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July 17, 2024

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In Focus

Leading Healthcare Experts to Speak at 2024 HMA Fall Conference

The Health Management Associates (HMA) Fall Conference, Unlocking Solutions in Medicaid, Medicare, and Marketplace, will take place October 7−9 in Chicago, IL. This premier event brings together hundreds of influential leaders from across the healthcare spectrum to address critical issues facing organizations today and to chart a course for future success in an increasingly competitive landscape.  

During the conference, attendees will hear from a varied group of experts from the entire healthcare sector. Healthcare leaders and people who have experienced inequities in the system will discuss their efforts to develop an actionable framework to embed equity and excellence throughout their work. They’ll explore innovative programs that are designed to strengthen the financing and reimbursement for behavioral health services, as well as nascent strategies to ensure access is available for novel prescription drug and digital health therapies.  

Key Highlights: 

  • Diverse speaker lineup: Hear from a distinguished roster of speakers, including executives from Medicaid, Medicare, and Marketplace plans, as well as state and federal government officials and industry thought leaders, who will share insights on pivotal strategies and innovations shaping the healthcare sector. 
  • Discussion of innovative topics: Engage in discussions led by healthcare pioneers and equity advocates exploring actionable frameworks to integrate equity and excellence across healthcare initiatives. Discover groundbreaking programs that are enhancing the financing and accessibility of behavioral health services, as well as emerging strategies to ensure access to novel prescription drugs and digital health therapies. 

Featured Speakers and Sessions 

  • Keynote Speaker: Darshak Sanghavi, MD, from the Advanced Research Projects Agency for Health (ARPA-H), will kick off the conference by focusing on initiatives under way to modernize today’s healthcare landscape—from modes of healthcare delivery to services, technology, and payment  
  • Executive Insights: C-suite leaders from diverse health plans will address pivotal issues regarding AI integration, network adequacy, value-based purchasing, and the impact of federal and state policies on operational strategies  
  • State Government Perspectives: Gain invaluable insights from more than a dozen state leaders representing Medicaid, behavioral health, child welfare agencies, and other stakeholders; explore critical analytics driving success and opportunities for collaboration 
  • Addressing Social Determinants: Esteemed state and federal officials will join healthcare leaders to delve into efforts addressing the intersection of housing and health, with a focus on social determinants of health 

Pre-Conference Workshop 

  • Kickstart your experience with our exclusive pre-conference workshop October 7, which will feature HMA’s foremost experts on policy, managed care contracting, and information technology. Participate in hands-on simulations, timely case studies, and strategic deep dives crucial for organizational success. 

Participants will leave with actionable insights gained during networking opportunities and conversations led by former federal and state agency leaders, seasoned actuaries, clinicians, health plan executives, strategists, and advisors.  

Don’t Miss Out 

As we approach the November elections, this year’s conference is more pertinent than ever. Register now to secure your place among leaders shaping the future of healthcare. 

Take advantage of early bird pricing ending July 31. For more information and registration details, visit HMA Fall Conference. 

 

CMS’s Newly Released CY 2025 Medicare Physician and Hospital Outpatient Proposed Rules Include Proposals Supporting Primary Care, Care Coordination, and Increased Access to Care for Medicare Beneficiaries

This week, our In Focus section provides an overview of the two key Medicare proposed payment rules that the Centers for Medicare & Medicaid Services (CMS) released last week—the Physician Fee Schedule (PFS) and the Hospital Outpatient Prospective Payment System (OPPS). These two rules include policies that will affect a variety of providers. Below we highlight some key provisions. Comments on these proposals are due to CMS in early September.

PFS Proposed Rule for 2025

Released on July 10 and with comments due by September 9, this wide-ranging regulation proposes policy changes for many different types of providers.

PFS Payment Update: The estimated 2025 PFS conversion factor is $32.36, a $0.93 or 2.80 percent decrease from the calendar year (CY) 2024 level of $33.29, which included a one-time update required by statute. In previous years with cuts like this one looming, Congress has stepped in and adjusted the payment update in the positive direction. Congress is now considering approaches to do so again for this year.

