Policy Update - May 3, 2016

Federal Updates in This Issue
- Two New CMS Documents Affect FQHCs
- New Access Point Application Open

State Updates in This Issue
- 2016 Legislative Session
- 3-Star Healthy Project
- Tennessee Health Link
- Tennessee Patient-Centered Medical Home

Federal Update

Two New CMS Documents Affect FQHCs

A final rule updating regulations governing Medicaid Managed Care Organizations. Key points include:

  • Incentive payments made by Medicaid MCOs may not be counted against PPS payment. 
  • Value-based payment (VBP) arrangements must adhere to the statutory requirements for PPS. 

letter to state health officials addresses “delegated” wraparound payments. In some states, MCOs pay wrap payments; in Tennessee the State administers them. Key points include:

  • Starting in July 2017, every Medicaid and CHIP MCO will be required to contract with at least one FQHC in each service area.
  • Starting in July 2017, states may “delegate wrap” to MCOs only for those FQHCs that have agreed to this approach. 

New Access Point Application Open

Subject to the availability of appropriated funds, HRSA anticipates awarding approximately $50 million to support an estimated 75 New Access Point awards in Fiscal Year 2017. The maximum annual funding that can be requested in a NAP application is $650,000. Technical assistance is available from HRSA; the deadline is June 17 and the EHB deadline is July 15.

State Update

2016 Legislative Session

The Tennessee General Assembly adjourned on April 22, 2016. As reported in a previous Health Policy Blog post, FQHCs and Charitable Clinics will receive $12.5 million in Safety Net dollars in FY 2017 due to the passage of a $3.2 million budget amendment. A future blog post will provide a legislative wrap-up summarizing legislation of consequence for health centers.

3-Star Healthy Project

In mid-April, Speaker Harwell and Governor Haslam announced the formation of the 3-Star Healthy Project. The 3-Star Healthy Project's Task Force is charged with developing a list of options for making TennCare more efficient and increasing access to care for Tennesseans. These options will be tested through a set of pilots.

The Task Force began meeting last week; on April 26, TennCare director Darin Gordon met with the Task Force and on April 27 Melinda Buntin, Vanderbilt Health Policy Chair, met with the Task Force. The meetings were open to the media and stakeholders. Mr. Gordon focused on TennCare funding, population characteristics, the coverage gap, and CMS conditions for the enhanced Medicaid match under the ACA. Dr. Buntin focused on plans that other states have attempted or implemented and helped Task Force members think through options that have the potential to be approved by CMS. Task Force members had many questions focusing on phase-in options (including by geographic area, income level, health condition, etc.), incentives for health behavior, the hospital assessment fee that would cover the State's share of the cost, provider capacity to handle an increase in the Medicaid population, and cost thresholds or circuit breakers. At the end of the meeting, Chairman Cameron Sexton announced the Task Force would be traveling the state including stops in Memphis, Chattanooga, Knoxville, and the Tri-Cities. TPCA will be sure that members are informed about future meetings.

Tennessee Health Link

TennCare is now accepting provider applications for Tennessee Health Link. Tennessee Health Link incentivizes increased care coordination for TennCare members with severe behavioral health needs. Tennessee Health Link is a team of professionals associated with a mental health clinic or other behavioral health provider who provides whole-person, patient-centered, coordinated care for an assigned panel of members with behavioral health conditions. Members who would benefit from a Health Link will be identified based on diagnosis, health care utilization patterns, or functional need. They will be identified through a combination of claims analysis and provider referral. Providers selected to participate as Tennessee Health Links will be notified by June 15, 2016. The program will launch October 1, 2016.

Tennessee Patient-Centered Medical Home

The application for Tennessee's Patient-Centered Medical Home will be released on June 1 and will be due July 1. TennCare plans to select 20-30 practices for Wave 1; Wave 1 will begin January 1, 2017. You can view the latest provider stakeholder presentation here. Tennessee's goal is to enroll 65 percent of TennCare members in a PCMH practice by 2020.




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