This week, our In Focus section reviews Medicaid spending data collected in the annual CMS-64 Medicaid expenditure report. After submitting a Freedom of Information Act request to Centers for Medicare & Medicaid Services (CMS), we have received a draft version of the CMS-64 report that is based on preliminary estimates of Medicaid spending by state for federal fiscal year (FFY) 2018. The final version of the report will be completed by the end of 2019 and posted to the CMS website at that time. Based on the preliminary estimates, Medicaid expenditures on medical services across all 50 states and six territories in FFY 2018 exceeded $588 billion, with over half of all spending now flowing through Medicaid managed care programs. In addition, total Medicaid spending on administrative services was $27.8 billion, bringing total program expenditures to $616 billion.
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White paper prepared by HMA aligns CenteringPregnancy with value-based payment models
In, “Aligning Value-Based Payment with the CenteringPregnancy Group Prenatal Care Model: Strategies to Sustain a Successful Model of Prenatal Care,” HMA authors Diana Rodin, MPH, and Margaret Kirkegaard, MD, MPH, review new opportunities to promote improved outcomes and lower costs in maternity care though value-based payment strategies. Prepared for the Centering Healthcare Institute, it demonstrates specifically how CenteringPregnancy can be an effective, financially sustainable model of maternity care, that meets the goals of value-based payment contracts.
The report examines:
- Value-based payment in Medicaid maternity care
- Alternating payment models in maternity care across states
- CenteringPregnancy as a model of prenatal group care – outcomes, evidence, cost and savings
- CenteringPregnancy alignment with value-based payment framework
The complete white paper can be downloaded below.
HMA Summary of 2020 Medicare Advantage and Part D Flexibility Final Rule
This week, our In Focus reviews the Calendar Year (CY) 2020 Medicare Advantage (MA) and Part D Flexibility Final Rule (Final Rule) issued by the Centers for Medicare & Medicaid Services (CMS) on April 5, 2019. The Final Rule implemented various provisions contained in the Bipartisan Budget Act of 2018 (BBA), which required the expansion of MA telehealth benefits and established new criteria for Dual Eligible Special Needs Plans (D-SNPs) integration requirements and streamlined Medicare and Medicaid grievance and appeals processes. The Final Rule also established rules to improve MA and Part D program quality and accessibility, clarified program integrity policies, and established new rules for the MA and Part D Quality Rating System.
Webinar Replay: Activating Local Communities to Successfully Address Opioid Addiction and Recovery
This webinar was held on April 17, 2019, and was the fifth webinar in a series about addressing the opioid crisis in America.
Local communities are organizing to battle opioid use disorder, based on the growing understanding that addiction and treatment happen at the community level. Successful efforts include tracking spikes in opioid use, effectively targeting high-burden areas, conducting community-based research on needs and resources, and deploying community-based resources in a meaningful and coordinated fashion.
During this webinar, HMA public health, prevention, and research experts explored how to activate local communities in the battle to prevent the rise of opioid use disorder and how to respond to the needs of community members for wraparound services. Speakers also addressed how the engagement of those most impacted by opioids can improve the availability and effectiveness of recovery and prevention options and solutions.
Learning Objectives
- Understand the importance of peers and community health workers and the roles they play in keeping local communities activated.
- Find out how to conduct a community gap analysis to identify the type of wraparound supports and services needed to best address opioid use disorder.
- Learn how to engage community members in community-based participatory research and program implementation to develop and implement effective services.
- Understand how to use surveillance data needed to identify and respond to neighborhoods at growing risk for opioid deaths.
- Find out how local communities in Delaware are organizing to prevent overdose deaths in their neighborhoods and ensure those in need have opportunities to engage in treatment.
- Learn why targeted Naloxone distribution makes more sense than passive distribution among the “worried well.”
HMA Speakers
- Liddy Garcia-Bunuel, Principal, HMA Community Strategies
- Marci Eads, PhD, Managing Director, HMA Community Strategies
Who Should Listen
State and local public health officials; behavioral health practitioners; addiction treatment providers; officials from state healthcare organizations, Medicaid agencies, community-based organizations, federally qualified health centers, and other provider organizations; and community members who have been impacted by addiction.
HMA Analysis of 2020 Medicare Advantage Rate Notice and Final Call Letter
This week, our In Focus reviews the Announcement of Calendar Year (CY) 2020 Medicare Advantage Capitation Rates and Medicare Advantage (MA) and Part D Payment Policies (Rate Announcement) and Final Call Letter, issued by the Centers for Medicare & Medicaid Services (CMS) on April 1, 2019. The Rate Announcement and Call Letter includes final updates to MA payment rates and guidance to plan sponsors as they prepare their bids for CY 2020. Bids for CY 2020 are due to CMS on or before Monday June 3, 2019. It is important to note that the Announcement and final Call Letter does not take into consideration the Health and Human Services (HHS) Office of Inspector General (OIG) proposed rule which seeks to remove anti-kickback protection for prescription drug rebates, which, if finalized as proposed, could have significant impacts on Part D plans’ bids. While the administration has not provided any guidance on how plans should construct their 2020 bids in response to the rebate changes, HHS could decide to delay the rule’s effective date to 2021 or CMS may allow plans to update their 2020 bids later this year.
Webinar Replay: Rethinking Behavioral Health Crisis Systems: Saving Lives, Saving Resources
This webinar was held on April 16, 2019.
Across the country, police and EMS are increasingly called upon to respond to individuals experiencing behavioral health crises, without having received the training, skills and resources to effectively address those scenarios. At the same time, civilian crisis response services (e.g. crisis hotlines, mobile crisis teams) are often siloed from the public safety response, contributing to system fragmentation and inappropriate interventions. Local governments are spending considerable resources without getting the desired outcomes, and individuals frequently receive subpar care, placing them at risk for future crises and cycling in and out of emergency rooms and the criminal justice system.
During this webinar, experts from HMA explored the four key elements of a successful crisis system redesign: crisis prevention, early intervention, appropriate response, and improved post-crisis support. Speakers also addressed why system redesign is the foundational element to a new way of delivering crisis services.
Learning Objectives
- Understand the key components of common behavioral health crisis systems.
- Identify opportunities for system improvement.
- Learn strategies or approaches to achieve a reimagined crisis system where law enforcement, health professionals and community members work together to respond to crises.
- Identify funding opportunities to support your crisis system.
HMA Speakers
- Laquisha Grant, Senior Consultant
- John Volpe, Principal
Who Should Listen
Officials of state and local government, law enforcement, fire departments, emergency response, crisis hotlines and crisis centers; executives of hospitals, health systems, mobile crisis units, and affiliated community providers and payers of crisis services, including Medicaid payers.
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.