HMA Weekly Roundup
Trends in Health Policy
This week's roundup:
- In Focus: CMS Finalizes Mix of Reimbursement Reductions and Increases in 2024 Hospital Inpatient Final Rule
- Arizona Releases Long Term Care System RFP
- Arkansas Releases Medicaid Enterprise Pharmacy System and Services RFP
- Medicaid Eligibility Redeterminations News: Arkansas, California, Idaho, Illinois, Kansas, Louisiana, Maine, Minnesota, Pennsylvania, West Virginia
- California Releases Medi-Cal Dental Managed Care RFP for Los Angeles, Sacramento Counties
- Massachusetts Releases Section 1115 Waiver Amendment for Public Comment
- New York To Continue Coverage of Extended Medicaid Telehealth Services Through 2024
- North Carolina State Budget May Stall Until September, Delay Medicaid Expansion Until At Least December
- Utah Requests Three 1115 Demonstration Amendments for Chronic Conditions, Dental Services, Family Planning
- Virginia to Release NEMT RFP September 1
- Washington Requests Section 1115 Medicaid Waiver Amendment To Cover Former Foster Care Youth, CHIP Children
- Wyoming Releases Draft Section 1115 Medicaid Waiver to Expand Income, Asset, Need Eligibility for Existing HCBS Waiver Services
- CMS Extends HCBS Flexibilities Granted During COVID-19 Until November 11
- OIG Finds High Rates of Prior Authorization Denials Among Medicaid MCOs
- Health Connect America Acquires Specialized Youth Services of Virginia
CMS Finalizes Mix of Reimbursement Reductions and Increases in 2024 Hospital Inpatient Final Rule
This week, our In Focus section continues analysis and insights from Health Management Associates (HMA) and its affiliate The Moran Company on recent Medicare payment and policy developments. Today, we review the policy changes that the Centers for Medicare & Medicaid Services (CMS) released August 1, 2023, for the fiscal year (FY) 2024 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) final rule (CMS-1788-F).
This year’s IPPS final rule includes several important policy changes that will alter hospital margins and change administrative procedures beginning October 1, 2023. More specifically, the IPPS rule increases payments to hospitals, enhances the wage index policy for rural hospitals, reduces Medicare disproportionate share payments, and modifies the New Technology Add-on Payment (NTAP) program.
Key provisions of the FY 2024 Hospital IPPS and LTCH Final Rule
We highlight four policies that will significantly affect Medicare beneficiaries, hospitals, health systems, payers, and manufacturers:
- The annual inpatient payment update
- Medicare disproportionate share hospital (DSH) payments
- Hospital wage index adjustments
- NTAP policy changes
Hospital market basket update and the inpatient standardized amount
CMS’s Medicare 2024 IPPS final rule will increase payments to acute care hospitals by an estimated $2.2 billion from 2023. The primary driver of this increase is CMS’s 3.1 percent increase in the annual update to inpatient operating payment rates. The update is the sum of the hospital market basket update of 3.3 percent and a statutorily required 0.2 percentage point reduction for productivity growth.
HMA/Moran analysis: Between the time CMS released the 2024 proposed IPPS rule and the final rule, the inpatient payment update for 2024 increased to 3.1 percent from 2.8 percent. This spike occurred because of the effects of an increase in estimated inflation on the cost of a standard basket of hospital goods (hospital market basket) throughout 2022 and 2023. Although economy-wide inflation slowed in mid-2023, inflation was higher in late 2022 and early 2023—the period in which the market basket is measured for the final rule.
For beneficiaries, increasing payment rates eventually will lead to a higher Medicare inpatient deductible and greater out-of-pocket costs for many other services. For hospitals and healthcare systems, payers, and manufacturers, a payment increase of 3.1 percent falls below economy-wide inflation (5−6 percent in recent months).
Despite the publicized 3.1 percent payment update for 2024, after factoring in various policy adjustments the actual change between 2023 and 2024 to inpatient payments per case will be roughly 2 percent. The primary reason per-case payments will increase only 2 percent is a budget-neutrality adjustment that CMS finalized for 2024 to account for hospital wage index reclassifications. This adjustment will reduce payments to all hospitals by more than 1 percent to neutralize the added program spending associated with payments to hospitals that choose to reclassify into higher paying wage index areas. The final rule states, “[T]he geographic reclassification budget neutrality adjustment is significantly larger than in prior years.”
