This week, our In Focus summarizes the findings of an HMA Information Services analysis of Medicaid managed care plan profitabilty, based on data from annual statutory filings made with the National Association of Insurance Commissioners (NAIC). For information on how to subscribe to HMA Information Resources, contact Carl Mercurio, email@example.com.
This week, our In Focus section reviews updated information issued by the Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) on Medicaid expansion enrollment from the “January 2019 Medicaid and CHIP Applications, Eligibility Determination, and Enrollment Report,” published on April 25, 2019. Additionally, we review 2019 Exchange enrollment data from the “Health Insurance Exchanges 2019 Open Enrollment Period: Final State-Level Public Use File,” published by CMS on March 25, 2019. Combined, these reports present a picture of Medicaid and Exchange enrollment in 2019, representing 72.4 million Medicaid and CHIP enrollees and 11.4 million Exchange enrollees.
This week, our In Focus section reviews the Centers for Medicare & Medicaid Services (CMS)-issued Fiscal Year (FY) 2020 Medicare Part A proposed rules. Between April 17 and April 23, 2019, the CMS issued the proposed rules for general acute care hospitals paid under the Inpatient Prospective Payment System (IPPS), the skilled nursing facility (SNF) prospective payment system (PPS), the Inpatient Rehabilitation Facility (IRF) PPS, the Long-Term Care Hospital (LTCH) PPS, the Hospice PPS, and the Inpatient Psychiatric Facility (IPF) PPS. These proposed regulations include annual payment rate changes and other proposed policy changes. Comment deadlines for these rules vary.
Pre-Conference Workshop: September 8, 2019
Conference: September 9-10, 2019
Location: Chicago Marriott Downtown Magnificent Mile
Health Management Associates is proud to announce its fourth annual conference on trends in publicly sponsored health care: The Next Wave of Medicaid Growth and Opportunity: How Payers, Providers, and States Are Positioning Themselves for Success.
The HMA conference has emerged as a premier informational and networking event, attracting more than 450 executives and policy experts. Speakers this year include state Medicaid directors and leaders from Medicaid managed care, hospitals, clinics, community-based organizations, and other providers.
On April 22, 2019, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced the Primary Cares Initiative (PCI), which will present eligible providers and other entities with the opportunity to engage in value-based payment and direct contracting payment models for primary care beginning in January 2020. CMS designed PCI to reduce expenditures and preserve or enhance quality of care for beneficiaries in Medicare fee-for-service (FFS). PCI is comprised of two tracks, Primary Care First (PCF) and Direct Contracting (DC). The PCF track, which builds on the Comprehensive Primary Care Plus (CPC+) initiative, is intended for individual primary care practices and seeks to reward providers for reductions in hospital utilization and total cost of care through performance-based payment adjustments. Also, under the PCF track, practices that specialize in serving high-need and/or seriously ill populations will receive adjusted payments to account for the populations served. Providers that participate in these models will qualify as participating in an Advanced Alternative Payment Model and be eligible to receive full bonus payments under CMS’s Medicare Incentive Payment System (MIPS).
As the national opioid epidemic continues, HMA experts are sharing their vast knowledge and experience related to substance use disorders (SUD) and addiction treatment systems with providers, policymakers and other stakeholders addressing this crisis.
Medicare policy expert and HMA Managing Principal Jonathan Blum weighed in on the Trump administration’s recently proposed rules for pharmacy rebates and plans to reduce prescription drug prices in a blog post for Health Affairs.
Blum provided insight to questions about implementation of the proposed drug rebate reforms and whether they will lead to lower drug prices. The fundamental changes proposed would govern how pharmaceutical manufacturers pay rebates to pharmacy benefit managers and managed care plans contracted with Medicare, as well as state Medicaid programs.
He also addressed the variables outlined in the administration’s 2018 plan, American Patients First, which aim to reduce out-of-pocket costs and lower drug prices.
Blum joined HMA in 2018. In his previous leadership role at the Centers for Medicare and Medicaid Services from 2009-2014 he had direct responsibility for administration of the Medicare program.
A team of HMA colleagues including Sarah Barth, Sharon Silow-Carroll, Esther Reagan, Mary Russell and Taylor Simmons completed a study for the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) to examine care coordination requirements for several Medicare-Medicaid integrated care models.
The study’s final report, Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries – Health Plan Standards, Challenges and Evolving Approaches, is posted to the MACPAC website.
The final report details state and federal managed care contract requirements for care coordination, summarizes stakeholders’ perspectives on care coordination based on structured interviews, and highlights promising care coordination practices and challenges for ensuring effective care coordination for dually eligible beneficiaries.
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 Centers for Medicare & Medicaid Services (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) 2018. The final version of the report will be completed by the end of 2019 and posted to the CMS website at that time. Based on the preliminary estimates, Medicaid expenditures on medical services across all 50 states and six territories in FFY 2018 exceeded $588 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 $616 billion.
This week, our In Focus reviews the Calendar Year (CY) 2020 Medicare Advantage (MA) and Part D Flexibility Final Rule (Final Rule) issued by the Centers for Medicare & Medicaid Services (CMS) on April 5, 2019. The Final Rule implemented various provisions contained in the Bipartisan Budget Act of 2018 (BBA), which required the expansion of MA telehealth benefits and established new criteria for Dual Eligible Special Needs Plans (D-SNPs) integration requirements and streamlined Medicare and Medicaid grievance and appeals processes. The Final Rule also established rules to improve MA and Part D program quality and accessibility, clarified program integrity policies, and established new rules for the MA and Part D Quality Rating System.