Recently, the Centers for Medicare & Medicaid Services (CMS) issued proposed rules to update the Medicare payment rates and implement other policy changes for three types of Part A providers: hospice, inpatient psychiatric facilities (IPFs), and skilled nursing facilities (SNFs). CMS is publishing these proposed rules in accordance with existing statutory and regulatory requirements to update Medicare payment policies for these providers on an annual basis. This brief summarizes the proposed payment rates and key policy changes for each of these provider types.
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Medicare and Medicaid Telehealth Coverage in Response to COVID-19
Telehealth service expansions by Medicare and most Medicaid programs aim to rapidly increase access to care and reduce transmission, but also provide a natural experiment for policymakers.
This week, our In Focus section examines the extensive scope of flexibilities Federal and State governments have made to Medicare and Medicaid telehealth coverage in response to the COVID-19 national emergency. In March and April 2020, federal and state policymakers responded to the COVID-19 emergency by temporarily and aggressively expanding the definition of and reimbursement for telehealth services—moves intended to improve access to care and reduce virus transmission. Under the Medicare and Medicaid programs, these temporary expansions have been rapid and historic in scope, and will have substantial implications for patients, providers, payers, and federal/state financing. For policymakers, this temporary expansion may serve as a natural experiment for assessing which forms of telehealth services successfully expand access to care and should become permanent healthcare policy.
HMA Model Provides Forecast of COVID-19 Impact on Medicaid, Marketplace, Uninsured
A model developed by Health Management Associates (HMA) assesses COVID-19’s potential impact on health insurance coverage for each state and forecasts Medicaid enrollment could increase by 11 to 23 million across all states over the next several months.
HMA Review of State Appendix K Waivers in Response to COVID-19
This week, our In Focus section comes from HMA Principals Ellen Breslin (MA) and Sharon Lewis (OR). In direct response to COVID-19, the Centers for Medicare & Medicaid Services (CMS) has encouraged states to maximize Medicaid flexibilities to protect people during the pandemic emergency. This includes state flexibilities for people receiving home and community-based services. States may temporarily amend their Home and Community-Based Services (HCBS) 1915(c) waivers through an expedited process by submitting an Appendix K request. As of March 31, 2020, CMS had approved Appendix K submissions for thirteen states with effective periods ranging from four months to one year.[1] The thirteen states are: Alaska, Connecticut, Colorado, Hawaii, Iowa, Kentucky, Minnesota, New Mexico, Pennsylvania, Rhode Island, Washington, West Virginia and Wyoming.
D-SNP 2021 Hospital and Skilled Nursing Facility Admission Data Sharing Requirements: States and Health Plan Opportunity to Support Care Transitions
This week, our In Focus section provides an overview of new requirements and opportunities for states and Medicare Advantage (MA) Dual Eligible Special Needs Plans (D-SNPs) to increase Medicare and Medicaid coordination in plan year 2021. Specifically, states and health plans will need to partner for compliance with calendar year (CY) 2021 Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) data sharing requirements for D-SNPs that are not designated as a fully integrated D-SNP (FIDE SNP) or a highly integrated D-SNP (HIDE SNP)[1]. CY 2021 State Medicaid Agency Contracts (SMACs) with these D-SNPs must document the notification process for sharing hospital and skilled nursing facility (SNF) admissions for at least one group of high-risk enrollees.[2]
HMA Article Highlights Value-Based Payment Models
With a focus on value-based payment (VBP) models and helping primary care practices prepare for a value-driven future, HMA experts Suzanne Daub, Caroline Rosenzweig and Meggan Christmas Schilkie will publish their article in the American Psychological Association journal Families, Systems & Health.
Medicare and Medicaid Flexibilities During Public Health Emergencies
This week, our In Focus comes from HMA Vice President Kathleen Nolan and Managing Principal Jon Blum. On March 13, 2020, President Trump declared a national emergency due to the rapid spread of COVID-19 virus. This declaration provides Health and Human Services (HHS) and the Centers of Medicare and Medicaid Services (CMS) new abilities to waive Medicare and Medicaid regulatory requirements to help health care providers, health plans and other stakeholders respond to immediate needs of their patients and communities. In the past, HHS and CMS have solicited requests for relief needs from states, local providers and trade associations, among other stakeholders. Health care providers, health plans and others should continue to monitor policy announcements from HHS and CMS and work with their states and trade associations to identify potential areas of need for requested regulatory relief.
HMA Analysis of the 2020 Medicare Advantage Annual Election Period
This week, our In Focus section examines Medicare Advantage (MA) enrollment changes resulting from the 2020 Annual Election Period (AEP). The AEP takes runs from October 15 to December 7 each year, and provides an opportunity for Medicare beneficiaries to sign up for, change, or disenroll from an MA plan for the upcoming year. The majority of enrollment changes occur during this period, but depending on beneficiary circumstances, additional opportunities may exist throughout the year to change coverage. Initial findings from the enrollment data suggest:
HMA Analysis of New Requirements Expanding Medicare Advantage Eligibility to Individuals with End-Stage Renal Disease
This week, our In Focus section comes from HMA Principal Eric Hammelman and Senior Consultant Narda Ipakchi. Today, Medicare beneficiaries with End-Stage Renal Disease (ESRD) are only eligible to enroll in Medicare Advantage (MA) plans if they select a MA Special Needs Plan (SNP) that specifically serves individuals with ESRD or develop ESRD while already enrolled in a MA plan. In 2018, approximately 121,000 MA enrollees (0.6 percent of the MA population) had diagnoses of ESRD, accounting for approximately 20 percent of the total Medicare ESRD population.[1] The 21st Century Cures Act, which was passed in 2016, included a provision that alters the eligibility and enrollment options for Medicare beneficiaries with ESRD. Starting in 2021, Medicare beneficiaries with ESRD will be able to enroll in any MA plan in their area. The Centers for Medicare & Medicaid Services (CMS) estimates MA enrollment of individuals with ESRD will nearly double to 242,000 in 2024, or approximately 41 percent of the total Medicare ESRD population.[2]
Medicaid Managed Care Enrollment Update – Q4 2019
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 29 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 29 states highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2019. This report reflects the most recent data posted. HMA has made the following observations related to the enrollment data shown on Table 1 (below):
HMA to Lead Jail-Based Opioid Response Program in Pennsylvania
In the nationwide effort to combat opioid use disorder (OUD), Health Management Associates (HMA) is expanding its successful Medications for Opioid Use Disorder (MOUD) initiative to jails in Pennsylvania counties. The multi-tiered technical assistance approach, developed by HMA and implemented in the California correctional system, works to combat opioid overdoses by expanding access to treatment for OUD in jails and prisons.
POTUS FY 2021 Budget: Summary of Medicare Provisions
This week, our In Focus section examines President Trump’s budget for fiscal year (FY) 2021. The budget includes a number of legislative and administrative proposals related to Medicare that are estimated to reduce net Medicare spending by $872 billion over the next ten years. It is important to note that the legislative proposals included in the President’s budget are non-binding and serve as recommendations to Congress where they may or may not be advanced. Under a Democratic-majority House of Representatives, many of the legislative proposals outlined in the FY 2021 budget are unlikely to advance. Administrative proposals are more likely to move forward, as the administration can implement these policies through its regulatory channels.