This week, our In Focus section reviews value-based payment (VBP) opportunities for long-term care providers. HMA Principal Dana McHugh authored the article, “Life Plan Communities and Value-Based Payments: Aligning Incentives So Everyone Benefits”, for LeadingAge national magazine, discussing how life plan communities can establish value-based payment arrangements with managed care organizations (MCOs) to maximize value and add additional revenue streams.
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New NCQA Scoring- What Health Plans Should Know
Starting in 2020, a systemic shift will change the way health plans prepare for, and are scored, during National Committee for Quality Assurance (NCQA) accreditation. With the focus on quality of care, this transition means keeping up with new requirements is important now more than ever.
DC and Kentucky Medicaid Managed Care RFPs
This week, our In Focus section reviews two Medicaid managed care requests for proposals (RFPs) released on January 10, 2020. The District of Columbia Department of Health Care Finance (DHCF) issued an RFP for the DC Healthy Families Program (DCHFP); the District of Columbia Healthcare Alliance Program (Alliance); and the Immigrant Children’s Program (ICP) as part of a broader effort to fully transition Medicaid to managed care over the next five years. The new contracts will cover approximately 224,000 lives. Meanwhile, the Kentucky Cabinet for Health and Family Services (CHFS), Department for Medicaid Services (DMS) released a statewide Medicaid managed care RFP to serve approximately 1.2 million lives. In December 2019, Kentucky announced that it will cancel and rebid the current Medicaid managed care contracts.
Texas STAR Kids – Dallas Service Area RFP
This week, our In Focus section reviews the Texas STAR Kids Medicaid Managed Care in the Dallas Service Area (SA) request for proposals (RFP) released by the Texas Health and Human Services Commission (HHSC) on December 13, 2019. The RFP comes after Children’s Medical Center, which covers approximately 9,000 members under the program, said it would be leaving the market. The contracts for the SA are worth approximately $500 million. Anthem/Amerigroup will remain in the Dallas SA and continue to provide services. STAR Kids provides Medicaid coverage to individuals with disabilities under age 21.
West Virginia Releases Medicaid Managed Care RFP
This week, our In Focus section reviews the West Virginia Mountain Health Trust request for proposals (RFP) released by the West Virginia Department of Administration (DOA) for the Department for Health and Human Resources (DHHR) on December 17, 2019. Mountain Health Trust (MHT) is the statewide physical and behavioral Medicaid managed care program. West Virginia will award contracts, worth over $1.5 billion, to three managed care organizations (MCOs), with implementation beginning July 1, 2020.
Highlights from Kaiser/HMA Study on Access to Reproductive Health for Low-Income Women
This week, our In Focus section reviews highlights and major findings from the study, Beyond the Numbers: Access to Reproductive Health Care for Low-Income Women in Five Communities, conducted by The Kaiser Family Foundation (KFF) and Health Management Associates (HMA). The report, published in November 2019, was prepared by Sharon Silow-Carroll, Carrie Rosenzweig, Diana Rodin, and Rebecca Kellenberg from Health Management Associates; and by Usha Ranji, Michelle Long, and Alina Salganicoff from KFF.
Medication Assisted Treatment in Justice Settings
With funding from the California Health Care Foundation, Health Management Associates created the following video to capture the thoughts and feelings of various stakeholders in the criminal justice system about treating Opioid Use Disorder with Medication Assisted Treatment (MAT). It includes comments from two clients who received MAT through the criminal justice system. The parties interviewed are all involved in a project HMA is administering to coach teams from 29 counties to expand access to at least two forms of MAT in jails and drug courts.
D-SNP 2021 Integration Requirements: Opportunities for Plans, States to Partner on Medicare-Medicaid Integration
This week, our In Focus section provides a high-level overview of the new Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) integration requirements in the Centers for Medicare & Medicaid Services (CMS) April 16, 2019, final rule[1] for calendar year (CY) 2021. CMS recently released two publications providing guidance and technical assistance to assist with the implementation of these new opportunities: the November 14, 2019, CMCS Informational Bulletin[2] and Integrated Care Resource Center technical assistance tool Sample Language for State Medicaid Agency Contracts with Dual Eligible Special Needs Plans.[3] Both identify steps to ensure that states’ Medicaid agency contracts (SMACs) with D-SNPs comply with the new 2021 requirements, and further encourage states and D-SNPs to work together to address the often fragmented care provided to the Medicare-Medicaid dually eligible population.
NCQA’s Medicaid Health Insurance Plan Ratings 2019-20
This week, our In Focus section reviews the annual Medicaid health plan ratings released in September by the National Committee for Quality Assurance (NCQA), which rated 171 Medicaid plans. For 2019-20, NCQA used a ratings methodology that scored each health plan from 0 to 5 in 0.5 increments – a system similar to the Five-Star Quality Rating System used by the Centers for Medicare and Medicaid Services. A plan is considered top-rated if it scores a 4.5 or 5 and low-rated if it scores a 1 or 2. For 2019-20, only 15 Medicaid plans across the country were awarded a 4.5 or 5.
California Releases Medicaid Delivery System Waiver Proposal
This week, our In Focus section reviews the California Advancing and Innovating Medi-Cal (CalAIM) proposal, issued by the California Department of Health Care Services (DHCS) on October 28, 2019. CalAIM would implement broad delivery system, program, and payment reform for the state’s Medicaid program. The proposal includes efforts to address social determinants of health and other policy priorities such as homelessness, lack of access to behavioral health care, children with complex medical conditions, justice-involved populations, and aging individuals. According to DHCS, the three key goals of the proposal are to:
Albany and New York City HMA Offices Host First Regional Provider Conference
On November 13, HMA’s Albany and New York City offices hosted their first regional provider conference, “Make Your New Risk Model Pay: How New York Healthcare Providers are Making Population Health Sustainable.” Roughly 120 people attended the event.
New Medicare Benefit: Opioid Use Disorder Treatment
This week, our In Focus section examines the new Medicare benefit for Opioid Use Disorder (OUD) treatment that includes counseling, as well as medication-assisted treatment (MAT) and related items and services. This benefit was established by Congress in the SUPPORT Act of 2018 and is now being implemented by the Centers for Medicare & Medicaid Services (CMS). Medicare beneficiaries, including those dually eligible for Medicare & Medicaid, are the fastest growing group of OUD patients. Beneficiaries may access one of two types of providers: Opioid Treatment Programs (OTPs) (i.e., methadone clinics), or physicians + other health professionals. Providers offering these services will receive a bundled payment, either weekly or monthly depending on the type of provider, that can repeat as long as a patient needs treatment. Based on early guidance, Medicare Advantage (MA) plans have already created 2020 benefit packages that provide a level of access to OTP services that is “consistent with prevailing community patterns of care.” Now that the new benefit is final, MA will need to cover both OTP & Physician OUD treatment for 2021.