Medicare Disproportionate Share Hospital Payments
CMS finalized two Medicare disproportionate share hospital (DSH)-related policies for 2024. First, DSH payments and Medicare uncompensated care payments combined will decrease in FY 2024 by approximately $957 million. Second, CMS finalized its proposal to limit the number of patient days included in the Medicare DSH calculation to only those days when the patient’s Medicaid Section 1115 Demonstration health insurance covers inpatient hospital services or the patient’s premium assistance program covers 100 percent of the premium cost for patients who buy health insurance that covers inpatient hospital services, if the patient is ineligible for Medicare Part A.
HMA/Moran analysis: CMS’s $957 million reduction in DSH and uncompensated care payments stems from the agency’s estimate of the percentage of individuals without insurance in the United States. Between the 2024 proposed and final rules, CMS estimates the percentage of individuals without insurance will decline from 9.3 percent to 7.7 percent in 2023 and from 9.2 percent to 8.5 percent in 2024. As a result, the pool of uncompensated care dollars available to hospitals for 2024 was reduced from roughly $6.7 billion to $5.9 billion.
CMS’s estimated decline in the rate of uninsured beneficiaries is somewhat surprising given the common projection that Medicaid enrollment will drop following the end of Medicaid’s COVID-19 related continuous coverage policy. However, HMA/Moran colleagues believe state-level Medicaid enrollment changes will vary in the year ahead. Consequently, hospitals located in states where levels of Medicaid enrollment are sustained will benefit from CMS’s uninsured rate estimates and hospitals in states where Medicaid enrollment drops will not.
With regard to the Section 1115 demonstration related DSH policy, hospitals located in states that have not expanded Medicaid under the Accountable Care Act and instead rely on Section 1115 Demonstrations to expand health coverage, are likely to receive lower DSH payments. In addition to the Medicare DSH payment adjustments, reductions in the Medicaid DSH program are scheduled to begin October 1, 2023. The $8 billion reduction in FY 2024 is the first time CMS has planned to make cuts in the program.
Hospital Wage Index Adjustments
CMS finalized two wage index policies for FY 2024. First, CMS will extend the low-wage index hospital policy, which boosts the wage index of hospitals in geographic areas with low wages relative to other areas. Second, CMS finalized a policy to begin including labor data from urban hospitals that choose to reclassify as providers in rural areas to maximize their payment into the calculation of rural wage index areas.
HMA/Moran analysis: These two wage index policies for FY 2024 will increase payment to rural hospitals. Under the first policy, hospitals with wage indexes below 0.8667 (the 25th percentile across all hospitals) will automatically receive an increase in their wage index and therefore their payment rates for inpatient cases. Under the second policy, the inclusion of labor data for geographically urban hospitals that choose to reclassify into rural wage index areas within the calculation of state-level rural wage indexes and the state-level rural floor will increase payments to rural hospitals in many states. The overall impact of both proposed wage index policy changes for FY 2024 will be an increase in inpatient payment rates for rural hospitals.
New Technology Add-On Payments (NTAP)
Citing the increased number of applications for NTAP over the past several years and noting the need for CMS staff to have time to review and analyze the applications, CMS finalized two changes to the NTAP application requirements. First, CMS will require that all applicants have a complete and active U.S. Food and Drug Administration (FDA) market authorization request in place at the time of NTAP application submission, if not already FDA approved. The FDA’s acceptance letter will serve as proof of a full and complete application. In addition, CMS proposes to move the FDA approval deadline from July 1 to May 1, beginning with applications for FY 2025.
HMA/Moran analysis: The stated aim of these CMS policy changes is to “increase transparency, facilitate public input, and improve the review process.” As a result of these modifications, products will need to be on the market longer before the NTAP payment begins, and fewer products will be eligible for the three full years of NTAP payments. Taken together, hospitals will have a shorter NTAP payment window for most products. The further tightening of FDA application and approval requirements runs counter to the efforts of various stakeholders to establish more flexible or additional NTAP application windows.
