health, well-being and health services access for hundreds of thousands of Black and Brown residents,” said Ambrose Lane, chairman of the Health Alliance Network.

In a statement to WTOP, spokeswoman Marianne Worley said MedStar Health has an unwavering history of caring for all patients in D.C. and its intent has never been to cancel contracts and leave the District’s most vulnerable residents without care.

“MedStar Health’s notifications to the other two Managed Care Organizations (MCOs) in the Medicaid Managed Care program were intended to prompt renegotiation of the existing provider agreements,” Worley said. “Such notices are a routine way to initiate negotiations and occur across our industry as a normal part of how healthcare is delivered and financed.”

With the mayor and the D.C. Council at odds over the Medicaid contracts, the D.C. Department of Health Care Finance warned that if the current contracts between the health plans and MedStar expire Sept. 30, D.C. Medicaid patients will be left without access to MedStar hospitals, clinics, rehabilitation facilities and a network of physicians.

 
 

Clipped from: https://wtop.com/dc/2021/09/civil-rights-groups-file-complaint-over-dc-medicaid-dispute/

 
 

 
 

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New Hampshire Extends Partnership with Conduent to Maintain, Operate and Enhance Medicaid

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Conduent (nee Xerox, nee ACS) continues its now 16-year contract for the huge MMS contract in NH.

 
 

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.

 
 

Company will continue to support Medicaid beneficiaries and providers with a range of services including online enrollment, eligibility verification and claims processing

Conduent will also upgrade technical capabilities of the Medicaid system to increase security and processing speed and provide cost efficiencies

FLORHAM PARK, N.J., Sept. 09, 2021 (GLOBE NEWSWIRE) — Conduent Incorporated (Nasdaq: CNDT), a business process services and solutions company, today announced it has extended its partnership with the New Hampshire Department of Health and Human Services (NH DHHS), serving as the exclusive provider of services to modernize the state’s Medicaid Management Information System (MMIS). Conduent will provide maintenance, operations and enhancements that support NH DHHS’s ability to serve approximately 220,000 beneficiaries and process more than 15 million claims annually.

In addition, the company will upgrade the state’s MMIS to a virtualized environment, while increasing system security, reliability, scalability, and performance. 

Since 2005, Conduent has provided solutions to the NH DHHS to enhance the effectiveness, coordination and delivery of numerous initiatives that embody the agency’s mission to facilitate whole-person care. The company will continue to serve as fiscal agent for the state’s Medicaid program, providing online enrollment, eligibility verification and claims processing to help 30,000 providers meet the medical, behavioral and social needs of people across New Hampshire.

“This award demonstrates our strong MMIS expertise, and the trust NH DHHS has placed in us to help the state move its Medicaid program forward for the future,” said Pat Costa, President, Government Healthcare Solutions at Conduent. “Our team is committed to the department’s effort to bring about new technologies and efficiencies that will ultimately benefit providers and beneficiaries across New Hampshire.”

The contract renewal for MMIS maintenance, operations and enhancements, which is valued at approximately $206 million, includes a five-year base term plus a five-year option to extend until 2031.

Earlier this year, Conduent announced a related contract to help the state comply with the federal Interoperability and Patient Access Final Rule. That project provides Medicaid beneficiaries with improved, secure access to their personal health information, enabling them to make more informed healthcare decisions.

With 50 years of experience in the government health and social services industry, Conduent supports more than 41 million customers annually with various government health programs and other eligibility services. For Medicaid, Conduent supports systems in 23 states, Puerto Rico and Washington, D.C., and it has facilitated federal MMIS certifications in 14 states.

About Conduent Conduent delivers mission-critical services and solutions on behalf of businesses and governments – creating exceptional outcomes for its clients and the millions of people who count on them. Through process, technology, and our diverse and dedicated associates, Conduent solutions and services automate workflows, improve efficiencies, reduce costs, and enable revenue growth. It’s why most Fortune 100 companies and over 500 government entities depend on Conduent every day to manage their essential interactions and move their operations forward.

