Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

NH Postpones Medicaid Managed Care Implementation

By Elizabeth Snell

- New Hampshire has been working toward its Medicaid managed care implementation, but state officials recently announced that Stage 2 of the initiative has been postponed. Concerns have been raised about the program’s potential impact on those receiving intensive or complex medical care, reported the Concord Monitor. Additionally, some were worried that more time was needed to prepare for the implementation.

The Governor’s Commission on Medicaid Care Management held a meeting last week, which was where Department of Health and Human Services (DHHS) Commissioner Nick Toumpas announced the postponement.

There were “challenges to implement 1915 waiver for Mandatory enrollment,” according to the meeting’s slideshow from the New Hampshire DHHS. Moreover, having two separate dates for Mandatory and CFI and NF services posed a potential challenge for clients, DHHS explained. However, “DHHS has developed a detailed framework for Step 2 Concepts built on the prior SIM work, Stakeholder feedback and input, and the draft principles from the Commission and other sources.”

DHHS added that these concepts will be presented at the next MCM Commission meeting, which is schedules for Nov. 6.

A timeline was announced over the summer, and it would have required many Medicaid recipients who rely on long-term care and supports to enroll in managed care plans at the beginning of 2015.

The second phase – Step 2 – of managed care implementation would have been broken up into three phases starting in January. The long-term care population could have opted-out of the state’s managed care programs during “Step 1” of the program. However, they are required to enroll under the next step.

Addressing the public’s concerns and ensuring that implementation was done correctly have always been the most important aspects throughout the Step 2 process, spokesman for Governor Hassan, William Hinkle, told the news source.

“Governor Hassan has consistently said that Step 2 would not be launched until it was ready,” Hinkle said in an email. “There is critical work left to do to ensure that Medicaid recipients continue to receive the best possible community-based care in a managed care environment.”

Just last month, the Office of the Inspector General (OIG) announced that state standards for access to care often vary. OIG recommended that the Centers for Medicare and Medicaid Services (CMS) strengthen its oversight of state standards and ensure that it develops standards for key providers.

Moreover, CMS needs to strengthen its oversight of states’ methods to assess plan compliance with access standards and work with states to make sure that the developed methods accurately determine plan compliance, according to OIG.

CMS was also told that it needed to improve states’ efforts to identify and address violations of access standards and provide technical assistance and share effective practices. OIG reported that CMS agreed with all recommendations and would collaboratively work with states to find best practices for testing plan compliance instead of endorsing a specific method.

 

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