CMS Interoperability and Patient Access Final Rule – Part 1

This blog was written by Laura Zaremba, Principal, HMA, and Robert Chouinard, VP Public Sector, HealthEC

What are we really talking about?

CMS published the Interoperability and Patient Access Final Rule in the Federal Register on March 4, 2019, the pre-publication text of the final rule was released on March 9, 2020, and the final rule was published in the Federal Register on May 1, 2020. The rules are effective as of January 2021 and will be enforced by July 2021.

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Health Management Associates Provides Updates in 2021 Federal Healthcare Policy Landscape

This week, our In Focus comes from an HMA cross-cutting subject matter team, who have updated a core set of federal policy slides that analyzes recent federal policy actions following the Presidential and Congressional elections. It includes an analysis of President Biden’s $1.9 trillion COVID-19 relief legislation currently in development and recent CMS regulatory and administrative actions. Specifically, the analysis looks at:

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Medicaid Managed Care Spending in 2020

This week, our In Focus section reviews preliminary 2020 Medicaid spending data collected in the annual CMS-64 Medicaid expenditure report. After submitting a Freedom of Information Act request to the Centers for Medicare & Medicaid Services (CMS), HMA 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) 2020. Based on the preliminary estimates, Medicaid expenditures on medical services across all 50 states and six territories in FFY 2020 exceeded $649.4 billion, with over half of the total now flowing through Medicaid managed care programs. In addition, total Medicaid spending on administrative services was $29.7 billion, bringing total program expenditures to $679.1 billion.

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Medicaid Managed Care Enrollment Update – Q4 2020

This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 33 states.[1] Many state Medicaid agencies post monthly enrollment figures by health plan for their Medicaid managed care population to their websites. This data allows for the timeliest analysis of enrollment trends across states and managed care organizations. All 33 states highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2020. This report reflects the most recent data posted. HMA has made the following observations related to the enrollment data shown on Table 1 (below):

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New Report Supports State Medicaid Programs to Advance Health Justice

Rates of illness and death due to the COVID-19 pandemic have disproportionally impacted Americans who are Black, African American, Latinx, Native American, Asian, and other people of color as well as people with disabilities and those subsisting on poverty-level income. In response to this, AcademyHealth, in partnership with the Disability Policy Consortium (DPC), a Massachusetts-based cross-disability advocacy and action research organization, released a new report: Advancing Health Justice Using Medicaid Data: Key Lessons from Minnesota for the Nation. This report provides information on the importance of investing in data analysis to advance health justice in Medicaid populations. It further highlights the importance of partnering with communities most impacted by injustices that cause inequities in health outcomes.

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CMS Releases New Tools

Two new tools have been released by the Centers for Medicare & Medicaid Services (CMS) to help states and territories plan to transition back to regular operations after the COVID-19 public health emergency (PHE) ends.

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The Centers for Medicare & Medicaid Services Innovation Center’s Geographic Direct Contracting Model Opportunity

This week, our In Focus section reviews a new model – Geographic Direct Contracting – introduced by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. The model will test whether a geographic-based approach to care delivery and value-based care can improve health and reduce costs for Medicare beneficiaries enrolled in the traditional fee-for-service program across an entire region. This model represents one of the most transformational models released by the Innovation Center.  During the 6-year Geographic Direct Contracting model performance period the traditional Medicare program will be replaced by the Direct Contracting program in the 10 selected regions.

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