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

HMA Insights – including our new podcast – puts the vast depth of HMA’s expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.

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Blog

Regulatory Changes to Medicare in Response to COVID-19

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This week, our In Focus section examines how the federal government implemented changes to the Medicare program in response to COVID-19.  As the COVID-19 pandemic began in the United States, Congress and the Administration responded with a series of legislative, regulatory, and sub-regulatory changes to the Medicare program that were designed to provide relief from certain Medicare rules to assist health care providers, Medicare Advantage organizations, and Part D plans in responding to the pandemic. Some of these changes waived conditions of Medicare participation to enable patients to be treated in alternative care settings. Others permitted physicians and other providers to receive Medicare reimbursements for telemedicine services.

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Brief & Report

HMA releases COVID-19 Medicare regulation tracking tool

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The Medicare program has rapidly transformed how it pays for healthcare providers in response to the COVID-19 pandemic. In an effort to capture these changes, HMA, commissioned by The Commonwealth Fund and The SCAN Foundation, tracked, categorized, and analyzed the 212 Medicare policy modifications made in response to the public health emergency.

HMA Senior Consultant Jennifer Podulka and Managing Principal Jon Blum led efforts to analyze and synthesize COVID-19-related legislative, regulatory, and subregulatory changes to existing Medicare regulations issued beginning January 1, 2020. The resulting issue brief Regulatory Changes to Medicare in Response to COVID-19 and companion Policy Tracker use nine categories to organize the data and will be periodically updated to include new information.

The issue brief outlines key COVID-19-related changes including providing telehealth reimbursement for more types of services and providers, and waived conditions of Medicare participation permitting patients to be treated in alternative care settings including community facilities, temporary facilities, homes and in some cases, out of state services on a temporary basis.

Congress and the Trump administration waived or changed regulations to allow flexibility to help healthcare providers, Medicare Advantage plans and Part D plans. The policy tracker catalogs and categorizes these regulatory changes based on characteristics, including types of providers and plans affected, effective date, and expected duration.

These changes have affected virtually all healthcare providers and health plans that participate in the Medicare program, and the issue brief examines several questions surrounding the changes moving forward including risk to beneficiary protections and Medicare spending controls established in the original legislation and rules.

Webinar

Webinar Replay: HMA Community Health Worker Webinar Series Part 2: The Role of Community Health Workers as COVID-19 Contact Tracers

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This webinar was held on July 13, 2020. 

Aggressive COVID-19 contact tracing is key to state reopening strategies. During this webinar, HMA community health experts addressed how community health workers can play a critical role in contact tracing, leveraging their trusted position in local communities and simultaneously furthering efforts to assist patients with multiple needs, including housing instability, food insecurity and co-morbidity. HMA experts also outlined best practices for establishing a contact tracing infrastructure and discuss how community health workers are positioned to emerge as the vanguard for COVID-19 vaccination efforts.

Learning Objectives:

  • Learn how to apply creative workforce strategies to address contact tracing, isolation support, co-morbid disease management, and immunization efforts.
  • Obtain creative financing and sustainability strategies for staffing and infrastructure.
  • Understand how community health workers and paraprofessionals can play an expanded role in the post-COVID-19 delivery system of the future.

HMA Speakers

Kathleen Nolan, Vice President, Washington, DC
Pat Casanova, Principal, Indianapolis, IN
Uma Ahluwalia, Principal, Washington, DC

 

A recording of the first webinar and supporting materials are now available here.

Webinar

Webinar Replay: HMA Community Health Worker Webinar Series Part 1: Health and Human Services Workforce Needs in the Context of COVID-19

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This webinar was held on June 30, 2020.

In the midst of the COVID-19 pandemic, state and local governments and safety net providers are faced with a clear indication of disparities in population health outcomes and looming budgetary challenges across the nation. These entities are committed to their residents and are looking for creative strategies to mitigate health risks and deliver responsive health and human services despite budgetary challenges. As such, the role of the community health worker or the navigator rises to the top. Engaging and integrating trusted community health workers and other paraprofessionals is a promising, cost-effective and trust-building practice that can support the seamless dissemination of these essential services in these unprecedented times.

This webinar was the first in HMA’s Community Health Worker Series. During this webinar, HMA experts put forth a value proposition for the timely engagement and integration of community health workers/navigators/peer support specialists in the delivery of health and human services. Presenters provided several compelling case studies and three successful implementation models for integrating paraprofessionals into the delivery system. Participants learned how community health workers are poised to support the unique needs of residents in urban, suburban, rural, and public health and human services settings. Finally, respondents reflected on the paraprofessional role from a social determinants of health standpoint and from the perspective of minority populations and their communities.

Learning Objectives: 

  • Understand the role community health workers and other paraprofessionals can play in the health and human services workforce in the COVID-19 era.
  • Learn how select states explored the certification, education, financing and roles of community health workers and other paraprofessionals when integrated into specific health and human services.
  • Find out how to build trust in minority communities, incorporating social determinants of health in the COVID-19 recovery response at the crossroads of health disparities and racial inequities.

