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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


SITUATION

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.

CHALLENGE

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

Electronic Visit Verification Requirements

Real Challenges, Real Solutions

Well-designed (EVV) systems can efficiently and accurately track the provision of in-home services provided to individuals receiving Medicaid funded personal care and home health services providing states the opportunity to improve program integrity and long term financial sustainability. In fact, the Congressional Budget Office scoring of the Cures legislation attributed EVV system implementation with savings of $290M between Fiscal Years 2017 – 2026.

Learn more here

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 mercer.government@mercer.com 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.
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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 Presents 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 Discusses 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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Stay Informed

Recent Mercer Communications

If you'd like to be included on future communications, please contact us to join our exclusive distribution list.

MERCER GOVERNMENT NEWSLETTER - 2017


HELPING SUPPORT HEALTHCARE'S FOUNDATION DURING THIS TIME OF CHANGE

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. We face an unprecedented environment of uncertainty and change in the Medicaid and CHIP programs, and yet, there is a need to keep moving forward. This newsletter shares information you need to move your health programs forward.

AFFORDABLE CARE ACT REPEAL AND REPLACE EFFORTS:  UNCERTAIN TIMES

After a dramatic journey through the House and the Senate, Congressional efforts to repeal and replace the Affordable Care Act (ACA) are now stalled, with Medicaid a key focus of the Senate deliberations. At the time of the drafting of this article, Senate GOP leadership has announced plans to introduce a repeal and delay bill to repeal ACA but provide Congress...
 
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 Overcoming the VBP Challenge

https://info.mercer.com/rs/521-DEV-513/images/107670154_200x260.jpgHow will you maximize your Medicaid dollar while increasing access and quality in an uncertain healthcare environment?

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Medicaid/CHIP Parity Compliance

https://info.mercer.com/rs/521-DEV-513/images/135538194_200x260.jpgStates with Medicaid managed care organizations, alternative benefit plans, and separate CHIP programs are...

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Quality Encounter Data

https://info.mercer.com/rs/521-DEV-513/images/163392141_200x260.jpgQuality encounter data can seem like an elusive unicorn in the health care world. However, having complete, accurate...

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Medical Loss Ratio: Not as Bad as it Seems

https://info.mercer.com/rs/521-DEV-513/images/482912363_200x260.jpgNew medical loss ratio requirements play a prominent role in the Centers for Medicare and Medicaid Services...

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Management of Specialty Drug Trend

https://info.mercer.com/rs/521-DEV-513/images/162501764_200x260.jpgSpecialty drugs are generally considered to be high cost drugs that are used to treat complex, chronic, or rare medical...

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MERCER GOVERNMENT FLASH NEWS - FDA APPROVES MAVYRET


On August 3rd, the Food and Drug Administration (FDA) approved Mavyret™ (mav-EH'-rit), a new product manufactured by Abbvie for the treatment of hepatitis C virus (HCV).  Mavyret™ is approved for the treatment of all six major HCV genotypes for both treatment naïve and treatment experienced patients. Mavyret™ is a combination of two new HCV antivirals, glecaprevir and pibrentasvir. An estimated 95% of patients with chronic hepatitis C in the U.S. could be candidates for treatment with Mavyret™. The list price of Mavyret™ is significantly lower than the list price for other HCV antiviral regimens.  

Mavyret™ is a game changer in the Hepatitis C market. Its approval for a short 8-week regimen for treatment naïve patients across all genotypes coupled with a list price that is less than half of the competition will position it well for preferred placement on Medicaid fee-for-service (FFS) and managed care formularies.  Abbvie representatives have stated publicly that they are focusing on getting coverage approved through the Medicaid, Medicare, and Veterans Administration markets. 

Read more about Indication and Use, Place in Therapy, and Cost

Services

Overview

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

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Strategy

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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Financial

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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An overview of our experience assisting government with their Medicaid and Medicare programs.

Our passion is to work as a team with our clients to help those in need throughout the country.

DID YOU KNOW?
Mercer Government includes more than 15 former state and federal health care leaders and:
290+ Staff - 27 ASAs - 20 FSAs - 5 CPAs - 9 Clinicians - 6 Pharmacists

  Download overview

Mercer Contributes to NGA's Medicaid Compendium

Released in 2016, NGA's Medicaid Health Care Purchasing Compendium is "intended to serve as a reference guide for states when purchasing health care services for their Medicaid program..."
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The NGA Compendium

"States face the ongoing challenge of managing the costs of their Medicaid programs while ensuring beneficiaries have access to quality health care."

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Section II - Federal Authorities and Compliance

Employees contributing to Compendium Section II include Leena Hiilivirta, Bill Lasowski and Stephanie Kurlanzik

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Section V - Financial Models

Including rate setting, risk adjustment, performance indicators. Contributors were Fred Gibison, Kevin Lurito, Gabe Smith, Doug Shannon, Amanda Rhodes

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