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.
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This webinar was held on February 18, 2020.
On February 6, the Centers for Medicare & Medicaid Services (CMS) issued Part II of the Advance Notice of Methodological Changes for Calendar Year (CY) 2021 which includes proposed updates to Medicare Advantage (MA) payment rates. In a departure from previous years, the agency did not release a separate Call Letter which typically includes Part C and Part D policy guidance and bidding instructions. Instead, the agency released a proposed rule which includes proposed policy and technical changes, most of which are scheduled to go into effect in the 2022 plan year. CMS also issued separate bidding instructions for plans as they prepare their bids for CY2021.
During this webinar, an HMA team of Medicare experts including Jonathan Blum, Eric Hammelman, Julie Faulhaber, and Narda Ipakchi presented an overview of the payment rate updates and proposed policy changes included in the Advance Notice and Proposed Rule. They provided interested stakeholders with an overview and analysis of the proposed changes as well as what these changes mean for Medicare Advantage plans’ existing strategies and opportunities.
- Understand what the expected 2021 rate increase for Medicaid Advantage plans means for continued industry growth and financial performance.
- Learn about updates to the Medicare Advantage Star Ratings system, including proposals to increase measure weights for patient experience and complaints.
- Learn about the proposed changes to network adequacy requirements and how the agency is promoting further use of telehealth among plans.
- Understand CMS’ efforts to implement requirements that expand Medicare Advantage coverage to beneficiaries with ESRD.
Jon Blum, Managing Principal, Washington, DC
Eric Hammelman, Principal, Chicago
Narda Ipakchi, Senior Consultant, Washington, DC
Julie Faulhaber, Principal, Chicago
This week, our In Focus section covers the report, Medicaid Expansion in Missouri – Economic Implications for Missouri and Interviews Reflecting Arkansas, Indiana, and Ohio Experiences, prepared by HMA Medicaid Market Solutions (MMS) Managing Director Matt Powers and Managing Principal Sharon Silow-Carroll, and Independent Health Policy Consultant Jack Meyer. Health Management Associates (HMA) conducted a targeted analysis of the likely economic impact of an ACA Medicaid Expansion in Missouri, with an emphasis on the effects on the state budget. The report was commissioned by the Missouri Hospital Association and Missouri Primary Care Association and released in partnership with stakeholders from the health care community in January 2020.
Starting in 2021, Medicare beneficiaries with End-Stage Renal Disease (ESRD) will be able to enroll in any Medicare Advantage (MA) plan. The Anthem Public Policy Institute asked HMA to explore some of the potential issues associated with how MA plans are currently paid by the Centers for Medicare & Medicaid Services (CMS) for individuals with ESRD, and identify any possible modifications that CMS or Congress could make to more closely align payment with costs.
This week, our In Focus section comes from HMA Medicaid Market Solutions (MMS) Managing Director Matt Powers and Senior Consultant Desmond Banks. On January 30, 2020, the Centers for Medicare & Medicaid Services (CMS) convened an event titled, Transforming Medicaid: A New Opportunity for Better Health, in Washington, DC, during which CMS Administrator Seema Verma announced the Healthy Adult Opportunity (HAO), an optional Section 1115 Medicaid Demonstration initiative. Commonly referred to as, “block grant” or “spending cap” model, the HAO seeks to provide states with enhanced flexibility to design and administer parts of their Medicaid program. Administrator Verma articulated the HAO to be an important step to support the fiscal sustainability of Medicaid and invited state Medicaid directors to submit waiver applications.
This webinar was held on January 31, 2020.
HMA’s how-to session last year on development and implementation of social determinants of health (SDOH) partnerships for vulnerable Colorado populations was a tremendous success, offering frameworks and tools for effective SDOH initiatives among community-based organizations (CBOs), health systems, and other providers. As a follow-up to this discussion, HMA hosted a “lessons learned” session, in which two CBOs who have implemented innovative SDOH partnerships outlined the results of their programs and provided insights on how to develop an effective SDOH collaboration.
- Learn how CBOs and health systems are successfully collaborating on SDOH services, payment models, and payer-provider relationships.
- Understand the opportunities and challenges related to contracting between CBOs and healthcare systems, including referrals, coordinated care, and pay-for-performance models.
- Find out how to engage and support local communities by activating and financing Community Health Workers (CHWs) for payment by health plans within the Pathways HUB framework.
- Learn how to assess potential partnerships and arrangements that address whole person health, including SDOH.
- Grace Damio, Center Director, Hispanic Health Council, Hartford, CT. The Hispanic Health Council has contracted with multiple healthcare provider systems to implement its community CHW-led, home-based diabetes intervention – Diabetes Among Latinos Best Practices Trial (DIALBEST).
- Giovanna Rogow, Chief Executive, Maternal Infant Services Network (MISN), Newburgh, NY. MISN has contracted individually with healthcare providers and serves as the backbone organization leading a 30-member CBO consortium called Hudson Valley Collective for Community Wellness (HVCCW). This consortium addresses social determinants of health throughout a seven-county region through capacity building and collective action. The HVCCW is presently forming an Independent Practice Association to collectively contract for CHWs to conduct outreach and provide care coordination services on behalf of member organizations via the Pathways HUB model.
Who Should Listen
Representatives of Colorado state and county governments, Colorado Regional Accountable Entities, hospitals, providers, and CBOs working to address SDOH.
Recently, the book, Nursing Informatics for the Advanced Practice Nurse: Patient Safety, Quality, Outcomes, and Interprofessionalism, which features a chapter written by HMA Principal David Bergman, was awarded first place in the 2019 American Journal of Nursing Book of the Year Awards in the Informatics category.