HMA and The Moran Company collaborate to monitor legislative and regulatory developments in the inpatient hospital space and assess the impact of inpatient policy changes on the hospital sector. HMA’s Medicare experts interpret and model inpatient policy proposals and use these analyses to help clients develop their strategic plans and their comments on proposed regulations. Moran replicates the methodologies CMS uses in setting hospital payments and models alternative payment policies to help support stakeholder comment letters and strategies. Moran also assists clients with modeling diagnosis-related group reassignment requests and to support innovative NTAP applications.
For more information or questions about the policies described above, contact Zach Gaumer ([email protected]), Amy Bassano ([email protected]), Clare Mamerow ([email protected]), or Kevin Kirby ([email protected]).
Arizona Releases Long Term Care System RFP. The Arizona Health Care Cost Containment System (AHCCCS) released on August 1, 2023, a request for proposals (RFP) for the Arizona Long Term Care System (ALTCS) Program for individuals who are elderly and/or have a physical disability. Winning bidders will provide integrated care addressing physical health, behavioral health, and long-term services and supports. Intent to bid forms are due by August 31. Proposals are due October 2 and awards are expected December 13. Implementation will begin October 1, 2024. Current incumbents are United, Mercy Care, and Banner. Additionally, AHCCCS contracts with Department of Economic Security/Division of Developmental Disabilities (DES/DDD) health plans to provide LTC to individuals with an intellectual/developmental disability; DDD plans are administered by United and Mercy. Read More
Arkansas Releases Medicaid Enterprise Pharmacy System and Services RFP. The Arkansas Department of Human Services, Division of Medical Service released on August 8, 2023, a request for proposal (RFP) to procure a new pharmacy vendor. Arkansas will award one contract, to run for three years, with four one-year contract extensions. Incumbent Magellan currently has five one-year contract extensions available, with an end date of July 1, 2027. Proposals are due October 2, 2023, with awards expected on or around January 5, 2024. The anticipated implementation date is set for June 1, 2024. The state will also reprocure the Core/MMIS contract with Gainwell, ending July 1, 2027, and the Decision Support System contract with Optum, ending December 1, 2028. Read More
Arkansas Disenrolls 82,279 Medicaid Beneficiaries During July Redeterminations. The Arkansas Department of Human Services announced on August 8, 2023, the disenrollment of 82,279 Medicaid beneficiaries during July eligibility redeterminations. More than 50,000 beneficiaries had their coverage renewed. Read More
California Releases Medi-Cal Dental Managed Care RFP for Los Angeles, Sacramento Counties. The California Department of Health Care Services (DHCS) released on August 3, 2023, the Medi-Cal Dental Managed Care Plans request for proposals (RFP). DHCS will award at least four contracts, with at least two in Sacramento County under the geographic managed care model and at least two in Los Angeles County under the prepaid health plan program. Proposals are due October 6 and awards are expected January 18, 2024. Implementation is scheduled for July 1, 2024. Contracts will run for 54 months, with five additional one-year options. Current incumbents are Access Dental, Health Net of California, and LIBERTY Dental, serving over 1 million members. Read More
California Disenrolls 225,231 Medicaid Beneficiaries During June Redeterminations. California Department of Health Care Services (DHCS) announced on August 7, 2023, that California disenrolled 225,231 Medi-Cal members during June redeterminations. Medi-Cal members who were disenrolled in June have until September 30 to return needed information to have their coverage restored. DHCS launched a new interactive Medi-Cal redeterminations dashboard with statewide and county-level demographic data on Medi-Cal application processing, enrollments, redeterminations, and renewal outcomes. Read More
Idaho Disenrolls 89,325 Medicaid Beneficiaries Following Redeterminations. The Idaho Capital Sun reported on August 4, 2023, that Idaho has disenrolled 89,325 Medicaid beneficiaries during eligibility redeterminations. Of those disenrolled, 48,857 lost coverage due to procedural reasons. Read More
Illinois Disenrolls Over 47,000 Medicaid Beneficiaries Following July Redeterminations. Health News Illinois reported on August 3, 2023, that Illinois disenrolled over 47,000 Medicaid enrollees during July redeterminations. Of those disenrolled, 34,250 lost coverage for procedural reasons and the remaining 13,375 were deemed ineligible. Read More
