This September 1, 2009 Centers for Medicare & Medicare Services (CMS) letter from Center for Medicaid and State Operations (CMSO) Director Cindy Mann to state Medicaid directors provides preliminary guidance for state Medicaid programs' meaningful use of electronic health records (EHRs) under the American Recovery and Reinvestment Act of 2009 (ARRA). 

From the letter:

The purpose of this letter is to provide initial guidance on section 4201 of the American Recovery and Reinvestment Act of 2009 (Recovery Act), Pub. L. 111-5 which establishes a program for payment to providers who adopt and become meaningful users of electronic health records. This letter, including the enclosures, will provide preliminary guidance on State expenses related to activities in support of the administration of incentive payments to providers. More information will be forthcoming through guidance and rule-making regarding State administrative expenses and provider incentive payments. We intend to publish proposed regulations to address the steps outlined in this letter by the end of the year.

Full letter: http://www.cms.hhs.gov/smdl/downloads/SMD090109.pdf 

Enclosure A: State Medicaid HIT Plan: http://www.cms.hhs.gov/smdl/downloads/SMD090109Att1.pdf

Enclosure B: Relationship between MMIS, MITA, and HIT Adoption: http://www.cms.hhs.gov/smdl/downloads/SMD090109Att2.pdf 

Enclosure C: Roles and Responsibilities: http://www.cms.hhs.gov/smdl/downloads/SMD090109Att3.pdf 

Enclosure D: CMS Coordination with the Office of the National Coordinator and Section 3013: http://www.cms.hhs.gov/smdl/downloads/SMD090109Att4.pdf 

Enclosure E: Medicaid HIT Planning Activities Eligible for 90 Percent Administrative HIT FFP: http://www.cms.hhs.gov/smdl/downloads/SMD090109Att5.pdf

Enclosure F: HIT Resources: http://www.cms.hhs.gov/smdl/downloads/SMD090109Att6.pdf

This Brookings Institution paper, published in Health Affairs, proposes linking federal Medicaid disproportionate-share funding to state-level enrollment and/or uninsured populations.

McKethan, A., Nguyen, N., Sasse, B. & Kocot, S.L.(2009). Reforming the Medicaid Disproportionate-Share Hospital Program. Health Affairs, 28 (5): 926-936. DOI: 10.1377/hlthaff.28.5.w926. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.5.w926

Authors: Aaron McKethan, Nadia Nguyen, Benjamin E. Sasse, S. Lawrence Kocot. 

From the introduction:

Predictive models are data-driven, decision-support tools that estimate an individual’s future potential health care costs and/or opportunities for care management. Most commercially available PM tools classify individuals into future cost categories with a focus on high-cost cases. A few tools add a second component — commonly referred to as “impactability” — to identify patients who will potentially benefit from care management. Adapting PM tools to address the Medicaid population’s intense and complex array of needs — ranging from physical and behavioral health comorbidities to socioeconomic issues — is a critical consideration for states that are planning to use PM. This holds true for states buying off-the-shelf tools as well as those with the analytical capabilities to build and/or customize PM tools in-house.

Center for Health Care Strategies, Inc. (2009). Predictive modeling: a guide for state Medicaid purchasers. Dave Knutson, Melanie Bella and  Karen Llanos.

Full report: http://www.chcs.org/usr_doc/Predictive_Modeling_Guide.pdf

This toolkit, created by CHCS’ Collaborative on Improving Managed Care Quality for Youth with Serious Behavioral Health Needs, offers best practices implemented by managed care organizations (MCOs), challenges and lessons learned, and opportunities for continued innovations in care for children and youth with serious behavioral health needs.

From CHCS:

Although Medicaid managed care programs are covering children with serious behavioral health disorders, limited funds for program evaluation have prevented most from examining their impact on children’s behavioral health care. The 10-year, SAMHSA-funded Health Care Reform Tracking Project found that in roughly 45% of Medicaid managed care programs, the impact of managed care on children’s behavioral health care (e.g., service utilization, quality, cost, and family satisfaction) was unknown, and in 63% of programs, impact on clinical and functional outcomes was unknown. Notably, SAMHSA found that the Medicaid fee-for-service system did not provide such data either. 16 This Collaborative provided a timely opportunity for participating MCOs to look more closely at their data for this population, and develop new data to inform and track quality enhancements.

Center for Health Care Strategies, Inc. (2009). Improving Medicaid managed care for youth with serious behavioral health needs: a quality improvement toolkit. Kamala Allen and Sheila A. Pires.

Full toolkit: http://www.chcs.org/usr_doc/Improving_Medicaid_Managed_Care_for_Youth_with_Serious_Behavioral_Health_Needs_Toolkit.pdf

This Commonwealth Fund report analyzes small business -sponsored health insurance costs and coverage.

From the Report:

Rising premiums have weakened small busi­nesses’ ability to offer comprehensive coverage or have led them to drop coverage altogether. In 2008, less than half of firms with fewer than 10 employees offered health benefits, compared with nearly all firms with more than 200 employees. When small employers do offer health insurance, their workers pay substan­tially higher premiums for family coverage and face higher deductibles, on average, compared with those working for larger businesses. As a result, millions of small-business workers are either uninsured or, when they have health benefits, spend a large share of their income on out-of-pocket health care expenses.

The Commonwealth Fund. (2009). Out of options: why so many workers in small businesses lack affordable health insurance and how health reform can help. M. M. Doty, S. R. Collins, S. D. Rustgi, and J. L. Nicholson.

Full report: http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2009/Sep/1316_Doty_out_of_options_ib_FINAL_v2.pdf 

This New England Journal of Medicine article analyzes how care management may be able to reduce costs and improve quality for people with complex health care needs.

Bodenheimer, T. & Berry-Millett, R. (2009). Follow the money – controlling expenditures by improving care for patients needing costly services. New England Journal of Medicine DOI: 10.1056/NEJMp0907185.

*Note: The New England Journal of Medicine (NEJM) policies preclude us from providing an article abstract or linking to the NEJM website; however, this article is available in full via the NEJM website. 

Authors: Thomas Bodenheimer and Rachel Berry-Millet.