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.
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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.
HMA summary of Medicare Fee-for-Service (FFS) proposed rules
This week, our In Focus section reviews two Medicare fee-for-service (FFS) proposed rules recently issued by the Centers for Medicare & Medicaid Services (CMS). On August 3, 2020, CMS released a proposed rule that includes updates to services furnished under the Medicare Physician Fee Schedule (PFS). On August 4, CMS released the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule. These proposed regulations include payment rate and policy changes for the upcoming calendar year. Key features in this year’s PFS proposed rule include: policies to retain, extend, or end certain telehealth flexibilities implemented in response to the novel COVID-19 public health emergency (PHE), changes to enable certain health care professionals to practice at the top of their licenses, modifications to opioid treatment programs (OTPs), and updates to the Medicare Shared Savings Program (MSSP). View additional information on the PFS Proposed Rule. Among the most notable policy changes in the OPPS and ASC proposed rule are: 1) transitioning services to lower cost settings by eliminating the inpatient-only list to enable more services to be provided in the outpatient settings and increasing the scope of procedures that can be provided in ASCs, 2) further reducing payments for the 340B drug program, and 3) modifying the formula for calculating Hospital Star Ratings, and expand the use of prior authorization for outpatient services. Find additional information about these proposals.
HMA examines current state of Medicare-Medicaid integration programs
The experts at Health Management Associates (HMA) have released the Medicare-Medicaid Integration: Reflecting on Progress to Date and Charting the Path to Making Integrated Programs Available to all Dually Eligible Individuals issue brief and companion bibliography appendix, the second in a series of issue briefs examining Medicare-Medicaid integrated programs.
Based on HMA’s review of the literature and available public information, this brief summarizes the elements for success and barriers encountered by integrated programs. It concludes with essential questions and next steps to move forward with federal and state public policies and care delivery options centered around, informed by, and available to, more dually eligible individuals.
HMA colleagues Sarah Barth, Jon Blum, Elaine Henry, Narda Ipakchi and Sharon Silow-Carroll contributed to the research and final brief.
For the next phase of research, HMA will convene and interview individuals, their families and other caregivers, providers, payers, community-based organizations, state government, and other stakeholders in select regions across the country.
The project was funded by a grant from Arnold Ventures, a philanthropy dedicated to tackling some of the most pressing problems in the United States.
Regulatory changes to Medicare in response to COVID-19
This week, our In Focus section examines how the federal government implemented changes to the Medicare program in response to COVID-19. As the COVID-19 pandemic began in the United States, Congress and the Administration responded with a series of legislative, regulatory, and sub-regulatory changes to the Medicare program that were designed to provide relief from certain Medicare rules to assist health care providers, Medicare Advantage organizations, and Part D plans in responding to the pandemic. Some of these changes waived conditions of Medicare participation to enable patients to be treated in alternative care settings. Others permitted physicians and other providers to receive Medicare reimbursements for telemedicine services.
HMA Information Services adds Medicare Advantage competitive data and state profiles
HMA Information Services (HMAIS) is pleased to announce the expansion of its industry-leading healthcare information website to include information and state-by-state profiles of the market for Medicare Advantage and Special Needs Plans (SNPs).
HMA releases COVID-19 Medicare regulation tracking tool
The Medicare program has rapidly transformed how it pays for healthcare providers in response to the COVID-19 pandemic. In an effort to capture these changes, HMA, commissioned by The Commonwealth Fund and The SCAN Foundation, tracked, categorized, and analyzed the 212 Medicare policy modifications made in response to the public health emergency.
HMA Senior Consultant Jennifer Podulka and Managing Principal Jon Blum led efforts to analyze and synthesize COVID-19-related legislative, regulatory, and subregulatory changes to existing Medicare regulations issued beginning January 1, 2020. The resulting issue brief Regulatory Changes to Medicare in Response to COVID-19 and companion Policy Tracker use nine categories to organize the data and will be periodically updated to include new information.
The issue brief outlines key COVID-19-related changes including providing telehealth reimbursement for more types of services and providers, and waived conditions of Medicare participation permitting patients to be treated in alternative care settings including community facilities, temporary facilities, homes and in some cases, out of state services on a temporary basis.
Congress and the Trump administration waived or changed regulations to allow flexibility to help healthcare providers, Medicare Advantage plans and Part D plans. The policy tracker catalogs and categorizes these regulatory changes based on characteristics, including types of providers and plans affected, effective date, and expected duration.
These changes have affected virtually all healthcare providers and health plans that participate in the Medicare program, and the issue brief examines several questions surrounding the changes moving forward including risk to beneficiary protections and Medicare spending controls established in the original legislation and rules.
Data collection and analysis for the policy tracker was conducted by HMA colleagues Jennifer Podulka, Narda Ipakchi, Zach Gaumer, Yamini Narayan, and Elaine Henry. This project was supported by grants from The SCAN Foundation and The Commonwealth Fund.
Health Management Associates, HealthEC Announce New Collaboration
Today, Jay Rosen, founder and president of Health Management Associates (HMA), and Arthur Kapoor, president and CEO of HealthEC, announced the two firms have engaged in an effort designed to accelerate improvements in healthcare service delivery and outcomes.