Conduent’s differentiated services and solutions improve experiences for millions of people every day, including three out of every four U.S. insured patients, 10 million employees who use its HR Services, and nearly 18 million benefits recipients. Conduent’s solutions deliver exceptional outcomes for its clients, including $16 billion in savings from medical bill review of workers compensation claims, up to 40% efficiency increase in HR operations, up to 27% reduction in government benefits costs, up to 40% improvement in finance, accounting and procurement expense, and improved customer service interaction times by up to 20% with higher end-user satisfaction. Learn more at https://www.conduent.com.

Media Contacts: Sharon Lakes, Conduent, +1-214-592-7637, sharon.lakes2@conduent.com

Investor Relations Contact: Giles Goodburn, Conduent, +1-203-216-3546, ir@conduent.com

Note: To receive RSS news feeds, visit www.news.conduent.com. For open commentary, industry perspectives, and views, visit http://twitter.com/Conduent, http://www.linkedin.com/company/conduent or http://www.facebook.com/Conduent.

Trademarks Conduent is a trademark of Conduent Incorporated in the United States and/or other countries. Other names may be trademarks of their respective owners.

 
 

Clipped from: https://www.bakersfield.com/ap/news/new-hampshire-extends-partnership-with-conduent-to-maintain-operate-and-enhance-medicaid/article_9e52249b-50c0-586f-b2a2-95a32707b1f8.html

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Governor Lamont Announces Public-Private Initiative to Address Homelessness and Chronic Health Problems

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CT has gotten federal approval to use Medicaid dollars to coordinate services for 150 homeless members, including housing services.

 
 

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.

 
 

 
 

09/08/2021

Connecticut Among First States to Connect Medicaid and Housing Services

(HARTFORD, CT) – Governor Ned Lamont today announced that his administration has received federal approval to combine Medicaid health coverage with a range of housing services for Connecticut residents struggling with homelessness and chronic health issues.

The ‘CHESS’ initiative – short for Connecticut Housing Engagement and Support Services – will pool the efforts of state agencies and nonprofit partners to bring coordinated healthcare and housing support to individuals with mental health, substance use, and other serious health conditions.

“For the first time, the resources of Connecticut’s nationally-recognized Medicaid program will reinforce our ongoing initiatives in the areas of housing and homelessness prevention,” said Governor Lamont. “Also known as the HUSKY Health program, Medicaid will add a crucial dimension to our ability to not only stabilize a person’s housing situation, but to really improve the quality of his or her health and life. The CHESS initiative also reflects my direction to find ways to best coordinate expertise and services across our health and human services agencies.”

Connecticut Medicaid’s CHESS benefit is one of the first of its kind to receive federal approval, joining Arkansas, California, Minnesota, and North Dakota. It will combine the Coordinated Access Network and housing subsidy programs administered by the Connecticut Department of Housing; supportive housing programs administered by the Connecticut Department of Mental Health and Addition Services; and the Money Follows the Person program administered by the Connecticut Department of Social Services (the state agency administering Medicaid).

CHESS is aimed at managing the difficulties that are often part of homelessness, including access to health care and handling chronic health issues, with the overall goal of promoting health and well-being by coordinating targeted healthcare with housing.

“Simply put, we know that housing instability and serious health issues are often related,” said Department of Social Services Commissioner Deidre Gifford, who also serves as senior advisor to the governor for health and human services. “The new Medicaid benefit offers a flexible package of services to help people find and maintain housing, and to coordinate medical and behavioral health services, chronic disease management and wellness education. With CHESS, our public-private partnership aims to reduce homelessness and unnecessary hospitalizations, while making lasting improvements in the lives of some of our most vulnerable residents. The COVID-19 pandemic has also taught us more about the close relationship between safe, stable housing and health.”

Housing subsidies for CHESS enrollees, administered by the Department of Housing, will be prioritized for applicants who meet the Medicaid program requirements and are subject to separate eligibility requirements.

“We are proud to participate in this collaborative effort,” said Department of Housing Commissioner Seila Mosquera-Bruno. “Our goal is to reduce and end homelessness in Connecticut. The CHESS program contributes additional resources to our homeless service system, allowing it to provide the necessary supportive services to vulnerable residents and to maintain stable housing in our communities.”

“Nonprofit supportive housing providers across Connecticut have a tremendous amount of knowledge and years of experience serving people with complex needs and long histories of housing instability,” said Department of Mental Health and Addiction Services Acting Commissioner Nancy Navarretta. “I’m confident that the evidence-based supportive housing model that will be available to CHESS participants will contribute to our collaborative efforts to make homelessness rare, brief, and one time.”

