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Mercer has been partnering with states and other stakeholder organizations for over 30 years to support health care programs for the low-income and most vulnerable populations in this country.

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This newsletter shares information you need to move your health programs forward:

Medicaid & CHIP

Predictions for 2018

The beginning of 2018 looks to be a continuation of 2017’s trend of uncertainty when it comes to ACA, Medicaid and CHIP. To the surprise of many by the end of 2017...

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Lower Cost Versions of Biologic Drugs

Most of us are familiar with the concept of generic drugs. Lower cost generic versions of drugs become available when the patent...

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A Holistic Care Approach

States are challenged with building high quality, cost-effective health care systems to meet the growing needs of individuals amidst...

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Harnessing Data

Transforming Data into Actionable Information

Like the rest of the world, healthcare has been bitten by the “big data” bug. States have greater access to more data than ever before...

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21st Century Cures Act

EVV...And Beyond

As we enter 2018 states are focusing on how they will comply with the electronic visit verification (EVV) requirements in the 21st Century...

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Update on the CHIP and the ACA Health Insurer Provider Fee

On January 22, 2018, Congress passed short-term funding legislation to end the government shutdown and authorize government spending through February 8, 2018. The law includes two provisions of interest to CHIP Programs.  Read more here or contact us via email.

Substance Use Disorders

Mercer understands states must consider cost containment and program sustainability, network development and capacity needs and how to incentivize high-quality performance through effective procurement and contracting. States must consider how they will finance these services and understand the regulatory requirements of funding streams. Requirements related to the Mental Health Parity and Addiction Equity Act (MHPAEA) final rule, the Home and Community-Based Services (HCBS) final rule and the Medicaid Managed Care final rule all impact the design and implementation of a state’s SUD service system.

Mercer assists states in SUD program design, development of federal state plan amendments and CMS waivers, procurement activities, actuarial rate setting and analysis, managed care contracting, value-based purchasing, staff training and development, and conversion from fee-for-service to a managed care delivery system.


Case Study


Prior to 2011, the state’s Medicaid program did not include SUD treatment services as a covered benefit. State general funds and/or federal block grant dollars were the primary source of funding to pay for SUD services to Medicaid-eligible members. In an effort to contain costs while also expanding access to SUD services for Medicaid-eligible members, the state decided to add SUD benefits to its Medicaid state plan and incorporate these benefits into its managed care structure.


The state wanted to expand coverage and capacity for an array of ASAM levels of care and support adoption of medication-assisted treatment. The state wanted to support providers and managed care organizations in this transition by helping them fully understand service definitions, provider qualifications and billing expectations. The state also recognized the need to gather current SUD program and staffing information from providers in order to assist in provider reimbursement and capitation rate development.

Read about the ACTION taken and the result

Mercer is Dedicated to Keeping States Informed

21st Century Cures Act

Signed into law on December 13, 2016, the Cures Act is designed to help accelerate medical product development and bring new innovations and advances to patients who need them faster and more efficiently.  Mercer is here to help.  Contact us at for more information.

Potential Changes in Medicare Landscape

Mercer continues to monitor potential changes in the Medicare and Medicaid systems. We understand that States may have concerns and are uncertain about how these changes may impact their services. If you are interested in talking to a consultant about your State, please contact one of our office business leaders or your assigned client leader, or contact us with your questions and concerns via email.

Supporting Key Conferences

Mercer participates in and sponsors a number of health care conferences each year.

Discussing Substance Use Disorders at NASHP

Mercer partnered with the State of New York and the Commonwealth of Pennsylvania to facilitate a roundtable at the National Academy for State Health Policy

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Mercer Presented MLTSS at NASUAD

Mercer joined New Mexico, Pennsylvania and New Jersey to share design and implementation experience in a roundtable discussion

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Mercer Discussed LTSS VBP at NASUAD

We facilitated a presentation on bridging the gap between theory and application with state partners from New Jersey and Tennessee along with CMS

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Mercer Government Human Services Consulting provides a full range of consulting services.

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Policy and Operations

Rich in experience with strategic planning, interpretation and application of regulations and policy, managed care procurement, operations, waivers, financing, and rate setting.

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Actuarial and Financial

Mercer is well positioned to assist clients on a variety of topics ranging from traditional capitated rate setting to program development and compliance with these new health care delivery models.

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