Weekly Roundup

HMA Weekly Roundup

Trends in Health Policy

In Focus

Medicare Hospital Outpatient Rule Proposes Details for New Rural Emergency Hospitals, Creates New Questions for Other Payment Policies

This week, our In Focus section is the next in our series highlighting significant developments in the Medicare program. In our first article we covered the Centers for Medicare and Medicaid Services’ (CMS) calendar year 2023 Medicare Physician Fee Schedule (MPFS) proposed rule. This week we are highlighting a few key policy developments in the proposed rule that governs payment levels and policy updates for hospital outpatient departments and ambulatory surgical centers (ASCs).

As we discussed last week, this is a pivotal moment for the Biden Administration’s Medicare policy agenda. Because the rulemaking cycle takes about 18 months, CMS needs to begin the process of collecting input on new proposals this year if it intends to finalize proposals before the end of the President’s first term. Additionally, the CY2023 rule represents an important transition year for CMS as it navigates the COVID-19 related anomalies in the data used to calculate payment levels.

Health care plans, providers, and facilities are continuing to transition to value based payment strategies, making it increasingly important to assess the entire environment of Medicare payment rules as these payment systems are the basis of financial benchmarks, quality incentives, and other key components of value-based payments. In addition, these payment rules provide insight into the cost pressures, incentives, and areas of misalignment throughout the health care system.

HMA experts are analyzing and closely tracking several issues in the CY 2023 hospital outpatient prospective payment system (OPPS) proposed rule. A brief summary of some of the most important proposed policy changes for the outpatient hospital setting are included below and highlight many of the Administration’s top health care priorities.

  1. Policies to sustain access and address health disparities in rural communities.
  2. Enhancing Medicare’s behavioral health payment and access policies beyond the COVID-19 public health emergency.
  3. Uncertainty in the hospital outpatient prospective payment system (OPPS) rate increase due to future implementation of changes in 340B payment.
  4. Increasing transparency of consolidation and mergers in the marketplace to help advance quality and affordability.

The remainder of our post delves into these issues and other notable proposals. Our post also includes analysis of the implications of these policies for stakeholders deserving.

Key Action Items for Stakeholders

The CY 2023 OPPS Proposed Rule was published on July 15, 2022, and all comments from stakeholders are due to CMS by September 13, 2022. We anticipate CMS will release their Final Rule in late fall 2022, before the new rules are implemented January 1, 2023.

The public comment period is also an important window of opportunity during which stakeholders can analyze the impact of CMS’s proposed policies, assess the proposals against other applicable pending federal and state payment policies, and consider how the proposals may impact business decisions. Further, the public comment period is essential for CMS to deepen its understanding of the impact of its policies on stakeholders. The agency benefits from hearing stakeholder’s perspectives, viewing their quantitative and legal analyses, and understanding the general stakeholder environment.

Rural Emergency Hospitals: Definition and Payment

The Consolidated Appropriations Act of 2021 (CAA) established a new provider type called Rural Emergency Hospitals (REHs) beginning in 2023. REHs are facilities that convert from either a critical access hospital (CAH) or a rural hospital with less than 50 beds, by choosing to close their inpatient capacity. Instead, these facilities provide emergency department services, outpatient services, post-hospital extended care services, and other defined services.

While the statute specifies many foundational aspects of REHs, CMS was given the authority to further define REH eligibility status and to specify the unique reimbursement mechanisms for REHs. All of these components will be vital to a provider or entity’s decision to pursue REH status.

On June 30, CMS released the first component: Conditions of Participation (CoPs) for REHs, which defined REH status within the Medicare program. Within the CY 2023 OPPS Proposed Rule CMS proposed to define reimbursement and several other key components of REHs. Below we detail the key elements of REH reimbursement. In HMA’s blog next week we will offer greater detail on the COP and reimbursement policies.

REH policies proposed in the CY 2023 OPPS Proposed Rule:

  • REHs will receive a monthly facility payment of approximately $268,000 (or more than $3 million per year) beginning in CY 2023.
  • REHs will receive a 5 percent payment increase for all services covered under the Medicare OPPS.
  • REHs may provide outpatient services that are not otherwise paid under the OPPS (e.g., the Clinical Lab Fee Schedule) as well as post-hospital extended care services furnished in a unit of the facility that is a distinct part of the facility licensed as a skilled nursing facility (SNF).
  • Beneficiaries served at REHs will not be charged a copayment on the additional 5 percent OPPS payments, but standard OPPS cost-sharing requirements would still apply.
  • REHs must comply with all applicable provider enrollment provisions in order to enroll in Medicare.
  • REHs will have a unique quality reporting program distinct to REHs, in order to reduce reporting burden on these smaller facilities. CMS seeks feedback from stakeholders on the measures used for the REH quality reporting program.
  • REHs will be provided an exception from the Physician Self-Referral Law (commonly known as the “Stark Law”).

