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New Guidance, Pediatric Core Measure Set, May 2017 Eligibility & Enrollment Report, and Other Announcements

Recent Releases and Announcements

CIB: Medicaid and CHIP Managed Medical Loss Ratio (MLR) Credibility Adjustments and New Toolkit for Promoting Access in Medicaid and CHIP Managed Care: Strategies for Ensuring Provider Network Adequacy and Service Availability

Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued an Informational Bulletin providing the required MLR credibility adjustments for Medicaid and CHIP managed care plans with rating periods beginning July 1, 2017 or later. This bulletin also contains OACT’s methodology for developing the credibility adjustments as required in the final rule and examples of how states should apply the MLR credibility adjustments. In alignment with MLR requirements for health plans operating in the private market and Medicare Advantage, the Medicaid and CHIP managed care rule provides a credibility adjustment to account for the potential variation in smaller managed care plans. The credibility adjustment is used to account for random statistical variation related to the number of enrollees in a managed care plan. CMS will publish MLR credibility adjustment factors on an annual basis.

CMS also released a toolkit to assist states in developing their network adequacy and service availability standards for Medicaid and CHIP managed care. To develop this toolkit, CMS formed a working group of states to discuss common access challenges and goals, as well as to create a forum for states to present their successful techniques for establishing and monitoring network adequacy in their programs. The product of this group’s efforts is a compilation of effective and promising network adequacy and service availability strategies and analysis techniques, as well as valuable data sources that states are using to develop and assess the availability of providers and services in their states.

Core Quality Measures Collaborative Pediatric Core Measure

The Centers for Medicare & Medicaid Services (CMS) is announcing the release of a Pediatric measure set as part of the Core Quality Measures Collaborative (CQMC). This release marks the next step forward for alignment of quality measures between public and private payers. Seven of the nine measures in this Pediatric set of quality measures are harmonized with existing state-level measures in the Medicaid and CHIP Child Core Set . 

The CQMC core measure sets are intended for practitioner (e.g., physician/clinician) or group practice level accountability. The initial seven core sets, released in February 2016, were in the following areas: Accountable Care Organizations (ACOs)/ Patient Centered Medical Homes (PCMHs)/primary care, OB/GYN, Cardiology, HIV/Hepatitis C, Gastroenterology, Oncology and Orthopedics.

May 2017 Medicaid & CHIP Eligibility and Enrollment Report

The Centers for Medicare & Medicaid Services (CMS) released the May 2017 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.

New Medicare Card (formerly called SSNRI)

CMS is removing Social Security Numbers from Medicare cards to help fight identity theft and safeguard taxpayer dollars. In previous messages, we said that you must be ready by April 2018 for the change from the Social Security Number based Health Insurance Claim Number to the randomly generated Medicare Beneficiary Identifier (the new Medicare number). Up to now, we referred to this work as the Social Security Number Removal Initiative (SSNRI). Moving forward, we will refer to this project as the New Medicare Card. Please visit the New Medicare Card  homepage for more information.


IAP Commentary: Welcoming in the Third Year of the Medicaid Innovation Accelerator Program! By Tim Hill, Deputy Director, CMCS

Three years ago, the Center for Medicaid and CHIP Services (CMCS) launched a collaboration with the Center for Medicare-Medicaid Innovation (CMMI) entitled the Medicaid Innovation Accelerator Program (IAP). Our Center created IAP to ensure that Medicaid had an imprint in the delivery system reform efforts that were going on across the country and in acknowledgement that were already many Medicaid-driven delivery system reforms underway to leverage. As the Deputy Director of CMCS, I am so pleased to have a resource like IAP available to our state partners so that we can continue to support even more states as they design and implement their delivery system reforms. In this anniversary commentary, I provide a brief overview of states we’ve been able to work with through IAP; share examples of how IAP is supporting state innovation; and announce the latest group of states with whom IAP is collaborating. 

Comment Now: Measures that Address Key Quality Issues in each of the Four IAP Program Areas (Due August 21, 2017)

The National Quality Forum, under contract with the Centers for Medicare & Medicaid Services (CMS), convened a multi-stakeholder Coordinating Committee and four Technical Expert Panels -- one for each priority area of the Medicaid Innovation Accelerator Program (IAP)  -- to identify the most relevant, existing measures for each of the following areas:

  • Reducing Substance Use Disorders
  • Improving Care for Medicaid Beneficiaries with Complex Care Needs and High Costs;
  • Promoting Community Integration through Long-Term Services and Supports; and
  • Supporting Physical and Mental Health Integration.

These measures will serve as a resource for state Medicaid agencies developing measurement strategies for their related delivery system reform efforts. The draft report is open for public comment from July 21, 2017-August 21, 2017. To access the draft report or to submit a comment, visit NQF’s  webpage.

Upcoming Calls and Webinars

CMS Innovation Center Medicare Quality Payment Program Year 2 proposed rule – All-Payer Combination Option

Centers for Medicare & Medicaid Services Innovation Center will host an overview webinar on the Medicare Quality Payment Program Year 2 proposed rule, with a focus on the participation of non-Medicare payers including Medicaid through the All-Payer Combination Option. This event is for all CMMI model participants, their partnering providers and the general public. Join the webinar to hear CMS policy experts provide an overview of proposed All-Payer Combination Option requirements for the Quality Payment Program.

Thursday, August 3, 2017 from 1:30 pm to 2:30 pm ET.

Audio option #1: 1-844-396-8222 Participant Code:  905 358 656

Audio option #2 and webinar 

HCBS SOTA Presentation: Trends in Rate Methodologies for High-Cost, High-Volume Taxonomies

This training will review the most frequently utilized and highest cost service taxonomy categories reported in 1915(c) HCBS waivers. Common rate setting methodologies for each taxonomy and notable approaches unique to those taxonomies will also be discussed. 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).  Lewis & Ellis and Navigant Consulting will present the training and Ralph Lollar, DLTSS Division Director, and the DLTSS Team will support the training and lead the Q&A Session. State fiscal staff are encouraged to participant in this training. 

Wednesday, August 9, 2017 1:30 – 3:00 pm ET

To join the call (via computer or WebEx app) and webinar:

  • Go to the Webinar 
  • Enter your name and email address (or registration ID).
  • Enter the session password: This session does not require a password.
  • Click "Join Now".
  • Follow the instructions that appear on your screen.

Option #2” To join Toll Free and follow along with slide deck:

  • Dial: 1-844-396-8222 Your WebEx Meeting Number: 908 621 799
  • Follow the instructions you hear on the phone.

As always:

If you'd like to be added to the SOTA email distribution, please email us at sotaupdates@cms.hhs.gov.

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