Summary of Key Updates - Sellers Dorsey
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ISSUE #71
Summary of Key Updates Federal Updates
A bipartisan group of governors have requested the Biden Senators Susan Collins and Jeanne
administration “move away from the pandemic.” Shaheen have proposed a bill in the
Stakeholders have voiced concerns about state-managed Senate that will extend the provider
pandemic responses, which could negatively impact both the relief spending deadline and
health care workforce and disrupt health care networks that accelerate the distribution of the
patients depend on for care (Inside Health Policy, February remaining funds in the Provider Relief
11; Inside Health Policy, February 11; Inside Health Policy, Fund.
February 11).
The Food and Drug Administration (FDA) recently announced State Updates
its decision to delay moving forward with authorizing COVID- On February 9, California released a
19 vaccines for children under five years old (Modern Request for Proposals (RFP) soliciting
Healthcare, February 11). bids to contract with its Medicaid
program (Medi-Cal).
From February 10 to February 16, CMS approved one Section
1915(c) Appendix K waiver and seven SPAs, all of which are
COVID-19 disaster relief SPAs.
Sellers Dorsey helps clients every step of the way to get the
resources they need to drive health outcomes. Read our Private Sector Updates
latest case study about how we helped a Medicaid provider A study published in Health Affairs
in Baltimore, MD expand access, lower costs, and improve found racial and ethnic minority
quality of care. enrollees in Medicaid managed care
plans describe inferior experiences
of care when compared to others
with identical coverage.
Sellers Dorsey Updates
Sellers Dorsey is proud to have
members of our expert team
attending this year’s State of Reform
Federal Health Policy Conference.2 Sellers Dorsey Digest
FEDERAL UPDATES
News
• In a 50-46 vote, the Senate confirmed Robert Califf as the next Commissioner of the FDA. Six Republicans
voted for Califf, and five Democrats voted against his confirmation (Senate.gov, February 15).
• As provider relief funds continue to diminish, a bipartisan group of governors wants the Biden
administration to “move away from the pandemic,” but a variety of stakeholders are concerned that state-
managed pandemic responses could negatively impact both the health care workforce and disrupt health
care networks that patients depend on for care. Additionally, House Republicans asked the administration
to provide a solid timeline for ending the public health emergency (PHE) and to provide a list of the
emergency provisions and regulatory flexibilities that should be made permanent (Inside Health Policy,
February 11; Inside Health Policy, February 11; Inside Health Policy, February 11).
• The Medicaid Health Plans of America (MHPA) continues to express concern about a sudden end to the
PHE and wrote a letter to Congress urging them to include an unwinding timeline in the omnibus budget
package currently underway. The Biden administration updated previous guidance to give states 12
months to resume normal redetermination processes, but the administration cannot change the date
when the increased Federal Medical Assistance Percentage (FMAP) ends. However, if the Build Back Better
proposal is attached to the omnibus budget package, it would phase out the 6.2% FMAP beginning March
31, 2022, eventually reducing it to 1.5% on July 1, 2022. MHPA is asking for at least a four-month leeway
from the date of enactment to ensure there is enough time to conduct redeterminations (Inside Health
Policy, February 14).
• On February 9, the National Association of Medicaid Directors (NAMD) wrote a letter in response to CMS’
proposed National Coverage Determination of Coverage with Evidence Development for monoclonal
antibodies directed against amyloid for the treatment of Alzheimer’s disease. In the letter, NAMD
acknowledges the clinical reasoning for the coverage but asserts that limited Medicare coverage will shift
primary coverage responsibilities onto state Medicaid programs for the dual eligible members prescribed
this therapy. NAMD asks CMS to allow states to utilize medical necessity and prior authorization criteria to
establish appropriate use of the therapies. The association asserts that Medicaid programs should not be
expected to provide widespread coverage for therapies that do not meet evidentiary standards for
similarly widespread Medicare coverage (NAMD, February 14).
Federal Legislation
• Senators Susan Collins (R-ME) and Jeanne Shaheen (D-NH) have proposed a Senate bill that will the extend
the provider relief spending deadline and accelerate the distribution of the remaining funds in the Provider
Relief Fund (PRF). A similar bill has also been introduced in the House. The bills would require the Health
Resources and Services Administration (HRSA) to distribute all the remaining funds by March 31 and
extend the PRF spending deadline for providers to June 2023 or the end of the PHE, whichever is later.
Given the proposed deadline extension, the bills also mandates the Department of Health and Human
Services (HHS) to return the relief money to providers who were required to send unused relief funds back
to HHS if they were unable to spend it under the current deadline. Additionally, the proposed bills would
permit providers to use PRF to pay for workplace security and violence mitigation. The American Hospital
Association endorsed the Senate bill’s introduction (Inside Health Policy, February 11).