Takeaway: The creation of REHs is both a significant change for the Medicare program and potentially a unique opportunity for small rural hospitals and health systems which own/operate rural hospitals. The Congress and CMS believe this model will address access to care concerns and health disparities present in rural communities. Many assert that under the REH approach, hospitals and health system providers serving rural communities may have greater flexibility to support the rural communities they serve.

Look for our additional analysis of the set of proposed REH policies next week.

Mental Health Services Furnished Remotely by Hospital Staff

For CY 2023, CMS proposes several updates to its remote services policy to plan for a transition from temporary policies enacted during the PHE to when the PHE is declared over. CMS proposes to:

  • Allow clinical staff of a hospital to conduct remote mental health and substance abuse services and to designate these services as hospital outpatient department services for purposes of reimbursement. Patients will be permitted to be in the homes and hospital clinical staff must conduct the service from inside the hospital facility. Further, CMS proposes new hospital outpatient codes for these services, and CMS will not permit these outpatient services to be conducted (and billed) in tandem with physician fee schedule services.
  • The agency will require an in-person service within 6 months prior to the initiation of the remote service and then every 12 months thereafter. CMS will allow exceptions to the in-person visit requirement based on beneficiary circumstances.
  • The agency is also proposing that audio-only interactive telecommunications systems may be used to furnish these services when the beneficiary is not capable of, or does not consent to, the use of two-way, audio/video technology.

Takeaway: As CMS wrote in the proposed rule, many beneficiaries may be receiving mental health services in their homes from hospital or critical access hospital staff during the COVID-19 PHE. The policy update could help minimize disruptions in continuity of care that might otherwise occur following the end of the PHE. The proposals also reflect CMS’ desire to adapt to changing beneficiary preferences and new methods of providing services that have evolved during the COVID-19 PHE.

Hospitals and health systems may benefit from these proposals because it will maintain and expand patient-provider access points and care coordination after the patient has left the hospital. Stakeholders will need to continue to assess beneficiary utilization of services furnished remotely, potential staffing changes to support these services, and community-specific access needs for remote mental health services. Stakeholders may have important perspectives to offer CMS through the regulatory comment proceed as the agency determines whether to finalize a requirement that hospital clinical staff be physically located in the hospital when furnishing services remotely using communications technology.

Payment Policies  

CMS is proposing to update OPPS payment rates for hospitals and ASCs that meet their respective applicable quality reporting requirements by 2.7 percent. This update reflects the following factors:

  • Projected hospital market basket percentage increase of 3.1 percent; and
  • A 0.4 percentage point reduction for projected multifactor productivity.

In the context of the OPPS, CMS proposes to increase the OPPS conversation factor by 2.7 percent from CY 2022 to CY 2023, from $84.18 to $86.79. CMS estimates this will increase OPPS payments to providers from CY 2022 to CY 2023 by $1.8 billion.

In the context of ASCs, CMS estimates a proposed increase to the ASC conversation factor by 2.7 percent from CY 2022 to CY 2023, from $49.91 to $51.31. CMS estimates this change will increase industry-wide payments from CY 2022 to CY 2023 by $130 million. In addition, CY 2023 is the final year in which CMS will apply the productivity-adjusted hospital market basket update to ASC payment system rates for an interim period of 5 years (CY 2019 through CY 2023).

Consistent with CMS’s methods for updating other Medicare prospective payment systems during the 2023 regulatory cycle, the agency proposes to use claims data from CY 2021 and hospital cost report data from the June 2020 Healthcare Cost Report Information System (HCRIS) to update payment rates for CY 2023. Some stakeholders have expressed concern during this regulatory cycle that claims data continue to include anomalous trends influenced by covid cases and the cost data do not accurately reflect covid-related costs because the data primarily are associated with pre-COVID time period.

340B Payment Policy

CMS’s proposed rule acknowledges the recent Supreme Court decision in American Hospital Association v. Becerra (No. 20-1114, 2022 WL 2135490), which will have a significant impact on the 340B program. However, given the recency of this decision the agency formally proposed to maintain the current payment rate of Average Sale Price (ASP) minus 22.5 percent for drugs and biologics acquired through the 340B program.

