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Majority Of Full Benefit Dual Eligibiles Are Not Enrolled In Integrated Program

This week, our In Focus section reviews an issue brief written by HMA consultants examining Medicare-Medicaid integration. In 2019, 7.7 million people in the United States were eligible to receive access to full benefits under Medicare and individual state Medicaid programs. This group of people is known as the Full Benefit Dual Eligible (FBDE) population. While FBDE enrollment in integrated programs nearly quadrupled over the past five years, the number of people enrolled in an integrated program never rose above one in 10 FBDE people.

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Examining Key Considerations for Implementing Group Prenatal Care

A team of HMA consultants have authored a peer-reviewed journal article drawing on data from the recently completed five-year evaluation of the Strong Start for Mothers and Newborns II Initiative to discuss key considerations for implementing a group prenatal care model, including barriers to implementation and sustainability as well as strategies for overcoming barriers and sustaining the model.

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COVID-19 Education, Contact Tracing, and Care Connections: Community Health Workers Can Be Activated for Sustainable Public Health Response to Local Needs

As reported by the New York Times (An Army of Virus Tracers Takes Shape in Massachusetts, April 17), Massachusetts has hired 1,000 public health contact tracers to speed containment of COVID-19 during its surge in infections. Contact tracers are reaching out to those who have tested positive, providing information, and talking them through their recent movements and connections, using cell phones and triangulation data. They then, in turn, reach out to inform and educate those contacts.

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Dual Eligible Financial Alignment Demonstration Enrollment Update

This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (“Duals Demonstrations”) for beneficiaries dually eligible for Medicare and Medicaid (duals) in nine states: California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, and Texas. Each of these states has begun either voluntary or passive enrollment of duals into fully integrated plans providing both Medicaid and Medicare benefits (“Medicare-Medicaid Plans,” or “MMPs”) under three-way contracts between the state, the Centers for Medicare & Medicaid Services (CMS), and the MMP. As of February 2020, approximately 371, 200 duals were enrolled in an MMP. Enrollment fell 1.2 percent from February of the previous year.

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HMA Experts Examine Medicare-Medicaid Integration

In 2019, 7.7 million people in the United States were eligible to receive access to full benefits under Medicare and individual state Medicaid programs. This group of people is known as the Full Benefit Dual Eligible (FBDE) population. While FBDE enrollment in integrated programs nearly quadrupled over the past five years, the number of people enrolled in an integrated program never rose above one in 10 FBDE people.

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Proposed Medicare Payment and Policy Changes for Fiscal Year 2021 for Hospice, Inpatient Psychiatric Facilities, and Skilled Nursing Facilities

Recently, the Centers for Medicare & Medicaid Services (CMS) issued proposed rules to update the Medicare payment rates and implement other policy changes for three types of Part A providers: hospice, inpatient psychiatric facilities (IPFs), and skilled nursing facilities (SNFs). CMS is publishing these proposed rules in accordance with existing statutory and regulatory requirements to update Medicare payment policies for these providers on an annual basis. This brief summarizes the proposed payment rates and key policy changes for each of these provider types.

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Medicare and Medicaid Telehealth Coverage in Response to COVID-19

Telehealth service expansions by Medicare and most Medicaid programs aim to rapidly increase access to care and reduce transmission, but also provide a natural experiment for policymakers.

This week, our In Focus section examines the extensive scope of flexibilities Federal and State governments have made to Medicare and Medicaid telehealth coverage in response to the COVID-19 national emergency. In March and April 2020, federal and state policymakers responded to the COVID-19 emergency by temporarily and aggressively expanding the definition of and reimbursement for telehealth services—moves intended to improve access to care and reduce virus transmission. Under the Medicare and Medicaid programs, these temporary expansions have been rapid and historic in scope, and will have substantial implications for patients, providers, payers, and federal/state financing. For policymakers, this temporary expansion may serve as a natural experiment for assessing which forms of telehealth services successfully expand access to care and should become permanent healthcare policy.

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HMA Review of State Appendix K Waivers in Response to COVID-19

This week, our In Focus section comes from HMA Principals Ellen Breslin (MA) and Sharon Lewis (OR). In direct response to COVID-19, the Centers for Medicare & Medicaid Services (CMS) has encouraged states to maximize Medicaid flexibilities to protect people during the pandemic emergency. This includes state flexibilities for people receiving home and community-based services. States may temporarily amend their Home and Community-Based Services (HCBS) 1915(c) waivers through an expedited process by submitting an Appendix K request. As of March 31, 2020, CMS had approved Appendix K submissions for thirteen states with effective periods ranging from four months to one year.[1]  The thirteen states are: Alaska, Connecticut, Colorado, Hawaii, Iowa, Kentucky, Minnesota, New Mexico, Pennsylvania, Rhode Island, Washington, West Virginia and Wyoming.

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