The Connecticut Office of Health Strategy and Department of Public Health recently announced that the State Innovation Model (SIM) Healthcare Innovation Steering Committee has approved the Health Enhancement Community (HEC) initiative proposed framework. This blueprint is designed to build or expand collaborations across the state to improve healthy weight and physical fitness, advance child well-being, and strengthen health equity. The HEC initiative will further residents’ health and well-being by addressing both clinical need and the social determinants that impact overall health.
This week, our In Focus section reviews the Texas 2020-21 biennium budget. The Texas Legislature adjourned its biennial legislative session on May 27, 2019, after adopting a $250.6 billion budget (all funds). The total budget is 6.3 percent higher than the 2018-19 budget with an increase of $14.8 billion.
This week, our In Focus section reviews the Pathways HUB model, an approach designed to help coordinate outreach by specialized community health workers who are incentivized to engage high-need populations. An HMA webinar, held May 9, 2019, with Mark Redding, co-developer of the Pathways HUB model, and Heidi Arthur, HMA can be viewed here.
On May 16, 2019, the Centers for Medicare & Medicaid Services (CMS) issued its final rule, Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses (Final Rule). The proposed rule, which was issued in November 2018, included a number of provisions intended to improve drug price transparency and expand use of utilization management tools to further Medicare Advantage and Part D cost-cutting efforts. However, in response to significant pushback from beneficiary advocates, physician groups, insurers, and pharmaceutical stakeholders, CMS elected not to implement key provisions. These include proposals to allow Part D plans to exclude protected class drugs from formularies as a result of price increases or if the drug is a new formulation of an existing single-source drug as well as proposed reforms to pharmacy price concessions that would require discounts be passed on to beneficiaries at the point of sale. Commenters in opposition to the pharmacy price concession proposal contend that these reforms would result in higher Part D premiums. While CMS has postponed addressing this provision in this Final Rule, the recently issued Department of Health and Human Services (HHS) Office of Inspector General (OIG) proposed rule, if finalized, may include fundamental changes to these pricing arrangements and other federal safe harbors to the anti-kickback statute.
This week, our In Focus section reviews the Kentucky Medicaid managed care organizations (MCOs) request for proposals (RFP), issued by the Kentucky Finance and Administration Cabinet on May 16, 2019. The Kentucky Cabinet for Health and Family Services (CHFS), Department for Medicaid Services (DMS) will select up to five Medicaid MCOs to manage health care services for more than 1.2 million people, starting July 2020. Contracts are estimated at more than $7 billion.
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, firstname.lastname@example.org.
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).