In response to the decision, CMS stated that the agency will adjust 340B payment rates within the CY 2023 final rule. In its recent ruling, the Supreme Court held that HHS may not vary payment rates for drugs and biologicals among groups of hospitals without having surveyed hospitals’ acquisition costs. The decision relates to payment rates for CYs 2018 and 2019 but has implications for the CY 2023 rates.

CMS also stated that it anticipates applying a 340B payment rate of ASP plus 6 percent for specified drugs and biologics in the CY 2023 final rule. This would likely result in a budget neutrality reduction approaching 5% in the OPPS conversion factor.

Takeaway: Hospitals and federally qualified health centers (FQHCs) receiving 340B reimbursements will view the court ruling and potential increase to 340B payment rates as positive. However, it remains unclear at what exact level 340B payments will be set. Therefore, stakeholders may want to comment on the CY2023 policy options CMS is considering. Additionally, stakeholders should plan for CMS to conduct a survey of acquisition costs as it considers newly proposing changes to the payment rates. It remains possible that CMS will continue to apply the 340B cut for 2023 in light of a 2020 survey of hospital acquisition cost that it conducted. Future budget neutrality adjustments may also be necessary for any payments that are returned to hospitals due to the overturning of the 340B cut for 2018 and 2019.

Additional Issues for Stakeholder Consideration

In addition to the financing and policy issues discussed above, the wide-ranging rule contains numerous other policy proposals with direct and indirect implications on Medicare providers, beneficiaries, and other stakeholders. Table 1 provides a snapshot of some of the issues that warrant further consideration.

 Table 1. Other Notable Proposed Changes Impacting Health Care Providers and Stakeholders

Provider TransparencyCMS issues a request for information linked to the President’s July 2021 Executive Order (E.O.) on Promoting Competition in the American Economy. CMS currently manages a database of nursing homeowners and operators, and the agency has begun to leverage that data to support hospital and nursing home patients and their families. The agency solicits feedback on whether it should release additional data that is already being collected “to help identify the impact of provider mergers, acquisitions, consolidations, and changes in ownership on the affordability and availability of medical care.” CMS also invites comments on whether the agency should release similar data for other types of providers. The solicitation represents the next phase in CMS’ expansive portfolio of work to address the impact of market consolidation on health care prices, consumer costs, and quality in the healthcare industry writ large. Medicare providers and stakeholders should be tracking how federal health care regulators, including CMS, are working to respond to the E.O. There is a strong likelihood that CMS will begin to include data on other types of providers and stakeholders will need to understand this shifting landscape and how it could impact their current and potential future business decisions.
SaaSCMS discusses its desire to address the novel and evolving nature of Software as a medical Service (Saas) procedures. The agency is seeking comments on the specific payment approach we might use for these services under the OPPS as SaaS-type technology becomes more widespread. We are also concerned about the potential for bias in algorithms and predictive modeling, and are seeking comments on how we could encourage software developers to prevent or mitigate the possibility of bias in new applications of this technology.
Inpatient Only ListRemoves ten services from the Inpatient Only (IPO) list.While the IPO list has previously been targeted for major reforms, this year’s narrower set of proposed changes signal CMS’ is deprioritizing IPO list reform.
Payment for surgical N95 RespiratorsCMS recognizes that hospitals may incur additional costs when purchasing domestic NIOSH-approved surgical N95 respirators. CMS is proposing payment adjustments under the IPPS and OPPS that would reflect, and offset, the additional marginal resource costs that hospitals face in procuring domestically made NIOSH-approved surgical N95 respirators. Under this proposal, these payments would be provided biweekly as interim lump-sum payments to the hospital and would be reconciled at cost report settlement. The rule outlines the information providers need to include on the cost report to determine payments for cost reporting periods beginning on or after January 1, 2023.
Ambulatory Surgery CentersCMS requests stakeholder feedback on methods that could be implemented to collect cost data from ASCs that minimize reporting burden.This could be the beginning of a process to implement cost reports for ASCs.

The HMA Medicare team will continue to analyze these proposed changes. We have the depth and breadth of expertise to assist with tailored analysis, to model policy impacts, and to support the drafting of comment letters to this rule.


