This week, our In Focus section reviews a new model – Geographic Direct Contracting – introduced by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. The model will test whether a geographic-based approach to care delivery and value-based care can improve health and reduce costs for Medicare beneficiaries enrolled in the traditional fee-for-service program across an entire region. This model represents one of the most transformational models released by the Innovation Center. During the 6-year Geographic Direct Contracting model performance period the traditional Medicare program will be replaced by the Direct Contracting program in the 10 selected regions.
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Health Management Associates Launches Institute on Addiction
Health Management Associates (HMA) announced today creation of the HMA Institute on Addiction (IOA), a division dedicated to supporting the national effort to build an evidence-based, patient-centered, and sustainable addiction treatment ecosystem.
HMA expert provides Medicaid funding insights
HMA Managing Principal Anne Winter joined the “Our American States” podcast, produced by the National Conference of State Legislatures, to discuss emerging gene therapies and the high costs associated with them. The episode, The Fiscal Challenge of Emerging Gene Therapies, originally aired Jan. 11, 2021.
HMA and Wakely Consulting Group collaborate on states, Medicaid, and economic hard times report
In the wake of the COVID-19 pandemic and resulting economic crisis, public health, the economy, health coverage, and state budgets saw major impacts with state Medicaid programs at the intersection of these programs and challenges.
HI, MN Rerelease Medicaid Managed Care RFPs
This week, our In Focus section reviews the Hawaii Quest Integration (QI) Medicaid managed care request for proposals (RFP) released on December 8, 2020, and the Minnesota Families and Children Medical Assistance (MA) and MinnesotaCare programs RFP released on January 4, 2021.
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.
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
North Carolina releases RFA for behavioral health, IDD tailored plans
This week, our In Focus section reviews the statewide North Carolina request for applications (RFA) for Behavioral Health and Intellectual/Developmental Disability (BH IDD) Tailored Plans released by the North Carolina Department of Health and Human Services (DHHS) on November 13, 2020. BH IDD Tailored Plans are part of the statewide effort to transition to Medicaid managed care and are one of the four types of integrated Medicaid managed care plans the state will contract with to serve Medicaid and NC Health Choice beneficiaries. The other three are Standard Plans, the Statewide Specialized Foster Care Plan, and the Eastern Band of Cherokee Indians Tribal Option.
20th annual state Medicaid budget survey released
The 20th annual Medicaid Budget Survey conducted by The Kaiser Family Foundation (KFF) and Health Management Associates (HMA) was released on October 14, 2020 and included two new reports: State Medicaid Programs Respond to Meet COVID-19 Challenges: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2020 and 2021 and Medicaid Enrollment & Spending Growth: FY 2020 & 2021.
The reports were prepared by Kathleen Gifford, Aimee Lashbrook, and Sarah Barth from HMA and by Elizabeth Hinton, Robin Rudowitz, Madeline Guth, and Lina Stolyar from the Kaiser Family Foundation. The survey was conducted in collaboration with the National Association of Medicaid Directors.
This survey reports on trends in Medicaid spending, enrollment, and policy initiatives for FY 2020 and FY 2021, highlighting COVID-19 policy planned for implementation in FY 2021. The conclusions are based on information provided by the nation’s state Medicaid Directors.
Ohio Releases Medicaid Managed Care RFA
This week, our In Focus section reviews the Ohio Medicaid Managed Care request for applications (RFA) released by the Ohio Department of Medicaid (ODM) on September 30, 2020. The RFA follows the release of two requests for information (RFIs) in June 2019 and February 2020, soliciting feedback from individuals, providers, and interested bidders to help design a new Medicaid managed care program. Ohio will award contracts, worth over $11 billion annually, to no more than five managed care organizations (MCOs) in each of the state’s three regions (Central/Southeast Region, Northeast Region, and West Region), with implementation beginning January 5, 2022. The procurement will not include the MyCare Ohio dual demonstration.
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.
CMS considers expanding Medicaid APMs to control spending growth
On September 15, 2020, the Centers for Medicare & Medicaid Services (CMS) released State Medicaid Director (SMD) letter #20-004 regarding value-based care (VBC) opportunities in Medicaid. [1] In the letter, CMS lays out a road map for state Medicaid agencies to adopt value-based payment (VBP). The SMD describes how states can use existing – or obtain new – authorities to adopt VBP. It lists examples of successful VBP designs in other states and identifies key enabling factors from its examination of lessons learned over the last ten years of investments in VBC activities.