COVID-19
• On February 11, the FDA announced its decision to delay moving forward with authorizing COVID-19
vaccines for children under five years old. The agency indicated the need for more data from Pfizer
involving a third dose of vaccine in children under age five, the study of which has not yet been completed,
before moving forward with the authorization process. The FDA previously urged Pfizer to apply for the
authorization despite not having completed its study on the full vaccine sequence in children under age
five, citing an urgent need for vaccines due to the toll the COVID-19 virus has taken on young children.
Pfizer expects to have the data sought by the FDA by early April (Modern Healthcare, February 11).
If you are a client and have questions, we advise you to consult with your Sellers Dorsey account or project contact. If you are not currently working with Sellers
Dorsey, please email info@sellersdorsey.com. Subscribe to this newsletter here: www.sellersdorsey.com/about/newsletter.3 Sellers Dorsey Digest
• On February 11, the FDA granted emergency use authorization to Eli Lilly’s new COVID-19 monoclonal
antibody, bebtelovimab, which works against the Omicron variant and its subvariant. This authorization
means there are now two monoclonal antibodies available to treat mild to moderate COVID-19. The
therapy is for adults and pediatric patients at least 12 years old who are at high risk for severe COVID-19
and for whom alternative FDA-authorized or approved COVID-19 treatment options are not accessible or
appropriate (Inside Health Policy, February 11).
• A February 11 Centers for Disease Control and Prevention (CDC) report indicated that protection against
COVID-19 infection offered by mRNA vaccines and their boosters wanes over time. The study looked at
urgent care and emergency department utilization in 10 states during periods of high prevalence for both
the Delta and Omicron variants. The study also found protection against severe illness hospitalization
remains high even as protection against infection decreases over time (Modern Healthcare, February 11).
Studies and Reports
• On February 10, HHS released a report detailing the impact of federal and state economic relief efforts on
poverty reduction. The report indicates that direct cash payments, unemployment benefits, and monthly
Advance Child Tax Credit payments kept 20.1 million people out of poverty and reduced overall poverty by
45% in 2021. The individuals kept out of poverty include 7.8 million children, a group for which the
economic relief efforts reduced poverty by 56%. The report credits the American Rescue Plan (ARP) with
keeping an estimated three million children out of poverty, the highest of any 2021 economic relief effort.
The report also indicates that American Indian/Alaska Native individuals, non-Hispanic Black individuals,
and Hispanic individuals experienced greater poverty reductions in 2021 than other racial and ethnic
groups (HHS, February 10).
STATE UPDATES
Waivers
• Section 1915(c) Appendix K
o Pennsylvania
Temporarily provides supplemental payments, increases rates for waiver services, and
increases applicable fiscal year limits using ARP funds for the Consolidated Waiver,
Community Living Waiver, and Person/Family Directed Support Waiver.
SPAs
• COVID-19 SPAs
o Massachusetts (MA-21-0001, effective April 1, 2020): Adds a temporary rate increase of 10% to
behavioral health services including applied behavioral analysis services, Children's Behavioral
Health Initiative services, early intervention rates, and substance abuse disorder clinic rates
effective April 1, 2020 through April 15, 2020, and psychologist rates effective April 1, 2020
through April 22, 2020.
o Nebraska (NE-22-0001, effective January 1, 2022): Pays nursing facilities an additional $20 per day
per Medicaid beneficiary through June 30, 2022, or through the end of the PHE, whichever is
sooner. This time-limited COVID-19 SPA terminates at the end of the PHE.
o New Mexico (NM-22-0001, effective January 1, 2022): Increases payment rates by 6.81% for non-
emergency medical transportation providers through June 30, 2022, or through the end of the
PHE, whichever is sooner. This time-limited COVID-19 SPA terminates at the end of the PHE.
o New Mexico (NM-22-0003, effective January 1, 2022): Increases payment rates by 50% for ICU
inpatient services and 12.4% for all other in-patient hospital services through June 30, 2022, or
through the end of the PHE, whichever is sooner. This time-limited COVID-19 SPA terminates at
the end of the PHE.
If you are a client and have questions, we advise you to consult with your Sellers Dorsey account or project contact. If you are not currently working with Sellers
Dorsey, please email info@sellersdorsey.com. Subscribe to this newsletter here: www.sellersdorsey.com/about/newsletter.4 Sellers Dorsey Digest
o New Mexico (NM-22-0002, effective January 1, 2022): Increases payment rates for short-term
skilled and custodial nursing facility services through June 30, 2022, or through the end of the
PHE, whichever is sooner. This time-limited COVID-19 SPA terminates at the end of the PHE.
o Nevada (NV-22-0003, effective October 1, 2021): Increases payment rates for Self Help/Peer
Services, Self Help/Peer Services-Group, Behavioral Health Assessment, and Adult Daycare
Services using ARP funds through June 30, 2022, or through the end of the PHE, whichever is
sooner. This time-limited COVID-19 SPA terminates at the end of the PHE.
o Oregon (OR-22-0001, effective January 1, 2021): Increases rates by 10% to selected Behavioral
Rehabilitation Service providers. This time-limited COVID-19 SPA terminates at the end of the PHE.
