The National Association of Medicaid Directors has published its legislative priorities for 2017. Those 13 priorities, and the manner in which the group hopes to achieve them, are:
Implement requirements for advance review of federal regulations and guidance by state Medicaid staff. Require in federal statute a distinct role for state Medicaid leaders to review the conceptual soundness and operational feasibility of federal regulations and guidance prior to finalization, which directly or indirectly impact the Medicaid program.- Advance value-based reimbursement methodologies for all types of Medicaid providers. Update the tools states may use to allow for aligned value-based purchasing approaches for all Medicaid safety-net providers, including modest down-side risk where consistent with broader statewide reforms.
- Provide long-term certainty for effective state Medicaid program innovations. Establish a reasonable path for states to make permanent the foundational aspects of their Section 1115 demonstrations programs.
- Make consistent the federal financing options for Medicaid eligibility expansions and ensure state flexibility on coverage strategies. Provide states more options under the Medicaid state plan to address coverage gaps for low-income populations. An example is to allow a phased approach to coverage for new populations up to 100 percent of the federal poverty level. The existing phase down in federal financing should be consistent for all states, regardless of their starting point.
- Provide flexible options for states to streamline waiver authorities and braid funding for Medicaid, overlapping health-related services programs and the social determinants of health. Establish federal demonstration pilots that allow states to integrate funding from other federal health care funding streams, particularly those for behavioral health services, with the explicit purpose of enhancing states’ ability address the total cost of care for Medicaid enrollees.
- Resolve statutory conflicts presented by federal mental health and addiction disorder parity requirements, the federal payment exclusion for Medicaid Institutions for Mental Diseases (IMD) exclusion and federal privacy laws for individuals with a substance use disorder. Repeal or make meaningful modifications to the parameters of the Medicaid IMD payment exclusion or authorize defined waiver authority to do so. Revise existing privacy rules to enable access to protected health information (PHI) of individuals with a substance use disorders diagnosis.
- Delink Medicaid from Medicare financing. Congress should develop a mechanism for keeping the impact of Medicare policies on states predictable, reasonable, and sustainable.
- Address the service dichotomy that continues to impede coordinated, high value care for individuals dually eligible for Medicare and Medicaid. Enhance support for the MMCO’s work with states around the dual eligible population, including by authorizing permanent authority for demonstration models which align and coordinate services for the population dually eligible for Medicare and Medicaid. Permanently reauthorize the SNP program, requiring agreements between all types of SNP plans and states, and providing clear expectations for CMS and states to collaborate to maximize the administrative and care coordination opportunities.
- Allow all states to cover complex populations in managed care. Repeal the prohibition on requiring enrollment in Medicaid managed care for the Medicare and Medicaid dual eligible population and children with special health care needs. States have significant experience designing, launching and administering managed care programs for special populations.
- Harmonize federal payment rules across Medicaid delivery system models. Resolve the inconsistency in federal Medicaid policy so that payment rules apply equitably, regardless of the state’s delivery system model.
- Expand the tools states can use to design and manage Medicaid’s optional prescription drug benefit, including flexibility to exclude some FDA-approved drugs from coverage. Expand the factors states may consider in setting their prescription drug benefit, including cost. Also, advance a multi-pronged strategy to address the affordability of prescription drugs, including providing: transparency for drug pricing for public programs; providing authority for new purchasing and reimbursement strategies for Medicaid’s prescription drug benefit, including flexibility to exclude some FDA-approved drugs from coverage; and limiting the states’ exposure to high-cost prescription drugs.
- Equalize treatment of the territories of the United States. Apply the same formulary to the territories as for the broader group of states and remove the Medicaid cap.
- Facilitate innovation in long-term care, particularly home and community-based services. Allow states to target services to specific populations who will most benefit and for whom the services would be cost-effective.
Learn more about NAMD’s goals for 2017 in its publication NAMD’s Legislative Priorities for 2017.