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Medication Assisted Treatment in Justice Settings

With funding from the California Health Care Foundation, Health Management Associates created the following video to capture the thoughts and feelings of various stakeholders in the criminal justice system about treating Opioid Use Disorder with Medication Assisted Treatment (MAT).  It includes comments from two clients who received MAT through the criminal justice system.  The parties interviewed are all involved in a project HMA is administering to coach teams from 29 counties to expand access to at least two forms of MAT in jails and drug courts.

For more information, contact HMA Principal Donna Strugar-Fritsch, BSN, MPA, CCHP

D-SNP 2021 Integration Requirements: Opportunities for Plans, States to Partner on Medicare-Medicaid Integration

This week, our In Focus section provides a high-level overview of the new Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) integration requirements in the Centers for Medicare & Medicaid Services (CMS) April 16, 2019, final rule[1] for calendar year (CY) 2021. CMS recently released two publications providing guidance and technical assistance to assist with the implementation of these new opportunities: the November 14, 2019, CMCS Informational Bulletin[2] and Integrated Care Resource Center technical assistance tool Sample Language for State Medicaid Agency Contracts with Dual Eligible Special Needs Plans.[3] Both identify steps to ensure that states’ Medicaid agency contracts (SMACs) with D-SNPs comply with the new 2021 requirements, and further encourage states and D-SNPs to work together to address the often fragmented care provided to the Medicare-Medicaid dually eligible population.

Read MoreD-SNP 2021 Integration Requirements: Opportunities for Plans, States to Partner on Medicare-Medicaid Integration

NCQA’s Medicaid Health Insurance Plan Ratings 2019-20

This week, our In Focus section reviews the annual Medicaid health plan ratings released in September by the National Committee for Quality Assurance (NCQA), which rated 171 Medicaid plans. For 2019-20, NCQA used a ratings methodology that scored each health plan from 0 to 5 in 0.5 increments – a system similar to the Five-Star Quality Rating System used by the Centers for Medicare and Medicaid Services. A plan is considered top-rated if it scores a 4.5 or 5 and low-rated if it scores a 1 or 2. For 2019-20, only 15 Medicaid plans across the country were awarded a 4.5 or 5.

Read MoreNCQA’s Medicaid Health Insurance Plan Ratings 2019-20

California Releases Medicaid Delivery System Waiver Proposal

This week, our In Focus section reviews the California Advancing and Innovating Medi-Cal (CalAIM) proposal, issued by the California Department of Health Care Services (DHCS) on October 28, 2019. CalAIM would implement broad delivery system, program, and payment reform for the state’s Medicaid program. The proposal includes efforts to address social determinants of health and other policy priorities such as homelessness, lack of access to behavioral health care, children with complex medical conditions, justice-involved populations, and aging individuals. According to DHCS, the three key goals of the proposal are to:

Read MoreCalifornia Releases Medicaid Delivery System Waiver Proposal

New Medicare Benefit: Opioid Use Disorder Treatment

This week, our In Focus section examines the new Medicare benefit for Opioid Use Disorder (OUD) treatment that includes counseling, as well as medication-assisted treatment (MAT) and related items and services. This benefit was established by Congress in the SUPPORT Act of 2018 and is now being implemented by the Centers for Medicare & Medicaid Services (CMS). Medicare beneficiaries, including those dually eligible for Medicare & Medicaid, are the fastest growing group of OUD patients. Beneficiaries may access one of two types of providers: Opioid Treatment Programs (OTPs) (i.e., methadone clinics), or physicians + other health professionals. Providers offering these services will receive a bundled payment, either weekly or monthly depending on the type of provider, that can repeat as long as a patient needs treatment. Based on early guidance, Medicare Advantage (MA) plans have already created 2020 benefit packages that provide a level of access to OTP services that is “consistent with prevailing community patterns of care.”  Now that the new benefit is final, MA will need to cover both OTP & Physician OUD treatment for 2021.

Read MoreNew Medicare Benefit: Opioid Use Disorder Treatment

HMA Colleagues Lead Health Reproductive Care Access Study

Health Management Associates (HMA), working with the Kaiser Family Foundation, recently conducted research and completed five case studies to identify distinct challenges that low-income women face in obtaining reproductive healthcare in five diverse communities, and the key factors contributing to them.

The findings will be the centerpiece of a briefing and roundtable discussion on Thursday, Nov. 14 in Washington, D.C.

HMA colleagues, including Managing Principal Sharon Silow-Carroll, Consultant Carrie Rosenzweig, Principal Rebecca Kellenberg, and Senior Consultant Diana Rodin, contributed to the research through state policy reviews, site visits, and interviews with local stakeholders. The HMA team learned about the experiences of women living in these communities and the reproductive health professionals caring for them.

They engaged participants from various demographics, including populations with historically greater health inequities such as low-income women, African Americans, Native Americans, immigrants, and refugees. Research was conducted in Dallas County (Selma), Alabama; Tulare County, California; St. Louis, Missouri; Crow Tribal Reservation, Montana; and Erie County, Pennsylvania. The selected regions represent urban and rural areas, including regions with limited healthcare resources due to closure and consolidation of family planning providers and hospitals.

The final study and five case studies will be published following the briefing and roundtable discussion.

Indiana Releases Hoosier Care Connect Managed Care RFP

This week, our In Focus section reviews the Indiana Hoosier Care Connect request for proposals (RFP), issued by the Indiana Family and Social Services Administration (FSSA), Office of Medicaid Policy and Planning (OMPP) on October 18, 2019. Hoosier Care Connect is the state’s Medicaid managed care program for approximately 90,000 aged, blind, and disabled (ABD) Medicaid beneficiaries. Implementation is expected April 1, 2021, with contracts worth $1.4 billion annually.

Read MoreIndiana Releases Hoosier Care Connect Managed Care RFP

2020 Medicare Advantage, Part D Landscape Files and Quality Performance Data

This week, our In Focus reviews the Medicare Advantage (MA) and Part D landscape files and quality performance data for the 2020 plan year from the Centers for Medicare & Medicaid Services (CMS). Data on MA and Part D offerings include premiums and benefit design, as well as Star Ratings for each MA contract. This year’s release signals continued growth for the MA program in 2020. The total number of MA plans increased by 403 offerings to 3,144, up from 2,741 in 2019, the highest number since inception of the program. Notably, growth appears to be occurring in parts of the country with existing market saturation, as many MA organizations are offering new plans in states with MA enrollment levels of 30 percent or higher. There is also significant growth in the number of Dual Eligible Special Needs Plans (D-SNPs) offered by MA organizations, particularly among top MA sponsors Humana and CVS (Aetna).

Read More2020 Medicare Advantage, Part D Landscape Files and Quality Performance Data