California Proposed May Revision Budget Adds Medi-Cal Expansions

This week, our In Focus section reviews California’s May Revision to the Governor’s Budget, which proposes a $267.8 billion budget (with $196.8 billion General Fund) for fiscal year 2021-22. The revised budget includes $24.4 billion in reserves, the largest in history. The May Revision builds on the California Advancing and Innovating Medi-Cal (CalAIM) proposal and introduces several Medi-Cal initiatives and benefits for fiscal year 2021-22.

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CMS Inpatient Hospital Proposed Rule to Repeal Market-based MS-DRG Weight Methodology

This week, our In Focus section reviews the key provisions of the Centers for Medicare & Medicaid (CMS) Fiscal Year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Proposed Rule (CMS-1752-P), which includes Medicare payment updates and policy changes for the upcoming FY, with a comment deadline of June 28, 2021. This year’s proposed rule includes several proposals the hospital industry should carefully consider. In particular, the Biden Administration has proposed to:

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HMA Launches Behavioral Health Webinar Series

In the last decade, there has been increasing awareness of the role behavioral health plays in healthcare outcomes and cost of care—especially in the public sector. Starting with Medicaid expansion and the high rates of behavioral health conditions in the expansion population to evidence of the impact of behavioral health on physical chronic disease and medical spending, behavioral health is an area of focus for improving the quality of care and reducing cost.

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HMA Analysis Finds Provider Sponsored MA Plans Generally Have Lower Churn Rates

This week, our In Focus section examines differences in Medicare Advantage (MA) churn rates among select provider-sponsored plans (PSPs) and non-PSPs. Enrollee churn rates, or rates at which enrollees switch plans, may be an indicator of enrollee satisfaction. In the years studied, PSP organizations had lower average churn rates compared to non-PSP organizations.  

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Dual Eligible Financial Alignment Demonstration Enrollment Updated

This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (“Duals Demonstrations”) for individuals dually eligible for Medicare and Medicaid (dual eligibles) 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 dual eligibles 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 2021, approximately 392,000 dual eligibles were enrolled in an MMP. Enrollment rose 5.7 percent from February of the previous year.

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Modest Skilled Nursing Facility Payment Update and Policy Updates in 2022 Proposed Rule

This week, our In Focus reviews the fiscal year (FY) 2022 skilled nursing facility (SNF) proposed payment rule, released by the Centers for Medicare & Medicaid Services (CMS) on April 8, 2021. If the proposals contained in the rule are foreshadowing, SNFs will continue to face financial pressures coming out of the public health emergency. This payment update, combined with other policy proposals, is likely to lead to the smallest payment update since the Medicare Access and CHIP Reauthorization Act of 2015 set a 1 percent increase in FY 2018. The rule proposes a net payment update of 1.3 percent after accounting for forecast error and the multifactor productivity adjustment. In addition to the payment update, CMS proposes changes to the SNF Quality Reporting Program (QRP), and the SNF Value-Based Program (VBP) for FY 2022. Notably, CMS proposes an eventual payment correction to achieve a budget neutral implementation of the Patient-Driven Payment Model (PDPM) that could result in a 5 percent rate reduction.

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Federal Funding for Home and Community-based Services (HCBS): Enacted and Proposed Investments

This week, our In Focus reviews federal enacted and proposed investments in home and community-based services (HCBS). HCBS are critically important for millions of Americans with disabilities and older adults, assisting them to remain in their homes and participate in their communities. People with disabilities and older adults have also been disproportionately affected by COVID-19, yet little federal funding has been directed to HCBS during the public health emergency. This changed on March 11, 2021, when the American Rescue Plan Act (ARPA) was signed into law, with both Medicaid and non-Medicaid HCBS funding included. Additionally, the Administration has recently proposed further HCBS investments in both The American Jobs Plan and the President’s 2022 Discretionary Request.

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HMA Analysis of Medicare Advantage Star Rating Challenges

This week, our In Focus section highlights changes that may affect the Centers for Medicare & Medicaid Services (CMS) Medicare Advantage Star Rating program and how these changes impact future summary Part C & D Star Rating scores. As the CMS Medicare Advantage Star Rating program continues evolving from year to year, many plans have yet to achieve at least four star status, and therefore are missing out on additional Medicare revenues. The Star Rating landscape is expected to change drastically over the next two years for plans due to CMS’ continued focus on phasing-in greater reliance on outcomes measures and measures of care experience, rather than process measures. As a result, many plans are at risk of losing their four star overall rating and underperforming plans could be at risk of receiving a low performance indicator. 

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CMS Interoperability and Patient Access Final Rule – Part 3

This blog was written by Juan Montanez, Principal, HMA, and Robert Chouinard, VP Public Sector, HealthEC

Where are you going to invest to maximize benefits?

In thinking about the value that can be derived from implementation of the Interoperability Rule, both payers and providers need to ensure their perspective of the rule positions them for long-term success.

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CMS Interoperability and Patient Access Final Rule – Part 2

This blog was written by Laura Zaremba, Principal, HMA, and Robert Chouinard, VP Public Sector, HealthEC

Making the Economics Work for You

Most health care organizations impacted by the Interoperability Rule have very logically focused their attention and resources on interpreting what the new rule requires them to do within their own systems, in what timeframe, and at what cost. And to be sure, scoping the work and deploying the resources required to meet the compliance deadlines is a significant investment of time and money, but the compliance focus should be only the first action step for to the Interoperability Rule.

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