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.
Public Health
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.
New Flexibilities for Medicare Advantage Plans
This blog post was written by Managing Principal Mary Hsieh, Senior Consultant Aimee Lashbrook, and Senior Consultant Mary Russell.
In April, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2019 Final Rate Announcement and Call Letter for Medicare Advantage (MA) and Part D. The guidance was very good for the industry, with a projected average increase in revenue of 3.4 percent.
The Final Call Letter also included important new flexibilities that will help plans bring more innovative products to market and deliver more comprehensive care to enrollees. As early as next year, plans can offer supplemental benefits under an expanded definition of “primarily health related.”
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.
Electronic Visit Verification: Implications for States, Providers, and Medicaid Participants
This week, our In Focus, written by HMA Principal Jen Burnett in collaboration with the National Association of States United for Aging and Disabilities (NASUAD), summarizes key considerations and policy decisions contained in Electronic Visit Verification: Implications for States, Providers, and Medicaid Participants for state consideration as they work to implement electronic visit verification (EVV) systems in accordance with the mandate included in the December 2016 21st Century Cures Act (the CURES Act).
Medicaid Community Engagement Initiatives: A Comparison Of Three States
This week, our In Focus is the second in a series written by HMA Medicaid Market Solutions (MMS), which has worked with a number of states to design and implement Section 1115 Demonstration Waivers that support individual state goals for member engagement and personal responsibility while complying with new Centers for Medicare and Medicaid Services (CMS) guidance.
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.
The Policy, Implementation and Operations of Medicaid Personal Responsibility Initiatives: An Introduction
This week, our In Focus section highlights HMA Medicaid Market Solutions (MMS), formerly SVC, Inc., which is at the forefront in 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.