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Case study examines Georgia’s experience unbundling LARC payments from Medicaid prospective payment system
A new case study prepared by colleagues from Health Management Associates (HMA) analyzes the Georgia Medicaid program’s experience with unbundling long-acting, reversible contraception (LARC) devices and services from the Medicaid prospective payment system (PPS) for reimbursement in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).
HMA examined Medicaid claims data from 2012-2019 as well as conducted key interviews to understand whether the unbundling reimbursement policy change could have increased LARC utilization and provided analysis for policymakers and stakeholders in other states pursuing similar strategies and programs.
Additional findings and the full report are available here.
HMA’s research was supported by Medicines360 and Waxman Strategies with support from Arnold Ventures. The HMA team included Rebecca Kellenberg, Diana Rodin, and Jim McEvoy.
HMA Partners with the National Association of Latino Healthcare Executives
Health Management Associates (HMA), a leading independent, national research, and consulting firm specializing in publicly funded healthcare and human services, is pleased to announce its partnership with, and corporate sponsorship of, the National Association of Latino Healthcare Executives (NALHE).
HMA colleagues conduct environmental scan of NEMT benefit to Medicaid enrollees
As part of a larger Medicaid and CHIP Payment and Access Commission (MACPAC) study on Medicaid non-emergency medical transportation (NEMT) in response to a request from the Senate Appropriations Committee, a team of HMA colleagues conducted a 50-state environmental scan of NEMT programs and stakeholder interviews to better understand approaches and trends in the provision of the NEMT benefit to Medicaid enrollees across the United States.
The culminating report included NEMT trends, challenges, and innovations drawn from the scan of programs and interviews with stakeholders including federal officials, Medicaid officials from six study states, NEMT brokers and providers, managed care companies, beneficiary advocates, and subject matter experts.
The key findings are outlined in the report and include information about:
- NEMT populations and utilization
- Various modes of transportation
- NEMT delivery system model variations, advantages, and challenges
- NEMT complaints, performance issues, and innovation
- Performance improvement, oversight, and program integrity
- Transportation network challenges and increasing role of transportation network companies
- Coordination across federally assisted transportation services
- Stakeholders’ view on the value and role of NEMT
In December 2020, following the completion of the interviews for this study, Congress added a requirement to the federal statute requiring states to provide NEMT to Medicaid beneficiaries who have no other means of transportation to medically necessary healthcare services.
The HMA team included Principals Sharon Silow-Carroll, MSW, MBA and Kathy Gifford, JD, Senior Consultant Carrie Rosenzweig, MPP, Consultants Anh Pham and Julie George, JD as well as retired Managing Principal Kathy Ryland.
The research underlying this report was completed with support from the Medicaid and CHIP Payment and Access Commission (MACPAC). The findings, statements, and views expressed are those of the authors and do not necessarily represent those of MACPAC.
HMA briefs on Medicare-Medicaid integration
This issue brief from Health Management Associates, Medicare-Medicaid Integration: Essential Program Elements and Policy Recommendations for Integrated Care Programs for Dually Eligible Individuals is part of a multi-phased research initiative to increase enrollment in integrated care programs (ICPs)[1] that meet full benefit dually eligible individuals’[2] needs and preferences. Dually eligible individuals have a range of chronic conditions and disabilities requiring both Medicare and Medicaid services, which makes integrated programs important to their lives.
For a succinct overview of the essential elements and policy recommendations, please access the brief fact sheet. For a full discussion of the elements and policy recommendations, please access the full brief.
The authors are Sarah Barth, Ellen Breslin, Samantha DiPaola and Narda Ipakchi.[3]
For further information or questions, contact Sarah Barth, Ellen Breslin or Samantha DiPaola.
[1] Integrated Care Programs (ICPs): For this research, we defined ICPs as financing and care delivery organizing entities or programs that coordinate and integrate Medicare and Medicaid-covered services and supports for dually eligible individuals.They include the Centers for Medicare & Medicaid Services (CMS) Financial Alignment Initiative (FAI) capitated and fee-for-service models; the Program of All-Inclusive Care for the Elderly (PACE); Medicare Advantage (MA) Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs); Medicaid Managed Long-Term Service and Supports Program (MLTSS) managed care organizations and aligned MA dual eligible special needs plans (D-SNPs); and state-specific programs that may be proposed to CMS.
