This week, our In Focus section highlights changes that may affect the Centers for Medicare & Medicaid Services (CMS) Medicare Advantage Star Rating program and how these changes impact future summary Part C & D Star Rating scores. As the CMS Medicare Advantage Star Rating program continues evolving from year to year, many plans have yet to achieve at least four star status, and therefore are missing out on additional Medicare revenues. The Star Rating landscape is expected to change drastically over the next two years for plans due to CMS’ continued focus on phasing-in greater reliance on outcomes measures and measures of care experience, rather than process measures. As a result, many plans are at risk of losing their four star overall rating and underperforming plans could be at risk of receiving a low performance indicator.
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CMS Interoperability and Patient Access Final Rule – Part 3
This blog was written by Juan Montanez, Principal, HMA, and Robert Chouinard, VP Public Sector, HealthEC
Where are you going to invest to maximize benefits?
In thinking about the value that can be derived from implementation of the Interoperability Rule, both payers and providers need to ensure their perspective of the rule positions them for long-term success.
CMS Interoperability and Patient Access Final Rule – Part 2
This blog was written by Laura Zaremba, Principal, HMA, and Robert Chouinard, VP Public Sector, HealthEC
Making the Economics Work for You
Most health care organizations impacted by the Interoperability Rule have very logically focused their attention and resources on interpreting what the new rule requires them to do within their own systems, in what timeframe, and at what cost. And to be sure, scoping the work and deploying the resources required to meet the compliance deadlines is a significant investment of time and money, but the compliance focus should be only the first action step for to the Interoperability Rule.
Nevada Releases Medicaid Managed Care RFP
This week, our In Focus section reviews the Nevada Medicaid and Child Health Insurance Program (CHIP) managed care request for proposals (RFP) released by the Nevada Department of Health and Human Services, Division of Health Care Financing and Policy (DHCFP) on March 17, 2021. The RFP is for the current service area covering two urban counties of the state, Clark and Washoe; however, the state may extend the geographic service area under the contract. Through this RFP, Nevada seeks to advance the state’s goals of “improved clarity and oversight of requirements; increased focus on care management, member engagement, and access; and continued progress towards integration of services and efficiency.”
Nursing Home Report Highlights Benefits of Single Resident Rooms
The COVID-19 pandemic highlighted nursing home safety and infection control as critical public health issues. A new report authored by HMA colleagues found compelling evidence that single rooms in nursing homes have numerous benefits for both public health and residents’ experience. The authors conclude that transitioning from multi-resident rooms to single rooms should be a component of person-centered nursing home reform. The report calls on stakeholders to come to the table to discuss options and strategies for long-term care redesign and transformation.
Highlights from Kaiser/HMA 50-State Medicaid Director Survey COVID-19 Update for FY 2021 and FY 2022
This week, our In Focus section shares key takeaways from the Kaiser Family Foundation (KFF) and Health Management Associates (HMA) mini-survey of Medicaid directors in all 50 states and the District of Columbia titled, Medicaid Spending and Enrollment Trends Amid the COVID-19 Pandemic – Updated for FY 2021 & Looking Ahead to FY 2022. The survey, released on March 12, 2021, is an update to the 20th annual Medicaid Budget Survey conducted by KFF and HMA. The brief is authored by Elizabeth Hinton , Lina Stolyar , and Robin Rudowitz from KFF with survey assistance and dissemination from HMA Principal Kathy Gifford and Consultant Anh Pham.
California Releases Revised CalAIM Proposal
This week, our In Focus section summarizes the revised California Advancing and Innovating Medi-Cal (CalAIM) proposal, released on February 17, 2021. Medi-Cal, the state’s Medicaid program, covers over 12 million individuals, with over 11 million in managed care. CalAIM seeks to standardize and streamline the Medi-Cal program and address health disparities and social determinants of health for high-risk, high-cost Medi-Cal members through broad-based delivery system, program, and payment reform. CalAIM was originally scheduled to begin its tiered implementation in January 2021, but due to COVID-19 has been delayed until January 2022. The revised proposal incorporates additional stakeholder input, learnings from the workgroup meetings, and ongoing policy development.
CMS Interoperability and Patient Access Final Rule – Part 1
This blog was written by Laura Zaremba, Principal, HMA, and Robert Chouinard, VP Public Sector, HealthEC
What are we really talking about?
CMS published the Interoperability and Patient Access Final Rule in the Federal Register on March 4, 2019, the pre-publication text of the final rule was released on March 9, 2020, and the final rule was published in the Federal Register on May 1, 2020. The rules are effective as of January 2021 and will be enforced by July 2021.
Health Management Associates Provides Updates in 2021 Federal Healthcare Policy Landscape
This week, our In Focus comes from an HMA cross-cutting subject matter team, who have updated a core set of federal policy slides that analyzes recent federal policy actions following the Presidential and Congressional elections. It includes an analysis of President Biden’s $1.9 trillion COVID-19 relief legislation currently in development and recent CMS regulatory and administrative actions. Specifically, the analysis looks at:
Medicaid Managed Care Spending in 2020
This week, our In Focus section reviews preliminary 2020 Medicaid spending data collected in the annual CMS-64 Medicaid expenditure report. After submitting a Freedom of Information Act request to the Centers for Medicare & Medicaid Services (CMS), HMA received a draft version of the CMS-64 report that is based on preliminary estimates of Medicaid spending by state for federal fiscal year (FFY) 2020. Based on the preliminary estimates, Medicaid expenditures on medical services across all 50 states and six territories in FFY 2020 exceeded $649.4 billion, with over half of the total now flowing through Medicaid managed care programs. In addition, total Medicaid spending on administrative services was $29.7 billion, bringing total program expenditures to $679.1 billion.
HMA Enters Strategic Partnership with The College for Behavioral Health Leadership
HMA recently entered into a strategic partnership with The College for Behavioral Health Leadership (CBHL) for the 2021 calendar year.
Medicaid Managed Care Enrollment Update – Q4 2020
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 33 states.[1] Many state Medicaid agencies post monthly enrollment figures by health plan for their Medicaid managed care population to their websites. This data allows for the timeliest analysis of enrollment trends across states and managed care organizations. All 33 states highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2020. This report reflects the most recent data posted. HMA has made the following observations related to the enrollment data shown on Table 1 (below):