Caregiver training services (CTS): CMS is proposing a new code for caregiver training for direct care services and supports such as wound dressing changes, infection control, and medication administration. These services could be provided via telehealth.

Telehealth services: CMS is proposing to add several new codes to the telehealth list and to refine a variety of policies related to the type of technology that must be used and what supervision must be provided for telehealth services and other requirements such as removing frequency limitations. Nonetheless, several telehealth flexibilities will end December 31, 2024, because of the expiration of pandemic era expansions unless Congress extends or makes telehealth flexibilities permanent.

Advanced primary care management services (APCM): CMS proposes to create a new set of APCM codes that would incorporate parts of several existing care management and communication technology-based services into a monthly bundle of services. The billing codes are differentiated by three levels based on a person’s number of chronic conditions and enrollment as a qualified Medicare beneficiary to reflect patient medical and social complexity. These APCM services could be provided by advanced primary care teams and are tied to primary care quality measures.

CMS seeks feedback on whether the agency should consider additional payment policies to recognize the delivery of advanced primary care, including on potential changes to coding and payment policies within traditional Medicare such as for additional bundles of services.

Behavioral health services: CMS is proposing new codes for behavioral health crisis services, including safety planning and interventions for patients at risk of suicide or overdose, follow-up contact after a crisis emergency department (ED) visit, for digital mental health treatment (DMHT) services, and for nonphysician practitioners to bill for interprofessional consultations.

Screening and risk assessment: The agency updates and expands coverage for screening and preventive services, including proposals to cover screening computed tomography colonography (CTC) for colorectal cancer, drugs covered as additional preventive services, the hepatitis B vaccine, and cardiovascular risk assessment and risk management.

Dental and oral health services: CMS proposes to add services provided to Medicare beneficiaries with end-stage renal disease to the list of clinical scenarios in which Medicare payment may be made for dental services. CMS also seeks comments on other clinical conditions appropriate for coverage.

Improving ambulatory specialty care: CMS seeks stakeholder feedback about a potential Innovation Center model that would increase specialist participation in value-based care through Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) and expand incentives for primary and specialty care coordination.

Medicare Shared Savings Program (MSSP): CMS is proposing several refinements to the permanent accountable care program. These include a prepaid shared savings option that lets eligible accountable care organizations that have previously earned shared savings to receive advanced earned shared savings to make investments that support beneficiaries, the addition of a health equity benchmark adjustment (HEBA) that increases an ACO’s historical benchmark based on proportion of beneficiaries who are enrolled in the Medicare Part D low-income subsidy (LIS) or dually eligible for Medicare and Medicaid, changes to the MSSP quality measure set to align the measure with the universal foundation measure set and seeking comment on creating a risk track that is higher than what currently exists.

Rural health clinics and federally qualified health centers: CMS proposes several changes to update payment and coverage of services provided in these facilities including care coordination services, vaccines, and dental services.

Payment for major surgical procedures: CMS makes coding proposals to address scenarios in which follow-up care for beneficiaries who have undergone major surgical procedures is provided by different clinicians in different group practices.

Opioid treatment programs: CMS makes several proposals related to opioid treatment programs, including allowing assessments conducted via audio-only telecommunications, and increasing payments for social determinants of health (SDOH) risk assessments. CMS also proposes to pay for new FDA-approved opioid agonist and antagonist medications.

2025 Medicare Hospital OPPS Proposed Rule

CMS released the Medicare Hospital OPPS proposed rule on July 10, 2024, with comments due by September 9, 2024. This regulation proposes policy changes that largely impact hospital outpatient departments and ambulatory surgery centers (ASCs).

OPPS and ASC Updates: CMS proposes to update OPPS rates for hospitals that meet applicable quality reporting requirements as well as ASCs by 2.6 percent.