News
• After a three-year selection process, Louisiana awarded Medicaid managed care contracts, valued at an
estimated $21 billion, on February 11. The state intends to contract with Aetna, AmeriHealth Caritas, Blue
Cross and Blue Shield of Louisiana, Anthem’s Healthy Blue, and Humana and Centene’s Louisiana
Healthcare Connections. UnitedHealthcare was previously awarded the contract in the invalidated bid
from 2019 but failed to receive an award during the current procurement. UnitedHealthcare has the
option to lodge an objection during the 14-day protest period of February 12 through February 25 (Health
Payer Specialist, February 14; Louisiana Department of Health, February 11).
• On February 9, California released a Request for Proposals (RFP) soliciting bids to contract with its
Medicaid program (Medi-Cal). The five-year contract is the largest of its kind in the U.S., valued at $98
billion, and is the first Medi-Cal contract to solicit bids from commercial insurers on a statewide basis. The
state is accepting bids for its Two-Plan Model, Regional Model, and Geographic Managed Care Program,
which collectively represent 79% of managed care enrollees in the state. Non-binding letters of intent are
due March 2, and formal proposals are due April 11. Winners will be announced on August 22, and
coverage is scheduled to start on October 10 (Health Payer Specialist, February 14).
• A study conducted by Manatt Health and the Commonwealth Fund concluded that if Mississippi expands
Medicaid eligibility under the Affordable Care Act, it could save an estimated $212 million over the first
five years of expansion. The state would also have its total Medicaid program costs drop by $1.2 billion in
the first five years due to the expanded cost-sharing provisions afforded by ARP and could save $23 million
per year on mental health services. The study, however, also noted that Medicaid expansion in Mississippi
would cost $973 million per year starting 2023 and would cost nearly $8.8 billion over the first five years of
implementation. The study also referenced a previous analysis by the Commonwealth Fund that found
that expanding Medicaid in Mississippi would increase the state’s total economic output by $23.8 billion
between 2022 and 2025 and add 22,000 jobs in the first year of implementation. The current income
eligibility for healthy adults in the state is capped at 21% Federal Poverty Level (FPL)—that would increase
to 138% FPL under Medicaid expansion with approximately 229,000 adults expected to be enrolled in the
program (Health Payer Specialist, February 14).
• On February 15, a proposal introduced by State Senator Wayne Steinhauer (R) to expand Medicaid to
provide health care coverage to approximately 42,500 new South Dakota residents was defeated in the
South Dakota Senate. South Dakota’s major health care systems are now backing a campaign to pass a
constitutional amendment to expand Medicaid through voters in the November election ballot (Associated
Press, February 15).
PRIVATE SECTOR UPDATES
• A recent study published in the February issue of Health Affairs found racial and ethnic minority enrollees
in Medicaid managed care plans described inferior experiences of care when compared to White and
ethnic non-minority enrollees with identical coverage. This was the first known study to assess experience
of care on a multistate level and evaluated data from 2014 through 2018 on more than 242,000 non-
elderly managed care enrollees in 37 states. The four experiences of care measures include access to
needed care, access to a personal doctor, timely access to checkup, and timely access to specialty care.
If you are a client and have questions, we advise you to consult with your Sellers Dorsey account or project contact. If you are not currently working with Sellers
Dorsey, please email info@sellersdorsey.com. Subscribe to this newsletter here: www.sellersdorsey.com/about/newsletter.5 Sellers Dorsey Digest
Minority enrollees reported significantly worse outcomes on all of them. Proposed interventions include
gathering comprehensive data about race and ethnicity, adopting health equity quality and performance
metrics, engaging enrollees at the plan level, and developing initiatives to dismantle structural racism
(Fierce Healthcare, February 15).
SELLERS DORSEY UPDATES
• Sellers Dorsey helps clients every step of the way to get the resources they need to drive health outcomes.
Read our latest case study about how we helped a Medicaid provider in Baltimore, MD expand access,
lower costs, and improve quality of care.
• Sellers Dorsey is proud to have members of our expert team attending this year’s State of Reform Federal
Health Policy Conference. We can’t wait to learn more from this catalyzing conversation between thought
leaders in politics and health care.
• As the health care landscape moves from volume to value, states and managed care organizations
continuously seek ways to improve access to care for Medicaid beneficiaries. Our team of experts assists
managed care organizations with drafting winning responses to Medicaid managed care state
procurements. Here’s an example of how our team helped a client respond to a Request for Proposal
related to long-term services and supports.
If you are a client and have questions, we advise you to consult with your Sellers Dorsey account or project contact. If you are not currently working with Sellers
Dorsey, please email info@sellersdorsey.com. Subscribe to this newsletter here: www.sellersdorsey.com/about/newsletter.You can also read
