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Hawaii Releases Quest Integration Medicaid Managed Care RFP

This week, our In Focus section reviews the Hawaii QUEST Integration (QI) Medicaid Managed Care request for proposals (RFP), issued by the Hawaii Department of Human Services (DHS) on August 26, 2019. DHS intends to contract with four health plans. All four will serve Medicaid and Children’s Health Insurance Program (CHIP) members in Oahu, while two will also operate statewide. The two plans with the highest scoring technical proposals will serve beneficiaries statewide. The Quest Integration program is worth $2.2 billion annually.

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Strategies to Support Postpartum Visits for Women in Medicaid

This week, our In Focus section comes from HMA Community Strategies (HMACS) Senior Associate Diana Rodin and HMA Managing Principal Sharon Silow-Carroll who authored a recent article in the Journal of Women’s Health drawing on data from the recently completed five-year evaluation of the Strong Start for Mothers and Newborns II Initiative to identify promising approaches to support women in Medicaid to attend postpartum visits. Nationally, less than 60 percent of women enrolled in Medicaid or the State Children’s Health Insurance Program attend a scheduled postpartum medical visit, and some states have much lower rates.[1],[2]

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HMA Colleagues Author Journal Article on Strategies to Support Postpartum Visits for Women in Medicaid

HMA Community Strategies (HMACS) Senior Associate Diana Rodin and HMA Managing Principal Sharon Silow-Carroll have authored an article drawing on data from the recently completed five-year evaluation of the Strong Start for Mothers and Newborns II Initiative to identify promising approaches to support women in Medicaid to attend postpartum visits.

Read MoreHMA Colleagues Author Journal Article on Strategies to Support Postpartum Visits for Women in Medicaid

CMS Medicare Fee-For-Service FY 2020 Proposed Rules Part 2: Physician Fee Schedule and Home Health

This week, our In Focus section reviews the new Centers for Medicare & Medicaid Services (CMS) Medicare Fee-For-Service FY 2020 proposed rules: the Physician Fee Schedule (PFS), released on July 2019, and Home Health prospective payment system, released on July 11, 2019. For the hospital outpatient department (HOPD) and ambulatory surgical center (ASC) prospective payment systems (PPS) and the End-Stage Renal Disease (ESRD) PPS proposed rules, please see last week’s In Focus here.

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National Jail-Based Opioid Treatment Program Expands

A successful approach to expanding access to jail-based opioid treatment, that began in California, will grow to 16 additional counties across the country. Health Management Associates (HMA), a leading healthcare consulting firm, developed the program blueprint which was successfully deployed in 29 California counties and resulted in better access to Medication Assisted Treatment (MAT) for those in the criminal justice system.

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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.

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