HMA Speakers

Uma Ahluwalia, Principal, Washington, DC
Heidi Arthur, Principal, New York, NY
Stephanie Denning, Principal, Denver, CO
Julia Elitzer, Senior Consultant, San Francisco, CA
Iliana Gilman, Principal, Austin, TX
Catherine Guerrero, Principal, Denver, CO
Lori Weiselberg, Managing Principal, Chicago, IL

Reference Materials:

The National Academy of State Health Policy (NASHP) has a great website of state CHW models:  https://www.nashp.org/state-community-health-worker-models/

The Association of State and Territorial Health Officials (ASTHO) features tools and information about CHWs at: https://www.astho.org/Community-Health-Workers/

There is also a helpful image describing the ever-changing picture of state approaches to CHW certification as well: https://www.astho.org/Programs/Clinical-to-Community-Connections/Documents/Map-of-State-Approaches-to-CHW-Certification/

Multnomah County training: https://multco.us/health/community-health/community-health-worker-training

SAMHSA has great resources: https://www.samhsa.gov/brss-tacs/recovery-support-tools/youth-young-adults

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6703286/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3343233/

The VT interview is the March 4, 2020 podcast.  https://www.aha.org/advocacy/small-or-rural/rural-report-podcast-series

Blog

Impact of COVID-19 Federal Policy on Medicare Advantage

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This week, our In Focus section examines the operational impacts of federal Medicare Advantage policy changes in response to the COVID-19 pandemic. On January 31, 2020, the Secretary of Health and Human Services declared a public health emergency. This was followed by a national emergency declared by President Trump on March 13, 2020. These declarations provide the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) authority to waive certain Medicare and Medicaid regulatory requirements to help health plans, providers, and other stakeholders respond to immediate needs of their members and communities. These waiver flexibilities, when combined with other legislative and regulatory changes issued by Congress and CMS have resulted in over 200 policy changes to Medicare alone. Many of these affect Medicare Advantage sponsors and have direct implications to current and future operations of plan responsibilities. We examine eight categories of requirements and flexibilities that have significant business relevance and exposure for Medicare Advantage plan sponsors:

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Webinar

Webinar Replay: Federal COVID-19 Response: Medicare Advantage Policy Changes and Impacts

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This webinar was held on June 11, 2020.

In response to the rapid spread of the COVID-19 virus, Congress and the Centers for Medicare & Medicaid Services (CMS) have made significant policy changes to Medicare Advantage regulations, allowing for expanded benefits and other flexibilities designed to better serve the Medicare population.

During this webinar, HMA experts addressed the impact of these changes, including a look at policies affecting cost sharing, telehealth, Star Ratings, prescription drugs, provider funding, appeals, and Special Needs Plans (SNP). Speakers also addressed the likelihood that these policies remain in place even after the COVID-19 emergency ends.

Learning Objectives: 

  • Learn about changes in federal Medicare Advantage policies in response to COVID-19.
  • Understand how Medicare Advantage plans, including Special Needs Plans, are adjusting to the new rules, including the impact on benefit design, care delivery, payment models, and quality.
  • Identify operational implications of Medicare Advantage policy changes to ensure continued delivery of high-quality care to beneficiaries.

HMA Speakers:

  • Julie Faulhaber, MBA, Principal, Chicago
  • Mary Hsieh, PharmD, MPH, Managing Principal, Atlanta
  • Narda Ipakchi, MBA, Senior Consultant, Washington, DC
  • Sarah Owens, Principal, Philadelphia
  • Danielle Pavliv, MPH, PMP, Senior Consultant, Atlanta
Webinar

Webinar Replay: Tracking State Responses to COVID-19 for Home Health and Home Care Providers: Survey Results and Provider Perspectives

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This webinar was held on June 9, 2020. 

With most federal COVID-19 funding going to hospitals and nursing homes, states are implementing various Medicaid authorities, legislation, and policies of their own to improve access to long-term services and supports, including home and community-based services. HMA home care experts have tracked these state efforts and presented the results during this informational session. They were joined by home health and home care industry leaders, who offered important perspectives on state actions as well as thoughts on additional steps that will be necessary over the long term.

Learning Objectives:

  • Understand state COVID-19 legislation, executive orders, and policy guidance and how it affects home health and home care providers.
  • Gain perspective from home health and home care providers on how state COVID-19 efforts are playing out.
  • Understand the immediate and long-term challenges and opportunities home health and home care providers are likely to face as they respond to COVID-19.

Speakers

Karen Brodsky, Principal, HMA
Pat Kelleher, Executive Director, Home Care Alliance of Massachusetts
Linda Mintz, Co-Chair, CareFinders Total Care
Susan Tucker, Principal, HMA

Blog

Medicare FY 2021 Hospital Inpatient Proposed Rule, Federal Flexibilities for COVID-19

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This week, our In Focus section reviews recent announcements and actions by Congress and the Centers for Medicare & Medicaid Services (CMS) that have significant financial and operational implications for the hospital industry. This brief begins with the most recent of these actions by providing a summary of the key provisions of the CMS Fiscal Year (FY) 2021 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Proposed Rule (CMS-1735-P), which includes Medicare payment updates and policy changes for the upcoming FY, with a comment deadline of July 10, 2020.  Although somewhat limited in scope compared to previous proposals, this year’s proposed rule includes several disruptive proposals that the hospital industry should carefully consider.

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