“The recent federal approval of Connecticut’s innovative CHESS Medicaid benefit will lay the groundwork for deeper engagement with our healthcare system partners in efforts to end homelessness in our state,” said Sonya Jelks, Connecticut Director for the Corporation for Supportive Housing. “This trailblazing approach, one of the first in the nation, will provide a new and sustainable source of funding for the critical support services that are key to successfully supporting persons who experience chronic homelessness. The Corporation for Supportive Housing is proud to have been a partner in developing and designing the CHESS approach and looks forward to continuing to collaborate to build on Connecticut’s success with supportive housing – linking services, including housing provisions and healthcare, to permanent housing solutions.”

With federal approval to use Medicaid funding for CHESS, the Department of Social Services has opened applications at www.CTCHESSDSS.com. Application information is also available by calling 1-888-992-8637 or 2-1-1.

As a new benefit to be evaluated by the UConn Center on Aging, CHESS is currently estimated to serve 150 participants through next fiscal year. The joint state/federal initiative was designed by a collaborative of the Department of Social Services, the Department of Housing, the Department of Mental Health and Addiction Services, the Department of Developmental Services, the Connecticut Housing Finance Authority, the Corporation for Supportive Housing, the Partnership for Strong Communities, and the Connecticut Coalition to End Homelessness.

CHESS provides supportive housing benefits under Medicaid, coordinated with Medicaid services and non-Medicaid housing subsidies. Medicaid-covered housing engagement and support services include chronic disease management and wellness education, in addition to pre-tenancy supports (help with locating and securing housing); tenancy sustaining supports (help with maintaining successful tenancy); and non-emergency medical transportation. The CHESS staff will help participants apply for housing subsidy vouchers.

“We are especially proud of the strong and enthusiastic partnership that is bringing the CHESS initiative forward,” Commissioner Gifford said. “It’s built on leading-edge work in both state government and the private, nonprofit community as we focus on the so-called social determinants of health. In this case, the focus is on the vital area of housing and how lack of stability there relates to chronic disease and, alternatively, well-being.”

The Connecticut Behavioral Health Partnership, through Beacon Health Options, will provide eligibility assessment and service authorization. Federal support is provided by the Center for Medicaid and CHIP Services, part of the Department of Health and Human Services’ Centers for Medicare and Medicaid Services.

Twitter: @GovNedLamont Facebook: Office of Governor Ned Lamont

 
 

Clipped from: https://portal.ct.gov/Office-of-the-Governor/News/Press-Releases/2021/09-2021/Governor-Lamont-Announces-Public-Private-Initiative-to-Address-Homelessness

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Ohio fighting Biden’s decision to eliminate work requirement for Medicaid

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Ohio has officially resisted the current CMS effort to break its contract with the state over work requirements.

 
 

 
 

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.

 
 

 
 

Credit: SEAN GLADWELL/Moment/Getty Images

COLUMBUS, Ohio)—Ohio Governor Mike DeWine is fighting the Biden Administration’s decision to eliminate a work requirement for Medicaid.

DeWine requested on Wednesday that Ohio Attorney General Dave Yost take necessary legal action to reverse the decision.

Yost’s Office filed a notice of appeal with the Centers for Medicare and Medicaid Services (CMS).

Biden requiring federal workers, contractors to get COVID shot with no testing opt-out

“Removing a provision that says a healthy, able-bodied individual should be working, looking for work, participating in job training, or participating in a recovery program in order to receive free taxpayer-funded healthcare is contrary to Ohioans’ values,” said Governor DeWine. “Eliminating reasonable requirements discourages people from becoming self-sufficient and only reinforces government dependency. Ohio’s program would offer assistance when Ohioans need it while providing opportunities for future success.”

The Biden Administration revoked Ohio’s work requirements last month following the 2019 approval by the Trump Administration.

Members of the Ohio legislature passed a bill in 2017 requiring the state to establish work requirements for the Medicaid expansion population.

 
 

Clipped from: https://www.wytv.com/news/local-news/ohio-fighting-bidens-decision-to-eliminate-work-requirement-for-medicaid/