The experts at Health Management Associates (HMA) have released Medicare Advantage Supplemental Benefit Flexibilities: An Early Assessment of Adoption and Policy Opportunities for Expanded Access. The white paper examines the factors contributing to a Medicare Advantage plan’s decision to offer or not offer newly available supplemental benefits and opportunities and challenges with adoption and implementation. Newly available supplemental benefits are intended to address unmet health and social needs.
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2020 Highlights: Key Trends in Medicare-Medicaid Integration
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.
CMS finalizes expanded Medicare telehealth coverage through 2021
This week, our In Focus section reviews the finalized coverage expansions for Medicare telehealth services in the Centers for Medicare & Medicaid Services (CMS) Calendar Year (CY) 2021 Physician Fee Schedule (PFS) Final Rule. Telehealth advocates will be pleased to see meaningful expansions; however, the response of advocates will also be tempered by the impending return of the geographic and site of service limitations that will follow at the conclusion of the COVID-19 Public Health Emergency (PHE). During the PHE, millions of patients and providers increased their use of telehealth services to expand access to care. Given this shift in the delivery of care, telehealth advocates had been hopeful CMS would make extensive permanent coverage expansions in the Medicare program. In light of this, CMS’s new regulation will come as a reminder to many that the key to long term expansions of Medicare telehealth coverage lies in the hands of the U.S. Congress.
The Future of the Affordable Care Act (ACA): Implications of November’s Elections and a Supreme Court Decision
After the November 3 elections, the political landscape will shift as the composition of the next administration, Congress and many state legislatures and governors’ offices begins to take shape. If President Trump is reelected, his administration will position to govern for another four years. If former Vice President Joe Biden is elected, his campaign will accelerate transition planning and prepare actions to implement change immediately upon inauguration. At the same time, on November 10, the Supreme Court is scheduled to hear oral arguments regarding the continued validity of the Affordable Care Act.
The presidential, congressional and state elections, and the Supreme Court’s decision, will drive the future of the ACA and health care coverage in the U.S. While any significant change will take time to implement, uncertainty will require action and planning from all health care stakeholders as they navigate the emerging scenarios and position for future shifts.
During this webinar, HMA and Dentons will discuss the specific pathways that change could take. Specifically:
- What impact could the Supreme Court’s decision have on the ACA, and what is the expected timing of this decision?
- What impact could the November election results have on the Supreme Court’s decision?
- What immediate actions should stakeholders expect for Marketplace and Medicaid coverage as a result of the November elections?
- If Democrats gain control of the White House and Congress, how will Democrats implement campaign pledges, for example to create a public option and expand Medicare to those ages 60 to 65?
- How will the future direction of the ACA impact other health care coverage?
- How would Medicare be affected by the ACA decision and the results of the November elections?
- How should specific health care stakeholder groups (e.g., consumers and patients, health plans, delivery systems, states) respond and prepare for changes?
Speakers
Jonathan (Jon) Blum, MPP, Vice President, Federal Policy and Managing Director, Medicare, HMA
Bruce Merlin Fried, Partner, Dentons’ Health Care Practice
Charles Luband, Partner, Dentons’ Health Care Practice
Kathleen Nolan, Regional Vice President, HMA
CMS Introduces New Medicare Direct Contracting Model Opportunity
This week, our In Focus section looks at a new Medicare model, Direct Contracting, introduced by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. The new model will build on and continue testing potential reforms to the Medicare program encompassed by accountable care organizations (ACOs), Medicare Advantage (MA), and private sector risk-sharing arrangements. The payment model options may appeal to a broad range of physician and provider groups and other organizations because they are expected to introduce flexibility in health care delivery, support a focus on beneficiaries with complex, chronic conditions, and encourage participation from organizations that have not typically participated in traditional fee-for-service (FFS) Medicare or CMS Innovation Center models. However, there will be substantial financial risk—and reward—for participants based on a new, complex methodology, so organizations interested in this new model should carefully consider the possible outcomes from participating in Direct Contracting versus other options. CMS has announced that 51 organizations will participate in the model’s trial Implementation Period, which runs from October 1, 2020, through March 31, 2021. The agency has stated that it expects to announce additional Direct Contracting pathways in the future and that the next round of applications for participation in the second performance year will open in early 2021.