Access to non-opioid pain relief: The Consolidated Appropriations Act (CAA) of 2023, provides temporary additional payments for certain non-opioid treatments for pain relief in hospital outpatient department (HOPD) and ASC settings from January 1, 2025, through December 31, 2027. CMS proposes to implement this law with proposals on the evidence requirements for medical devices and the Food and Drug Administration (FDA)-approved indications that would meet the criteria for the temporary additional payments. CMS has identified seven drugs and one device that would qualify as non-opioid treatments for pain relief and proposes that they receive separate payment in 2025. CMS also is soliciting comments on other products that may qualify for these payments.

Justice-involved individuals: To support individuals returning to the community from incarceration, CMS proposes to narrow the definition of “custody” in Medicare’s payment exclusion rule and to revise the Medicare special enrollment period (SEP) for formerly incarcerated individuals. These modifications would remove real or perceived barriers to Medicare access for individuals who have recently been released from incarceration or are on parole, probation, or home detention.

Maternal health: CMS is proposing several new maternal health related requirements for hospitals and critical access hospitals (CAHs). The proposed changes to conditions of participation, include new requirements for maternal quality assessment and performance improvement; baseline standards for the organization, staffing, and delivery of care within obstetrical units; and annual staff training on evidence-based maternal health practices. CMS further proposes changes to the emergency services requirements related to emergency readiness for hospitals and CAHs that provide emergency services.

Connect with Us

HMA’s Medicare policy experts collaborate to monitor legislative and regulatory developments in the physician, outpatient, and ASC policy arenas and to assess the impact of changes in these reimbursement systems. HMA’s Medicare experts interpret and model policy proposals and use these analyses to assist clients in developing their strategic plans and comment on proposed regulations.

For more information or questions about the policies described below, please contact Amy Bassano ([email protected]), Zach Gaumer ([email protected]), Kevin Kirby ([email protected]), or Rachel Kramer ([email protected]).

HMA Roundup

California

California Releases Grant Opportunity for Behavioral Health Infrastructure Funding. The California Department of Health Care Services (DHCS) released on July 17, 2024, a request for application (RFA) for the Proposition 1 Bond Behavioral Health Continuum Infrastructure Program (BHCIP) Round 1: Launch Ready. DHCS will award up to $3.3 billion to organizations looking to build and expand behavioral healthcare facilities. The grant funding is estimated to create 6,800 residential treatment beds and 26,700 outpatient treatment slots for behavioral health. Applications are due December 13. DHCS previously awarded $1.7 billion in grants to construct, acquire, and expand properties and invest in mobile crisis infrastructure for behavioral health. Read More

Florida

Florida Reaches Agreement to Allow Four Plans to Retain a Medicaid Managed Care Contract. Health Payer Specialist reported on July 12, 2024, that Florida has reached an agreement with Aetna, UnitedHealthcare, Molina Healthcare, and Florida Community Care that would allow them to keep some or most of their managed care business, after the plans filed protests over the Medicaid managed care awards. The state has not reached agreements with the other protesters including AmeriHealth Caritas, ImagineCare, and Sentara Care Alliance. Contracts are expected to be formally announced between September and October, although implementation could be delayed past January 1, 2025, due to ongoing disputes. Read More

Georgia

Georgia Pathways to Coverage Medicaid Expansion Extension Rejected by Judge. The Associated Press reported on July 16, 2024, that a federal judge has declined Georgia’s request to extend the state’s Pathways to Coverage limited Medicaid expansion with work requirements until 2028. The judge ruled that the Biden administration was compliant when it attempted to revoke Georgia’s Pathways to Coverage work requirement, which delayed implementation. The Centers for Medicare & Medicaid Services have also twice rejected Georgia’s request extend its Pathways to Coverage existing agreement. The program is slated to expire at the end of September 2025. Read More

