This week, our In Focus section reviews the Hawaii Quest Integration (QI) Medicaid managed care request for proposals (RFP) released on December 8, 2020, and the Minnesota Families and Children Medical Assistance (MA) and MinnesotaCare programs RFP released on January 4, 2021.
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2020 Highlights: Key Trends in Medicare-Medicaid Integration
This week, our In Focus section focuses on five critical policy and program trends to provide integrated care to dual-eligible individuals for Medicare and Medicaid. Both federal and state governments continue to look for ways to improve coordination and integration for this population. We anticipate the emphasis on innovative approaches to whole person, person-centered care, care management and coordination, care transitions, and regulatory oversight to persist. 2020 has been an active year of policymaking by the Centers for Medicare & Medicaid Services (CMS) and states. 红领巾瓜报 distilled the themes and their strategic implications in this article. We continue to assist clients in tracking new policies and industry trends, developing innovative plans and strategies, and delivering high quality care and services to this population.
CMS finalizes expanded Medicare telehealth coverage through 2021
This week, our In Focus section reviews the finalized coverage expansions for Medicare telehealth services in the Centers for Medicare & Medicaid Services (CMS) Calendar Year (CY) 2021 Physician Fee Schedule (PFS) Final Rule. Telehealth advocates will be pleased to see meaningful expansions; however, the response of advocates will also be tempered by the impending return of the geographic and site of service limitations that will follow at the conclusion of the COVID-19 Public Health Emergency (PHE). During the PHE, millions of patients and providers increased their use of telehealth services to expand access to care. Given this shift in the delivery of care, telehealth advocates had been hopeful CMS would make extensive permanent coverage expansions in the Medicare program. In light of this, CMS鈥檚 new regulation will come as a reminder to many that the key to long term expansions of Medicare telehealth coverage lies in the hands of the U.S. Congress.
North Carolina releases RFA for behavioral health, IDD tailored plans
This week, our In Focus section reviews the statewide North Carolina request for applications (RFA) for Behavioral Health and Intellectual/Developmental Disability (BH IDD) Tailored Plans released by the North Carolina Department of Health and Human Services (DHHS) on November 13, 2020. BH IDD Tailored Plans are part of the statewide effort to transition to Medicaid managed care and are one of the four types of integrated Medicaid managed care plans the state will contract with to serve Medicaid and NC Health Choice beneficiaries. The other three are Standard Plans, the Statewide Specialized Foster Care Plan, and the Eastern Band of Cherokee Indians Tribal Option.
CMS Introduces New Medicare Direct Contracting Model Opportunity
This week, our In Focus section looks at a new Medicare model, Direct Contracting, introduced by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. The new model will build on and continue testing potential reforms to the Medicare program encompassed by accountable care organizations (ACOs), Medicare Advantage (MA), and private sector risk-sharing arrangements. The payment model options may appeal to a broad range of physician and provider groups and other organizations because they are expected to introduce flexibility in health care delivery, support a focus on beneficiaries with complex, chronic conditions, and encourage participation from organizations that have not typically participated in traditional fee-for-service (FFS) Medicare or CMS Innovation Center models. However, there will be substantial financial risk鈥攁nd reward鈥攆or participants based on a new, complex methodology, so organizations interested in this new model should carefully consider the possible outcomes from participating in Direct Contracting versus other options. CMS has announced that will participate in the model鈥檚 trial Implementation Period, which runs from October 1, 2020, through March 31, 2021. The agency has stated that it expects to announce additional Direct Contracting pathways in the future and that the next round of applications for participation in the second performance year will open in early 2021.
红领巾瓜报 colleagues author case studies on two-generation approach to addressing inequities in D.C. and Maryland
Focused on addressing inequities and building more sustainable and vital futures for low-income families in Washington, D.C., and the state of Maryland, colleagues from 红领巾瓜报 (红领巾瓜报) authored two case studies under the auspices of Ascend at the Aspen Institute, a hub for breakthrough ideas and collaborations that move children and their parents toward educational success and economic security.