Iowa to Use HTG MMIS Provider Solution Module. HHS Technology Group (HTG) announced on August 8, 2023, that the Iowa Department of Health and Human Services will use HTG’s Medicaid Management Information System (MMIS) provider solution module to update the state’s Medicaid provider management system. HTG is collaborating with Noridian Healthcare Solutions. The new system will be streamlined to reduce enrollment time for new providers; reduce state and contractor burden from the previous manual processes; apply a fully integrated pharmacy provider enrollment process with monitoring; and implement an entirely electronic provider agreement process, including signatures. Read More
Kansas Governor Pushes for Medicaid Expansion as Rural Hospitals Close. Kansas Governor Laura Kelly announced on August 8, 2023, her support to expand Medicaid to combat rural hospital closures. A Center for Healthcare Quality & Payment Reform report found that nine Kansas rural hospitals have closed since 2005, and a total of 60 rural hospitals are at risk of closing. Kelly stated that the costs of hospital closures would exceed that of Medicaid expansion. Read More
Kansas Disenrolls 60,000 Medicaid Beneficiaries During Redeterminations For Procedural Reasons. The Kansas Reflector reported on August 4, 2023, that Kansas has disenrolled 61,621 Medicaid beneficiaries for procedural reasons following April and May Medicaid redeterminations. These beneficiaries have been placed into a 90-day window during which they can return the renewal forms, have their eligibility assessed, and if eligible can have their coverage backdated. The Kansas Department of Health and Environment stated that contributing factors include lengthy delays in mail delivery, call center backlog, and unsigned applications. The department is working to extend deadlines, deploy additional staff, and collaborate with organizations. Read More
Louisiana Disenrolls 50,600 Medicaid Enrollees During June Redeterminations. The Louisiana Illuminator reported on August 2, 2023, that Louisiana disenrolled 50,600 Medicaid beneficiaries during June eligibility redeterminations. Nearly 75 percent were disenrolled for procedural reasons and the remaining 13,000 enrollees lost coverage due to ineligibility. Read More
Maine Disenrolls 3,000 Medicaid Beneficiaries During May and June Redeterminations. The Maine Wire reported on August 4, 2023, that approximately 3,000 Medicaid beneficiaries were disenrolled during May and June redeterminations. Another 32,000 who did not submit renewal forms will have their eligibility reassessed under a new passive renewal system, in which the department will check other sources to determine a member’s eligibility. Of the 61,935 MaineCare members up for renewal during that period, coverage was renewed for 24,769 individuals. Read More
Massachusetts Releases Section 1115 Waiver Amendment for Public Comment. The Massachusetts Executive Office of Health and Human Services (EOHHS) announced on August 2, 2023, its intent to submit an amendment request for the MassHealth Section 1115 demonstration to the Centers for Medicare & Medicaid Services. The waiver amendment seeks to provide 12 months continuous eligibility to adults and 24 months continuous eligibility for members experiencing homelessness who are 65 and over. It will also provide Medicaid services to individuals who are incarcerated in a public institution for 90 days prior to their expected release. EOHHS will accept comments through September 9, 2023. Read More.
Michigan Governor Increases Medicaid Reimbursement Rates by $150.6 Million in Fiscal 2024 Budget. Michigan Governor Gretchen Whitmer announced on July 31, 2023, the passing of the fiscal 2024 budget that includes $150.6 million to increase Medicaid reimbursement rates. The budget, which goes into effect October 1, also includes $56.4 million to fund the Healthy Moms, Healthy Babies program and $6.2 million to fund the Medicaid Plan First! program for family planning services and cancer screening. Read More
Minnesota Disenrolls 38,200 Medicaid Beneficiaries During Redeterminations. The Minnesota Department of Human Services announced on August 9, 2023, that 38,200 Medicaid beneficiaries were disenrolled during eligibility redeterminations. Of these, about 5,600 beneficiaries were found ineligible. Read More
Nevada Medicaid to Hold Focus Groups to Improve Services for ABD Population. The Nevada Department of Health and Human Services announced on August 7, 2023, that Health Management Associates will conduct a needs assessment and facilitate focus groups regarding value-based purchasing, Program of All-Inclusive Care for the Elderly models, and managed long-term services and supports for the aged, blind, and disabled (ABD) population in the state. The research is intended to improve services for these populations. Focus group meetings will take place August 21, 2023 through August 23, 2023. To sign up for a focus group, please email [email protected].