Illinois

Illinois Governor Signs Health Insurance Reform Measures, Outlaws Step Therapy. Health News Illinois reported on July 11, 2024, that Illinois Governor JB Pritzker signed a legislative package which will ban step therapy and prohibit prior authorization requirements before a patient can receive emergency inpatient treatment at a psychiatric facility. Insurers will also be required to cover the first 72 hours of inpatient mental health treatment at a hospital and maintain accurate lists of providers in their networks. Read More

Indiana

Indiana Seeks Stay in Healthy Indiana Plan Case. 953Wiki reported on July 15, 2024, that Indiana filed to stay a federal court ruling which invalidates several aspects of the Healthy Indiana Plan (HIP) 2.0, including POWER accounts with premiums and the lack of retroactive coverage. Unless the federal ruling is halted, the agency will transition HIP Plus members to different benefit designs that do not offer vision, dental, and other services. Read More

Iowa

Iowa Submits Extension Request for Section 1115 Iowa Wellness Plan Demonstration. The Centers for Medicare & Medicaid Services announced on July 12, 2024, that Iowa has submitted a request to extend its Section 1115 Iowa Wellness Plan demonstration to continue with current policies including the dental wellness plan, the healthy behaviors program, a non-emergency medical transportation waiver, and a retroactive eligibility waiver for certain beneficiaries. The federal comment period will run through August 11. Read More

Kentucky

Kentucky Expands Some NEMT Services. Public News Service announced on July 16, 2024, that Kentucky’s Medicaid non-emergency medical transportation (NEMT) benefit will now include individuals who own a working vehicle but cannot drive due to a medical condition. Nearly 60 percent of Kentucky Medicaid beneficiaries report lack of reliable and affordable transportation as a barrier to receiving health care services. Read More

Maryland

Maryland to Expand Medicaid Supportive Housing Waiver Services Statewide. Hoodline reported on July 16, 2024, that Maryland Governor Wes Moore and the Maryland General Assembly fully funded the necessary non-federal match in the fiscal 2025 state budget to allow for statewide expansion of its Assistance in Community Integration Services (ACIS) pilot. The ACIS program, also known as the Medicaid supportive housing waiver, offers support services to Medicaid beneficiaries with chronic health conditions, including housing tenancy support and financial management. Read More

Nebraska

Nebraska Expands Katie Beckett Medicaid Program for Children With Developmental Disabilities. 10/11 Now reported on July 16, 2024, that the Nebraska Department of Health and Human Services is expanding Medicaid for children with developmental disabilities through the Katie Beckett program. The expansion allows individuals with intellectual disabilities under 19 who live at home that need an intermediate care facility or nursing facility level of care (LOC) to be evaluated for eligibility without their parents’ income or resources taken into consideration. Previously, children had to meet a hospital LOC to receive services through the Katie Beckett program. The expansion went into effect July 1. Read More

New Hampshire

New Hampshire to Expand Medicaid Coverage for Preventative Services, Increase Medicaid Rates. The Conway Daily Sun reported on July 10, 2024, that New Hampshire Governor Chris Sununu approved contracts with three managed care organizations (AmeriHealth Caritas, Boston Medical Center/WellSense, and Centene/New Hampshire Healthy Families) to provide Medicaid coverage for preventive treatments in primary care, effective September 1. Coverage will include health risk assessments, preventive screenings, preventive mental health screening and counseling, comprehensive medication reviews, and coverage for care coordination performed in primary care offices. Sununu also approved Medicaid rate increases for inpatient services of 120 percent for critical access hospitals and 133 percent increase for Prospective Payment System hospitals. Read More

New Hampshire Receives Approval for Section 1115 SUD Treatment and Recovery Access Demonstration Extension. The Centers for Medicare & Medicaid Services announced on July 16, 2024, that it has approved New Hampshire’s five-year extension of its Section 1115 Substance Use Disorder (SUD), Serious Mental Illness, and Serious Emotional Disturbance, Treatment Recovery and Access demonstration. The state received new authority to provide targeted pre-release services to eligible incarcerated individuals up to 45 days immediately prior to release. The demonstration is effective through June 30, 2029. Read More

