In the wake of the COVID-19 pandemic and resulting economic crisis, public health, the economy, health coverage, and state budgets saw major impacts with state Medicaid programs at the intersection of these programs and challenges.
Medicaid
HI, MN Rerelease Medicaid Managed Care RFPs
This week, our In Focus section reviews the Hawaii Quest Integration (QI) Medicaid managed care request for proposals (RFP) released on December 8, 2020, and the Minnesota Families and Children Medical Assistance (MA) and MinnesotaCare programs RFP released on January 4, 2021.
2020 In Review: Top Medicare-Medicaid Integration Trends and Policies
This week, our In Focus section focuses on five critical policy and program trends to provide integrated care to dual-eligible individuals for Medicare and Medicaid. Both federal and state governments continue to look for ways to improve coordination and integration for this population. We anticipate the emphasis on innovative approaches to whole person, person-centered care, care management and coordination, care transitions, and regulatory oversight to persist. 2020 has been an active year of policymaking by the Centers for Medicare & Medicaid Services (CMS) and states. HMA distilled the themes and their strategic implications in this article. We continue to assist clients in tracking new policies and industry trends, developing innovative plans and strategies, and delivering high quality care and services to this population.
North Carolina Releases RFA for Behavioral Health, Intellectual/ Developmental Disability Tailored Plans
This week, our In Focus section reviews the statewide North Carolina request for applications (RFA) for Behavioral Health and Intellectual/Developmental Disability (BH IDD) Tailored Plans released by the North Carolina Department of Health and Human Services (DHHS) on November 13, 2020. BH IDD Tailored Plans are part of the statewide effort to transition to Medicaid managed care and are one of the four types of integrated Medicaid managed care plans the state will contract with to serve Medicaid and NC Health Choice beneficiaries. The other three are Standard Plans, the Statewide Specialized Foster Care Plan, and the Eastern Band of Cherokee Indians Tribal Option.
Ohio Releases Medicaid Managed Care RFA
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.
CMS Eyes Medicaid Alternative Payment Models (APM) Expansion to Control Growth in Spending
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. [1] 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.
HMA to lead Integrated Care Technical Assistance Program in the District of Columbia
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.
Missouri Pharmacy and Clinical Services Management Solution RFI; Kentucky Pharmacy Benefit Manager RFP
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).
CMS Finalizes Policy to Use Hospital Negotiated Charge Data to Set Payment Rates
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.
California Releases Medi-Cal Managed Care RFI
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.