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policy

In a white paper, the association encourages CMS to develop policies that reduce disparities and incorporate equity into waiver approval and evaluation processes.

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policy

The waiver makes Illinois the first state to provide continuity of full Medicaid benefit coverage for mothers by extending eligibility during the entire first year after delivery.

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policy

In response to an executive order, a new issue brief reviews four policy areas under Section 1115 demonstrations and their impact on Medicaid coverage and access to care. The brief notes all examined areas create barriers to enrollment and reduce coverage, leading to adverse health effects.

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state-action

With community partnerships already underway through California's Whole Person Care initiative — part of its Section 1115 Medicaid waiver — localities in California found it easier to reach vulnerable communities at high risk for contracting COVID-19.

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state-action

The report, requested by Republican representatives, details challenges states face in administering Medicaid programs, including with coverage exclusions and care coordination, coverage benefits and eligibility, and Medicare and Medicaid alignment.

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policy

CMS issued several checklists and templates for state Medicaid and the Children's Health Insurance Program agencies to request regulatory relief and flexibility to respond to the COVID-19 outbreak.

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state-action

Under the proposed Section 1115 waiver, Oklahoma would accept a per-capita cap on federal funds for the Medicaid expansion population and incorporate other market-based reforms.

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policy

This decision is the latest of several court cases invalidating work requirements policies in Medicaid; Utah now is the only state with these requirements in effect. It is unknown at this time if Michigan or the Department of Health and Human Services will appeal the decision.

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policy

In the unanimous decision, the United States Court of Appeals for the District of Columbia Circuit found that the Department of Health and Human Services failed to adequately assess the potential impact of work requirements on coverage under Arkansas' Section 1115 demonstration waiver.

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policy

Through this newly approved Section 1115 demonstration waiver, South Carolina becomes the first state to apply work requirements primarily to parents and caregivers.

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state-action

States are leveraging financial incentives, quality measures, waivers, and public-private partnerships to slow climbing rates of substance use disorder and overdose among pregnant women.

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policy

The report includes recommendations to the Centers for Medicare & Medicaid Services for improved oversight of these waivers.

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policy

The court ruled that the Secretary of Health and Human Services failed to adequately consider the effect of the work requirements on Medicaid coverage.

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policy

Under five-year demonstration projects, these states are approved to receive Medicaid matching funds for treatment in facilities that qualify as institutions for mental diseases.

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Essential Insights

As essential hospitals target social determinants of health in their communities, it is crucial that the Medicaid program continues to evolve to ensure this vital work can continue.

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Essential Insights

Decisions made at the state and federal levels regarding Medicaid expansion continue to evolve nearly a decade after passage of the Affordable Care Act.

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policy

Utah joins a growing list of states with approval to implement Medicaid work requirements, but it is the first state to limit enrollment to individuals below the federal poverty level and implement a spending cap.

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policy

The court ruled that the Department of Health and Human Services overstepped its authority and failed to show that work requirements would help promote the purpose of the Medicaid program

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policy

The tools and guidance aim to help states monitor and evaluate the effects of Section 1115 waiver demonstrations, including those with work and community engagement requirements and those that combat substance use disorder.

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policy

Ohio’s waiver requires beneficiaries ages 18 to 49 who are eligible through Medicaid expansion to work or participate in other community engagement activities for at least 80 hours a month.

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policy

A Centers for Medicare & Medicaid Services bulletin notes that states can cover non-opioid pain management therapies using several Medicaid authorities, including Section 1945 health home benefits, 1915(i) state plan amendments, Section 1115 demonstrations, and managed care strategies.

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policy

The waiver requires beneficiaries ages 19 to 49 who are eligible through Medicaid expansion to work or participate in community engagement activities for at least 80 hours a month.

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policy

Maine and Michigan join five other states to receive approval for Medicaid work requirements; unlike most other states, Maine's work requirements will apply to both existing beneficiaries and those newly eligible through expansion.

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policy

The waiver permits federal reimbursement for short-term stays in institutions for mental disease for individuals with substance use disorders.

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policy

The state’s waiver initially was approved in May, but required a second approval to extend beyond Dec. 31.

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policy

The U.S. District Court for the District of Columbia vacated the previous approval, saying the administration failed to adequately assess the waiver's impact on Medicaid’s core objective: to provide health care coverage for beneficiaries.

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policy

A new demonstration opportunity, which can be carried out through Section 1115 waivers, would allow states to receive reimbursement for services at institutions for mental disease for individuals with serious mental illness or serious emotional disturbance.

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policy

Wisconsin is the fifth state to receive approval to incorporate work and community engagement requirements as a condition of Medicaid eligibility.

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policy

The expansion is expected to give up to 400,000 additional Virginians access to the program; the Centers for Medicare & Medicaid Services has not announced a decision on the state's Section 1115 waiver, which includes work requirements.

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Essential Insights

Several presentations at VITAL2018 focused on a foundational issue for essential hospitals—finance and payment policy—and provided member insights on topics such as Section 1115 Medicaid waivers, state policy trends in the 340B Drug Pricing Program, and digitizing the revenue cycle.

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webinar

Learn more about the Essential Hospitals Value-Based Care Collaborative and hear how Premier helped NewYork-Presbyterian Queens in the 1115 DSRIP Waiver program to bring additional value to the community.

