Weekly Roundup

December 21, 2022

In Focus:

CMS Introduces Significant Proposed Changes to Medicare Advantage and Medicare Prescription Drug Benefit Programs for 2024

Roundup:

California to Transition Dual Eligibles in 31 Counties to Medi-Cal Managed Care Plans in January 2023
Georgia Receives Approval for 2 State-Directed Payment Programs
Hawaii Governor Proposes Medicaid Provider Reimbursement Rate Increases
Iowa Releases Medicaid Enterprise Systems RFI
Idaho Looks to Expand Access to Crisis Services for Individuals with Developmental Disabilities
Indiana Releases Medicaid NEMT RFP
New Mexico Proposes 16 New Programs in Section 1115 Medicaid Waiver Renewal Application
New York Medicaid Pharmacy Carve-Out Could Cost $400 Million More Annually, Wakely Report Finds
Oregon Governor-Elect to Appoint James Schroeder as Interim Director of OHA
Puerto Rico to Receive $17.6 Billion in Medicaid Funding Over 5 Years Under Omnibus Spending Bill
Vermont Considers Punitive Cuts to 2023 All-Payer ACO Budget
Washington Receives Federal Approval to Offer Exchange Plans to Non-Citizens
Medicaid Eligibility Redeterminations to Begin April 2023 Under Omnibus Spending Bill
Rise Health Secures Investments from Lorient Capital, Martis Capital

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December 14, 2022

In Focus:

Roundup:

California to Sanction 22 Medi-Cal Plans for Poor Quality Ratings
California Governor Awards $480.5 Million in Grants for Youth Behavioral Health Infrastructure
Connecticut Governor to Appoint Andrea Barton Reeves Commissioner of Social Services
Massachusetts Medicaid Secretary To Step Down
Minnesota Judge Blocks Managed Care Plan from Expanding Board of Directors
Missouri, Mississippi, Montana, Wyoming Are Expected to Extend Medicaid Postpartum Eligibility in 2023
Nevada Releases External Quality Review Organization RFP
North Carolina Faces Lawsuit for Foster Children in Residential Psychiatric Treatment Facilities
Wyoming Requests $22 Million to Increase Nursing Home Medicaid Reimbursement Rates in 2024
CMS Rule Would Increase Availability of Standardized Exchange Plans
MedPAC Draft Recommendations Call for Medicare Payment Increases for Hospitals, Physicians in 2024
Exchange Enrollment Rises 18 Percent in First Five Weeks of Open Enrollment
SCAN Group, CareOregon to Merge as HealthRight Group
Centene Names New President, Chief Operating Officer, Other Leadership Changes

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December 7, 2022

In Focus:

The Impact of the 340B Program on Drug Prices Charged by Manufacturers and Covered Entities

Roundup:

North Carolina Appeals Ruling on Additional Community Services for Individuals with Disabilities
New Mexico Health Plan Submits Bid for New Medicaid Managed Care Contract
New York SMI Treatment Programs Face Over 1,000-Person Waiting List
Oregon Reaches $17 Million Settlement with Former PBM
Tennessee to Release Dental Benefit Management RFP in Late 2023
Texas Releases STAR & CHIP Managed Care Services RFP
Wisconsin Receives Federal Approval to Continue Exchange Plan Reinsurance Program Through 2028
HHS Releases Medicaid, CHIP FMAP for Fiscal 2024
Defense Misses Deadline for Announcing Tricare Contract Awards
Prime Therapeutics Completes Acquisition of Magellan Rx Management from Centene

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November 30, 2022

In Focus:

Oklahoma Rereleases Medicaid Managed Care RFPs

Roundup:

Arkansas Medicaid Looks to Expand Access to Behavioral, Mental Health Services
California Seeks Federal Approval to Limit Medicaid Managed Care Choice in Metro, Urban Counties
PHE News: Delaware, New Mexico, Tennessee
Florida Medicaid Secretary Is Stepping Down
Florida Releases Medicaid Managed Care Data Books Ahead of Procurement Process
Georgia to Implement Medicaid Expansion Work Requirements After End of Public Health Emergency
Idaho Delays Medicaid Behavioral Health Plan Contract Award
Michigan to Cover Doula Services for Medicaid Beneficiaries in 2023
Mississippi Medicaid Managed Care Enrollment Falls As State Shifts Members to FFS During Public Health Emergency
Montana Faces Lawsuit Concerning Hiring of Medicaid Director
Oklahoma Releases SoonerSelect Children’s Specialty Program RFP Covering Foster Kids
Oregon Proposes Continuous Medicaid Coverage for Certain Beneficiaries Until State Launches Basic Health Program
Medicare Advantage Plans Overbilled Government by More Than $1,000 Per Patient Per Year, Audits Find
CMS Reports $70 Million in Medicare Savings Through Direct Contracting Model in 2021
Centene Sells Magellan Specialty Health to Evolent Health

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November 16, 2022

In Focus:

Should You Put the PHE’s Medicaid Unwinding at the Top of Your To-Do List?

