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.
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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.
HMA Colleagues Lead Health Reproductive Care Access Study
Health Management Associates (HMA), working with the Kaiser Family Foundation, recently conducted research and completed five case studies to identify distinct challenges that low-income women face in obtaining reproductive healthcare in five diverse communities, and the key factors contributing to them.
Indiana Releases Hoosier Care Connect Managed Care RFP
This week, our In Focus section reviews the Indiana Hoosier Care Connect request for proposals (RFP), issued by the Indiana Family and Social Services Administration (FSSA), Office of Medicaid Policy and Planning (OMPP) on October 18, 2019. Hoosier Care Connect is the state’s Medicaid managed care program for approximately 90,000 aged, blind, and disabled (ABD) Medicaid beneficiaries. Implementation is expected April 1, 2021, with contracts worth $1.4 billion annually.
2020 Medicare Advantage, Part D Landscape Files and Quality Performance Data
This week, our In Focus reviews the Medicare Advantage (MA) and Part D landscape files and quality performance data for the 2020 plan year from the Centers for Medicare & Medicaid Services (CMS). Data on MA and Part D offerings include premiums and benefit design, as well as Star Ratings for each MA contract. This year’s release signals continued growth for the MA program in 2020. The total number of MA plans increased by 403 offerings to 3,144, up from 2,741 in 2019, the highest number since inception of the program. Notably, growth appears to be occurring in parts of the country with existing market saturation, as many MA organizations are offering new plans in states with MA enrollment levels of 30 percent or higher. There is also significant growth in the number of Dual Eligible Special Needs Plans (D-SNPs) offered by MA organizations, particularly among top MA sponsors Humana and CVS (Aetna).
Highlights from Kaiser/HMA 50-State Medicaid Director Survey
This week, our In Focus section reviews highlights and shares key takeaways from the 19th annual Medicaid Budget Survey conducted by The Kaiser Family Foundation (KFF) and Health Management Associates (HMA). Survey results were released on October 18, 2019, in two new reports: A View from the States: Key Medicaid Policy Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2019 and 2020 and Medicaid Enrollment & Spending Growth: FY 2019 & 2020. The report was prepared by Kathleen Gifford and Aimee Lashbrook from HMA; Eileen Ellis and Mike Nardone; and by Elizabeth Hinton, Robin Rudowitz, Maria Diaz, and Marina Tian from the Kaiser Family Foundation. The survey was conducted in collaboration with the National Association of Medicaid Directors.
Pennsylvania Releases HealthChoices Physical Health RFA
This week, our In Focus section reviews the Pennsylvania HealthChoices Physical Health Medicaid managed care request for applications (RFA), issued by the Pennsylvania Department of Human Services on October 15, 2019. Medicaid managed care organizations (MCOs) will serve the five HealthChoices zones covering all 67 counties: Southeast, Southwest, Lehigh-Capital, Northwest, and Northeast. Contracts are worth nearly $13 billion.
Utah Releases Medicaid Expansion Fall Back Plan Waiver Amendment
This week, our In Focus section reviews the Utah Medicaid Section 1115 Demonstration Waiver amendment Fallback Plan, released for public comment on September 27, 2019. The Fallback Plan would raise Utah’s Medicaid expansion income limit to 138 percent of the federal poverty level (FPL)[1]. Voters in the state passed full Medicaid expansion through a ballot initiative in 2018, however, the state only enacted partial expansion through a waiver. The Fallback Plan looks to fully expand Medicaid, while also implementing certain provisions, including work requirements and premiums.
HMA Medicare Experts in Demand
HMA Principal Mary Hsieh offered her expertise and insights during a panel discussion at the America’s Health Insurance Plans (AHIP) Conference. The panel, Blockbuster Medicare Innovations, focused on sweeping policy changes announced by the Centers for Medicaid and Medicare Services.