Public Health

Public Health

Managing Principal Jonathon Blum Breaks Down Trump Administration’s Agenda for Pharmacy Rebates

by

Medicare policy expert and HMA Managing Principal Jonathan Blum weighed in on the Trump administration’s recently proposed rules for pharmacy rebates and plans to reduce prescription drug prices in a blog post for Health Affairs.

Blum provided insight to questions about implementation of the proposed drug rebate reforms and whether they will lead to lower drug prices. The fundamental changes proposed would govern how pharmaceutical manufacturers pay rebates to pharmacy benefit managers and managed care plans contracted with Medicare, as well as state Medicaid programs.

He also addressed the variables outlined in the administration’s 2018 plan, American Patients First, which aim to reduce out-of-pocket costs and lower drug prices.

Blum joined HMA in 2018. In his previous leadership role at the Centers for Medicare and Medicaid Services from 2009-2014 he had direct responsibility for administration of the Medicare program.

HMA MACPAC Report Published

by

A team of HMA colleagues including Sarah Barth, Sharon Silow-Carroll, Esther Reagan, Mary Russell and Taylor Simmons completed a study for the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) to examine care coordination requirements for several Medicare-Medicaid integrated care models.

The study’s final report, Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries – Health Plan Standards, Challenges and Evolving Approaches, is posted to the MACPAC website.

The final report details state and federal managed care contract requirements for care coordination, summarizes stakeholders’ perspectives on care coordination based on structured interviews, and highlights promising care coordination practices and challenges for ensuring effective care coordination for dually eligible beneficiaries.

CMS Increases Monitoring and Evaluation Requirements for Section 1115(a) Medicaid Demonstrations

by

This week, our In Focus reviews the implications of the new federal guidance for state waivers with community engagement, premiums, non-eligibility periods, and other personal responsibility provisions.

Background

On March 14, 2019, the Centers for Medicare & Medicaid Services (CMS) issued several new guidance documents that significantly increase the level of monitoring and evaluation required for Section 1115(a) Medicaid Demonstrations. These new requirements apply to community engagement, premiums, and other waiver provisions that impact eligibility and enrollment, and affect states currently with such waivers as well as any states proposing these ideas.  Changes in reporting, data collection, and waiver monitoring processes will be necessary, and soon—as the materials details compliance dates for these significant new requirements.

Read More

Will Hospitals Serving Racial and Ethnic Minorities Lose Out in a Value-Based Payment World?

by

HMA Principal Madeleine Shea, with her partners from the National Committee for Quality Assurance and American Hospital Association, recently authored the Health Equity article, Explaining the Relationship between Minority Group Status and Health Disparities. While federal policy has moved in the direction of adjusting for poverty and disability as proxies for social risks, this article keeps the focus on race and ethnicity as a major explanation for health disparities in the United States.

Read More

Minnesota Releases Medicaid Managed Care RFPs

by

This week, our In Focus reviews requests for proposals (RFPs) for Minnesota’s Medicaid managed care programs: 1. Families and Children Medical Assistance and MinnesotaCare; 2. Minnesota Senior Care Plus (MSC+)/Minnesota Senior Health Options (MSHO). The two RFPs were released by the Minnesota Department of Human Services on February 25, 2019, with implementation scheduled to begin on January 1, 2020 for all programs.

Read More

Medicaid Plan PMPM Rates Rise 0.3 Percent in 2018 for TANF/CHIP In 19 States, 4 Percent for Expansion, HMAIS Analysis Shows

by

This week, our In Focus summarizes the findings of an HMA Information Services (HMAIS) analysis of Medicaid managed care rates in 2018 versus 2017. The analysis represents HMAIS’ first attempt at what will be an annual tracking of Medicaid managed care rate increases, which we will expand upon and refine over time with input from our readers and the Medicaid community. Complete results, including spreadsheets showing underlying analysis, will be made available to HMAIS subscribers. For information on how to subscribe, contact Carl Mercurio.

Read More

MA Releases One Care Dual Demonstration 2.0 Request for Responses

by

This week, our In Focus reviews the Massachusetts One Care Dual Demonstration 2.0 request for responses (RFR), released by the Massachusetts Executive Office of Health and Human Services (EOHHS). One Care will cover Medicare and Medicaid dual eligible adults with disabilities ages 21 through 64 and includes medical, behavioral, Long-term Services and Supports (LTSS), community supports, and care management services statewide.

Read More