Blog

CMS Increases Monitoring and Evaluation Requirements for Section 1115(a) Medicaid Demonstrations

This week, our In Focus reviews the implications of the new federal guidance for state waivers with community engagement, premiums, non-eligibility periods, and other personal responsibility provisions.

Background

On March 14, 2019, the Centers for Medicare & Medicaid Services (CMS) issued several new guidance documents that significantly increase the level of monitoring and evaluation required for Section 1115(a) Medicaid Demonstrations. These new requirements apply to community engagement, premiums, and other waiver provisions that impact eligibility and enrollment, and affect states currently with such waivers as well as any states proposing these ideas.  Changes in reporting, data collection, and waiver monitoring processes will be necessary, and soon—as the materials details compliance dates for these significant new requirements.

Read MoreCMS Increases Monitoring and Evaluation Requirements for Section 1115(a) Medicaid Demonstrations

Patient Protection and Affordable Care Act; 2020 Proposed Notice of Benefit and Payment Parameters

This week, our In Focus reviews the Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2020. The new proposed rule does not contain as many major changes as the 2019 rule, but there are requests for comment on potentially important rulemaking starting in 2021 and guidance on important policy, such as:

Read MorePatient Protection and Affordable Care Act; 2020 Proposed Notice of Benefit and Payment Parameters

Analysis of Key Medicare Proposals in the President’s FY 2020 Budget

This week, our In Focus comes to us from HMA Senior Consultant Narda Ipakchi. On March 11, 2019, the White House released President Trump’s budget for fiscal year (FY) 2020, which includes a number of legislative and administrative proposals related to Medicare that would reduce net Medicare spending by $811 billion over the next ten years. It is important to note that the legislative proposals included in the President’s budget are non-binding and serve as recommendations to Congress where they may or may not be advanced. Under a Democratic-majority House of Representatives, many of the legislative proposals outlined in the FY 2020 budget are unlikely to advance. Several of the policies, however, such as reductions to Medicare bad debt and implementing site neutral payment systems were also proposed by the previous administration. Administrative proposals are more likely to move forward, as the administration can implement these policies through its regulatory channels.

Read MoreAnalysis of Key Medicare Proposals in the President’s FY 2020 Budget

Will Hospitals Serving Racial and Ethnic Minorities Lose Out in a Value-Based Payment World?

HMA Principal Madeleine Shea, with her partners from the National Committee for Quality Assurance and American Hospital Association, recently authored the Health Equity article, Explaining the Relationship between Minority Group Status and Health Disparities. While federal policy has moved in the direction of adjusting for poverty and disability as proxies for social risks, this article keeps the focus on race and ethnicity as a major explanation for health disparities in the United States.

Read MoreWill Hospitals Serving Racial and Ethnic Minorities Lose Out in a Value-Based Payment World?

Minnesota Releases Medicaid Managed Care RFPs

This week, our In Focus reviews requests for proposals (RFPs) for Minnesota’s Medicaid managed care programs: 1. Families and Children Medical Assistance and MinnesotaCare; 2. Minnesota Senior Care Plus (MSC+)/Minnesota Senior Health Options (MSHO). The two RFPs were released by the Minnesota Department of Human Services on February 25, 2019, with implementation scheduled to begin on January 1, 2020 for all programs.

Read MoreMinnesota Releases Medicaid Managed Care RFPs