This week, our In Focus Focus reviews the Mississippi Children’s Health Insurance Program (CHIP) request for qualifications (RFQ) issued by the state’s Division of Medicaid on June 8, 2018. The Mississippi CHIP program provides statewide health coverage in all 82 counties to children in families with incomes up to 209 percent of the federal poverty level (FPL). As of March 2018, 46,958 children were enrolled in CHIP.
Government Programs & The Uninsured
Massachusetts’ Duals Demo 2.0 to Grow the SCO and One Care Programs
This week, our In Focus section comes from Ellen Breslin in our Boston office who provides an overview of MassHealth’s Duals Demonstration 2.0 (“Duals Demo 2.0”) proposal to the Centers for Medicare and Medicaid Services (CMS) which is designed to “grow and sustain One Care and Senior Care Options (SCO) while encouraging innovation and care delivery improvement.” MassHealth currently provides coverage to about 310,000 dually-eligible individuals. Combined, MassHealth and Medicare spend more than $9 billion annually with costs nearly evenly split across the two payers.
Registration Open for HMA Conference on the Rapidly Changing World of Medicaid
HMA Conference on the Rapidly Changing World of Medicaid to Feature Insights from 30-Plus Speakers, Including Health Plan CEOs, State Medicaid Directors, Providers
Pre-Conference Workshop: Sept. 30
Conference: Oct. 1-2
Location: The Palmer House, Chicago
Health Management Associates is proud to announce its third annual conference on trends in publicly sponsored health care: The Rapidly Changing World of Medicaid: Opportunities and Pitfalls for Payers, Providers and States.
North Carolina Prepaid Health Plans Policy Paper
This week, our In Focus section reviews the North Carolina Department of Health and Human Services (DHHS) Medicaid Managed Care Proposed Policy Paper released on May 16, 2018, Prepaid Health Plans in North Carolina Medicaid Managed Care, ahead of a competitive procurement for the new Medicaid managed care program expected to be released in spring or summer 2018. North Carolina will be contracting with statewide Medicaid managed care organizations (Commercial Plans, CPs) as well as regional provider-led managed care entities (Provider-Led Entities, PLEs) to serve 1.9 million Medicaid beneficiaries beginning in 2019. All plans are considered by the state to be Prepaid Health Plans (PHPs). The policy paper provides additional detail on the characteristics and requirements that apply to CPs and PLEs. To read HMA’s previous analysis of “North Carolina’s Proposed Program Design for Medicaid Managed Care,” click here.
HHS Releases Blueprint to Address Prescription Drug Costs
This week, our In Focus, written by HMA Principal Anne Winter and Senior Consultant Aimee Lashbrook, examines American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs, released May 11, 2018. Over time, the pharmaceutical supply chain has become a complex ecosystem, responding to the ever-changing dynamics of new drug products, pricing strategies, health care reform, benefit design, and the regulatory environment making it, arguably, the most complicated in health care. Due to this complexity, solutions to equitably control drug pricing will take a multiprong approach that includes regulatory redesign.
Alabama Integrated Care Network Program
This week, our In Focus section reviews Alabama’s Integrated Care Network (ICN) program, based on a concept paper released by the Alabama Medicaid Agency in March 2018. The ICN program will establish a new Medicaid long-term care program focusing on a person-centered approach to care delivery using the Primary Care Case Management (PCCM) Entity delivery model, with implementation expected on October 1, 2018.
Roles and Responsibilities in a Value Based Payment World
This week, our In Focus section, written by HMA Principal Denise Soffel, reviews New York’s Medicaid Redesign Team Structural Roadmap: Roles and Responsibilities in a Value Based Payment World, released by the state’s Department of Health on March 19, 2018.
New York is committed to the transformation of its health care delivery system. Its Delivery System Reform Incentive Payment (DSRIP) program envisions a significant shift to community-based care, a more integrated delivery system, and a shift to value-based payment. A new document, released in draft form for public comment, lays out an ambitious objective: “New York seeks to make health care a team sport. The State seeks to forever banish the traditional silos that made care navigation for patients difficult and in some cases impossible.” (p. 13)
HCBS Settings Rule Issue Briefs
This week’s In Focus section highlights four briefs written by Health Management Associates (HMA) in collaboration with the National Council on Assisted Living that address key areas of compliance with the Centers for Medicare & Medicaid Services (CMS) home and community-based services (HCBS) settings final rule. The briefs are intended to inform states and Assisted Living (AL) communities on common challenges facing AL communities, the strategies for compliance available, and the steps states have taken to address them in their approved statewide transition plans. To create the briefs, HMA analyzed the regulations, CMS guidance, and the statewide transition plans that had received final approval from CMS at the time of writing. State plans reviewed were: Arkansas, District of Columbia, Delaware, Kentucky, Oklahoma, Tennessee, and Washington.
SNP Provisions of the Bipartisan Budget Act of 2018
This week’s In Focus section reviews the recent Bipartisan Budget Act of 2018 (the Act), which adopts policies aimed at improving care for Medicare beneficiaries with chronic conditions, including individuals dually enrolled in Medicare and Medicaid (dual eligible individuals). The Act provides new authority to the Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office or MMCO), which serves dual eligible individuals, and will help accelerate its goals of providing full access to seamless, high quality health care and a system that is as cost-effective as possible.[i] The Act also includes several provisions that have an impact on Medicare Advantage (MA) Dual Eligible Special Needs Plans (D-SNPs). These provisions and their implications for D-SNPs and Medicare-Medicaid integration strategies follow.
CMS Renews Healthy Indiana Plan Through 2021
HMA Medicaid Market Solutions helped the State of Indiana secure approval for an extension of its Medicaid Section 1115 Waiver, the Healthy Indiana Plan. Below is a summary of what the renewal entails.
On February 1, 2018, Indiana received approval from the Centers for Medicare and Medicaid Services (CMS) to continue its long-standing Healthy Indiana Plan (HIP) with a three-year renewal. This CMS approval maintains the core of the HIP program and incorporates additional features, including expansion of the current Gateway to Work initiative to add required community engagement for non-exempt HIP members beginning in 2019. Also new is a substance use disorder component that will be available to all Indiana Medicaid members, including those enrolled in HIP.