[2] Dually Eligible Individuals: When using the term dually eligible individuals, we are referencing Medicare-Medicaid full benefit dually eligible individuals (FBDEs), those who qualify for full Medicaid benefits.
[3] Narda Ipakchi was formerly a Senior Consultant with HMA.
Vermont Proposes Risk-Bearing, State-Run Medicaid Managed Care Entity
This week our In Focus section reviews Vermont’s Global Commitment to Health Section 1115 waiver renewal application. In the proposed five-year demonstration extension, Vermont seeks to move the Medicaid population to a new a risk-bearing public, state-run managed care organization (MCO). Under the arrangement, the Department of Vermont Health Access (DVHA) would transition into the new entity and accept capitated risk for the state’s Medicaid population, covering physical and mental health, pharmacy services, substance use disorder (SUD) services, and long-term services and supports (LTSS) beginning January 1, 2022.
HMA prepared issue briefs explore MLTSS impacts on state Medicaid programs
In a recent pair of reports prepared for Arizona for Better Medicaid, HMA colleagues examined the impact of managed long-term services and supports (LTSS) in state Medicaid programs. The first report, Growth in MLTSS and Impacts on Community-Based Care, examines the historical increase in the adoption of LTSS by state Medicaid programs and how that has contributed to a shift in long-term care from institutions to the community. The second report, Managed LTSS Improves Quality of Care, describes the evidence on the impact of managed LTSS in state Medicaid programs on the quality of care.
Authors:
Principal Stephen Palmer
Senior Consultant Ashlen Strong
Senior Consultant Aaron Tripp
Medicare-Medicaid Integration: Essential Elements, Policy Recommendations for Integrated Dual Eligible Care Programs
This week, our In Focus section releases a new brief from Health Management Associates, Medicare-Medicaid Integration: Essential Program Elements and Policy Recommendations for Integrated Care Programs for Dually Eligible Individuals. The authors are Sarah Barth, Ellen Breslin, Samantha DiPaola and Narda Ipakchi.[1]
Health Management Associates Acquires The Moran Company
Today, Jay Rosen, founder and president of Health Management Associates (HMA), announced the firm’s acquisition of The Moran Company, a Washington, D.C.-based healthcare research and consulting firm.
Webinar Replay: Value Propositions and Roadmaps for Integrating Children’s Behavioral Health and Medicaid with Child Welfare Systems
This held on July 15, 2021, was the seventh webinar in the series “Exploring the Landscape of Behavioral Healthcare,” covering the growing impact of behavioral healthcare on clinical outcomes and cost.
The success of the delivery of state and local child welfare systems is predicated on a strong collaboration across child welfare, children’s behavioral health and Medicaid, building a multigenerational, multisystem response to the problem of child maltreatment. During this webinar, HMA behavioral health, child welfare and Medicaid experts broke down what’s needed to get the integration process started, including a practical approach to workflows as well as an understanding of the touchpoints where integration efforts are likely to have their biggest payoff.
Learning Objectives
- Understand how child welfare services departments currently interact with the behavioral health service continuum.
- Learn how to build value by identifying areas where the intersection of child welfare, Medicaid and children’s behavioral health helps improve outcomes and mitigate risk.
- Identify potential barriers to integration efforts.
- Learn how other states have applied solutions and strategies aimed at better integrating child welfare systems, Medicaid, and children’s behavioral health.
- Learn about financing infrastructures that support meaningful whole family approaches to improving protective factors and strengthening family resilience.
HMA Speakers:
Uma Ahluwalia, MSW, MHA, Managing Principal, Washington, DC
Annalisa Baker, MPH, LCSW, Senior Consultant, New York, NY
Caitlin Thomas-Henkel, MSW, Principal, Philadelphia, PA
Heidi Arthur, MSW, Principal, New York, NY
Health Management Associates Acquires Edrington Health Consulting
Today, Jay Rosen, founder and president of Health Management Associates (HMA), announced the firm’s acquisition of Edrington Health Consulting (EHC), an Arizona-based firm that specializes in providing actuarial and financial analyses to health plans, providers, and government agencies.
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.