A short-term solution to ACA uncertainty amid ongoing pandemic
In this week’s In Focus section, Health Management Associates (HMA) Managing Director MMS Matt Powers, Senior Consultant Kaitlyn Feiock, and Regional Vice President Kathleen Nolan look at the future of the Patient Protection and Affordable Care Act (ACA). On November 10, 2020, the Supreme Court of the United States (SCOTUS) heard oral arguments for California v. Texas, challenging the constitutionality and severability of the ACA. This challenge became possible after the 2017 Tax Cuts and Jobs Act, which zeroed out the individual mandate penalty for not purchasing health insurance. While most experts agree that an entire invalidation of the ACA is the least likely outcome based on the oral arguments, some uncertainty remains and more than $100 billion federal funds are at risk. The ACA standardized insurance rules offset premium costs for many individual market consumers and provided authority and funding for Medicaid Expansions in the overwhelming majority of states. The ACA also included other provisions that may be at risk but are not the subject of this note, such as the creation of Center for Medicare and Medicaid Innovation (CMMI) and the Medicare-Medicaid Coordination Office, as well as demonstration authority that has led to the creation of numerous coverage models. As states, Congress, and the federal executive branch face the possibility that the ACA may not survive in its present form, what mitigation strategies are available at the state and federal levels to stabilize uncertainties and protect against abrupt coverage changes?
HMA colleagues author evidence-based programs paper
Health Management Associates (HMA), in contract with The National Council on Aging (NCOA), and with support from the Administration for Community Living (ACL), recently provided research and strategy services to support the goal to increase the adoption of evidence-based health promotion and disease prevention programs, known as evidence-based programs (EBPs) by Medicaid, Medicare, and other health insurance markets.
Evidence-based programs paper authored by HMA colleagues
Health Management Associates (HMA), in contract with The National Council on Aging (NCOA), and with support from the Administration for Community Living (ACL), recently provided research and strategy services to support the goal to increase the adoption of evidence-based health promotion and disease prevention programs, known as evidence-based programs (EBPs) by Medicaid, Medicare, and other health insurance markets.
Health Management Associates Names Douglas Elwell CEO; Charles (Chuck) Milligan Joins Firm as COO
Health Management Associates (HMA) announced today that Chief Operating Officer Douglas (Doug) L. Elwell will assume the role of Chief Executive Officer, effective Nov. 1.
HMA analysis of the 2021 Medicare Advantage landscape and mandatory Medicare radiation oncology and ESRD treatment choices innovation models
This week, our In Focus section reviews two recent Medicare developments from the Centers for Medicare & Medicaid Services (CMS). On September 24, 2020, CMS released the Medicare Advantage (MA) and Part D landscape files for the 2021 plan year. These files include information on MA and Part D offerings, including plan types and premiums. Earlier this month, CMS also released a final rule implementing two new mandatory payment models addressing radiation oncology and end-stage renal disease (ESRD).
Webinar Replay: Medicare, Medicaid and the ACA’s Evolution After the 2020 Presidential Election
This webinar was held on September 30, 2020.
The upcoming federal elections portend tremendous change for federal health care programs, in particular Medicare, Medicaid and the Affordable Care Act. If there is a change in administration and Congressional control, stakeholders should expect rapid implementation of new policy agendas and regulatory frameworks. New presidents generally pursue aggressive policy and regulatory agendas to fulfill campaign promises and quickly secure their policy objectives. Second-term presidents seek to solidify and extend their policy legacies. Health care stakeholders should begin to prepare for potential changes now to ensure that their organizations are best positioned for 2021 and beyond.
Through a new collaboration between Health Management Associates (HMA) and Dentons global law firm, a former presidential candidate and governor, presidential transition team veterans, former federal government administrators, and health policy experts outlined the different health care platforms of the Biden and Trump campaigns. The webinar explored:
- The major differences in policy positions and how a Trump or Biden Administration will administer the Medicare, Medicaid and Affordable Care Act (ACA) programs.
- How the current COVID-19 pandemic, economic downturn, and a potential Supreme Court decision will shape these agendas.
- The process for presidential transitions and how new governing and regulatory agendas are established.
During this webinar, the first in a series hosted by HMA and Dentons, presenters discussed the implications of the upcoming elections and their potential impact on federal health program policies and regulatory agendas.
Speakers
Governor Howard Dean (VT), Former Presidential Candidate & Senior Advisor, Dentons’ Public Policy and Regulation Practice
Kathleen Nolan, Regional Vice President, HMA
Jonathan Blum, Vice President, Federal Policy & Managing Director, Medicare, HMA
Bruce Fried, Partner, Dentons’ Health Care Practice
Health Management Associates Acquires Health Policy Consulting Firm Burns & Associates
Today, Jay Rosen, founder and president of Health Management Associates (HMA), announced the firm’s acquisition of Burns & Associates, Inc., an Arizona-based health policy consulting firm that specializes in innovative approaches to the financing and delivery of health care and human services.