A short-term solution to ACA uncertainty amid ongoing pandemic
In this week鈥檚 In Focus section, 红领巾瓜报 (红领巾瓜报) Managing Director MMS Matt Powers, Senior Consultant Kaitlyn Feiock, and Regional Vice President Kathleen Nolan look at the future of the Patient Protection and Affordable Care Act (ACA). On November 10, 2020, the Supreme Court of the United States (SCOTUS) heard oral arguments for California v. Texas, challenging the constitutionality and severability of the ACA. This challenge became possible after the 2017 Tax Cuts and Jobs Act, which zeroed out the individual mandate penalty for not purchasing health insurance. While most experts agree that an entire invalidation of the ACA is the least likely outcome based on the oral arguments, some uncertainty remains and more than $100 billion federal funds are at risk. The ACA standardized insurance rules offset premium costs for many individual market consumers and provided authority and funding for Medicaid Expansions in the overwhelming majority of states. The ACA also included other provisions that may be at risk but are not the subject of this note, such as the creation of Center for Medicare and Medicaid Innovation (CMMI) and the Medicare-Medicaid Coordination Office, as well as demonstration authority that has led to the creation of numerous coverage models. As states, Congress, and the federal executive branch face the possibility that the ACA may not survive in its present form, what mitigation strategies are available at the state and federal levels to stabilize uncertainties and protect against abrupt coverage changes?
Oklahoma, North Dakota release Medicaid managed care RFPs
This week, our In Focus section reviews the statewide Oklahoma Medicaid managed care request for proposals (RFP) released by the Oklahoma Health Care Authority on October 15, 2020, and the North Dakota Medicaid expansion managed care RFP released by the North Dakota Department of Human Services, Medical Services Division on October 20, 2020.
Evidence-based programs paper authored by 红领巾瓜报 colleagues
红领巾瓜报 (红领巾瓜报), in contract with The National Council on Aging (NCOA), and with support from the Administration for Community Living (ACL), recently provided research and strategy services to support the goal to increase the adoption of evidence-based health promotion and disease prevention programs, known as evidence-based programs (EBPs) by Medicaid, Medicare, and other health insurance markets.
Highlights from the 20th annual Kaiser/红领巾瓜报 50-state Medicaid director survey
This week, our In Focus section shares highlights and key takeaways from the 20th annual Medicaid Budget Survey conducted by The Kaiser Family Foundation (KFF) and 红领巾瓜报 (红领巾瓜报). Survey results were released on October 14, 2020, in two new reports: State Medicaid Programs Respond to Meet COVID-19 Challenges: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2020 and 2021 and Medicaid Enrollment & Spending Growth: FY 2020 & 2021. The reports were prepared by Kathleen Giff颅ord, Aimee Lashbrook, and Sarah Barth from 红领巾瓜报 and by Elizabeth Hinton, Robin Rudowitz, Madeline Guth, and Lina Stolyar from the Kaiser Family Foundation. The survey was conducted in collaboration with the National Association of Medicaid Directors.
红领巾瓜报 Summary of UnitedHealth Group鈥檚 鈥楾he Path Forward鈥�
This week, our In Focus section reviews UnitedHealth Group鈥檚 The Path Forward to a Next-Generation Health System, an outline of policy recommendations to achieve a high-quality, affordable health care system. The paper focuses on four goals: 1) achieve universal coverage; 2) improve health care affordability; 3) enhance the health care experience; and 4) drive better health outcomes. UnitedHealth Group (United) advocates for expanding Medicaid in the remaining states, passively enrolling individuals into Medicaid and the Exchanges, implementing a Medicaid Buy-In program, transitioning Medicaid fee-for-service (FFS) programs to managed care, strengthening Medicare Advantage, eliminating surprise billing, expanding access to telehealth, in addition to other policies.
Ohio Releases Medicaid Managed Care RFA
This week, our In Focus section reviews the Ohio Medicaid Managed Care request for applications (RFA) released by the Ohio Department of Medicaid (ODM) on September 30, 2020. The RFA follows the release of two requests for information (RFIs) in June 2019 and February 2020, soliciting feedback from individuals, providers, and interested bidders to help design a new Medicaid managed care program. Ohio will award contracts, worth over $11 billion annually, to no more than five managed care organizations (MCOs) in each of the state鈥檚 three regions (Central/Southeast Region, Northeast Region, and West Region), with implementation beginning January 5, 2022. The procurement will not include the MyCare Ohio dual demonstration.