North Carolina

Alliance Health, Cityblock Partner to Deliver Integrated Care for Tailored Plan Beneficiaries in North Carolina. Fierce Healthcare reported on July 10, 2024, that Cityblock has partnered with Alliance Health, a managed care organization in North Carolina, to provide medical and behavioral health care to members with serious mental illness and/or substance use disorder enrolled in Alliance Health’s Tailored Plan. The partnership launched in Mecklenburg, Cumberland, and Wake counties. Alliance Health covers 137,000 Medicaid enrollees across North Carolina, with 53,000 enrolled in its tailored plan. Read More

Oregon

Oregon Ombuds Program Recommends Behavioral Health Network Adequacy in Next CCO RFP. The Oregon Health Authority (OHA) announced on July 11, 2024, that the Ombuds Program, which provides recommendations for Oregon’s Medicaid programs, released its year-end 2023 report detailing areas of improvement around meaningful language access and culturally responsive services, and behavioral health network adequacy. Recommendations for OHA include prioritizing culturally and linguistically responsive services and include behavioral health network adequacy as part of coordinated care organization (CCO) procurement in 2025. Read More

Oregon to Open Public Forum on Section 1115 OPI-M Demonstration. Hoodline reported on July 11, 2024, that Oregon will open a public forum to gather feedback on its Section 1115 Oregon Project Independence – Medicaid (OPI-M) demonstration, which launched in February and provides limited home and community-based services for seniors and adults with disabilities. The program is slated to run through January 31, 2029. Read More

Rhode Island

Rhode Island Tentatively Awards Medicaid Managed Care Program Contracts to Two Plans. The Rhode Island Executive Office of Health and Human Services released on July 16, 2024, the tentative contract awards for its statewide, capitated risk-bearing Medicaid managed care program to incumbents Neighborhood Health Plan and UnitedHealthcare. The plans will serve approximately 321,000 Medicaid members. New program changes will include carving in long-term services and supports as an in-plan benefit for all populations and expanding managed care to include people who are dually eligible for Medicare and Medicaid. Incumbent Tufts and non-incumbent Blue Cross Blue Shield were not awarded contracts. The contracts, valued at upwards of $15.5 billion over five years, will begin on July 1, 2025, and will run through June 30, 2030, with one five-year renewal option. Read More

Tennessee

Tennessee Releases Medicaid NEMT Management Solutions RFI. The Tennessee Division of TennCare, Office of Contract Management (OCM), released on July 15, 2024, a request for information (RFI) on blockchain technology to perform online credentialing, auditing, and complaint management of the Medicaid non-emergency medical transportation (NEMT) benefits. TennCare, the state’s Medicaid program, is seeking insight from vendors with an existing commercial-off the-shelf, software-as-a-service, or platform-as-a-service solution. Responses are due by July 31. Read More

Tennessee Releases Incarceration Data Services RFI. The Tennessee Department of Finance and Administration released on July 15, 2024, a request for information (RFI) to identify county-level incarceration data sharing solutions for purposes of suspending TennCare Medicaid eligibility for the duration of incarceration. The state is seeking information relating to a web services data-sharing solution or an Application Program Interface integration that contains current and accurate data relating to the county-level incarcerated population in Tennessee’s county jails. Responses are due August 15. Read More

Texas

Texas Plan Miscalculated Air Ambulance Services Payments, CMS Audit Finds. Modern Healthcare reported on July 12, 2024, that Aetna’s Texas division miscalculated the qualifying payment amount for certain air ambulance services during negotiations with providers over surprise medical bills, which resulted in payments ranging from 73 percent below to 82 percent above the appropriate rate, according to a Centers for Medicare & Medicaid Services No Surprises Act audit spanning January to June 2022. The audit also found that Aetna did not properly inform air ambulance providers of the dispute resolution process and did not share the qualifying payment amount during the billing process. Read More

