Insights

CMS Increases Monitoring and Evaluation Requirements for Section 1115(a) Medicaid Demonstrations

This week, our In Focus reviews the implications of the new federal guidance for state waivers with community engagement, premiums, non-eligibility periods, and other personal responsibility provisions.

Background

On March 14, 2019, the Centers for Medicare & Medicaid Services (CMS) issued several new guidance documents that significantly increase the level of monitoring and evaluation required for Section 1115(a) Medicaid Demonstrations. These new requirements apply to community engagement, premiums, and other waiver provisions that impact eligibility and enrollment, and affect states currently with such waivers as well as any states proposing these ideas. Changes in reporting, data collection, and waiver monitoring processes will be necessary, and soon—as the materials details compliance dates for these significant new requirements.

Patient Protection and Affordable Care Act; 2020 Proposed Notice of Benefit and Payment Parameters

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This week, our In Focus reviews the Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2020. The new proposed rule does not contain as many major changes as the 2019 rule, but there are requests for comment on potentially important rulemaking starting in 2021 and guidance on important policy, such as:

Analysis of Key Medicare Proposals in the President’s FY 2020 Budget

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This week, our In Focus comes to us from HMA Senior Consultant Narda Ipakchi. On March 11, 2019, the White House released President Trump’s budget for fiscal year (FY) 2020, which includes a number of legislative and administrative proposals related to Medicare that would reduce net Medicare spending by $811 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 2020 budget are unlikely to advance. Several of the policies, however, such as reductions to Medicare bad debt and implementing site neutral payment systems were also proposed by the previous administration. Administrative proposals are more likely to move forward, as the administration can implement these policies through its regulatory channels.

Will Hospitals Serving Racial and Ethnic Minorities Lose Out in a Value-Based Payment World?

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HMA Principal Madeleine Shea, with her partners from the National Committee for Quality Assurance and American Hospital Association, recently authored the Health Equity article, Explaining the Relationship between Minority Group Status and Health Disparities. While federal policy has moved in the direction of adjusting for poverty and disability as proxies for social risks, this article keeps the focus on race and ethnicity as a major explanation for health disparities in the United States.

Louisiana Releases Medicaid MCO RFP

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This week, our In Focus reviews the Louisiana Medicaid managed care organizations (MCOs) request for proposals (RFP), released by the Louisiana Department of Health (LDH) on February 25, 2019. Selected MCOs will manage health care services for more than 1.5 million Medicaid enrollees statewide, starting January 2020.

Minnesota Releases Medicaid Managed Care RFPs

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This week, our In Focus reviews requests for proposals (RFPs) for Minnesota’s Medicaid managed care programs: 1. Families and Children Medical Assistance and MinnesotaCare; 2. Minnesota Senior Care Plus (MSC+)/Minnesota Senior Health Options (MSHO). The two RFPs were released by the Minnesota Department of Human Services on February 25, 2019, with implementation scheduled to begin on January 1, 2020 for all programs.

HMA Input, Analysis Identify California Provider Shortage

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A team of HMA colleagues, including Carrie Cochran, Helen DuPlessis, Jon Freedman, Kelly Krinn, Nora Leibowitz and Ryan Mooney conducted impact assessments of recommendations developed by the California Future Health Workforce Commission.

Medi-Cal Explained: HMA expert shares insights

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Medi-Cal experts, including HMA’s Margaret Tatar, provided an overview of the program during a presentation in Sacramento, and via webcast, on Feb. 25. The event was sponsored by the California HealthCare Foundation (CHCF).

Medicaid Plan PMPM Rates Rise 0.3 Percent in 2018 for TANF/CHIP In 19 States, 4 Percent for Expansion, HMAIS Analysis Shows

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This week, our In Focus summarizes the findings of an HMA Information Services (HMAIS) analysis of Medicaid managed care rates in 2018 versus 2017. The analysis represents HMAIS’ first attempt at what will be an annual tracking of Medicaid managed care rate increases, which we will expand upon and refine over time with input from our readers and the Medicaid community. Complete results, including spreadsheets showing underlying analysis, will be made available to HMAIS subscribers. For information on how to subscribe, contact Carl Mercurio.

MA Releases One Care Dual Demonstration 2.0 Request for Responses

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This week, our In Focus reviews the Massachusetts One Care Dual Demonstration 2.0 request for responses (RFR), released by the Massachusetts Executive Office of Health and Human Services (EOHHS). One Care will cover Medicare and Medicaid dual eligible adults with disabilities ages 21 through 64 and includes medical, behavioral, Long-term Services and Supports (LTSS), community supports, and care management services statewide.

Evolving Integrated Managed Care Models for Medicare-Medicaid Dual Eligible Beneficiaries: Key Considerations for Health Plans

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This week we are providing a brief recap of our January 8^th webinar Evolving Integrated Managed Care Models for Medicare-Medicaid Dual Eligible Beneficiaries: Key Considerations for Health Plans presented by Principals Sarah Barth, JD and Ellen Breslin, MPP.

CMS Issues Medicare Advantage Advance Notice Part II and Draft Call Letter

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On January 30, 2019, the Centers for Medicare & Medicaid Services (CMS) issued Part II of the Advance Notice of Methodological Changes for Calendar Year (CY) 2020 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2020 Draft Call Letter. The Advance Notice and Call Letter includes proposed updates to MA payment rates and guidance to plan sponsors as they prepare their bids for CY 2020. Comments are due by 6:00 PM EST on Friday, March 1, 2019. The final Announcement and Call Letter will be published on April 1, 2019.

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CMS Increases Monitoring and Evaluation Requirements for Section 1115(a) Medicaid Demonstrations

Background

Patient Protection and Affordable Care Act; 2020 Proposed Notice of Benefit and Payment Parameters

Analysis of Key Medicare Proposals in the President’s FY 2020 Budget

Will Hospitals Serving Racial and Ethnic Minorities Lose Out in a Value-Based Payment World?

Louisiana Releases Medicaid MCO RFP

Minnesota Releases Medicaid Managed Care RFPs

HMA Input, Analysis Identify California Provider Shortage

Medi-Cal Explained: HMA expert shares insights

Medicaid Plan PMPM Rates Rise 0.3 Percent in 2018 for TANF/CHIP In 19 States, 4 Percent for Expansion, HMAIS Analysis Shows

MA Releases One Care Dual Demonstration 2.0 Request for Responses

Evolving Integrated Managed Care Models for Medicare-Medicaid Dual Eligible Beneficiaries: Key Considerations for Health Plans

CMS Issues Medicare Advantage Advance Notice Part II and Draft Call Letter

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HMA Insights: Your source for healthcare news, ideas and analysis.

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