Congress Returns Next Week to Begin Final Stretch of 2018 Legislative Session. The House and the Senate will reconvene early next week, November 13, to begin a lame duck session in which Congress will focus on unfinished legislative business and work to bring the 2018 session to a conclusion. The top priority is finalizing the appropriations process for fiscal year 2019. Senate and House leadership elections will be another important priority over the next few weeks.
Federal Regulatory Activity
CMS Issues Proposed Rule on Program Integrity for ACA Exchanges. On November 7, CMS announced a proposed rule that takes steps aimed at improving program integrity with respect to operations in the ACA Exchanges. The proposed rule, which has a 60-day comment period, also is discussed in this CMS fact sheet.
Departments Release Final Rules on Religious and Moral Exemptions and Accommodations for Contraceptive Coverage. On November 7, the Departments of Health and Human Services (HHS), Treasury, and Labor published two final rules that provide conscience protections for those who have a religious or moral objection to health insurance that covers different methods of contraceptive services. These rules finalize the interim rules that were issued in October 2017 and will take effect 60 days after publication (January 6, 2019). The new rules also are discussed in this HHS press release and fact sheet.
CMS Releases Enrollment Snapshot for First 3 Days of Open Enrollment. CMS has released the first Weekly Enrollment Snapshot providing data on plan selections in the 39 states using the HealthCare.gov platform during the first three days (November 1-3) of 2019 Open Enrollment. CMS will be issuing enrollment snapshots for the HealthCare.gov platform on a weekly basis throughout 2019 Open Enrollment.
CMS Releases Medicaid and CHIP Managed Care Proposed Rule. On November 8, CMS released the pre-publication version of the Medicaid and CHIP Managed Care Proposed Rule. The agency also issued a press release and fact sheet discussing many of the proposed changes.
CIB: Strong Start for Mothers and Newborns initiative (Strong Start). CMS in conjunction with the Center for Medicare and Medicaid Innovation (CMMI) is issuing an informational bulletin to announce the final evaluation of the CMMI Strong Start for Mothers and Newborns model, including an overview of the findings and key Medicaid covered services. The bulletin is available on Medicaid.gov here: https://www.medicaid.gov/federal-policy-Guidance/index.html.
MACPAC Calls for “Pause” in Dis-enrollments Under Arkansas’ Medicaid Work and Community Engagement Requirements. MACPAC has addressed a letter to HHS Alex Azar about the implementation of work and community engagement requirements under a waiver that HHS has approved for Arkansas’ Medicaid program.
1115 Waiver Demonstration – New Hampshire Building Capacity for Transformation. New Hampshire is submitting a request to amend its Building Capacity for Transformation (BCT) section 1115(a) demonstration. The goal of the amendment is to substitute three Designated State Health Programs (DSHP) in the Special Terms and Conditions (STC) and related Attachments to the STCs. The federal public comment period will be open from November 6, 2018 through December 6, 2018.
Health Policy Institute (HPIO):
HPIO/Policy Focus Focuses on Approaches to Balance the Healthcare Spending Side of the Health Value Equation. HPIO will be hosting a forum on August 23 at Nationwide & Ohio Farm Bureau 4-H Center, 2201 Fred Taylor Dr., Ohio State University. This forum will explore factors that drive high healthcare spending in the U.S. and discuss policy approaches that can impact healthcare spending, with a focus on payment reform, drug prices and investing early in children and prevention.
Health Policy Institute of Ohio. The Health Policy Institute of Ohio has released an addendum to its Private Health Insurance Basics series titled “2017 Update: Current policy issues impacting the individual health insurance market in Ohio.” HPIO released its latest edition of Private Health Insurance Basics as a series of six fact sheets in October 2016. The new fact sheet serves as an update to the original series, giving policymakers and stakeholders the latest information on the most relevant policy issues related to the individual private health insurance market. The fact sheet includes information on:
– Current and expected trends in premium price increases
– ACA marketplace enrollment
– Federal state innovation waivers
Health Policy Institute of Ohio. HPIO’s newly updated healthcare cost and quality data transparency resource page includes federal, state and local-level healthcare cost and quality datasets, tools and reporting, as well as information on organizations setting healthcare quality standards. In 2012, HPIO released its first Health Data Transparency Basics publication which provides an overview of the availability of transparent, accessible health data and discusses how access to information on price and quality impacts consumer choice, quality of care, healthcare spending and health outcomes. Due to growing interest in the topic, HPIO released a second iteration of the publication in 2016, Healthcare Data Transparency Basics, which explores the rationale for healthcare price transparency, the challenges it presents and potential policy approaches at the state level to increase transparency.
