The Massachusetts Executive Office of Health and Human Services (EOHHS) has released the state’s Medicaid waiver proposal – the document that lays out the state’s plans for operating the state’s Medicaid program (MassHealth) and related healthcare initiatives.  EOHHS is seeking public comment on the proposal through July 15 before submitting it formally to CMS.

Section 1115 of the Social Security Act allows the federal government to waive certain aspects of the Medicaid program to allow states the flexibility to devise programs for certain populations or to allow a state to use federal Medicaid funds in ways that are not otherwise allowed under federal rules.

The main aspect of the state’s waiver proposal is to shift the basic structure of MassHealth from a fee-for-service program (where providers are paid for each individual service) to an accountable care model (where services and payments throughout the full spectrum of care are bundled). To do this, EOHHS’ Office of Medicaid proposes offering providers three Accountable Care Organization models that are each tied in some form to MassHealth’s managed care organizations.

Another key component of the state’s waiver involves restructuring the state’s Safety Net Care Pool.  Massachusetts needs CMS to sign off on the proposed waiver because the federal authorization for the current Safety Net Care Pool – as well as other healthcare programs – expires on June 30, 2017. “If Massachusetts does not reach an agreement to restructure the Safety Net Care Pool prior to the end of June 2017, it will lose federal authorization for over a billion dollars in expenditures each year,” EOHHS notes in the waiver proposal.

Behavioral healthcare – generally recognized as the portion of the Massachusetts system most in need of repair – is a major focus of the waiver. EOHHS writes that “an explicit goal of this waiver demonstration is the integration of physical health and behavioral health for individuals with a range of behavioral health needs.” To do so, the state offers a variety of approaches, including “the role of certified Behavioral Health Community Partners; contractual expectations for managed care plans, the Massachusetts Behavioral Health Partnership, and ACOs; and other payment model adjustments.” Massachusetts also will encourage ACOs to integrate behavioral health and long-term services and supports community partners into care teams.

As it refines its proposal, the state will hold two public listening sessions: Session #1 will be on Friday, June 24, from 2:30 to 4 p.m. at 1 Ashburton Place, 21st Floor, Boston; conference Line: 1-866-565-6580, Passcode: 9593452.  Session #2 is set for Monday, June 27, from 2 to 3:30 p.m. at Fitchburg Public Library, 610 Main Street, Fitchburg.

MHA is reviewing the document along with its membership and has been in contact with EOHHS throughout the process.

The state’s 92-page Section 1115 Demonstration Project Amendment and Extension Request is below. 

How are the health insurance companies that operate in Massachusetts doing? The answer to that question can be found in MHA’s Semi-Annual Health Plan Performance Report, which is now available and contains data from all of Fiscal Year 2015. The report looks at plan membership, premium rates, medical and administrative expense trends, and profitability, liquidity, and solvency statistics. It provides information about health plan market share, and it presents trends in premium rates to employer groups. The report includes figures important to evaluate a plan’s financial condition: net worth, net income, total premium revenues collected, and medical expenses. The plans covered are Blue Cross and Blue Shield of Massachusetts, BMC HealthNet Plan, CeltiCare, Fallon Health, Harvard Pilgrim Health Care, Health New England, HMO Blue, Minuteman Health, Neighborhood Health Plan, Tufts Public (formerly Network Health), Tufts Health Plan, and United Health Care of New England (United). This report also contains enrollment information on activity of the Health Connector.

One main general conclusion of interest: while most plans were profitable, margins were generally quite low, with only a few plans having strong years.

To purchase the report, contact MHA’s Leanne Banks at lbanks@mhalink.org.

TOBACCO FREE MASS is holding its Fourth Annual Awards Ceremony and Fundraiser on Thursday, June 23, from 8 to 10 a.m. at the Massachusetts Medical Society, 860 Winter Street, Waltham. Boston Mayor Martin “Marty” Walsh will be recognized for his leadership in reducing tobacco use among young people and for bringing tobacco-free baseball to Fenway Park. MHA President and CEO Lynn Nicholas, FACHE, who has been a longtime proponent of tobacco-reduction efforts, including MHA’s own “Healing Inside and Out: Mass. Tobacco-Free Hospitals”, is the honorary chair of the event. Individual $100 tickets are still available.

The Organization of Nurse Leaders – Mass., R.I., N.H., and Conn. chose its new leadership team during its annual meeting June 16 and 17. ONL’s new president is Timothy “Tim” Quigley, R.N., VP of Nursing/CNO at South Shore Hospital. He replaces Maria Ducharme, RN, SVP, patient care services & CNO at The Miriam Hospital in Providence, R.I. The new president elect is Joanne Fucile, R.N., VP for hospital operations and director of nursing at Spaulding Hospital for Continuing Medical Care in Cambridge. 

Ray Campbell has been named the new executive director of the state’s Center for Health Information and Analysis (CHIA), effective August 1. He is currently the acting executive director of the Group Insurance Commission, and was executive director and CEO of the Massachusetts Health Data Consortium from 2005 through 2012. The interim director until Campbell assumes his post will be Steve McCabe, CHIA’s deputy executive director, health analytics & finance. The announcement was made at the CHIA Advisory Board meeting on Thursday. Aron Boros, CHIA’s executive director since November 2012, left his post on June 17. His term was scheduled to end in November 2017.

THURSDAY, JULY 14; 9 A.M. - 4 P.M.
MHA CONFERENCE CENTER, BURLINGTON, MASS.

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