This week’s HMA Weekly Roundup features an In Focus article from HMA Senior Consultants Amber Swartzell and Stephanie Baume (Indiana), who reviewed the Centers for Medicare & Medicaid Services (CMS) proposed Medicaid managed care regulations. On November 8, 2018, CMS released a proposed rule that would update several sections of the Medicaid and Children’s Health Insurance Program (CHIP) managed care rules, which were most recently amended in 2016. This much anticipated proposal, scheduled to appear in the Federal Register on November 14, 2018, focuses on “promoting flexibility, strengthening accountability, and maintaining and enhancing program integrity.” The key provisions of the proposed regulations are summarized below.
Long-Term Services and Supports
Highlights From This Week’s HMA Conference On The Rapidly Changing World Of Medicaid
This week, our In Focus section provides a recap of the third annual HMA Conference, The Rapidly Changing World of Medicaid: Opportunities and Pitfalls for Payers, Providers and States, held this Monday, October 1, and Tuesday, October 2, in Chicago, Illinois. More than 450 leading executives representing managed care organizations, providers, state and federal government, community-based organizations, and other stakeholders in the health care field gathered to address the opportunities and challenges facing health plans, states, and providers as they strive to provide the best possible care to Medicaid beneficiaries and other vulnerable populations at a time of significant uncertainty and change. Conference participants heard from keynote speakers, engaged in panel discussions and connected during informal networking opportunities. Below is a summary of highlights from this year’s conference.
Companion Medicaid and Medicare Advantage Dual Eligible Special Needs Plans
This week, our In Focus section reviews Medicare-Medicaid integration opportunities through Dual Eligible Special Needs Plans (D-SNPs). States are motivated to expand their capacity to address the needs of dually eligible beneficiaries through integrated care. They are increasingly requiring health plans that operate Medicaid managed long-term services and supports (MLTSS) programs to become Medicare Advantage (MA) D-SNPs. A few states require D-SNPs to be Medicaid MLTSS health plans.[1]
New Hampshire Medicaid Care Management Draft RFP
This week, our In Focus reviews the New Hampshire Medicaid Care Management (MCM) Services Draft request for proposals (RFP), released by the state Department of Health and Human Services (DHHS) on July 9, 2018. The MCM program, worth $750 million in annualized spending, will provide full-risk, fully capitated Medicaid managed care services to approximately 181,000 beneficiaries from July 1, 2019 through June 30, 2024. The final RFP is expected August 10, 2018.
MACPAC June Report to Congress Addresses Role of Managed Care in LTSS
This week, our In Focus comes from Senior Consultant Rachel Patterson, who provides an overview of Chapter 3 of the Medicaid and CHIP Payment and Access Commission (MACPAC) June 2018 Report to Congress on Medicaid and CHIP, which examines the growing role of managed care in long-term services and supports (LTSS). Chapter 3 includes research conducted by teams including HMA Principals Sarah Barth and Karen Brodsky regarding network adequacy for home and community-based service (HCBS) and Principals Sarah Barth, and Sharon Lewis and Senior Consultant Rachel Patterson regarding enrollment of people with intellectual and developmental disabilities (ID/DD) into MLTSS.
Benefit Options for the Medicaid Expansion Population: Alternative Benefit Plans and the Medically Frail
This week, our In Focus section highlights HMA Medicaid Market Solutions (MMS) which is supporting state flexibility in designing and implementing initiatives, including Section 1115 Demonstration Waivers, promoting member engagement, and personal responsibility. Over the coming weeks, HMA MMS will present a series of articles providing an in-depth look at the facets of these new Medicaid models.
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.
MLTSS Implementation Plans in North Carolina and New Hampshire
This week, our In Focus reviews two recently released papers outlining North Carolina’s and New Hampshire’s plans to implement Medicaid managed care long-term services and supports (MLTSS). The North Carolina Department of Health and Human Services released “North Carolina’s Vision for Long-term Services and Supports under Managed Care” on April 5, 2018, and is accepting comments through April 27. The New Hampshire Department of Health and Human Services released its “Implementation Plan for Medicaid Care Management – Nursing Facility/Choices for Independence Services” on March 6, 2018, and is accepting comments through May 4, 2018. Both states are anticipated to release requests for proposals (RFPs) for integrated Medicaid managed care services in the next several months.
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.
Kentucky Becomes First State to Enact Community Engagement & Employment Requirements for Medicaid Members
This article was written by Senior Consultants Amanda Schipp and Lora Saunders of HMA Medicaid Market Solutions (HMA MMS). HMA MMS helped the Commonwealth of Kentucky secure a groundbreaking Medicaid Section 1115 Waiver. Below is a summary of what the waiver entails.
On January 12, 2018, Kentucky’s section 1115 Medicaid Demonstration Waiver was approved by the Centers for Medicare and Medicaid Services (CMS). The demonstration includes two significant components: an expansion of substance use disorder (SUD) services, including a waiver of the Institution for Mental Disease (IMD) exclusion, and the creation of a new Medicaid program for able-bodied adults, known as Kentucky HEALTH (Helping to Engage and Achieve Long Term Health). The demonstration contains several groundbreaking policies never previously approved by CMS, most notably, a requirement for non-exempt Medicaid enrollees to work or participate in approved work-related activities, such as education, training, or volunteering as a condition of Medicaid eligibility. This approval paves the way for the nine other states that also have pending waivers requesting similar work requirements.[1]