New York To Continue Coverage of Extended Medicaid Telehealth Services Through 2024. The Record reported on August 9, 2023, that the New York State Department of Health will continue covering extended Medicaid telehealth services through December 31, 2024. Read More
North Carolina State Budget May Stall Until September, Delay Medicaid Expansion Until At Least December. The Associated Press reported on August 7, 2023, that the final North Carolina state budget may not be enacted until September, according to a spokesperson for House Speaker Tim Moore (R-Cleveland). If the budget is not enacted by September 1, health secretary Kody Kinsley said Medicaid expansion implementation would be delayed until at least December 1. Read More
Oklahoma Rural Hospitals at Risk of Shutting Down Amid Financial Struggles. KGOU News reported on August 4, 2023, that 37 of Oklahoma’s 78 rural hospitals are at risk of closing in the next six to seven years, due to financial issues such as loss of inpatient services and low monetary savings, according to a report from the Center for Healthcare Quality and Payment Reform. The report found that nationwide insufficient payments from private insurers are the primary contributing factor to rural hospitals being at risk and that 24 of the Oklahoma hospitals at risk could close within the next two to three years. Read More
Pennsylvania Disenrolls 137,000 Medicaid Enrollees Following Redeterminations. WHYY reported on August 8, 2023, that Pennsylvania has disenrolled 137,000 Medicaid beneficiaries since eligibility redeterminations began in April. Approximately 44 percent have been disenrolled for procedural reasons and the remaining 56 percent lost coverage due to ineligibility. Read More
Rhode Island Releases Grant Funding to Boost Housing Support Services. Rhode Island Governor Dan McKee and the Executive Office of Health and Human Services announced on August 3, 2023, $400,000 in grant funding to support agencies assisting homeless and housing insecure individuals. Applicants must provide social determinants of health services and sustain at least a portion of their services through Medicaid billing and partnerships. Applications are due November 10, 2023. Read More
Utah Requests Three 1115 Demonstration Amendments for Chronic Conditions, Dental Services, Family Planning. The Centers for Medicare & Medicaid Services (CMS) announced on August 3, 2023, that Utah has requested three amendments for the Medicaid Reform Section 1115 Demonstration. The first calls for support services for Medicaid-eligible individuals with a qualifying chronic condition, the second requests provision of dental services to Medicaid-eligible individuals, and the third asks for family planning services to qualifying individuals below 185 percent of the federal poverty level. The federal comment period for each amendment ends September 4, 2023. Read More
Virginia to Release NEMT RFP September 1. The Virginia Department of Medical Assistance Services announced plans to release a request for proposals (RFP) for its Medicaid non-emergency medical transportation (NEMT) program on September 1, 2023. The current NEMT vendor is ModivCare (formerly LogistiCare). Read More
Washington Requests Section 1115 Medicaid Waiver Amendment to Cover Former Foster Care Youth, CHIP Children. The Washington Health Care Authority announced on August 3, 2023, the submission of a proposed amendment to the state’s Medicaid Transformation Project Section 1115 Medicaid waiver to extend Medicaid coverage for former foster care youth from other states who turned 18 prior to January 2023 and continuous enrollment for children through the age of six for the Children’s Health Insurance Program. Read More
West Virginia Disenrolls 20,000 Medicaid Enrollees Following July Redeterminations. The Center Square reported on August 7, 2023, that West Virginia disenrolled 20,000 Medicaid enrollees during July eligibility redeterminations. Of those disenrolled, 4,756 were deemed ineligible, 1,489 were transferred to the Exchange, and 14,611 lost coverage due to procedural reasons. Read More
Wisconsin to Launch Training Program for Caregivers to Address State Shortage. The Wisconsin Department of Health Services announced on August 8, 2023, that it will launch a free online program to train 10,000 individuals as certified direct care professionals to provide home and community-based care to older adults and people with disabilities and address the state’s caregiver shortage. Read More
Wyoming Releases Draft Section 1115 Medicaid Waiver to Expand Income, Asset, Need Eligibility for Existing HCBS Waiver Services. The Wyoming Department of Health released on August 4, 2023, a draft Section 1115 Medicaid waiver, Aging in Wyoming Part II: Long-Term Care Eligibility Expansion, to expand income, asset, and need eligibility for existing home and community based Medicaid waiver services. The waiver is intended to reduce long-term care costs and prevent individuals from entering nursing homes paid by Medicaid prematurely. The federal public comment period is open from August 21, 2023, through September 22, 2023, but comments can also be submitted now. Read More
CMS Temporarily Suspends Out-of-network Arbitration Process in Response to Court Order. Fierce Healthcare reported on August 7, 2023, that the Centers for Medicare & Medicaid Services (CMS) has temporarily suspended arbitration of out-of-network payment disputes between providers and payers, known as the federal Independent Dispute Resolution process, including the ability to initiate new disputes. A federal judge ruled that the federal fee increase and batching rule for the No Surprises Act violates the Administrative Procedures Act’s notice-and-comment requirement. Read More
