This week, our In Focus section shares highlights and key takeaways from the 20th annual Medicaid Budget Survey conducted by The Kaiser Family Foundation (KFF) and Health Management Associates (HMA). Survey results were released on October 14, 2020, in two new reports: State Medicaid Programs Respond to Meet COVID-19 Challenges: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2020 and 2021 and Medicaid Enrollment & Spending Growth: FY 2020 & 2021. The reports were prepared by Kathleen Gifford, Aimee Lashbrook, and Sarah Barth from HMA and by Elizabeth Hinton, Robin Rudowitz, Madeline Guth, and Lina Stolyar from the Kaiser Family Foundation. The survey was conducted in collaboration with the National Association of Medicaid Directors.
This week, our In Focus section reviews UnitedHealth Group’s The Path Forward to a Next-Generation Health System, an outline of policy recommendations to achieve a high-quality, affordable health care system. The paper focuses on four goals: 1) achieve universal coverage; 2) improve health care affordability; 3) enhance the health care experience; and 4) drive better health outcomes. UnitedHealth Group (United) advocates for expanding Medicaid in the remaining states, passively enrolling individuals into Medicaid and the Exchanges, implementing a Medicaid Buy-In program, transitioning Medicaid fee-for-service (FFS) programs to managed care, strengthening Medicare Advantage, eliminating surprise billing, expanding access to telehealth, in addition to other policies.
This week, our In Focus section reviews the Ohio Medicaid Managed Care request for applications (RFA) released by the Ohio Department of Medicaid (ODM) on September 30, 2020. The RFA follows the release of two requests for information (RFIs) in June 2019 and February 2020, soliciting feedback from individuals, providers, and interested bidders to help design a new Medicaid managed care program. Ohio will award contracts, worth over $11 billion annually, to no more than five managed care organizations (MCOs) in each of the state’s three regions (Central/Southeast Region, Northeast Region, and West Region), with implementation beginning January 5, 2022. The procurement will not include the MyCare Ohio dual demonstration.
This week, our In Focus section reviews two recent Medicare developments from the Centers for Medicare & Medicaid Services (CMS). On September 24, 2020, CMS released the Medicare Advantage (MA) and Part D landscape files for the 2021 plan year. These files include information on MA and Part D offerings, including plan types and premiums. Earlier this month, CMS also released a final rule implementing two new mandatory payment models addressing radiation oncology and end-stage renal disease (ESRD).
Focused on ongoing support and solutions for those living with opioid use disorder (OUD), Health Management Associates (HMA) has developed a robust web-based training program about addiction and its treatment in the criminal justice and child welfare systems, including access to, and continued use of, medications for addiction treatment (MAT).
On September 15, 2020, the Centers for Medicare & Medicaid Services (CMS) released State Medicaid Director (SMD) letter #20-004 regarding value-based care (VBC) opportunities in Medicaid.  In the letter, CMS lays out a road map for state Medicaid agencies to adopt value-based payment (VBP). The SMD describes how states can use existing – or obtain new – authorities to adopt VBP. It lists examples of successful VBP designs in other states and identifies key enabling factors from its examination of lessons learned over the last ten years of investments in VBC activities.
The District of Columbia’s Department of Health Care Finance (DHCF) has engaged Health Management Associates (HMA) to spearhead a multi-year training and coaching effort across the District. The five-year project will support Medicaid providers’ efforts to deliver whole person care by integrating physical and behavioral health in order to better manage the complex needs of Medicaid beneficiaries.
This week, our In Focus sections reviews the Missouri HealthNet Pharmacy and Clinical Services Management Solution request for information (RFI) and the Kentucky Medicaid Managed Care Organization (MCO) Pharmacy Benefit Manager request for proposals (RFP).
This week, our In Focus section reviews the policy changes included in the Centers for Medicare & Medicaid Services (CMS) Fiscal Year (FY) 2021 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Final Rule (CMS-1735-F). This year’s IPPS Final Rule includes several important policy changes that will change hospitals’ administrative procedures and may alter hospitals’ Medicare margins, beginning as soon as October 1, 2020.
This week, our In Focus section reviews the California request for information (RFI) regarding the Medi-Cal Managed Care Plan (MCP) contract and the upcoming Medi-Cal MCP procurement. The California Department of Health Care Services (DHCS) is seeking information to update boilerplate contracts and develop the request for proposals (RFP) scheduled for release in 2021.