This week, our In Focus section reviews the Minnesota Integrated Health Partnerships (IHP) Program request for proposals (RFP) released by the Minnesota Department of Human Services (DHS), Health Care Administration on July 6, 2021. Minnesota will contract with provider organizations to serve as IHPs and provide health care services to Medical Assistance and MinnesotaCare enrollees under alternative payment arrangements.
Government Programs & The Uninsured
Louisiana Releases Medicaid Managed Care RFP
This week our In Focus section reviews the Louisiana Medicaid managed care request for proposals (RFP) released on June 23, 2021, by the Louisiana Department of Health. Louisiana is seeking full-risk health plans to serve approximately 1.6 million Medicaid beneficiaries. Contracts are worth approximately $9 billion annually.
State efforts to integrate care across Medicaid FFS LTSS and Medicare Advantage D-SNPs
This week, our In Focus section reviews a new paper from Health Management Associates,State Efforts to Integrate Care Across Medicaid Fee-for-Service Long-Term Services and Supports and Medicare Advantage Dual Eligible Special Needs Plans by Sarah Barth, Rachel Deadmon and Julie Faulhaber. Funded by UnitedHealthcare, this paper outlines approaches taken by Medicaid programs seeking to coordinate Medicare and Medicaid services for dually eligible individuals without first implementing standalone Medicaid managed long-term services and supports (MLTSS) programs.
COVID-19 policy flexibilities impacting children and youth with special healthcare needs
This week, our In Focus section reviews a new report from Health Management Associates, COVID-19 Policy Flexibilities Affecting Children and Youth with Special Health Care Needs: What to Keep, Modify, or Discard?. In response to the COVID-19 pandemic, the federal government and states rapidly established new, temporary regulations and flexibilities, while providers deployed innovative technologies to connect with their patients. The report examines how COVID-19 and the responses by federal and state governments, health systems, and providers affect health care for children and youth with special health care needs (CYSHCN).
Tennessee Releases Medicaid Managed Care RFP
This week our In Focus reviews the Tennessee Medicaid managed care request for proposals (RFP) released on June 11, 2021, by the State of Tennessee, Division of TennCare. Tennessee will select three plans to provide physical services, behavioral services, and Managed Long-Term Services and Supports (MLTSS), including nursing facility services and home and community-based services (HCBS), to beneficiaries enrolled in TennCare (Medicaid), CoverKids (Children’s Health Insurance Program), and Dual Eligible Special Needs Plans (D-SNP). Current incumbents serve over 1.5 million beneficiaries, with contracts worth $12 billion annually.
Indiana Releases Medicaid Managed Care RFP
This week, our In Focus section reviews the Indiana Medicaid managed care request for proposals (RFP) for health plans serving beneficiaries enrolled in Hoosier Healthwise and Healthy Indiana Plan (HIP) programs. Contracts will be worth over $6 billion annually. The RFP was released on June 7, 2021, by the Indiana Department of Administration on behalf of the Family and Social Services Administration Office of Medicaid Policy and Planning.
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.
CMS proposed rule to repeal market-based MS-DRG weight methodology for inpatient hospitals
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:
Dual eligible financial alignment demonstration 2021 enrollment update
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.
Skilled nursing facility payment 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.