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Money Follows the Person Rebalancing Demonstration, Request for Comments on Proposed Policy Changes, & Upcoming Webinars

Recent Releases and Announcements

Money Follows the Person Rebalancing Demonstration

Today, the Centers for Medicare & Medicaid Services published the Money Follows the Person (MFP) Rebalancing Demonstration Report to the President and Congress.

The MFP Rebalancing Demonstration program was launched more than nine years ago.  As of September 2016, the 44 grantee states were awarded nearly $3.7 billion in grant funding. As of the end of calendar year 2015, grantee states had transitioned a total of 63,337 Medicaid beneficiaries from long-term institutional care to community residences and home and community-based LTSS.

When MFP participants transitioned to community living, Medicaid programs experienced cost savings. Costs of care for MFP participants transitioned through 2013 was reduced by $978 million during the first year after the transition to home and community-based LTSS. Further, MFP provides strong evidence of success at improving the quality of life of participants.                 

CMS Seeks Comments on Proposed Policy Changes and Updates for Medicare Advantage and the Prescription Drug Benefit Program

CMS issued a proposed rule that would make policy and technical changes to Medicare Advantage (MA) and the prescription drug benefit program (Part D). The proposed rule was published in the Federal Register on November 28th.

Comments on the proposed rule are due January 16, 2018 at 5:00 pm EST.

The following proposed changes may be of special interest to states working to integrate care for individuals dually eligible for Medicare and Medicaid:

  • Limited authorization of seamless conversion (called default enrollment) from Medicaid plans into D-SNPs. CMS proposes to codify the current optional enrollment mechanism that provides seamless continuation of coverage by way of enrollment into an MA plan for newly MA-eligible individuals who are currently enrolled in other health plans offered by the MA organization (such as commercial or Medicaid plans) but with new limitations. Specifically, CMS proposes to limit default enrollments to D-SNPs that are enrolling newly Medicare-eligible individuals who are already, and will remain, enrolled in a Medicaid managed care plan operated by the same parent organization. The state must approve use of this default enrollment process and provide Medicare eligibility information to the MA organization offering the D-SNP. (Discussion begins on page 56365, with proposed reg text at page 56494.)
  • Limited expansion of passive enrollment authority. To promote integrated care and continuity of care, CMS proposes a limited expansion of current passive enrollment authority for full-benefit dually eligible beneficiaries from a non-renewing integrated D-SNP into another comparable D-SNP. This process would be conducted in consultation with the state Medicaid agency and where other conditions are met to ensure continuity and quality of care. Integrated D-SNPs would be defined as fully integrated D-SNPs (FIDE SNPs) or highly integrated D-SNPs. (Discussion begins on page 56369, with proposed reg text at page 56493.)
  • Changes to the Special Election Period for dually eligible beneficiaries. To ensure that Part D sponsors are better able to administer benefits, including the coordination of Medicare and Medicaid benefits, CMS proposes to change the Special Election Period (SEP) for dually eligible and Low Income Subsidy (LIS) beneficiaries from an open-ended monthly SEP to: (1) one that would be limited to a certain period of time after a CMS or state-initiated enrollment; or (2) a one-time election to be used at any time in the year (unless the individual is identified as at-risk or potentially at-risk for prescription drug abuse under the CARA provisions described below). (Discussion begins on page 56373, with proposed reg text at page 56507.)
  • New tools to combat opioid misuse. To combat the growing opioid epidemic, CMS proposes to implement new Comprehensive Addiction and Recovery Act of 2016 (CARA) requirements, including allowing plans to limit at-risk enrollees to use of selected providers and/or pharmacies, and limiting the availability of the SEP for dually eligible or other LIS-eligible beneficiaries who are identified as at-risk or potentially at-risk for prescription drug abuse under such a drug management program. (See especially page 56351.)

We encourage states to review the entire proposal and comment by January 16th.

Medicaid Innovation Accelerator Program

Register Now: Emergency Department Treatment and Follow-Up Strategies for Opioid Use Disorder National Learning Webinar (Wednesday, December 13, 2017)

CMS’s Medicaid Innovation Accelerator Program (IAP) Reducing Substance Use Disorder (SUD) program area is holding a national learning webinar on December 13th from 2:30 to 4:00 PM ET.

This webinar, entitled, “Emergency Department Treatment and Follow-Up Strategies for Opioid Use Disorder”, will highlight successful strategies being used to treat opioid use disorders in hospital emergency departments, including effective approaches for initiating treatment, facilitating referrals and ensuring follow-up care. During this learning opportunity, participants will learn about these innovative approaches, hear about lessons learned and have an opportunity to pose questions to the speakers regarding their programs, including the Project ASSERT and Faster Paths to Treatment programs at the Boston Medical Center and Project ASSERT at the Yale-New Haven Hospital.