Roundup:

Alabama Medicaid Doubles Covered Physician Visits for Cancer Treatment
California Medi-Cal Procurement Protests Continue
California Releases Third-Party Monitoring RFI
Delaware Names First Director of Value-Based Healthcare Delivery
Illinois YouthCare Fails to Deliver Basic Services to Foster Children, Investigation Finds
Medicaid Expansion News: Kansas, North Carolina
Elevance Files Appeal After Its Protest of Nebraska Medicaid Managed Care Awards is Denied
Maryland Declines to Pursue Higher Damages Against Medicaid Behavioral Health ASO
Ohio Delays Implementation of New Medicaid Managed Care Contracts to February 2023
Oklahoma Re-releases Medicaid Managed Care RFP
Wisconsin Releases External Quality Review, Quality Improvement Services RFP
CMS Targets Gaps in Health Equity Data, To Gradually Release Equity Scores
Sanford Health, Fairview Health Services Agree to Merge

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November 9, 2022

In Focus:

Roundup:

California Medi-Cal Members Can Now Fill Prescriptions at Costco
Florida Healthcare Groups File Challenge to $15 Minimum Wage Budget Provision
Hawaii Works With HMA to Develop Medicaid Social Determinants of Health Initiative
Massachusetts Home Health Care Workforce Decreases by 13 Percent from 2019 to 2022
Nebraska Says Protest of Medicaid Managed Care Contracts Will Not Delay Implementation
New Hampshire Executive Council Approves Medicaid Dental Contract
Pennsylvania Receives Federal Approval to Extend Postpartum Medicaid Coverage From 60 Days to 12 Months
South Dakota Voters Approve Medicaid Expansion
Virginia Projects ‘Tiny’ Increase in Fiscal 2024 State Medicaid Costs
Medicaid FFS Is More Likely to Cover Opioid Use Disorder Treatment than Medicaid Managed Care, Study Finds
Medicaid Plans Report Barriers to Telehealth Access
19 States Have Implemented Strategies to Increase Direct Care Worker Wages, Report Finds
Walgreens’ VillageMD to Acquire Summit Health
Clover Health to Reduce Medicare ACO REACH Population by Two-Thirds in 2023

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November 2, 2022

In Focus:

Leavitt Center for Alliances, an HMA Initiative, Drives Collaboration and Solutions

Roundup:

Alabama Releases Medicaid Modernization Program System Integration Services RFP
Arkansas Receives Federal Approval to Expand Community-Based Care for Certain High-Risk Individuals
The District of Columbia Mayor Calls for Ethics Investigation Into Recently Awarded Medicaid Managed Contracts
Michigan Medicaid Plan Meridian Appoints Patricia Graham as CEO
Mississippi Submits 1115 Healthier Mississippi Waiver Extension Application for Aged, Blind, Disabled Individuals
New Hampshire to Award Adult Medicaid Dental Contract to Delta Dental South Dakota Seeks Five-Year Extension of Former Foster Care Youth Medicaid Section 1115 Waiver
Tennessee Seeks to Extend Enhanced HCBS Supports
Vermont Releases Medicaid IV&V RFP
Wisconsin Receives Federal Approval to Use CHIP Funds For Housing Support HHS Aims to Bolster Medicare Behavioral, Dental, Cancer Care in 2023 Physician Fee Schedule Final Rule
HHS Focuses on Rural Health Equity in Outpatient Hospital, Surgical Center Payment System Final Rule
Walgreens’ VillageMD Reportedly Explores Merger With Summit Health

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October 26, 2022

In Focus:

Advancing Health Equity and Integrated Care for Rural Dual Eligibles

Roundup:

Georgia Children on Medicaid, CHIP Face Behavioral Health Access Barriers
Medicaid Dental News: Kentucky, New Hampshire, Nevada
North Carolina Says Hospitals Profited from Medicare, Despite Claims of Losses
PBM News: Ohio, Puerto Rico, Centene
Oregon Seeks $1.5 Billion Increase in Medicaid Funds for 2023-25 Biennial Budget
Pennsylvania Lawmakers Consider Prior Authorization Legislation
States Leverage Medicaid Managed Care to Improve Health Equity, KFF Finds
Community Medicare Advantage Plans Are Leaders in Quality, ACHP Finds

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October 19, 2022

In Focus:

West Virginia Releases RFP for Foster Children, Youth in Medicaid Managed Care

Roundup:

Arizona Receives Federal Approval of Waiver to Address Housing Needs
District of Columbia Council Approves Medicaid Managed Care Contracts Idaho Delays Behavioral Medicaid Awards to November 2022
Indiana Awards Medicaid FFS Prior Authorization, Utilization Management Contract to KePro
Kansas, Gainwell Implement Modular Medicaid Technology Platform
Nevada Governor Tells SEIU He Will Push for Higher Payment Rates, Wages for Home Care Providers
New York Fails to Follow Up on Dual Eligible Cost Savings Opportunities, Comptroller Finds
Pennsylvania Senate Committee Passes Resolution to Study Medicaid Addiction Treatment Reimbursement Rates
HHS Offers States Certified Community Behavioral Health Clinic Planning Grants
CMS Agrees to Release Audits of 90 Medicare Advantage Plans
Acorn Health Acquires 7 Applied Behavior Analysis Centers in FL, VA For Children With Autism
Brave Health Secures $40 Million in Latest Funding Round to Expand Virtual Medicaid Behavioral Health Services

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October 12, 2022

In Focus:

Roundup:

California Faces Lawsuit from Health Plan Over Alleged Public Records Act Violation
Kansas to Hold Public Meetings on KanCare With Beneficiaries, Stakeholders
Massachusetts to Transition Dual Eligibles from MMP Demo to D-SNP
Mississippi Submits Amendment to Increase Reimbursement Rates for Private Duty Nurses by 15 Percent
Oklahoma Gubernatorial Candidates Clash on Medicaid Managed Care Implementation
Texas Releases STAR, CHIP Draft RFP
Utah to Transition to New MMIS in 2023
West Virginia Releases RFP for Foster Children, Youth in Medicaid Managed Care
Treasury Announces Rules Aimed at Fixing Exchange Plan ‘Family Glitch’
Walgreens Boots Alliance to Acquire Remaining 45 Percent Stake in CareCentrix
Cimarron Healthcare Capital, Tacoma Holdings Invest in Frontpoint Health

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