Exchange Plans Request 6 Percent Premium Increase for 2024. Kaiser Family Foundation reported on August 4, 2023, that Exchange insurers have requested a median premium increase of six percent for 2024 due to price increases for medical care and prescription drugs, health care utilization growth, and, to a lesser degree, Medicaid enrollment redeterminations. Read More
National Uninsured Rate Hits Record Low at 7.7 Percent in Early 2023, CDC Data Finds. Axios reported on August 3, 2023, that the uninsured rate hit a record low of 7.7 percent in early 2023, according to new data from the Centers for Disease Control (CDC). The highest uninsured rates were present in the South and among Hispanic and multiracial individuals. The uninsured rate is expected to increase following Medicaid eligibility redeterminations this year. Read More
CMS Extends HCBS Flexibilities Granted During COVID-19 Until November 11. The Centers for Medicare & Medicaid Services (CMS) released on August 2, 2023, state guidance that extends home and community-based services (HCBS) waiver flexibilities granted to states during the COVID-19 pandemic until November 11. The approved Appendix K provisions to the Section 1915c waivers were set to expire six months after the end of the public health emergency. States will also have the option to submit a request by November 11 to authorize Section 1915c-like services through a Section 1115 demonstration to continue services through existing HCBS programs. Read More
Primary Care Providers Who Saw Medicaid Patients Grew 12 Percent in 2019, Report Finds. Health Affairs reported on August 2, 2023, that the number of primary care providers who saw Medicaid patients grew from 427,472 in 2016 to 479,215 in 2019, or a 12 percent increase, based on a George Washington University Medicaid workforce tracker using Transformed Medicaid Statistical Information System data. Advanced practice nurses and physician assistants made up 96.6 percent of that increase. Read More
OIG Finds High Rates of Prior Authorization Denials Among Medicaid MCOs. The Department of Health and Human Services, Office of Inspector General published in July 2023, a report that found high rates of prior authorization denials among seven Medicaid managed care organization (MCO) parent companies. The report also found limited oversight of prior authorization denials and limited access to external medical reviews. OIG recommended that the Centers for Medicare & Medicaid Services require states to implement measures that would improve oversight and review enrollee protections and prior authorization denials. Read More
United’s PBM Optum Rx Names Patrick Conway as CEO. Fierce Healthcare reported on August 4, 2023, that Patrick Conway, M.D. was named chief executive of United’s pharmacy benefit manager Optum Rx. Conway was most recently head of Optum Health Care Solutions and prior to that, chief executive of Blue Cross and Blue Shield of North Carolina and director of the Center for Medicare and Medicaid Innovation. Read More
HCSC to Launch Maternal, Child Health Program in Five States. Fierce Healthcare reported on August 3, 2023, that Health Care Services Corporation (HCSC) will launch a new program to improve access and education with respect to maternal and child health in Illinois, Montana, New Mexico, Oklahoma, and Texas. The program requires collaboration with local organizations, and implementation will first begin in Texas. Read More
Health Connect America Acquires Specialized Youth Services of Virginia. Health Connect America, owned by Palladium Equity Partners, announced on August 3, 2023, that it has acquired Specialized Youth Services of Virginia, a Virginia-based private day school serving at-risk youth. Financial terms were not disclosed. Read More
HMA News & Events
Wakely, an HMA company, White Paper:
ROI Analyses for Musculoskeletal Care Management Programs. A care management program coordinates the delivery of healthcare, aims to improve patient outcomes, and focuses on optimizing the utilization of care. Although these programs can be effective, they can also involve significant investments of time, money, and resources. For this reason, it is important to regularly monitor and evaluate the effectiveness of these programs as well as the return on investment (ROI). There are many methods available to evaluate a care management program and determine an appropriate ROI. Wakely and RecoveryOne have partnered to provide an overview of care management program analyses available and address how these methodologies and principles can be applied specifically to a MSK care management program. Read More
Upcoming HMA Webinar:
Medicaid 1115 Justice Waivers and Special Populations: Meeting the Needs of Justice-Involved Youth. Youth in detention often have complex medical, behavioral health, developmental, social, and legal needs and have been exposed to adverse childhood experiences. Part 5 of this series on 1115 Medicaid Justice Demonstration Waivers: Bridging Healthcare, will delve into differences of care and services for youth so that a whole-person approach can be applied to their successful reentry to the community. Thursday, August 17, 2 pm ET. Click here to register.
