Medical Care Advisory Committee April 20, 2018 Responsibly providing access to quality health coverage for vulnerable Mississippians 1
State Plan Amendment (SPA) Updates SPA 17-0001 Home Health • CMS submission 8/14/2017 • CMS Request for Additional Information (RAI) Response (9/1/18) SPA 17-0004 Tribal Notification • Approved, Effective 10/1/17 SPA 17-0015 DME and Medical Supply Reimbursement • Approved, Effective 11/9/17 Responsibly providing access to quality health coverage for vulnerable Mississippians 2
SPA Updates SPA 18-0001 LTC Updates • Public Notice Posted 12/28/2017 • CMS Submission 3/22/18 SPA 18-0002 Physician UPL • Public Notice Posted 12/28/2017 • CMS Submission 3/22/18 Responsibly providing access to quality health coverage for vulnerable Mississippians 3
SPA Updates SPA 18-0003 Medicaid Administration • CMS Submission 3/30/18 SPA 18-0006 1915(i) Community Support Program (CSP) • Finalizing Public Notice • Expires 10/31/18 CHIP SPA #10 • CMS Submission 1/9/18 • RAI Issued 2/8/18 Responsibly providing access to quality health coverage for vulnerable Mississippians 4
Waiver Updates Healthier Mississippi Waiver Renewal • CMS Submission 9/28/2017 1115 Workforce Training Initiative • Completeness Letter 1/22/18 • Ongoing Discussions with CMS Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver Renewal • Expires 6/30/18 • Drafting Public Notice and Tribal Notification Responsibly providing access to quality health coverage for vulnerable Mississippians 5
Waiver Updates Assisted Living (AL) Waiver • Expires 9/30/18 • Renewal due to CMS 6/30/18 Statewide Transition Plan • Completing final draft to send to CMS Responsibly providing access to quality health coverage for vulnerable Mississippians 6
Administrative Code Updates AC 18-001 Therapeutic Leave • In Process AC 18-002 Speech Therapy • Effective 5/1/18 • Revised provider requirements for speech therapists AC 18-005 BCBA Telehealth • In Process Responsibly providing access to quality health coverage for vulnerable Mississippians 7
Administrative Code Updates AC 18-008 and 18-009 – Pharmacy Reimbursement and 340B • Revising language to mirror SPA 17-0002 AC 18-014 Search Fee • In Process AC 18-015 Program Integrity • In Process AC 18-016 Home Health • Revising language to mirror SPA 17-0001 Responsibly providing access to quality health coverage for vulnerable Mississippians 8
Administrative Code Updates AC 18-017 DME • Revising language to mirror SPA 17-0001 AC 18-018 Transportation • In Process AC 18-019 Respiratory Therapy • In Process • Adding language to mirror SPA 18-0001 Responsibly providing access to quality health coverage for vulnerable Mississippians 9
Potential Future Filings 2018 Legislative Session • Language Revision SPA 18-0009 APR-DRG Updates Under Executive Review • SPA 18-0005 Change of Ownership (CHOW) and Appeals Responsibly providing access to quality health coverage for vulnerable Mississippians 10
Physician Reimbursement Top 5 CPT Reimbursement by State Physician E&M Mississippi Florida Georgia Alabama Louisiana Arkansas Codes 99202 $62.12 $35.98 $54.57 $53.00 $42.77 $45.10 99203 $89.69 $53.55 $76.53 $78.00 $62.18 $64.90 99212 $36.02 $21.84 $29.67 $31.00 $24.83 $27.50 $36.30 99213 $61.01 $26.61 $40.70 $42.00 $41.53 $38.40 99214 $90.08 $41.46 $62.71 $67.00 $62.65 $70.05 Responsibly providing access to quality health coverage for vulnerable Mississippians 11
Physician Reimbursement Primary Care Physician (PCP) Increase Top 5 CPT Reimbursement by State Physician E&M Mississippi Florida Georgia Alabama Louisiana Arkansas Codes 99202 $69.02 *N/A $64.20 $69.27 *N/A *N/A 99203 $99.66 *N/A $93.42 $100.52 *N/A *N/A 99212 $40.02 *N/A $37.47 $40.36 *N/A *N/A 99213 $67.79 *N/A $63.14 $68.17 *N/A *N/A 99214 $100.09 *N/A $93.35 $100.91 *N/A *N/A *Florida, Louisiana, and Arkansas reported that they did not plan to continue the Affordable Care Act (ACA) primary care increase after the 100% federal funding ended on December 31, 2014. Responsibly providing access to quality health coverage for vulnerable Mississippians 12
Medicaid Enrollment by State Mississippi 1 in 4 Alabama 1 in 5 Arkansas 1 in 3 Florida 1 in 6 Georgia 1 in 6 Louisiana 1 in 3 Responsibly providing access to quality health coverage for vulnerable Mississippians 13
Adults Pregnant Children Preventive Health Screenings/Services (21+) Women (0-21) Annual Physical Examinations Anticipatory Guidance Autism Screening Bone Density Studies Cardiovascular Screening Cervical and Vaginal Cancer Screening Cervical Dysplasia Screening Colorectal Cancer Screening Dental Assessment and Counseling Depression Screening Development/Behavioral Assessment Developmental Surveillance Diabetes Screening Dyslipidemia Screening Hematocrit and/or Hemoglobin Immunizations Influenza and Pneumonia Vaccines Laboratory Testing Lead Screening and Testing Mammography Newborn Metabolic/Hemoglobin Screening Nutritional Assessment Prostate Cancer Screening Psychosocial/Behavioral Assessment Sexually Transmitted Infection/Disease Screening Tobacco Cessation Counseling Tobacco Cessation Products The Division of Medicaid pays for all medically necessary services for EPSDT-eligible beneficiaries in accordance with MS Administrative Code Title 23, Part 223, without regard to Tuberculin Testing service limitations and with prior authorization. Vision and Glaucoma Screening Eye Exams Responsibly providing access to quality health coverage for vulnerable Mississippians 14
U.S. Department of Health & Human Services Best Practices Agency for Healthcare Research and Quality (AHRQ) authorized by • Congress to convene U.S. Preventive Services Task Force • Panel of national experts in prevention and medicine make evidence- based recommendations about clinical preventive services, screenings, counseling services, and preventive medications • All recommendations published on Task Force’s Web site and/or in peer- reviewed journal • Recommendations assigned a letter grade based on strength of evidence and balance of benefits and harms • Task Force does not consider costs of preventive service when determining recommendation Annual report to Congress • https://www.uspreventiveservicestaskforce.org/BrowseRec/Index/browse- recommendations Responsibly providing access to quality health coverage for vulnerable Mississippians 15
Responsibly providing access to quality health coverage for vulnerable Mississippians 16
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