This week, our In Focus section reviews the statewide North Carolina request for applications (RFA) for Behavioral Health and Intellectual/Developmental Disability (BH IDD) Tailored Plans released by the North Carolina Department of Health and Human Services (DHHS) on November 13, 2020. BH IDD Tailored Plans are part of the statewide effort to transition to Medicaid managed care and are one of the four types of integrated Medicaid managed care plans the state will contract with to serve Medicaid and NC Health Choice beneficiaries. The other three are Standard Plans, the Statewide Specialized Foster Care Plan, and the Eastern Band of Cherokee Indians Tribal Option.
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CMS Introduces New Medicare Direct Contracting Model Opportunity
This week, our In Focus section looks at a new Medicare model, Direct Contracting, introduced by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. The new model will build on and continue testing potential reforms to the Medicare program encompassed by accountable care organizations (ACOs), Medicare Advantage (MA), and private sector risk-sharing arrangements. The payment model options may appeal to a broad range of physician and provider groups and other organizations because they are expected to introduce flexibility in health care delivery, support a focus on beneficiaries with complex, chronic conditions, and encourage participation from organizations that have not typically participated in traditional fee-for-service (FFS) Medicare or CMS Innovation Center models. However, there will be substantial financial risk—and reward—for participants based on a new, complex methodology, so organizations interested in this new model should carefully consider the possible outcomes from participating in Direct Contracting versus other options. CMS has announced that 51 organizations will participate in the model’s trial Implementation Period, which runs from October 1, 2020, through March 31, 2021. The agency has stated that it expects to announce additional Direct Contracting pathways in the future and that the next round of applications for participation in the second performance year will open in early 2021.
HMA Colleagues Make Case for Two-Generation Approach
Focused on addressing inequities and building more sustainable and vital futures for low-income families in Washington, D.C., and the state of Maryland, colleagues from Health Management Associates (HMA) authored two case studies under the auspices of Ascend at the Aspen Institute, a hub for breakthrough ideas and collaborations that move children and their parents toward educational success and economic security.
A Short-Term Path to Avoid ACA Uncertainty as the Pandemic Continues
In this week’s In Focus section, Health Management Associates (HMA) Managing Director MMS Matt Powers, Senior Consultant Kaitlyn Feiock, and Regional Vice President Kathleen Nolan look at the future of the Patient Protection and Affordable Care Act (ACA). On November 10, 2020, the Supreme Court of the United States (SCOTUS) heard oral arguments for California v. Texas, challenging the constitutionality and severability of the ACA. This challenge became possible after the 2017 Tax Cuts and Jobs Act, which zeroed out the individual mandate penalty for not purchasing health insurance. While most experts agree that an entire invalidation of the ACA is the least likely outcome based on the oral arguments, some uncertainty remains and more than $100 billion federal funds are at risk. The ACA standardized insurance rules offset premium costs for many individual market consumers and provided authority and funding for Medicaid Expansions in the overwhelming majority of states. The ACA also included other provisions that may be at risk but are not the subject of this note, such as the creation of Center for Medicare and Medicaid Innovation (CMMI) and the Medicare-Medicaid Coordination Office, as well as demonstration authority that has led to the creation of numerous coverage models. As states, Congress, and the federal executive branch face the possibility that the ACA may not survive in its present form, what mitigation strategies are available at the state and federal levels to stabilize uncertainties and protect against abrupt coverage changes?
HMA prepares NCQA distinction in multicultural health care report
Health Management Associates (HMA) was engaged by Covered California to evaluate and make recommendations about whether the state’s Marketplace should require Qualified Health Plan (QHP) Issuers to gain National Committee for Quality Assurance (NCQA) Distinction in Multicultural Health Care.
With a mission to increase insurance coverage in California and improve quality of care while reducing costs and health disparities, Covered California sought to learn how achieving Distinction in Multicultural Health Care has helped Issuers promote meaningful change and reduce disparities to advance health equity, in order to determine whether requiring the Distinction would help the Marketplace assure QHP Issuers effectively deliver quality care and improve population health
The HMA team reviewed the Distinction’s standards and guidelines within Attachment 7, Article 3interviewed four Issuers that have earned the Distinction. They recommended Covered California update its language in Article 3.04, requiring Issuers to achieve NCQA Distinction in Multicultural Health Care and allocate resources to deliberately address disparities and health equity, increasing infrastructure and reinforcing organizational commitment to this work.
HMA consultants Michael Anderson-Nathe, Nora Leibowitz and Michele Melden completed the assessment.