Center for Medicare Director Meena Seshamani to Deliver Virtual Keynote Address on The Future of Medicare Value-Based Payments at HMA Conference in Chicago, October 10-11

Meena Seshamani, deputy administrator and director of the Center for Medicare at the Centers for Medicare & Medicaid Services, will deliver a virtual keynote address on The Future of Medicare Value-Based Payments at the HMA conference, October 10-11, 2022, at the Fairmont Chicago, Millennium Park.

To register, visit https://conference.healthmanagement.com/.  For details on sponsorships and group discounts, contact Carl Mercurio, [email protected].

The overall theme of this year’s conference is How Medicaid, Medicare, and Other Publicly Sponsored Programs Are Shaping the Future of Healthcare in a Time of Crisis. More than 40 speakers are confirmed, and more than 400 people are expected to attend.

HMA Roundup


California Medicaid Plans Eye State Exchange in 2024. Health Payer Specialist reported on July 22, 2022, that California Medicaid managed care plans CalOptima and Inland Empire Health Plan may begin selling individual insurance on the state’s Exchange, Covered California in 2024. The only other California Medicaid plan participating on the state Exchange is L.A. Care Health Plan. Read More


Delaware Submits 1115 Waiver Amendment for Federal Approval. The Centers for Medicare & Medicaid Services (CMS) announced on July 26, 2022, that Delaware submitted for federal approval a Section 1115 waiver amendment to cover several additional services under Medicaid managed care, including home visits for pregnant women and children under two; home-delivered meals; pediatric respite; nursing home transition (formerly Money Follows the Person); and self-directed personal care. Federal public comments will be accepted through August 25. Read More


Georgia Awards $9 Million in Grants to 10 Rural Hospitals. The Georgia Department of Community Health announced on July 26, 2022, $9 million in grants for 10 rural Georgia hospitals as part of the state’s annual Rural Hospital Stabilization Grant program. Each hospital will receive $900,000 for initiatives and services to strengthen access to quality care for Georgia’s underserved communities. The Rural Hospital Stabilization Grant program was established in 2014. Read More

Medicaid to Cover Gender-Affirming Surgery Following Settlement of Lawsuit. The Hill reported on July 19, 2022, that the Georgia Medicaid program will cover gender-affirming surgeries as part of a settlement of a lawsuit filed on behalf of two transgender individuals. Georgia had previously banned Medicaid coverage of gender-affirming surgery. Read More


Louisiana Awards Medicaid Funds for Research on Neonatal, Behavioral, Substance Abuse, Health Equity. The Louisiana Department of Health announced on July 22, 2022, it will award $673,000 in Medicaid funds to LSU Health Sciences Center and Pennington Biomedical Research Center to study maternal and neonatal outcomes, early childhood health and development, preventive care, mental health and substance use outcomes, and health equity. Read More


Michigan Releases RFP for Electronic Visit Verification System for Medicaid Personal Care, Home Care Services. The Michigan Department of Technology, Management and Budget Procurement released on July 21, 2022, a request for proposals (RFP) for an electronic visit verification (EVV) system for Medicaid personal care services and home health care services that require an in-home visit by a provider. EVV for these services is required under the 21st Century Cures Act. Proposals are due on September 16, and contracts are anticipated to begin on March 1, 2023.


Mississippi Requests Renewal of Healthier Mississippi 1115 Waiver for Certain Aged, Blind, Disabled Individuals. The Mississippi Division of Medicaid announced on July 21, 2022, submission of a renewal request for the state’s Healthier Mississippi 1115 Waiver, which covers aged, blind, and disabled individuals who are not on Medicare or eligible for Medicaid. The waiver, which has an enrollment cap of 6,000, is currently set to expire on September 30, 2023. If approved, the waiver will be effective from October 1, 2023, through September 30, 2028. Read More

Mississippi Health Official Supports Extending Postpartum Medicaid Coverage to 12 Months. The Associated Press reported on July 21, 2022, that Daniel Edney, M.D., who takes over as Mississippi state health officer effective August 1, has expressed support for extending postpartum Medicaid coverage from two months to 12 months. Edney, who is currently deputy state health officer, made the remarks at a time when state lawmakers remain divided on extending postpartum coverage. Read More


Montana Medicaid to Cover Applied Behavioral Therapy for Children With Autism. The Montana Department of Public Health and Human Services announced on July 20, 2022, that the state’s Medicaid program will cover Applied Behavioral Analysis services for individuals up to age 21 with autism and serious emotional disturbance. Coverage will also apply to individuals eligible for the state’s Developmental Disabilities Program. Read More

