CMS resets the federal-state relationship modernizing Medicaid to deliver better outcomes

On January 30, 2020, the Centers for Medicare & Medicaid Services (CMS) announced the Healthy Adult Opportunity (HAO), which is an optional demonstration initiative.  It is designed to give states unprecedented tools to design innovative health coverage programs tailored to the unique needs of adult beneficiaries, while holding states accountable for results and maintaining strong protections for our most at risk populations.

 

These innovations deliver on the Trump Administration’s promise to improve health outcomes and care for our most vulnerable. The Healthy Adult Opportunity puts patients first through state flexibility, accountability, and patient protections. It is designed to provide states with an opportunity to meet the needs of their  adult beneficiaries under age 65 who aren’t eligible on the basis of a disability or their need for long-term care and for whom Medicaid coverage is optional for states.  Other low-income adults, children, pregnant women, elderly adults, and people with disabilities will not be directly affected – except from the improvements that result from states reinvesting savings to improve and sustain Medicaid for everyone.

 

“Vulnerable populations deserve better care. Data shows that barely half of adults on the Medicaid program report getting the care they need,” said CMS Administrator Seema Verma. “This opportunity is designed to promote the program’s objectives while furthering its sustainability for current and future beneficiaries, and achieving better health outcomes by increasing the accountability for delivering results. We’ve built in strong protections for our most vulnerable beneficiaries, and included opportunities for states to earn savings that have to be reinvested in strengthening the program so that it can remain a lifeline for our most vulnerable.”

 

For the first time, participating states will have more negotiating power to manage drug costs by adopting a formulary similar to those provided in the commercial market, with special protections for individuals with HIV and behavioral health conditions. In exchange for increased flexibility offered through the Healthy Adult Opportunity, states must accept increased accountability for the program’s results.

 

The Healthy Adult Opportunity also provides the opportunity for a full array of flexibilities that CMS has historically provided through section 1115 demonstrations – in addition to some that are entirely new – and outlines them in a streamlined application template. These include flexibilities to waive requirements like retroactive coverage periods and the ability to engage beneficiaries through nominal premiums and cost-sharing. Subject to comprehensive expectations for minimum standards for approval of a Healthy Adult Opportunity demonstration, states will also have the opportunity to customize the benefit package for those covered and make needed program adjustments.  This will be in real-time without lengthy federal bureaucratic negotiations or interference.

 

Key federal benefit and eligibility protections as well as due process and civil rights remain in place and beneficiaries will still have important protections through minimum benefit requirements, eligibility protections, and limits on out-of-pocket expenses.

 

The Healthy Adult Opportunity establishes financial metrics to ensure states are driving affordability and quality, with savings shared between the federal government and state governments to protect taxpayers. States participating in the Healthy Adult Opportunity will be required to report on a set of key quality measures. In a new initiative specific to Healthy Adult Opportunity, states will report real-time performance indicators to CMS for detection of any potential beneficiary quality or access issues that need to be quickly addressed.

 

All proposals that states submit in response to this demonstration will still need to comply with existing transparency and public notice requirements, and states will need to ensure adequate public notice before any prospective changes are implemented.

 

The State Medicaid Directors’ letter can be viewed here: https://protect2.fireeye.com/url?k=f1182f1c-ad4d260f-f1181e23-0cc47adb5650-c30736484f733316&u=https://www.medicaid.gov/sites/default/files/Federal-Policy-Guidance/Downloads/smd20001.pdf

To view the fact sheet, please visit: https://www.cms.gov/newsroom/fact-sheets/healthy-adult-opportunity

To view the Medicaid facts and figures, please visit: https://www.cms.gov/newsroom/fact-sheets/medicaid-facts-and-figures

 

To more formally recognize the value of Community Health Workers in the workforce and enhance recognition of CHWs, a new CHW certification is now being offered by the Pennsylvania Certification Board (PCB).

A time-limited (one-year) grandparenting process for those who meet the Certified CHW (CCHW) requirements and wish to obtain the new full certification is being provided. The grandparenting period will end December 31, 2020.

The requirements to become grandparented are:

• One year of full-time volunteer or paid employment or 2000 hours of part-time volunteer or paid employment as a Community Health Worker. Employment or volunteer experience must have been obtained within the last five (5) years.
• Sixty (60) hours of supervision of the volunteer or paid employment specific to the CHW domains (listed below).
• Seventy-five (75) hours of education/training relevant to the field of community health.
• Complete the CCHW Grandparenting Application.

CCHW Domains

Community Health Concepts; Advocacy and Capacity Building; Care Coordination; Health Literacy and Education; Safety and Self-Care; Cultural Competency; Communication and Interpersonal Skills; Ethical Responsibilities and Professionalism.  Summary of CCHW Domains (.pdf document)

The new CCHW certification will be valid for two years. A recertification process will be required every two years to maintain the CCHW credential. Recertification requires obtaining 30 hours of relevant education/training.

Once the grandparenting period ends on December 31, 2020, the 75 hours of education/training must be received from an approved CHW training program. A PCB CHW Advisory Council will create a process for this in 2020.  CCHW Grandparenting Application (.pdf document)

Questions about the new CCHW credential should be directed to the PCB:
Phone: 717-540-4455 | Email: info@pacertboard.org

The following organizations participated in the development of the new certification process:

• Pennsylvania CHW Steering Group and Task Force
• CHW Subject Matter Expert
• Pennsylvania Certification Board

The National Rural Health Information Hub has released a new toolkit, Rural Response to Farmer Mental Health and Suicide Prevention, which discusses the rising mental health crisis in farming communities and provides information on organizations and model programs that are addressing the challenges and mental health needs of this population.

The Pennsylvania Department of Health has released the 2019-2023 Pennsylvania Cancer Control Plan, recently adopted by Secretary of Health Rachel Levine. The plan contains 15 cancer control goals Pennsylvania is working to achieve over the next five-year period.  The new website, pacancercoalition.org also includes a Cancer Plan Report Card which will be used to monitor progress toward meeting the goals.

As the effort to count every resident in the United States begins, the Urban Institute provides data on rural populations living in hard-to-count areas and steps for achieving a more accurate count.  Population counts from the U.S. Census are used to allocate federal funding, provide data for research and policy-making, and plan economic development, among countless other needs for quality of life.  In addition to traditional challenges to counting in rural areas – remote homes, migrant workers, literacy – the 2020 Census will add a digital response option and many rural areas have low rates of internet access at home.  More information is available by clicking here.