Federal & State Updates


White House Activity

President Trump’s Address on Drug Pricing Proposal.   Today, President Trump outlined his proposals for addressing high prescription drug costs.   The proposal identifies four challenges in the American drug market:

– High list price for drugs;

-Senior and government programs overpaying for drugs due to lack of the latest negotiation tools;

-High and rising out-of-pocket costs for consumers; and

-Foreign governments free-riding off an American investment in innovation.


Under President Trump, HHS has proposed a comprehensive blueprint for addressing these challenges, identifying four key strategies for reform: 

Improved competition;

-Better negotiation;

-Incentives for lower list prices; and

-Lowering out-of-pocket costs. 


The blueprint encompasses two phases:  (1) actions the President may direct HHS to take immediately and (2) actions HHS is actively considering on which feedback is being solicited.  The entire 45 page proposal is available at: https://www.hhs.gov/sites/default/files/AmericanPatientsFirst.pdf


White House Announces Rescissions Package With Strong Focus on CHIP Funding.  This week, the White House announced a rescissions package that would rescind 38 separate appropriations, totaling $15.4 billion, that previously were approved by Congress. These rescissions would take effect only if they are approved by Congress.    This package includes five proposals addressing health-related programs administered by either the Department of Health and Human Services (HHS) or the Department of Labor. These proposals would rescind the following amounts:  

 –$5.15 billion from the Children’s Health Insurance Program (CHIP);  

-$1.865 billion from the CHIP Contingency Fund;  

-$800 million from the CMS Center for Medicare and Medicaid Innovation;  

-$220 million from an HHS Nonrecurring Expenses Fund (NEF) which is used for capital acquisition, including facilities infrastructure and information technology; and  

-$22.9 million from National Emergency Grants that were authorized to help states implement the Health Coverage Tax Credit for recipients of Trade Adjustment Assistance.


Congressional Activity


House Energy and Commerce Committee Approves Opioid Bills.  The House Energy and Commerce Committee approved 25 separate bills addressing opioid-related issues. All of these bills were approved by voice vote. A second committee markup, scheduled for May 17, will focus on additional legislative proposals for addressing the opioid crisis.  Some of the bills the committee approved include:  

 –H.R. 5603: Instructs CMS to evaluate the utilization of telehealth services in treating opioid use disorder.  

H.R. 3331: Promotes the testing of incentive payments for behavioral health providers for the adoption and use of certified electronic health record (EHR) technology.  

H.R. 5009: Requires HHS to develop and disseminate best practices regarding the prominent display of substance use disorder history in the records of patients who have previously provided this information to a health care provider.  

H.R. 3528: Requires e-prescribing, with exceptions, for coverage of prescription drugs that are controlled substances under the Medicare Part D program.  

H.R. 5675: Requires Medicare prescription drug plan sponsors to establish drug management programs for at-risk beneficiaries.  

H.R. 5686: Requires Medicare Part D prescription drug plans to include information on the adverse effects of opioid overutilization and of coverage of non-pharmacological therapies and non-opioid medications or devices used to treat pain.  

H.R 5684: Adds beneficiaries at-risk for prescription drug abuse to the list of targeted beneficiaries to be eligible for medication therapy management under Medicare Part D.  

H.R. 5582: Directs CMS to evaluate the use of abuse-deterrent opioids in Medicare plans.  

H.R. 5002: Provides the National Institutes of Health (NIH) new authorities to conduct research on innovative non-addictive pain medications.  

H.R. 5327: Directs HHS to award grants on a competitive basis to eligible entities to establish or operate a comprehensive opioid recovery center.  

H.R. 4284: Directs HHS to create a public and easily accessible electronic dashboard linking to all nationwide efforts to combat the opioid crisis.  

H.R. 5197: Establishes a demonstration program to test alternative pain management protocols to limit the use of opioids in hospital emergency departments.  

H.R. 5483: Directs the Attorney General, with the HHS Secretary, to promulgate interim final telemedicine waiver regulations within 90 days of passage of the law.  


Federal Regulatory Activity



CMS safeguards patient access to certain medical equipment and services in rural and other non-contiguous communities.  CMS issued an interim final rule with comment period (IFC) to increase the fee schedule rates from June 1, 2018, through December 31, 2018, for certain durable medical equipment (DME) items and services and enteral nutrition furnished in rural and non-contiguous areas (Alaska, Hawaii, and U.S. territories) of the country not subject to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP).   For more information or to submit a comment on or before July 9, 2018, please visit: http://www.regulations.gov.


CMS Announces Agency’s First Rural Health Strategy.  CMS released the agency’s first Rural Health Strategy intended to provide a proactive approach on healthcare issues to ensure that the nearly one in five individuals who live in rural America have access to high quality, affordable healthcare.  The agency-wide Rural Health Strategy focuses on five objectives to achieve the agency’s vision for rural health:

-Apply a rural lens to CMS programs and policies

-Improve access to care through provider engagement and support

-Advance telehealth and telemedicine

-Empower patients in rural communities to make decisions about their healthcare

-Leverage partnerships to achieve the goals of the CMS Rural Health Strategy


For more information on the Rural Health Strategy, please visit: http://go.cms.gov/ruralhealth. There is also a fact sheet available at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-05-08.html.



Kansas Lifetime Limit Request Denied.  CMS Administrator Seema Verma announced that CMS has denied Kansas’ request to impose a three-year lifetime limit on Medicaid benefits. Kansas included this request in its Section 1115 Demonstration Renewal Application for the KanCare program submitted late last year. Kansas’ application specified that KanCare members required to meet proposed work requirements would have a maximum length of 36 months of KanCare coverage.


CMS Approves New Hampshire’s Medicaid Work Requirement Request.  CMS approved New Hampshire’s request for an amendment to its section 1115 demonstration project “New Hampshire Health Protection Program Premium Program” (NHHPP).    The approval is effective May 7 through December 31, unless extended or otherwise amended. New Hampshire may begin the implementation of the work requirements no sooner than January 1, 2019, provided it fulfills the requirements outlined within the special terms and conditions to continue the demonstration beyond December 31 and contingent upon the reauthorization of the program by the New Hampshire legislature.



Health Policy Institute (HPIO):

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.

– Gongwer story on the Task Force meeting

– HPIO policy briefs on education


Health Policy Institute of Ohio – Medicaid Basics.

The Health Policy Institute of Ohio has released Ohio Medicaid Basics 2017.  A two-page executive summary is also available.

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. The JMOC 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.