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policy

The letter marks the first time the Centers for Medicare & Medicaid Services has clearly described its budget neutrality calculation and represents its attempts to streamline the waiver process and control costs.

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webinar

Hear about the state of Medicaid waivers under the Trump administration, and look ahead at the future of waiver innovations.

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policy

What comes next after the June 29 court ruling that vacated the U.S. Department of Health and Human Services approval of a Section 1115 waiver that allowed Kentucky to impose community engagement and work requirements on Medicaid beneficiaries.

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policy

The decision strikes down the state's overall Section 1115 waiver, which included community engagement and work requirements, but it upholds as a separate waiver a portion allowing Medicaid reimbursement for substance use disorder treatment in institutions for mental disease.

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policy

This year's Medicaid and CHIP Payment and Access Commission report focuses on the high cost of prescription drugs and the opioid epidemic.

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policy

New Hampshire is the fourth state to receive approval to incorporate work and community engagement requirements as a condition of Medicaid eligibility.

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policy

Reports by the National Academy of State Health Policy and the Medicaid and CHIP Payment and Access Commission point to new trends, including increased focus on reform, new financing mechanisms, and standardized evaluation.

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policy

A new policy brief examines Centers for Medicare & Medicaid Services guidance on work and community engagement requirements for Medicaid eligibility and outlines recently approved section 1115 waivers in Kentucky, Indiana, and Arkansas.

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policy

The three-pronged approach aims to reduce drug demand, cut off the flow of illicit drugs domestically and internationally, and expand opportunities for proven addiction treatments.

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policy

Under the approved waiver, Arkansas Medicaid beneficiaries ages 19 to 49 beginning June 1 must work or participate in community engagement activities for 80 hours per month to maintain their eligibility.

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policy

The Centers for Medicare & Medicaid Services announced the community engagement initiative, often referred to as work requirements, in a Jan. 11 letter and a frequently asked questions document.

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policy

The waiver extensions fund Texas' uncompensated care pool and delivery system reform incentive payment program and provide family planning services for low-income individuals in Mississippi for 10 years.

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policy

In response to the request for information, the association encouraged flexibility and a focus on hospitals treating high numbers of complex patients.

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policy

In a speech to the National Association of Medicaid Directors, Administrator Verma also announced an initiative to create scorecards for Medicaid and CHIP outcomes.

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policy

CMS announced a new streamlined process to encourage state innovation through demonstrations and approved new demonstrations for New Jersey and Utah.

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policy

The five-year demonstration project, beginning Jan. 1, 2018, aims to strengthen substance use disorder care for state Medicaid beneficiaries.

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webinar

Explore Whole Person Care, a pilot initiative through California’s Section 1115 Medicaid waiver that works to improve care for people with complex issues by tackling medical, behavioral, and socioeconomic needs.

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policy

The decision extends by five years the state's demonstration of a capitated Medicaid managed care program and a low-income pool to provide support for the safety net.

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policy

A publicly released set of slides describes dramatic restrictions to CMS' budget neutrality policy for Section 1115 waivers.

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policy

In this new policy brief, America's Essential Hospitals examines Section 1115 waivers that use a market-based approach to expanding Medicaid.

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policy

The letter affirms their desire to improve the Medicaid program and the vulnerable people it serves and to ensure the program provides value to taxpayers.

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policy

A CMS bulletin reminds states that Medicaid funds can be used for prevention, diagnosis, and treatment of the Zika virus.

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institute

Articles focus on innovative waivers that support states in transforming delivery systems to improve access and quality of care. Another focus is Medicaid coverage in areas of crucial need, such as mental health care.

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policy

States may apply for a Section 1115 Medicaid waiver to support innovative care delivery for substance abuse disorder. SAMHSA, HRSA to also offer funding opportunities.

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policy

Proposed renewals must be for demonstrations that are working effectively and have no major or complex policy changes. Certain waivers that use the enhanced FMAP are ineligible.

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policy

MACPAC's report to Congress touts potential of DSRIP programs to transform Medicaid reimbursement and improve health outcomes, also addresses the challenge and calls for clear and consistent federal guidance.

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policy

Calls for HHS to establish specific criteria for approval, document how programs will address the health of low-income populations, and ensure federal funding is not duplicated.

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policy

In an April 28 letter, the association urged CMS to adopt a holistic view of how payment mechanisms impact essential hospitals, including sustainable base payment rates, Medicaid waivers to address uncompensated care, and DSRIP waivers.

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policy

Report includes potential impact if CHIP was to expire, Section 1115 waivers used to expand Medicaid coverage, and other aspects of Medicaid payment policy.

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Essential Insights

Essential hospitals face barriers in providing care to immigrant populations. They must find unique ways to address the complexity surrounding immigration status for their patients.

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institute

The third in a series of waiver-related briefs, this research brief summarizes perspectives from hospital leaders in Massachusetts, California, and Texas.

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policy

GAO found that HHS did not ensure budget neutrality when approving Arkansas' Medicaid expansion waiver. Issues include lack of data to corroborate state assumptions and state flexibility to expand spending limits.

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policy

America’s Essential Hospitals released a policy brief that discusses approaches to extending the reach of health care transformation through Medicaid waiver incentive programs.

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policy

CMS will not approve SPAs that include non-bona fide donations as a portion, or all, of the non-federal share of Medicaid payments. Payment methodologies contingent upon the receipt of a non-bona fide donation would also be grounds for disapproval of an SPA.

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