Heath Policy Institute of Ohio – Education, Poverty and Health Presentation to House Task Force.
In a presentation before the House Speaker’s Task Force on Education & Poverty, Health Policy Institute of Ohio staff detailed the correlations between health, income and education, recommending that lawmakers and community stakeholders always view the factors as linked. Along with the Department of Health and the Governor’s Office of Workforce Transformation, HPIO has made a handful of health-related recommendations that could improve student outcomes. Among the suggestions are those to incentivize school-based health centers and modify Medicaid rates.
Health Policy Institute of Ohio – Medicaid Basics.
Guide to Evidence-Based Prevention. HPIO has added a new fact sheet to its recently updated Guide to Evidence-Based Prevention. The new evidence summary fact sheet highlights evidence-based prevention strategies to increase food security and access to healthy food in Ohio.
The Guide includes a policy brief, Navigating Sources of Evidence, that defines “evidence-based prevention” and provides guidance on how to find credible sources of evidence for what works to prevent Ohio’s greatest health challenges.
Office of Health Transformation:
OHT/Working Together to Fix Healthcare. Governor John Kasich was a guest on NBC’s Meet the Press where he was talking about the need for both parties in Congress to work together to fix Obamacare. Watch it here
Office of Health Transformation. Governor Kasich penned a piece in the New York Times titled: End the Partisan Warfare on Health Care. The piece is available at: https://mobile.nytimes.com/2017/03/10/opinion/john-kasich-end-the-partisan-warfare-on-health-care.html
Ohio’s expansion fate in the news. The Columbus Dispatch reported on what may lay ahead for Ohio’s Medicaid expansion. In the story, OHT Director Greg Moody reaffirmed the administration’s intent to preserve Medicaid expansion in the upcoming budget proposal. Read more here.
OHT/Physicians Boost Use of Ohio’s Rx Reporting System. Governor John R. Kasich has made use of the Ohio Automated Rx Reporting System (OARRS) by prescribers of controlled substances a priority in the fight to reduce abuse of prescription pain medication. The OARRS website used by Ohio doctors, nurses, dentists and pharmacists allows prescribers to track a patient’s opioid prescription history with the goal of stopping drug abuse before it starts. A recent audit conducted by the Ohio Board of Pharmacy found more than 12,000 physicians to be non-compliant with laws enacted in 2015 requiring the use of OARRS. By partnering with the Ohio Medical Board, all 12,000 physicians were urged to make the necessary corrections immediately. As a result, more than 1,800 new accounts have been created in OARRS and daily use of the system has increased from 83,544 requests to over 96,300 per weekday.
Common Sense Initiative:
Common Sense Initiative/Annual Report. CSI released the 2016 Annual Report of the Common Sense Initiative.
CSI/Business Survey. The Lt. Governor Mary Taylor distributed the following message, which solicits comments and feedback on Ohio’s business and regulatory environment. If interested, I would encourage you to participate in providing feedback. The link and information is below.
Since 2011, Lieutenant Governor Mary Taylor has led Ohio’s Common Sense Initiative (CSI) Office which is intended to promote innovation and common sense regulation of Ohio’s businesses. The Executive Order creating CSI explicitly recognized that Ohio’s business community is a partner in the state’s success, so while regulations play an important role in promoting fair competition and protecting the public, they should do so in a way that also facilitates economic growth and opportunity.
The CSI Office functions as a partnership between the Administration, state agencies, the business community, and the public to develop a regulatory framework that balances the important need for regulation with the equally important need to promote economic opportunity and job creation. It has created a more jobs-friendly regulatory climate in Ohio by independently evaluating the economic impact of state agency regulations on Ohio businesses.
Continued reform and updating of Ohio’s regulations helps Ohio’s economy and job creation by fostering a more business-friendly environment, but we need your help. Below is a link to this year’s CSI business survey. Please take a few minutes to give us your feedback by completing this survey. It should take about 5-7 minutes to complete. Your feedback is important to the success of the CSI Office and will help us identify specific areas where government hinders Ohio’s business community’s ability to create jobs. All responses are anonymous unless you choose to provide your contact information at the end of the survey.
Click the link to start the 2016 CSI Annual Business Survey.
