Tag: Megan Blue

MDHHS Announces Medicaid Rebid Contract Awardees

Member News

The Michigan Department of Health and Human Services (MDHHS) announced April 8 Medicaid program contract awardees for the contract that begins Oct. 1, 2024. Nine health plans were awarded contracts to cover Medicaid services for nearly two million eligible individuals across Michigan’s 10 Prosperity Regions. The contracts will be in effect for up to eight years when the initial five-year period and up to three one-year extensions are considered.

Contracts were awarded to the same nine health plans that currently cover Medicaid enrollees, with changes to the regions in which some plans operate:

  • Aetna Better Health of Michigan
  • Blue Cross Complete of Michigan
  • HAP CareSource
  • McLaren Health Plan
  • Molina Healthcare of Michigan
  • Meridian Health Plan of Michigan
  • Priority Health Choice
  • United Healthcare Community Plan
  • Upper Peninsula Health Plan

The MHA created an excel document to help members compare the regions in which plans operate under the existing and new contracts. Maps illustrating current prosperity regions and new prosperity regions are available on the MDHHS website.

Health plans may appeal MDHHS recommendations through Monday, April 22.

Members with questions can contact Megan Blue at the MHA.

Congressional Spending Package Solidifies Medicare SUD Coverage

Member News

The President signed March 9 a six-bill Congressional funding package to avoid a federal government shutdown that evening. The funding package included several healthcare provisions, including a measure expanding access to substance use disorder (SUD) services.

Specifically, the legislation permanently requires state Medicaid plans to cover medication-assisted treated for opioid use disorder. This includes counseling services, behavioral therapy and methadone. The bills also add the option for states to cover care in Certified Community Behavioral Health Clinics, as well as Institutions of Mental Disease, regardless of the size of the facility, for up to 30 days per 12-month period. The MHA will follow-up with the Michigan Department of Health and Human Services  to ensure the Michigan Medicaid program is prepared to comply.

Finally, the package calls for states to monitor the prescribing of antipsychotic medications to adults in institutional care setting, home health and community-based settings and requires the U.S. Department of Health and Human Services to issue guidance on integrating behavioral health services with other medical services under Medicaid and the Children’s Health Insurance Program.

The following healthcare measures were also included in the funding package:

  • Eliminated Medicaid Disproportionate Share Hospital cuts for fiscal year (FY) 2024 and delays FY 2025 cuts until Jan. 1, 2025.
  • Provides partial relief for Medicare physician reimbursement rates by increasing the Medicare conversation factor adjustment from 1.25% to 2.93%. This results in a final cut of 1.66%, compared to a previously expected 3.4% cut.
  • Extends incentive payments for alternative payment models though calendar year 2026.
  • Extends the Work Geographic Index Floor (GPCI) under the Medicare program by extending a 1.0 floor on the GPCI through Dec. 31, 2024.
  • Extends the Medicare-dependent hospital and enhanced low-volume hospital programs for three months through Dec. 31, 2024 opposed to Sept. 30, 2024.

Members with questions should contact Megan Blue at the MHA.

 

 

CMS Finalizes Prior Authorization Reform Rule for MA, Medicaid and CHIP Plans

Member News

The Centers for Medicare & Medicaid Services (CMS) released a final rule last week intended to expedite the prior authorization process for those covered by Medicare Advantage, Medicaid and Children’s Health Insurance Program (CHIP) plans.

Under the new rule taking effect in 2026, Medicare Advantage, Medicaid and CHIP plans will have 72 hours to answer urgent requests and seven days for a standard request. Affected payers will also be required to provide a specific reason when denying requests, as well as publicly report certain prior authorization metrics.

Additionally, the rule will require affected payers to implement a Health Level 7 Fast Healthcare Interoperability Resources standard application programming interface (API) to support electronic prior authorization. Payers must expand patient access to APIs beginning in 2027 to include information about prior authorizations. They must also implement a provider access API that providers can use to retrieve their patients’ claims, encounters and clinical and prior authorization data.

These actions addressing prior authorization come amid conversations on this same issue on Capitol Hill. The House Ways and Means Committee advanced the bipartisan Improving Senior’s Timely Acccess to Care Act in 2023, which gained traction following a report from the U.S. Department of Health and Human Services highlighting abuse of the prior authorization program and a letter signed by 233 House and 61 Senate members urging action by the CMS. The bill would have required plans to adopt a “real time” process for answering routinely approved items and a 24-hour response for any urgent requests. The release of the final rule may pre-empt further legislative action.

Members with questions should contact Megan Blue at the MHA.