Register Now 

Upcoming Calls and Webinars

TODAY! Webinar: Increasing Rates of Virologic Suppression: Promising Practices from HIV Health Improvement Affinity Group States

Wednesday December 6, 2017, 2:30 to 4 pm (EST)

Register Now 

This webinar  features leaders from the Office of HIV/AIDS and Infectious Disease Policy in the US Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), the Health Resources and Services Administration (HRSA), and the Centers for Disease Control and Prevention (CDC). It also features affinity group state representatives from Alaska and North Carolina sharing lessons learned and best practices from their performance improvement projects.

The affinity group is a joint initiative of the following HHS agencies -- CMS, CDC, and HRSA -- in collaboration with the Office of HIV/AIDS and Infectious Disease Policy, and in partnership with the National Academy for State Health Policy.

SMDL: Limitation of FFP for Medicaid DME

Effective January 1, 2018, the statute requires a limit to available FFP for state Medicaid fee-for-service expenditures for DME, per Section 1903(i)(27) (text is copied below). The limit is calculated in the aggregate to the amount that Medicare would have paid for the same items through the Medicare DMEPOS fee schedule, or, as applicable, the Medicare competitive bidding program. The statute specifically applies to items of durable medical equipment that are covered by both Medicare and Medicaid, and does not limit Medicaid's ability to provide DME that is not covered by Medicare. It does not include prosthetics, orthotics, or supplies. The statute also does not mandate that states pay Medicare rates for all Medicaid DME. This guidance is being issued to provide options for states to comply with the statute.

Thursday, December 7, 2017 from 1:30 pm to 2:30 pm ET

Audio option #1: 1-844-396-8222 Participant Code:  900 547 849

Audio option #2 and Webinar 

Quality Payment Program: All-Payer Combination Option and Impact on State Medicaid Agencies

An overview webinar on the Medicare Quality Payment Program Year 2 final rule, with a focus on the participation of non-Medicare payers, including State Medicaid Agencies, through the All-Payer Combination Option. Non-Medicare payers includes Medicaid, Medicare Health Plans, and payers participating in CMS Multi-Payer models.  Join the webinar to hear CMS policy experts provide an overview of the All-Payer Combination Option requirements for the Quality Payment Program, particularly as it effects State Medicaid Agencies.

Thursday, December 14, 2017 from 1:30 pm to 2:30 pm ET

Audio option #1: 1-844-396-8222 Participant Code:  900 547 849

Audio option #2 and Webinar 

Electronic Visit Verification (EVV) Two-Part Training Series

December 13, 2017: Part One – Overview of the 21st Century CURES Act & Current Status of EVV Implementation

This training will review EVV requirements delineated in section 12006 of the 21st Century CURES Act.  Authorities and services impacted by the CURES Act, EVV system requirements, penalties for non-compliance, available federal support, and considerations for self-direction will be discussed. This training will also review EVV design models currently used by states and will share findings from a nationwide EVV survey performed in partnership with the National Association of Medicaid Directors. Lewis & Ellis with assistance from Navigant Consulting is currently the training lead through the Rate Review Multi-Award Contract overseen by the Division of Long Term Services & Supports (DLTSS) and will present the training. Ralph Lollar, DLTSS Division Director and Kenya Cantwell, Technical Director with the Division of Benefits and Coverage will support the training and lead the Q&A Session.

Wednesday, December 13th 1:30-3pm

Audio Option #1: 1-844-396-8222 Your WebEx Meeting Number: 908 621 799

Audio Option #2 and Webinar 

January 10, 2018: Part Two – Strategies for EVV Implementation

This training will share promising practices for states to consider when selecting and implementing their EVV model. This training will also review strategies for training and educating state staff, providers, individuals and their families on the use of EVV. Lewis & Ellis and Navigant will present this training with support from Ralph Lollar and Kenya Cantwell.

Wednesday, January 10th 1:30-3pm

Audio Option #1: 1-844-396-8222 Your WebEx Meeting Number: 907 626 064

Audio Option #2 and Webinar 

“Part D PDE Data and the Opioid Epidemic” Webinar Materials Available

CMS’ Medicare-Medicaid Coordination Office is pleased to announce the availability of materials from the State Data Resource Center (SDRC)  webinar entitled “Part D PDE Data and the Opioid Epidemic,” that occurred on August 30 and September 21, 2017.  The webinar documents are posted to SDRC Public website - Announcement & Webinars, and include the following:

  • Webinar agenda
  • Webinar slide deck
  • Webinar recordings (the full webinar presentation from the original presentation, as well as the Q & A session from the second airing)
  • Webinar Q&A document
  • Two Medicare-Medicaid Data Integration (MMDI) Use Case tools

For any questions regarding the webinar or inquiries about obtaining Medicare data, please contact the SDRC at sdrc@econometricainc.com.

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