This issue brief, the twelfth in a series, addresses Hilltop’s latest update of the Community Benefit State Law Profiles to reflect new community benefit legislation enacted between January 1, 2015, and October 31, 2015. Just two states—Connecticut and North Carolina—enacted new community benefit legislation during this time. This brief discusses these changes, as well as community benefit bills in twelve states that were introduced but not enacted in 2015 in order to better understand current trends in legislative action.
HealthChoice—Maryland’s statewide mandatory Medicaid managed care program—was implemented in 1997 under authority of Section 1115 of the Social Security Act. Since the inception of HealthChoice, the Maryland Department of Health has conducted five comprehensive evaluations of the program as part of the 1115 waiver renewals. Between waiver renewals, the Department completes an annual evaluation for HealthChoice stakeholders. This report is the 2013 annual evaluation of the HealthChoice program.
The Medicaid Long-Term Services and Supports in Maryland Chart Book, Volume 2, The Autism Waiver is the second chart book in a series of two that explores service utilization and expenditures for Medicaid-funded long-term services and supports in Maryland. Volume 1 in this series explores service utilization and expenditures for Maryland Medicaid’s Living at Home Waiver, Waiver for Adults, and Medical Day Care Waiver, as well as Maryland State Plan personal care services and Medicaid nursing facility utilization and expenditures.
Network adequacy refers to a health plan’s ability to provide reasonable access to sufficient in-network providers. Essential community providers (ECPs) serve low-income and medically underserved populations and include such providers as federally qualified health centers (FQHCs), Ryan White designated providers, family planning clinics, Indian health providers, and specified hospitals. Pursuant to federal regulations, the Maryland Health Benefit Exchange (MHBE) is interested in further developing policies for ECPs and provider network adequacy. To achieve this goal, the MHBE tasked its Standing Advisory Committee (SAC) to create a Network Adequacy and ECP Workgroup (Workgroup), charged with reviewing background materials and developing and assessing various policy options for provider network standards. The Workgroup included 16 members, representing carriers, providers, and consumer advocacy organizations.
This report summarizes the background materials Hilltop developed for the Workgroup and the Workgroup’s discussions of policy options. The purpose of this report is to provide input to the MHBE Board of Trustees for the 2017 benefit year.
This chart book summarizes demographic and Medicaid service and expenditure data for Marylanders using LTSS in state fiscal years (FYs) 2010 through 2013. Medicaid programs and services addressed in this chart book include the Living at Home (LAH) Waiver, the Medical Day Care Services (MDC) Waiver, the Waiver for Older Adults (WOA), Medical Assistance Personal Care (MAPC) Program, Medicaid Nursing Facility Services, and Money Follows the Person.
With the establishment of the Exchange in Maryland law in 2012, the memorandum of understanding (MOU) that supported Hilltop’s work on health care reform between the Maryland Department of Health and Mental Hygiene (DHMH) and Hilltop transitioned to one between the Maryland Health Benefit Exchange (MHBE) and Hilltop.
This report presents the activities and accomplishments of that MOU, covering April 1, 2014, through April 30, 2015.
Hilltop Hospital Community Benefit Program Director Gayle D. Nelson, JD, gave this presentation at a Payers and Providers webinar titled The New Era: Hospital Community Benefits & Patient Financial Assistance on June 26, 2015. The webinar was attended by a national audience of state policymakers, community benefit directors of hospitals and health plans, financial officers, and providers. In her presentation, Nelson gave an overview of Affordable Care Act (ACA) §9007, “Additional Requirements for Charitable Hospitals,” which added I.R.C. §501(r) when it was enacted in 2010; gave a regulatory history from 2010 to the present; and discussed the Final Rules and their stipulations that were promulgated on December 31, 2014
Hilltop staff made several presentations at the 2015 AcademyHealth Annual Research Meeting (ARM) held June 13 through June 15 in Minneapolis. Policy Analyst Carl Mueller, MS, presented this poster at an ARM poster session on June 15.
This study examined whether an association exists between utilization of well or ambulatory medical and preventive or diagnostic dental services for children aged 2 to 18 years in Maryland Medicaid. We found that children receiving a well or ambulatory care visit had three times the odds of receiving a preventive or diagnostic dental service. This association provides a rationale for the use of mandates and/or incentives to encourage physicians to further promote oral health.
Hilltop staff made several presentations at the 2015 AcademyHealth Annual Research Meeting (ARM) held June 13 through June 15 in Minneapolis. Senior Policy Analyst Shamis Mohamoud, MA, presented this poster at an ARM poster session on June 15.
The objective of the analysis presented in the poster is to explore the prevalence of potentially preventable hospitalizations among adult Medicaid enrollees in Maryland, and the characteristics associated with increased likelihood of a potentially preventable hospitalization.
Hilltop staff made several presentations at the 2015 AcademyHealth Annual Research Meeting (ARM) held June 13 through June 15 in Minneapolis. Executive Director Cynthia H. Woodcock, MBA, presented this poster for Director of Special Studies Ian Stockwell, PhD, at an ARM poster session on June 14.
This poster shows that mental illnesses are both a cause for becoming dually eligible (eligible for both Medicare and Medicaid) and a factor contributing to the complexity of managing the care for individuals with multiple chronic conditions and associated functional impairments.