National

CMS Proposes CY 2025 Medicare Physician Fee Schedule Rule. The Centers for Medicare & Medicaid Services (CMS) announced on July 10, 2024, the calendar year (CY) 2025 Medicare Physician Fee Schedule proposed rule, which would decrease Medicare physician payments by 2.9 percent. The proposed policies include extensions of Medicare reimbursement for telehealth services; coverage for dental services associated with dialysis treatments for end-stage renal disease; increased access to behavioral health care; expanded access to cancer screenings and the hepatitis B vaccine; and support for caregiver training services. Additionally, high-performing providers in the Medicare Shared Savings Program accountable care organizations would have access to advance payments based on the savings accrued, which may be used on practice improvements. The public comment period will run through September 9. Read More

CMS Releases Cell and Gene Therapy Access Model RFA. The Centers for Medicare & Medicaid Services (CMS) released on June 28, 2024, a request for applications (RFA) for states to participate in the Cell and Gene Therapy Access Model, designed to increase access to cell and gene therapy, improve health outcomes, and reduce health care costs. Applications will be accepted from December 2024 through February 28, 2025. The model will begin January 1, 2025, and states may begin participating between January 2025 and January 2026. Read More

House Oversight Panel to Hold Hearing on PBM’s Role in Escalating Healthcare Costs. Reuters reported on July 17, 2024, that the U.S. House oversight panel will hold a hearing to address the role of pharmacy benefit managers (PBMs) in rising healthcare costs. The hearing, set for July 23, will include executives from Cigna Subsidiaries, Evernorth Care Management and Express Scripts; CVS Health and CVS Caremark; and OptumRx. Read More

House Committee Approves $107 Billion for HHS in Fiscal 2025 Spending Bill. CQ reported on July 10, 2024, that the House Appropriations Committee approved a bill that would provide about $107 billion in discretionary spending for Health and Human Services (HHS) in fiscal 2025, $8.5 billion below the fiscal 2024 level. The bill includes $48.6 billion for the National Institutes of Health; $7.4 billion for the Centers for Disease Control and Prevention; $7.5 billion for the Substance Abuse and Mental Health Services Administration; and $7.4 billion for the Health Resources and Services Administration. Read More

U.S. Senator Introduces Stopgap Medicaid Expansion Bill For Individuals in Non-expansion States. U.S. Senator Reverend Raphael Warnock (D-GA) introduced on July 11, 2024, the Bridge to Medicaid Act which would provide Affordable Care Act premium subsidies to help individuals in non-expansion states with incomes between 100 and 138 percent of the federal poverty level buy health coverage in the private market, beginning in 2026. The legislation, co-sponsored by Senators Tammy Baldwin (D-WI), Bob Casey (D-PA), Elizabeth Warren (D-MA), and Jon Ossoff (D-GA), would continue for three years to give policymakers that have not expanded Medicaid time to debate the issue. Read More

Medicaid Disenrollments Top 24 Million During Redeterminations as of July. KFF reported on July 12, 2024, that nearly 24.2 million Medicaid beneficiaries have been disenrolled as of July 12, with 16.3 million pending eligibility cases. More than 5 million of those disenrolled were children, and almost 70 percent of those who have lost coverage were disenrolled for procedural reasons. Nearly 54 million recipients have had their coverage renewed. Read More

Healthcare Unaffordable for Almost Half of Americans, Report Finds. Newsweek reported on July 17, 2024, that almost half of all Americans are unable to afford quality healthcare or prescription medications, according to West Health and Gallup’s Healthcare Affordability Index report. Healthcare affordability fell to a record low in 2023, with just 55 percent of all adults reported as being “cost secure,” meaning they had no issues affording and accessing healthcare. Adults under 50 struggle to afford healthcare the most, with 53 percent of those surveyed reporting they could not cover their bills. Read More

