| Recently Released 2017 Managed Care Enrollment Data The 2017 Managed Care Enrollment Data is now available. The nationwide data is broken down by program and population, as well as by individual state. The enrollment data provides an accurate snapshot of managed care enrollment for a particular year as of July 1st. The nationwide enrollment data by program and population is available here and the state data is available here. SMDL: Three New Opportunities to Test Innovative Integrated Care Models for Individuals Dually Eligible for Medicaid and Medicare CMS recently released a State Medicaid Director Letter inviting states to collaborate with CMS to test innovative approaches to better serve those who are dually eligible for Medicare and Medicaid. Many of the 12 million dually eligible beneficiaries have complex healthcare issues, including multiple chronic conditions, and often have socioeconomic risk factors that can lead to poor outcomes. The letter opens new ways to address those complex needs, align incentives, encourage marketplace innovation through the private sector, lower costs, and reduce administrative burdens for dually eligible individuals and the providers who serve them. The opportunities in the letter, together with the Primary Cares Initiative, present an array of options for transforming care delivery. Update: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies CMS published changes to the Required Prior Authorization List of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items that require prior authorization as a condition of payment detailed in CMS 6080-N2. The Required Prior Authorization List will now include seven Power Mobility Devices (PMD) Healthcare Common Procedure Coding System (HCPCS) codes Prior authorization for these PMDs will be required nationwide beginning July 22, 2019. CMS is also adding five HCPCS codes for Pressure Reducing Support Surfaces (PRSS) to the Required Prior Authorization List. Prior authorization for these support surfaces will be required in California, Indiana, New Jersey, and North Carolina beginning July 22, 2019, and will expand nationwide October 21, 2019. Additionally CMS released the annual update to the Master List of DMEPOS items that the Secretary determined, on the basis of prior payment experience, are frequently subject to unnecessary utilization (CMS 6078-N2). As a reminder, on January 13, 2017, CMS released an Informational Bulletin that provided several strategies for states to support timely access to DMEPOS for people dually eligible for Medicaid and Medicare. This bulletin includes the guidance that a non-affirmed Medicare prior authorization decision is sufficient for meeting states' obligation to pursue other coverage before considering Medicaid coverage. Additional strategies for supporting timely access to DMEPOS can also be found in the Informational Bulletin released on January 4, 2019 and in the issue brief published by Integrated Care Resource Center titled "Facilitating Access to Durable Medical Equipment for Dually Eligible Beneficiaries in the Fee-for-Service System: Three State Approaches". SAMHSA Guidance on Inappropriate Use of Antipsychotics: Older Adults and People with Intellectual and Developmental Disabilities in Community Settings The Substance Abuse and Mental Health Services Administration (SAMHSA) recently released a new brief, "Guidance on Inappropriate Use of Antipsychotics: Older Adults and People with Intellectual and Developmental Disabilities in Community Settings". The brief is intended primarily for physicians and other prescribers, as well as support staff, administrators, and caregivers working with people with dementia and intellectual and developmental disabilities (IDD) in community settings. To reduce inappropriate prescribing, this brief reviews non-pharmacologic behavioral approaches and strategies to avoid and reduce prescribing of antipsychotics whenever possible. Opportunities to Support Enrollment in the Medicare Savings Programs and Extra Help The Medicare Savings Programs and Extra Help are critical to helping low-income Americans afford Medicare coverage. However, many people who are eligible for these programs are not yet enrolled. Each May, the Social Security Administration (SSA) sends letters to 2 million low-income Medicare beneficiaries, letting them know about the Medicare Savings Programs and how they can help with Medicare costs. These programs include Qualified Medicare Beneficiary (QMB), Specified Low-income Medicare Beneficiary (SLMB), and Qualifying Individual (QI). The letters, which will be mailed on or around May 15, 2019, provide information on what Medicare Savings Programs cover, a brief description of the income and asset criteria, and how to apply. SSA also sends a data file to each state – anticipated on or around April 24th -- identifying the Medicare beneficiaries to whom the outreach letters are being mailed. States can use these data files to support customer service representatives at Medicaid hotlines who may receive calls, or conduct additional outreach themselves. More information on this outreach effort and the model letters (see specifically SSA-L447 and SSA-L448) may be found on the SSA website; the data file name is OLBG.BTI.S**.MEDOUT1.Ryymmdd. See also the data file specifications. Upcoming Trainings and State Webinars Register: Engaging Stakeholders in the Rate Setting Process Monday, May 13, 2019 at 2:00pm – 3:30pm ET Stakeholder engagement during the rate-setting process is a critical component for approval of the 1915(c) waiver application. This process allows the state to ensure all concerned parties have an opportunity to provide their input in updating or determining rate methodologies. In this session, CMS will provide promising practice examples for engaging stakeholders (e.g., individuals, family members, advocates, providers, operating agency, State Medicaid Agency, legislators, etc.) in the rate-setting process. Lewis & Ellis is currently the training lead through the Rate Review Multi-Award Contract overseen by the Division of Long Term Services & Supports (DLTSS). Lewis & Ellis will present the training and Ralph Lollar, DLTSS Division Director, and the DLTSS Team will support the training and lead the Q&A Session. Medicaid Innovation Accelerator Program Register Now: Using Data Analytics to Better Understand Medicaid Populations with Serious Mental Illness: Additional Data Sources (May 16, 2019) On May 16, 2019 from 2:00 pm-3:30 pm ET, the Medicaid Innovation Accelerator Program will provide Medicaid agencies with an overview of a new technical resource, Using Data Analytics to Better Understand Medicaid Populations with Serious Mental Illness: Additional Data Sources. This Technical Resource describes approaches to combining Medicaid data with additional data sources that can assist state Medicaid agencies with developing data analytics to better understand their population with serious mental illness. Data analyses related to housing, corrections/justice involvement and food insecurity are highlighted as examples of the approaches described in the resource. The webinar will feature an overview of the technical resource, example analyses, and a discussion with state Medicaid leaders from Arizona and Minnesota who will share insights based on their experience conducting similar analyses. This resource builds on the Medicaid claims and encounters data analytics described in the IAP resource Using Data Analytics to Better Understand Medicaid Populations with Serious Mental Illness. | 
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