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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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1814 Results found.

Blog

HMA Evaluation of Montana’s Tribal Systems of Care Grant

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Editor’s Note: This post was authored by Principal Rebecca Kellenberg.

Montana Office of Public Instruction (OPI) contracted with HMA to serve as the independent evaluator of the Tribal Systems of Care grant from the Substance Abuse and Mental Health Services Administration (SAMHSA). In this four-year role, HMA will assist in reporting on project evaluation data to show progress in meeting the goals and objectives of the grant as well as the fidelity, implementation, and impact of the project in the participating tribal communities.

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Webinar

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

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This webinar was held on January 8, 2019.

Managed care plans face significant strategic and operational questions when it comes to serving individuals enrolled in both Medicare and Medicaid. That’s because existing managed care models and state and federal policies are evolving in ways that will dramatically impact the roles and responsibilities of participating plans. What’s more, no single model has emerged as preeminent – whether it involves variations on the Capitated Financial Alignment Demonstrations (aka dual demonstrations), Dual Eligible Special Needs Plans (D-SNPs), Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs), or even provider-led initiatives.

During this webinar, HMA experts provided an overview of the complex landscape for integrated Medicare-Medicaid managed care and assessed what state and federal changes mean for health plans. Speakers also provided insights into how health plans can best develop the expertise needed to effectively serve this population and successfully compete no matter which models emerge.

Learning Objectives

  • Learn how health plans are tailoring models of care and services within a shifting regulatory framework to successfully serve the diverse needs of dual eligible populations.
  • Understand the implications of new state requirements that Managed Long Terms Services and Supports (MLTSS) plans operate D-SNPs, and that D-SNPs serve and coordinate care for Medicaid members.
  • Understand how rules surrounding default enrollment of dual eligible populations will impact the growth prospects of Medicaid managed care plans and D-SNPs.
  • Find out what to watch for as federal regulators get ready to release new rules encompassing Medicare-Medicaid integration and care coordination.
  • Learn why health plans need to reevaluate internal operations and organizational structures to better focus care coordination efforts for dual eligible members and break down walls between Medicare and Medicaid business lines.

HMA Speakers
Sarah Barth, Principal, New York, NY
Ellen Breslin, Principal, Boston, MA

Who Should Listen
Executives of Medicaid managed care plans, Medicare-Medicaid Plans, D-SNPs, and FIDE-SNPs; providers and executives of provider-led Medicare-Medicaid initiatives; state and federal regulators.

Blog

Medicaid and Exchange Enrollment Update – September 2018

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This week, our In Focus section reviews updated information issued by the Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) on Medicaid expansion enrollment from the “September 2018 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report,” published on November 30, 2018. Additionally, we review 2018 Exchange enrollment data from the “Health Insurance Marketplaces 2018 Open Enrollment Period: Final State-Level Public Use File,” published by CMS on April 3, 2018. Combined, these reports present a picture of Medicaid and Exchange enrollment in 2018, representing 73 million Medicaid and CHIP enrollees and nearly 12 million Exchange enrollees.

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Blog

Premium Assistance Programs for the Working Adult Population in Medicaid Expansion States

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This week, our In Focus section comes to us from HMA Senior Consultant Erin Mathies (Indianapolis), who reviews the premium assistance programs for the working adult population in Medicaid expansion states. Medicaid programs that pay for premiums in commercial insurance for individuals eligible for Medicaid have been part of state Medicaid programs since the 1990s. Under a premium assistance program, the employer or individual market coverage is the primary plan and Medicaid supports the cost of the premium, pays for cost sharing, and provides any wrapped benefits. These programs can save money for state Medicaid agencies by leveraging the employer contribution towards premiums and holding expenditures per member to the annual out of pocket maximum amounts. Existing Health Insurance Premium Payment (HIPP) programs traditionally cover children and populations with disabilities. Individuals eligible under the Medicaid Expansions may be more likely to have access to employer sponsored-insurance (ESI) and leveraging premium assistance options for these populations represents an unrealized opportunity for many state Medicaid agencies.

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Blog

Proposed Policy Changes Affecting Health Reimbursement Arrangements

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This week, our In Focus section comes to us from HMA Senior Consultant Ryan Mooney (Austin), who reviewed the proposed rule on Health Reimbursement Arrangements (HRAs). On October 29, 2018, the U.S. Department of the Treasury, the Department of Labor, and the Department of Health and Human Services published a proposed rule (83 FR 54420), the purpose of which is to expand the use of HRAs. An HRA is an employer-supported account that helps employees pay for qualified medical expenses not covered by their health plans. The proposed rule is the latest component of the President’s Executive Order 13813, which directed the federal government to expand and facilitate access to association health plans, short-term and limited-duration insurance products, and HRAs. 

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Blog

Navigating CMS’ Proposed Medicaid Managed Care Regulations

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This week’s HMA Weekly Roundup features an In Focus article from HMA Senior Consultants Amber Swartzell and Stephanie Baume (Indiana), who reviewed the Centers for Medicare & Medicaid Services (CMS) proposed Medicaid managed care regulations. On November 8, 2018, CMS released a proposed rule that would update several sections of the Medicaid and Children’s Health Insurance Program (CHIP) managed care rules, which were most recently amended in 2016. This much anticipated proposal, scheduled to appear in the Federal Register on November 14, 2018, focuses on “promoting flexibility, strengthening accountability, and maintaining and enhancing program integrity.” The key provisions of the proposed regulations are summarized below.

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