Industry News

Pennant Group to Acquire Signature Healthcare Assets. Modern Healthcare reported on July 11, 2024, that Idaho-based healthcare provider Pennant Group has entered into two separate purchase agreements to acquire assets from home health and hospice provider Signature Healthcare at Home for $80 million. Pennant Group will acquire 13 locations and expects to close on the Washington and Idaho assets on August 1, and the Oregon assets on January 1, 2025. Pennant Group currently owns 113 home health and hospice facilities in 13 states. Read More

Steward Health Delays Arizona Hospital Sales, Indefinitely Delays Others Amid Bankruptcy. Modern Healthcare reported on July 15, 2024, that Steward Health Care has delayed the sale of its Arizona hospitals and indefinitely delayed the sale for its hospitals in Arkansas, Louisiana, Ohio, and Pennsylvania, amid the company’s Chapter 11 bankruptcy reorganization. Bids for the Arizona hospitals have been moved to July 29. Read More

RFP Calendar

HMA News & Events

NEW THIS WEEK ON HMA INFORMATION SERVICES
(Exclusive Access for HMAIS Subscribers):

HMAIS Reports

  • Updated Alaska State Overview
  • Updated Arizona State Overview
  • Updated Idaho State Overview
  • HMAIS State Marketplace and Medicaid Participation Requirements Inventory

Medicaid Data

Medicaid Enrollment:

  • California Medicaid Managed Care Enrollment is Up 4.7%, Mar-24 Data
  • Illinois Medicaid Managed Care Enrollment is Down 2.3%, Mar-24 Data
  • Illinois Dual Demo Enrollment is Down 9.4%, Mar-24 Data
  • Iowa Medicaid Managed Care Enrollment is Flat, Mar-24 Data
  • Kansas SNP Membership at 28,701, Mar-24 Data
  • Michigan Medicaid Managed Care Enrollment is Down 7.7%, Apr-24 Data
  • North Carolina Medicaid Managed Care Enrollment is Up 2.9%, Feb-24 Data
  • North Dakota Medicaid Expansion Enrollment is Down 16.4%, Jun-24 Data
  • Pennsylvania Medicaid LTSS Enrollment is Down 5%, Apr-24 Data

Public Documents: 

Medicaid RFPs, RFIs, and Contracts:

  • Alaska Medicaid Rate Maintenance Support and Consulting Services RFP, Jul-24
  • California Behavioral Health Continuum Infrastructure Program Round 1 Launch Ready RFA, Jul-24
  • Maine D-SNP Model Contracts, 2020-25
  • Rhode Island Medicaid Managed Care RFP, Proposals, and Related Documents, 2023-24
  • Tennessee Medicaid NEMT Credentialing, Auditing, and Complaint Management Solution RFI, Jul-24
  • Tennessee Incarceration Data Services RFI, Jul-24

Medicaid Program Reports, Data, and Updates:

  • Iowa Wellness Plan 1115 Waiver Documents, 2013-24
  • Michigan Medicaid Health Plan External Quality Review Reports, FY 2014-23
  • New Hampshire Medicaid SUD Treatment and Recovery Access Section 1115 Waiver, 2018-24
  • New Jersey FIDE SNP and MLTSS External Quality Review Annual Technical Reports, 2021-23
  • Oregon Health Authority Ombuds Program Report, 2023
  • Tennessee Managed Care Organization Financial Reports, 2024
  • Tennessee Managed Care Organization Financial Reports, 2023
  • Tennessee External Quality Review Organization Technical Reports, 2016-23
  • Tennessee TennCare Survey of Recipients, 2019-23
  • Tennessee TennCare Budget Presentations, FY 2020-25
  • Vermont All-Payer ACO Model Evaluation Report, 2018-22

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 Andrea Maresca at [email protected].

Edited by:

Alona Nenko
Andrea Maresca
Mary Goddeeris
Gabby Palmieri
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