New York

New York Proposes Rule For Medicaid Managed Care Plans to Bolster Special Investigations Units. Crain’s New York reported on July 26, 2022, that the New York Office of the Medicaid Inspector General released a proposed rule that would require Medicaid managed care plans to bolster special investigations units that investigate fraud and abuse. Under the proposed rule, plans with 1,000 members would be required to have a special investigations unit; the threshold is currently 10,000 members. In addition, each special investigations unit would be required to have a full-time lead investigator, a director, and an additional staffer for every 60,000 plan members (6,000 for managed long-term care plans). The state is accepting public comments through September. Read More

New York Announces Grants to Reduce COVID-19 Disparities. The New York State Department of Health announced on July 26, 2022, the availability of $10.7 million in grants for up to 210 community-based wellness organizations to provide COVID-19 mitigation and prevention resources to underserved communities. A second grant will award four organizations $49,999 each to train and develop the public health workers to help implement the initiatives. Grant applications are due August 5 and August 30, respectively. Read More

Centene/Fidelis Care, Yuvo Health Partner on FQHC Downside Risk Arrangement in New York. Modern Healthcare reported on July 22, 2022, that Centene/Fidelis Care and administrative software start-up Yuvo Health are partnering on a two-year downside risk arrangement involving federally qualified health centers (FQHCs) in New York. Yuvo Health takes on downside risks for the FQHCs and helps negotiate contracts with shared savings, while Fidelis Care handles reimbursements. Eventually, FQHCs would also take downside risk. Yuvo, which was founded in 2021, raised $7.3 million in a round of funding led by AlleyCorp, with participation from AV8 Ventures, New York Ventures, Laconia Capital, Brooklyn Bridge Ventures, and angel investors. Read More

North Carolina

Medicaid Expansion Negotiations Slow. The Associated Press reported on July 26, 2022, that discussions among North Carolina General Assembly leaders regarding Medicaid expansion have slowed since the legislative session ended on June 30. The state House and Senate separately passed different versions of expansion legislation, with the Senate version including measures to weaken need laws and to allow nurses to practice without a doctor’s supervision. Read More


Virginia Launches Behavioral Health Utilization, Expenditure Dashboard. WAVY TV 10 announced on July 23, 2022, that the Virginia Department of Medical Assistance Services launched a dashboard to track utilization of and expenditures on behavioral health services. Read More


Wyoming Hospital Group Warns of Closures, Reduced Services as Medicaid Costs Outpace Reimbursements. County 10 reported July 22, 2022, that Wyoming hospitals are at risk of closing or reducing services because Medicaid reimbursement rates are not covering the cost of care, according to Wyoming Hospital Association president Eric Boley. Boley made the remarks to the state’s Joint Legislative Committee on Labor, Health & Social Services. Read More


HHS Approves Extension of Postpartum Medicaid Coverage to 12 Months in CT, KS, MA. The U.S. Department of Health and Human Services (HHS) announced on July 26, 2022, approval for Connecticut, Kansas, and Massachusetts to extend postpartum Medicaid coverage to 12 months. The extensions will impact an additional 19,000 people annually. Read More

HHS Announces Plan to Reinstate Healthcare Nondiscrimination Rule. Modern Healthcare reported on July 25, 2022, that the U.S. Department of Health and Human Services (HHS) announced plans to reinstate the healthcare nondiscrimination rule. The rule, which was reversed during the Trump administration, prevents providers and payers from discriminating on the basis of gender, sexual orientation, race, nationality, age, and disability. Read More

MACPAC Meeting Is Scheduled for July 27. The Medicaid and CHIP Payment and Access Commission (MACPAC) announced on July 25, 2022, that its next meeting will be held on July 27. Medicaid and the public health emergency will be the topics of discussion. Read More

Extending Enhanced Subsidies Would Increase Exchange Enrollment by 4.8 Million Annually, CBO Projects. Fierce Healthcare reported on July 22, 2022, that extending enhanced Exchange subsidies would increase Exchange enrollment by 4.8 million annually from 2023-32, according to projections from the Congressional Budget Office (CBO). Enhanced subsidies are currently set to expire at the end of 2022, but Senate Democrats are hoping to extend them for another two years. Read More

Healthcare Groups Urge Congress to Extend Enhanced Exchange Subsidies. Modern Healthcare reported on July 22, 2022, that America’s Health Insurance Plans, Blue Cross Blue Shield Association, American Hospital Association, American Medical Association and other groups are urging Congress to pass legislation extending enhanced Exchange subsidies before the August recess. The enhanced subsidies are currently set to expire at the end of 2022. Read More

