This week, our In Focus section reviews the North Carolina Department of Health and Human Services (DHHS) Medicaid Managed Care Proposed Policy Paper released on May 16, 2018, Prepaid Health Plans in North Carolina Medicaid Managed Care, ahead of a competitive procurement for the new Medicaid managed care program expected to be released in spring or summer 2018. North Carolina will be contracting with statewide Medicaid managed care organizations (Commercial Plans, CPs) as well as regional provider-led managed care entities (Provider-Led Entities, PLEs) to serve 1.9 million Medicaid beneficiaries beginning in 2019. All plans are considered by the state to be Prepaid Health Plans (PHPs). The policy paper provides additional detail on the characteristics and requirements that apply to CPs and PLEs. To read HMA’s previous analysis of “North Carolina’s Proposed Program Design for Medicaid Managed Care,” click here.
This week, our In Focus, written by HMA Principal Anne Winter and Senior Consultant Aimee Lashbrook, examines American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs, released May 11, 2018. Over time, the pharmaceutical supply chain has become a complex ecosystem, responding to the ever-changing dynamics of new drug products, pricing strategies, health care reform, benefit design, and the regulatory environment making it, arguably, the most complicated in health care. Due to this complexity, solutions to equitably control drug pricing will take a multiprong approach that includes regulatory redesign.
This week, our In Focus section reviews updated reports issued by the Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) on Medicaid expansion enrollment from the “December 2017 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report,” published on April 30, 2018. Additionally, we review 2018 Exchange enrollment data from the “Health Insurance Marketplaces 2018 Open Enrollment Period: Final State-Level Public Use File,” published by CMS on April 3, 2018. Combined, these reports present a picture of Medicaid and Exchange enrollment at the beginning of 2018, representing more than 74 million Medicaid and CHIP enrollees and nearly 12 million Exchange enrollees.
This week, our In Focus, written by HMA Principal Jen Burnett in collaboration with the National Association of States United for Aging and Disabilities (NASUAD), summarizes key considerations and policy decisions contained in Electronic Visit Verification: Implications for States, Providers, and Medicaid Participants for state consideration as they work to implement electronic visit verification (EVV) systems in accordance with the mandate included in the December 2016 21st Century Cures Act (the CURES Act).
This week, our In Focus is the second in a series written by HMA Medicaid Market Solutions (MMS), which has worked with a number of states to design and implement Section 1115 Demonstration Waivers that support individual state goals for member engagement and personal responsibility while complying with new Centers for Medicare and Medicaid Services (CMS) guidance.
This week, our In Focus reviews two recently released papers outlining North Carolina’s and New Hampshire’s plans to implement Medicaid managed care long-term services and supports (MLTSS). The North Carolina Department of Health and Human Services released “North Carolina’s Vision for Long-term Services and Supports under Managed Care” on April 5, 2018, and is accepting comments through April 27. The New Hampshire Department of Health and Human Services released its “Implementation Plan for Medicaid Care Management – Nursing Facility/Choices for Independence Services” on March 6, 2018, and is accepting comments through May 4, 2018. Both states are anticipated to release requests for proposals (RFPs) for integrated Medicaid managed care services in the next several months.
The National Council for Behavioral Health Conference, held April 23-25, will host more than 5,000 leaders in healthcare. Attendees will explore healthcare’s greatest innovations in practice improvement, financing, integrated health care, technology, policy and advocacy, and professional development. Four HMA behavioral health experts will be speaking at NatCon18.
This week, our In Focus section highlights HMA Medicaid Market Solutions (MMS), formerly SVC, Inc., which is at the forefront in supporting state flexibility in designing and implementing initiatives including Section 1115 Demonstration Waivers promoting member engagement and personal responsibility. Over the coming weeks, HMA MMS will present a series of articles providing an in-depth look at the facets of these new Medicaid models.
This week, our In Focus section reviews Medicaid spending data collected in the annual CMS-64 Medicaid expenditure report. After submitting a freedom of information act request to CMS, we have received a draft version of the CMS-64 report that is based on preliminary estimates of Medicaid spending by state for federal fiscal year (FFY) 2017. The final version of the report will be completed by the end of 2018 and posted to the CMS website at that time. Based on the preliminary estimates, Medicaid expenditures on medical services across all 50 states and 6 territories in FFY 2017 exceeded $571 billion, with over half of all spending now flowing through Medicaid managed care programs. In addition, total Medicaid spending on administrative services was $27.8 billion, bringing total program expenditures to just under $600 billion.
Health Management Associates (HMA), a leading independent national consulting firm specializing in publicly funded healthcare, continues its growth with the opening of a new office in downtown Los Angeles.