NEW THIS WEEK ON HMA INFORMATION SERVICES (HMAIS):
- Medicaid Managed Care Enrollment for 300 Plans in 41 States, Plus Ownership, Updated 1Q23
- Louisiana Medicaid Managed Care Enrollment is Up 1.1%, May-23 Data
- Louisiana Medicaid Managed Care Enrollment is Up 1.2%, Apr-23 Data
- Louisiana Medicaid Managed Care Enrollment is Up 1.2%, Mar-23 Data
- Louisiana Medicaid Managed Care Enrollment is Up 0.8%, Feb-23 Data
- Minnesota Medicaid Managed Care Enrollment is Up 2.5%, Jul-23 Data
- Minnesota Medicaid Managed Care Enrollment is Up 3.5%, May-23 Data
- Nebraska Medicaid Managed Care Enrollment Is Up 3.1%, Jun-23 Data
- Nebraska Medicaid Managed Care Enrollment Is Up 3.4%, May-23 Data
- Nebraska Medicaid Managed Care Enrollment Is Up 3%, Apr-23 Data
- New Jersey Medicaid Managed Care Enrollment is Up 1.1%, Feb-23 Data
- Oklahoma Medicaid Enrollment is Up 3%, Apr-23 Data
- Oklahoma Medicaid Enrollment is Up 2.3%, Mar-23 Data
- Puerto Rico Medicaid Managed Care Enrollment is Up 1.1%, Jun-23 Data
Medicaid RFPs, RFIs, and Contracts:
- Arizona Long Term Care System RFP, Aug-23
- Arkansas Medicaid Enterprise Pharmacy System and Services RFP, Aug-23
- California Medi-Cal Dental RFP, Aug-23
- Illinois Medicaid Preventive Care and Education Organization Draft RFQ, Aug-23
Medicaid Program Reports, Data, and Updates:
- Arkansas PHE Medicaid Redeterminations Monthly Reports to CMS, Jul-23
- Colorado PHE Medicaid Redeterminations Monthly Report to CMS, Jun-23
- District of Columbia Medicaid Managed Care Capitation Rate Draft Report, FY 2022
- Florida PHE Medicaid Redeterminations Monthly Report to CMS, Jun-23
- Kentucky PHE Medicaid Redeterminations Monthly Report to CMS, Jun-23
- Louisiana PHE Medicaid Redeterminations Monthly Report to CMS, Jun-23
- Louisiana Medicaid HEDIS Report, 2019-21
- Nebraska Heritage Health External Quality Review Technical Reports, 2021-23
- Ohio Medicaid External Quality Review Reports, 2017-22
- Tennessee External Quality Review Organization Technical Reports, 2016-22
- Vermont PHE Medicaid Redeterminations Monthly Report to CMS, Jun-23
- Washington PHE Medicaid Redeterminations Monthly Report to CMS, Jun-23
- West Virginia PHE Medicaid Redeterminations Monthly Report to CMS, Jul-23
A subscription to HMA Information Services puts a world of Medicaid information at your fingertips, dramatically simplifying market research for strategic planning in healthcare services. An HMAIS subscription includes:
- State-by-state overviews and analysis of latest data for enrollment, market share, financial performance, utilization metrics and RFPs
- Downloadable ready-to-use charts and graphs
- Excel data packages
- RFP calendar
If you’re interested in becoming an HMAIS subscriber, contact Carl Mercurio at [email protected].