Federal Regulatory Activity
CMS Launches Efforts to Improve Patient Safety, Quality of Care in Nursing Homes. CMS announced upcoming efforts to support better care and outcomes for nursing home residents under the Civil Money Penalty Reinvestment Program (CMPRP). This three-year initiative aims to improve residents’ quality of life by equipping nursing home staff, administrators and stakeholders with technical tools and assistance to enhance resident care. For additional information on the Civil Money Penalty Reinvestment Program, please visit:
CMS Releases Snapshot for Week Three of 2019 Open Enrollment. CMS released an enrollment snapshot providing data on plan selections in the 39 states using the HealthCare.gov platform during Week Three (November 11-17) of 2019 Open Enrollment. CMS reports that plan selections totaled approximately 748,000 in this time frame and that cumulative plan selections for November 1-17 are roughly 1.9 million. Last year, CMS reported approximately 2.3 million plan selections during the first 18 days of 2018 Open Enrollment. Since November 1, new customers have accounted for about 24 percent of plan selections for 2019 Open Enrollment.
CIB: 2019 Updates to the Child and Adult Core Health Care Quality Measurement Sets. CMS released an informational bulletin that describes the 2019 updates to the core set of children’s health care quality measures (the Child Core Set) for Medicaid and the Children’s Health Insurance Program (CHIP) and the core set of health care quality measures for adults enrolled in Medicaid (the Adult Core Set). The Bulletin is available at: https://www.medicaid.gov/federal-policy-guidance/downloads/cib112018.pdf.
1115 Waiver Demonstration – TennCare II Amendment 37. Tennessee proposes to amend its demonstration in order to establish two new benefits and two new benefit groups within the Employment and Community First CHOICES Program. The new benefits/groups integrate behavioral health services with home and community-based services, and are targeted to individuals who have both an intellectual or developmental disability and enhanced behavioral support needs. The federal public comment period will be open from November 23, 2018 to December 23, 2018.
CMS Approves Kentucky Medicaid Work Requirement Again. CMS has approved, for the second time, a component of a Kentucky section 1115 demonstration project that includes a work and community engagement requirement for certain adult beneficiaries ages 19 to 64 who are covered under the Kentucky HEALTH program. CMS originally approved this demonstration project in January 2018. However, in a June 2018 ruling, the U.S. District Court for the District of Columbia vacated approval of the work requirements for Kentucky HEALTH on the grounds that CMS “never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid.” In a letter addressed to the Commissioner of Kentucky’s Department of Medicaid Services, CMS states that Kentucky HEALTH, as part of the broader KY Health Demonstration Program, “is likely to assist in promoting the objectives of the Medicaid program.” In making this determination, CMS argues that the demonstration: (1) promotes beneficiary health and financial independence; and (2) will furnish medical assistance in a manner that improves the sustainability of the safety net. The work requirements for the Kentucky HEALTH component of the state’s demonstration are scheduled to take effect on April 1, 2019. It is not clear whether this initiative will face further legal challenges.
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.