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CMS Medicare Fee-For-Service FY2020 Proposed Rules: Hospital Outpatient Department and End-Stage Renal Disease

This week, our In Focus section reviews the new Centers for Medicare & Medicaid Services (CMS) Medicare Fee-For-Service FY 2020 proposed rules. On July 29, 2019, CMS issued the Calendar Year (CY) 2020 proposed rules for the Physician Fee Schedule (PFS), the hospital outpatient department (HOPD) and ambulatory surgical center (ASC) prospective payment systems (PPS), and the End-Stage Renal Disease (ESRD) PPS. These proposed regulations include payment rate and policy changes for the upcoming calendar year. The comment deadline for all three of these proposed rules is September 27, 2019.

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CMS Releases Section 1332 Waiver Application Resource Tools

This week, our In Focus section reviews the new 1332 State Relief and Empowerment Waiver resources released by the Centers for Medicare & Medicaid Services (CMS) on July 15, 2019. The new resources, intended to help states better understand regulations and reduce burdens associated with waiver application, include four waiver concept papers on how states can take advantage of the flexibility to wave certain Affordable Care Act (ACA) requirements, as well as their respective application templates. CMS has also released an updated application checklist of required elements.

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HMA Summary of CMS Innovation Models Pertaining to Radiation Oncology, Kidney Care, and End-Stage Renal Disease

This week, our In Focus section reviews the four new payment models addressing radiation oncology, kidney care, and end-stage renal disease released by the Centers for Medicare & Medicaid Services (CMS), through the Center for Medicare and Medicaid Innovation (CMMI) on July 10, 2019. Two of the models would be mandatory in randomly selected geographies and were published as proposed rules: the End-Stage Renal Disease Treatment Choices (ETC) and Radiation Oncology (RO) models. For these two proposed models, stakeholders have until what will likely be mid-September 2019 (60 days following publication of the forthcoming publication of the proposed rules in the federal register) to submit comments to CMS. The other two models are voluntary demonstrations: the Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) models. This is the first time this administration has proposed a mandatory model since the hip fracture and cardiac bundled payment models, which were cancelled in 2017. For these two models stakeholders will not have the opportunity to submit comments.

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California 2019-20 Budget Overview

This week, our In Focus section reviews the California fiscal 2019-20 budget. California Governor Gavin Newsom signed his first budget, and much of its related legislation on June 27, 2019. The budget appropriates $214.8 billion ($147.8 billion General Fund) in total spending with $19.2 billion in reserves. The total reserves includes $16.5 billion in the Rainy Day Fund, $1.4 billion in the Special Fund for Economic Uncertainties, $900 million in the Safety Net Reserve, and nearly $400 million in the Public School System Stabilization Account.

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Dual Eligible Financial Alignment Demonstration Enrollment Update

This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (“Duals Demonstrations”) for beneficiaries dually eligible for Medicare and Medicaid (duals) in nine states: California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, and Texas. Each of these states has begun either voluntary or passive enrollment of duals into fully integrated plans providing both Medicaid and Medicare benefits (“Medicare-Medicaid Plans,” or “MMPs”) under three-way contracts between the state, the Centers for Medicare & Medicaid Services (CMS), and the MMP. As of May 2019, approximately 372,600 duals were enrolled in an MMP. Enrollment was flat from May of the previous year.

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HMA, CMCS Launch Resource for Medicaid Innovation Program

A team of HMA consultants, led by Izanne Leonard-Haak and Matt Roan, have collaborated with organizations under a Centers for Medicaid and CHIP Services (CMCS) contract to provide support to CMCS on the Medicaid Innovation Accelerator Program.

HMA subject matter experts, Gina Eckart, Marlana Thieler, and Rich VandenHeuvel, provided guidance and education for the Reducing Substance Use Disorder and Improving Care for Medicaid Beneficiaries with Complex Care Needs and High Costs program areas through webinars, technical support assistance to participating states, resource papers, and bi-weekly program updates.

The team completed a webinar that launched a new technical resource describing approaches to combine Medicaid data with additional data sources to help state Medicaid agencies develop data analytics to better understand populations with serious mental illness. The webinar replay and transcripts are available on the CMS website.

Highlights from NASBO Spring 2019 Fiscal Survey of States

This week, our In Focus section section highlights some of the key findings of the Spring 2019 Fiscal Survey of States, released this month by the National Association of State Budget Officers (NASBO). The association conducted surveys of state budget officers in all 50 states from March through May 2019. The findings in the report focus on the key determinants of state fiscal health, highlighting data and state-by-state budget actions by area of spending. Below we summarize the major takeaway points from the report, as well as highlight key findings on Medicaid-specific and other health care budget items.

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New Opportunities and Requirements for Integrated Managed Care Models for Medicare-Medicaid Dually Eligible Individuals Served by Health Plans

This week, our In Focus section provides a high-level overview and an analysis for how health plans should consider two related and significant policy statements from the Centers for Medicare & Medicaid Services (CMS) about opportunities to further integrate care for dually eligible individuals.  Specifically, the CMS April 24, 2019, State Medicaid Director letter (SMDL) outlines new opportunities for states, largely working with health plans, to test models of integrated care, including opportunities to continue current financial alignment initiatives (FAIs).[i] CMS also issued final rules related to Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) definitions and requirements for Medicare-Medicaid integration activities and unified grievances and appeals for calendar year 2021.[ii] Together, these guidance documents should present greater opportunities for health plans to partner with CMS and states to integrate care for dual eligible beneficiaries.[iii]

Read MoreNew Opportunities and Requirements for Integrated Managed Care Models for Medicare-Medicaid Dually Eligible Individuals Served by Health Plans