This week, our In Focus section reviews the Indiana Medicaid managed care request for proposals (RFP) for health plans serving beneficiaries enrolled in Hoosier Healthwise and Healthy Indiana Plan (HIP) programs. Contracts will be worth over $6 billion annually. The RFP was released on June 7, 2021, by the Indiana Department of Administration on behalf of the Family and Social Services Administration Office of Medicaid Policy and Planning.
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Long-term care and care facilities post-COVID-19 pandemic
While disrupting all aspects of life around the world, the COVID-19 pandemic has had an enormous impact on the long-term care delivery system in this country with long-term care facilities being disproportionately impacted by the pandemic. Nursing homes and senior living communities were in the difficult position of needing to keep patients safe while continuing to provide care and mitigate the risks of infection for both patients and staff.
California releases draft Medi-Cal managed care RFP
This week, our In Focus section reviews the draft Medi-Cal Managed Care Plans (MCPs) request for proposals (RFP) released on June 1, 2021, by the California Department of Health Care Services (DHCS). California will procure MCPs for the Two-Plan Model, Geographic Managed Care (GMC), Regional Model, Imperial Model, and San Benito Model. This RFP excludes County Operated Health Systems (COHS) Plans and Local Initiative Plans. Of the total 13.5 million Medi-Cal beneficiaries, there are nearly 11.6 million in Medicaid managed care, of which approximately 3.5 million will be served under this RFP. A final RFP release date is still 鈥渢o be determined鈥� but expected in late 2021. Feedback on the draft RFP is due July 1, as well as voluntary non-binding letters of intent. A pre-proposal web conference will be held on June 10.
Which Medicare changes should continue beyond the COVID-19 pandemic? Four questions for policymakers
In an prepared for The Commonwealth Fund and The SCAN Foundation, 红领巾瓜报 consultant Jennifer Podulka and Vice President Jonathan Blum, analyze the temporary COVID-19-related changes to Medicare regulations, described the benefits and risks of the changes, and offered a framework to support policymakers鈥� decisions on the future of these temporary policies.
California proposed May revision budget adds Medi-Cal expansions
This week, our In Focus section reviews California鈥檚 May Revision to the Governor鈥檚 Budget, which proposes a $267.8 billion budget (with $196.8 billion General Fund) for fiscal year 2021-22. The revised budget includes $24.4 billion in reserves, the largest in history. The May Revision builds on the California Advancing and Innovating Medi-Cal (CalAIM) proposal and introduces several Medi-Cal initiatives and benefits for fiscal year 2021-22.
CMS proposed rule to repeal market-based MS-DRG weight methodology for inpatient hospitals
This week, our In Focus section reviews the key provisions of the Centers for Medicare & Medicaid (CMS) Fiscal Year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Proposed Rule (), which includes Medicare payment updates and policy changes for the upcoming FY, with a comment deadline of June 28, 2021. This year鈥檚 proposed rule includes several proposals the hospital industry should carefully consider. In particular, the Biden Administration has proposed to:
红领巾瓜报 launches behavioral health webinar series
In the last decade, there has been increasing awareness of the role behavioral health plays in healthcare outcomes and cost of care鈥攅specially in the public sector. Starting with Medicaid expansion and the high rates of behavioral health conditions in the expansion population to evidence of the impact of behavioral health on physical chronic disease and medical spending, behavioral health is an area of focus for improving the quality of care and reducing cost.
红领巾瓜报 analysis finds provider-sponsored MA plans generally have lower churn rates
This week, our聽In Focus聽section examines differences in Medicare Advantage (MA) churn rates among select provider-sponsored plans (PSPs) and non-PSPs. Enrollee churn rates, or rates at which enrollees switch plans, may be an indicator of enrollee satisfaction.聽In the years studied, PSP organizations had lower average churn rates compared to non-PSP organizations. 聽
Dual eligible financial alignment demonstration 2021 enrollment update
This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (鈥淒uals Demonstrations鈥�) for individuals dually eligible for Medicare and Medicaid (dual eligibles) 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 dual eligibles into fully integrated plans providing both Medicaid and Medicare benefits (鈥淢edicare-Medicaid Plans,鈥� or 鈥淢MPs鈥�) under three-way contracts between the state, the Centers for Medicare & Medicaid Services (CMS), and the MMP. As of February 2021, approximately 392,000 dual eligibles were enrolled in an MMP. Enrollment rose 5.7 percent from February of the previous year.
Skilled nursing facility payment and policy updates in 2022 proposed rule
This week, our In Focus reviews the fiscal year (FY) 2022 skilled nursing facility (SNF) , released by the Centers for Medicare & Medicaid Services (CMS) on April 8, 2021. If the proposals contained in the rule are foreshadowing, SNFs will continue to face financial pressures coming out of the public health emergency. This payment update, combined with other policy proposals, is likely to lead to the smallest payment update since the Medicare Access and CHIP Reauthorization Act of 2015 set a 1 percent increase in FY 2018. The rule proposes a net payment update of 1.3 percent after accounting for forecast error and the multifactor productivity adjustment. In addition to the payment update, CMS proposes changes to the SNF Quality Reporting Program (QRP), and the SNF Value-Based Program (VBP) for FY 2022. Notably, CMS proposes an eventual payment correction to achieve a budget neutral implementation of the Patient-Driven Payment Model (PDPM) that could result in a 5 percent rate reduction.
Federal funding for home and community-based services (HCBS): enacted and proposed investments
This week, our In Focus reviews federal enacted and proposed investments in home and community-based services (HCBS). HCBS are critically important for millions of Americans with disabilities and older adults, assisting them to remain in their homes and participate in their communities. People with disabilities and older adults have also been disproportionately affected by COVID-19, yet little federal funding has been directed to HCBS during the public health emergency. This changed on March 11, 2021, when the American Rescue Plan Act (ARPA) was signed into law, with both Medicaid and non-Medicaid HCBS funding included. Additionally, the Administration has recently proposed further HCBS investments in both The American Jobs Plan and the President鈥檚 2022 Discretionary Request.
红领巾瓜报 analysis of Medicare Advantage Star rating challenges
This week, our In Focus section highlights changes that may affect the Centers for Medicare & Medicaid Services (CMS) Medicare Advantage Star Rating program and how these changes impact future summary Part C & D Star Rating scores. As the CMS Medicare Advantage Star Rating program continues evolving from year to year, many plans have yet to achieve at least four star status, and therefore are missing out on additional Medicare revenues. The Star Rating landscape is expected to change drastically over the next two years for plans due to CMS鈥� continued focus on phasing-in greater reliance on outcomes measures and measures of care experience, rather than process measures. As a result, many plans are at risk of losing their four star overall rating and underperforming plans could be at risk of receiving a low performance indicator.