In response to the nation’s opioid epidemic, an increasing number of states are applying for and receiving Medicaid Section 1115 demonstration waivers for substance use disorders. The Centers for Medicare and Medicaid Services (CMS) created this opportunity under the authority of section 1115(a) of the Social Security Act for states to draw down federal Medicaid payments for facilities with greater than 16 beds that provide short-term residential treatment, which are otherwise prohibited through the Institution for Mental Disease (IMD) exclusion. Waiving the IMD exclusion allows states to offer short-term residential treatment, thereby offering the entire continuum of addiction treatment services to their Medicaid members based on widely accepted standards for evidence-based care.
This research was supported by the Robert Wood Johnson Foundation’s Research in Transforming Health and Health Care Systems program, which is administered by AcademyHealth. Hilltoppers Cynthia Woodcock, Alice Middleton, David Idala, and Matthew Clark co-authored this report, which describes the experiences of two early adopters of IMD waivers, Maryland and Virginia, in terms of their implementation and impact on the addiction treatment system for Medicaid members.
The Maryland Primary Care Program (MDPCP) is a key element of the Total Cost of Care (TCOC) All-Payer Model, an agreement between the Centers for Medicare & Medicaid Services (CMS) and the state of Maryland. The MDPCP is a voluntary program that provides funding and support for the delivery of advanced primary care throughout the state. It allows primary care providers to play an increased role in the prevention and management of chronic disease, as well as in the prevention of unnecessary hospital utilization.
As an important part of supporting providers in their care management efforts, the MDPCP will provide to participating practices risk scores of their attributed beneficiaries according to each patient’s risk of incurring a potentially avoidable hospitalization or emergency department (ED) visit. Accordingly, The Hilltop Institute, in conjunction with the Maryland Department of Health, has developed the Hilltop Pre-AH (Predicting Avoidable Hospitalizations) Model™ in order to operationalize these risk scores. These patient-level risk scores are provided to participating medical practices on a monthly basis via the MDPCP portal on the Chesapeake Regional Information System for our Patients (CRISP) unified landing page.
This document aims to explain the intended use, technical implementation, and model performance of the Hilltop Pre-AH Model™ as of January 2020. It will be updated as future versions of the model become operational.
This provides a brief look at the Hilltop Pre-AH Model™, a risk prediction model that uses a variety of risk factors derived from Medicare claims data to estimate the probability that a given patient incurs an avoidable hospital event in the near future. These risk scores are intended to assist Maryland Primary Care Program (MDPCP) practices with the identification of beneficiaries that have a high risk of incurring an avoidable hospitalization or emergency department event. The Pre-AH Model™ risk scores, used in conjunction with provider clinical guidance, can facilitate a more efficient and impactful allocation of practices’ care management resources.
This report describes the services The Hilltop Institute provided to the Maryland Department of Health (the Department) under the Master Agreement between Hilltop and the Department. The report covers fiscal year (FY) 2019 (July 1, 2018, through June 30, 2019). Hilltop’s interdisciplinary staff provided a wide range of services, including: Medicaid program development and policy analysis; HealthChoice program support, evaluation, and financial analysis; long-term services and supports program development, policy analysis, and financial analytics; and data management and web-accessible database development.
Hilltop Senior Policy Analyst Charles Betley, MA, helped organize and participated on a panel titled Tobacco Costs: Present and Future Measurements and Effects at the 2019 Fall Research Conference of the Association for Public Policy Analysis and Management (APPAM) held in Denver, Colorado November 7-9, 2019. In his presentation, Betley talked about how policy studies are judged, based on both policymakers’ interests and researchers’ scientific directive. He then discussed the innovative methodology of the study: the use of state Medicaid claims data to estimate the costs of tobacco use to a state Medicaid program. Findings gleaned by this methodology are more timely and accurate than the use of national estimates alone.
This annual report, written for the UMBC community, provides an overview of key projects and staff accomplishments for FY 2019.
This fact sheet explains hospital community benefits—initiatives and activities undertaken by nonprofit hospitals to improve health in the communities they serve—in the context of the federal framework as well as the state and local framework.
As states have embraced additional flexibility to change coverage of and payment for Medicaid services, they have also faced heightened expectations for delivering high-value care. Efforts to meet these new expectations have increased the need for rigorous, evidence-based policy, but states may face challenges finding the resources, capacity, and expertise to meet this need. By describing state-university partnerships in more than 20 states, this commentary describes innovative solutions for states that want to leverage their own data, build their analytic capacity, and create evidence-based policy. From an integrated web-based system to improve long-term care to evaluating the impact of permanent supportive housing placements on Medicaid utilization and spending, these state partnerships provide significant support to their state Medicaid programs. In 2017, these partnerships came together to create a distributed research network that supports multi-state analyses. The Medicaid Outcomes Distributed Research Network (MODRN) uses a common data model to examine Medicaid data across states, thereby increasing the analytic rigor of policy evaluations in Medicaid, and contributing to the development of a fully functioning Medicaid innovation laboratory. Hilltop Executive Director Cynthia Woodcock and Senior Policy Analyst Shamis Mohamoud contributed to this article published in eGEMs.
In 1997, HealthChoice—Maryland’s statewide mandatory Medicaid and Children’s Health Insurance Program managed care program—became operational as a waiver of standard federal Medicaid rules, under authority of §1115 of the Social Security Act. The Centers for Medicare & Medicaid Services approved subsequent waiver renewals in 2005, 2007, 2010, 2013, and 2016. The Maryland Department of Health continually monitors HealthChoice performance on a variety of measures across the demonstration’s goals, culminating in an annual evaluation. This report—the 2019 annual evaluation—includes data from calendar year (CY) 2013 through CY 2017.
The Medicaid Long-Term Services and Supports in Maryland Chart Book, Volume 1, The Autism Waiver is the first in a series that explores service utilization and expenditures for Medicaid-funded long-term services and supports in Maryland. This chart book provides information about Maryland Medicaid participants who received services through the Autism Waiver in fiscal years (FYs) 2012 to 2016.