CMS Releases Voluntary HCBS Quality Measure Set. The Centers for Medicare & Medicaid Services (CMS) released on July 21, 2022, a voluntary home and community-based services (HCBS) quality measure set for states. The set is meant to promote consistent quality measures across the country and to allow states to better understand and compare health outcomes across groups receiving HCBS. Read More

Medicaid Beneficiaries Face Barriers to Accessing Cancer Care at High-Quality Facilities, Study Finds. Health Payer Intelligence reported on July 20, 2022, that Medicaid beneficiaries face barriers to accessing colorectal, breast, kidney, and skin cancer care at high-quality facilities, according to a recent JAMA study. The study found that 67.7 percent of the 334 facilities contacted for the study accepted Medicaid for all four cancer types. The study attributed the access issues to low Medicaid reimbursement rates, high administrative burdens, and limited specialist participation in Medicaid managed care networks. Read More

U.S. Justice Department Announces Medicare Fraud Charges Against 36 Defendants. Reuters reported on July 20, 2022, that the U.S. Justice Department announced criminal charges against 36 defendants for attempting to defraud Medicare out of $1.2 billion, with actual losses totaling about $440 million. The charges allege fraudulent billing schemes tied to telemedicine, genetic and cardiovascular testing, and equipment. Read More

Industry News

BayMark Health Services Acquires San Antonio Recovery Center. BayMark Health Services announced on July 26, 2022, the acquisition of San Antonio Recovery Center (SARC), a residential substance use disorder (SUD) treatment company. SARC will join BayMark’s 10 SUD facilities throughout Texas. Read More

Amazon to Buy 1LifeHealthcare in $3.9 Billion Deal. The Wall Street Journal reported on July 21, 2022, that Amazon has agreed to buy publicly traded 1Life Healthcare, which operates primary care clinics under the name One Medical, in a $3.9 billion deal, including about $400 million in debt assumption. One Medical provides in-person and virtual care, including healthcare services to more than 8,000 employers. Read More

Vistria Group Is Investing Upwards of $200 Million in Sandstone Care. Behavioral Health Business reported on July 21, 2022, that Vistria Group is investing upwards of $200 million in Sandstone Care, a provider of youth behavioral health services in Colorado, Maryland, and Virginia. Vistria has pledged $250 million toward investments in U.S. providers of youth mental health services over the next three years. Read More

SCAN Group Invests in SafeRide Health. Healthcare Dive reported on July 19, 2022, that SCAN Group has signed a deal to invest in SafeRide Health, a non-emergency medical transportation broker. SafeRide Health provides transportation for dialysis infusions, oncology, wellness visits, and other services. SCAN also owns a Medicare Advantage plan in California with 270,000 members. Read More

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Medicaid Data  

Medicaid Enrollment

  • Iowa Medicaid Managed Care Enrollment is Up 3.3%, Jun-22 Data
  • Kentucky Medicaid Managed Care Enrollment is Up 1.4%, May-22 Data
  • Michigan Medicaid Managed Care Enrollment is Up 1%, Mar-22 Data
  • Michigan Dual Demo Enrollment is Down 6.5%, Mar-22 Data
  • Minnesota Medicaid Managed Care Enrollment is Up 3.7%, May-22 Data
  • Missouri Medicaid Managed Care Enrollment is Up 8.7%, Apr-22 Data
  • Virginia Medicaid Managed Care Enrollment is Up 12.7%, 2021 Data
  • Virginia Medicaid MLTSS Enrollment is Up 6.2%, 2021 Data
  • Wisconsin Medicaid Managed Care Enrollment is Up 10.9%, 2021 Data

Public Documents:
Medicaid RFPs, RFIs, and Contracts:

  • Michigan Electronic Visit Verification System for Medicaid PCS, HHCS RFP, Jul-22

Medicaid Program Reports, Data and Updates:

  • Arizona Annual HCBS Reports, FY 2019-21
  • Delaware Diamond State Health Plan 1115 Waiver Documents, 2014-22
  • District of Columbia Medical Care Advisory Committee Meeting Materials, 2021-22
  • Mississippi Healthier Mississippi 1115 Waiver Documents, 2015-22
  • Texas Behavioral Health Presentations to Legislature, Jul-22
  • Texas Quarterly Reports from the HHS Ombudsman Managed Care Assistance Team, FY 2019-22

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  • State-by-state overviews and analysis of latest data for enrollment, market share, financial performance, utilization metrics and RFPs
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