Ohio Department of Medicaid:
Ohio Department of Medicaid and Ohio Department of Mental Health and Addiction Services – Behavioral Health Redesign. The state Behavioral Health Redesign Benefit and Service Development Work Group met to continue to discuss the implementation of the new billing codes, redesign timeline, and trainings. You can find the information discussed during the meeting at: http://bh.medicaid.ohio.gov/Portals/0/Users/008/08/8/20161130-BSD-Workgroup-Meeting-FINAL.pdf?ver=2016-11-30-115047-323
ODM Medical Care Advisory Committee. The ODM Medical Care Advisory Committee received an update from the Department on the new shared living services that will be made available to individuals receiving services on the PASSPORT and MyCare waivers. The Shared Living service will provide a live-in caregiver for PASSPORT recipients who need assistance with self-management and the presence of another person (occasional or continuous) in order to assure their health and safety. The Shared Living service includes personal care, chore, individual living assistance and homemaker tasks appropriate to an individual’s needs. The shared living service also assists individuals with managing the household, handling personal affairs, and self-administration of medications.
Dr. Mary Applegate provided the committee with a presentation on ODM’s Managed Care Quality Strategy as well as a briefing on the managed care plan quality improvement projects. Dr. Applegate informed the committee of the new “Transformational Quality Strategy” that shifts the focus to population health. She also provided an update on a number of the quality improvement project success through the Minds Matter project, the OPQC Progesterone Project, and MOMS project (focused on neonatal abstinence).
Dr. Applegate then went on to discuss ODM’s Medicaid managed care plan quality oversight as well as the quality oversight for the MyCare Ohio demonstration. Also discussed was the transformation of the managed care plans care management system, value-based purchasing efforts, and special needs populations.
Ohio Department of Insurance:
Ohio Department of Insurance – Checklist for College Bound kids.
The Ohio Department of Insurance (ODI) created an insurance checklist to help college students and their parents ensure appropriate financial protections are in place for the upcoming school year.
Taylor Steps Down as ODI Director, Froment Takes Over. Governor Kasich announced that Lieutenant Governor Mary Taylor will step down from her duties as Director of the Ohio Department of Insurance. Replacing Taylor is Jillian Froment who has served as the agency’s deputy director since 2011. Taylor remains Lieutenant Governor for the State of Ohio.
ODI/Form, Rate and Binder Filings Training Webinar. The Ohio Department of Insurance hosted a 2018 Plan Year Major Medical Form, Rate and Binder industry training on March 7, 2017. The power point presentation used in the training is available at:
Joint Medicaid Oversight Committee:
Joint Medicaid Oversight Committee – Behavioral Health Redesign Update. JMOC received an update on the State’s Behavioral Health Redesign project from ODM Director Barbara Sears and OMHAS Director Tracy Plouck. The Directors provided an update on the work to date and highlighted recent policy updates. Those updates include:
– Modifications to allow Qualified Mental Health Specialists with a minimum of 3 years of experience in a relevant field to render MH day treatment;
– Updates to the RN/LPN scopes of practice;
– Reimbursement updates TBS/PSR;
– Training and testing updates.
You can find the presentation at: http://www.jmoc.state.oh.us/meetings.
Joint Medicaid Oversight Committee/2016 Progress Report. The Joint Medicaid Oversight Committee release its 2016 progress report titled, Slowing Ohio’s Medicaid Per Capita Spending. The report states that since the creation of JMOC that year over year per capita Medicaid spending has slowed as well as the per member per member spending has been lower than estimated. Per the report the changes that have been made to the program have saved $1.6 billion across all funds in fiscal years 2015 and 2016 compared to the Executive Budget PMPM estimates.
The report states that a key factor in the savings is the expanded use of managed care as well as increased use of home and community based alternatives. The report:
– acknowledges policies that have increased spending such as provider rate increases, new services and program inflexibility.
– discusses opportunities to lower spending such as behavioral health integration, improved maternal and infant health, and increasing value in health care.
– concludes with a discussion on improving quality through managed care.
– calls for JMOC to increase its attention to managed care quality by increasing its review of current initiatives, progress made, and barriers that impeding better results.
You can find the report at: http://www.jmoc.state.oh.us/reports. JMOC Chairman Burke also issued the following release regarding the report: http://ohiosenate.gov/burke/press/burke-highlights-report-showing-16-billion-in-ohio-medicaid-savings.
Joint Medicaid Oversight Committee. TheJMOC committee reviewed the State Fiscal Years 2018-2019 Biennium Growth Rate Projections report from the committee’s actuary Optumas. Following the presentation, the committee voted to set the FY2013-2019 growth rate at 3.3%. This rate is the midpoint between Optumas’s lower and upper bound rates of growth. You can find the presentation and the Optumas report at: http://www.jmoc.state.oh.us/meetings.