This week, our In Focus section comes from 红领巾瓜报 Principals Ellen Breslin (MA) and Sharon Lewis (OR). In direct response to COVID-19, the Centers for Medicare & Medicaid Services (CMS) has encouraged states to maximize Medicaid flexibilities to protect people during the pandemic emergency. This includes state flexibilities for people receiving home and community-based services. States may temporarily amend their Home and Community-Based Services (HCBS) 1915(c) waivers through an expedited process by submitting an. As of March 31, 2020, CMS had approved Appendix K submissions for thirteen states with effective periods ranging from four months to one year.[1] 聽The thirteen states are: Alaska, Connecticut, Colorado, Hawaii, Iowa, Kentucky, Minnesota, New Mexico, Pennsylvania, Rhode Island, Washington, West Virginia and Wyoming.
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D-SNP 2021 hospital and SNF admission data sharing: opportunity for states and health plans to support care transitions
This week, our In Focus section provides an overview of new requirements and opportunities for states and Medicare Advantage (MA) Dual Eligible Special Needs Plans (D-SNPs) to increase Medicare and Medicaid聽 coordination in plan year 2021. Specifically, states and health plans will need to partner for compliance with calendar year (CY) 2021 Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) data sharing requirements for D-SNPs that are not designated as a fully integrated D-SNP (FIDE SNP) or a highly integrated D-SNP (HIDE SNP)[1]. CY 2021 State Medicaid Agency Contracts (SMACs) with these D-SNPs must document the notification process for sharing hospital and skilled nursing facility (SNF) admissions for at least one group of high-risk enrollees.[2]
红领巾瓜报 article highlights value-based payment models
With a focus on value-based payment (VBP) models and helping primary care practices prepare for a value-driven future, 红领巾瓜报 experts Suzanne Daub, Caroline Rosenzweig and Meggan Christmas Schilkie will publish their article in the American Psychological Association journal Families, Systems & Health.
Medicare and Medicaid flexibilities during public health emergencies
This week, our聽In Focus聽comes from 红领巾瓜报 Vice President聽Kathleen Nolan聽and Managing Principal聽Jon Blum.聽On March 13, 2020, President Trump declared a national emergency due to the rapid spread of COVID-19 virus. This declaration provides Health and Human Services (HHS) and the Centers of Medicare and Medicaid Services (CMS) new abilities to waive Medicare and Medicaid regulatory requirements to help health care providers, health plans and other stakeholders respond to immediate needs of their patients and communities.聽聽 In the past, HHS and CMS have solicited requests for relief needs from states, local providers and trade associations, among other stakeholders.聽 Health care providers, health plans and others should continue to monitor policy announcements from HHS and CMS and work with their states and trade associations to identify potential areas of need for requested regulatory relief.
红领巾瓜报 analysis of the 2020 Medicare Advantage annual election period
This week, our In Focus section examines Medicare Advantage (MA) enrollment changes resulting from the 2020 Annual Election Period (AEP). The AEP takes runs from October 15 to December 7 each year, and provides an opportunity for Medicare beneficiaries to sign up for, change, or disenroll from an MA plan for the upcoming year. The majority of enrollment changes occur during this period, but depending on beneficiary circumstances, additional opportunities may exist throughout the year to change coverage. Initial findings from the enrollment data suggest:
红领巾瓜报 analysis of new requirements expanding Medicare Advantage eligibility to individuals with end-stage renal disease
This week, our In Focus section comes from 红领巾瓜报 Principal Eric Hammelman and Senior Consultant Narda Ipakchi. Today, Medicare beneficiaries with End-Stage Renal Disease (ESRD) are only eligible to enroll in Medicare Advantage (MA) plans if they select a MA Special Needs Plan (SNP) that specifically serves individuals with ESRD or develop ESRD while already enrolled in a MA plan. In 2018, approximately 121,000 MA enrollees (0.6 percent of the MA population) had diagnoses of ESRD, accounting for approximately 20 percent of the total Medicare ESRD population.[1] The 21st Century Cures Act, which was passed in 2016, included a provision that alters the eligibility and enrollment options for Medicare beneficiaries with ESRD. Starting in 2021, Medicare beneficiaries with ESRD will be able to enroll in any MA plan in their area. The Centers for Medicare & Medicaid Services (CMS) estimates MA enrollment of individuals with ESRD will nearly double to 242,000 in 2024, or approximately 41 percent of the total Medicare ESRD population.[2]
Medicaid managed care enrollment update 鈥� Q4 2019
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 29 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 29 states highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2019. This report reflects the most recent data posted. 红领巾瓜报 has made the following observations related to the enrollment data shown on Table 1 (below):
红领巾瓜报 to lead jail-based opioid response program in Pennsylvania
In the nationwide effort to combat opioid use disorder (OUD), 红领巾瓜报 (红领巾瓜报) is expanding its successful Medications for Opioid Use Disorder (MOUD) initiative to jails in Pennsylvania counties. The multi-tiered technical assistance approach, developed by 红领巾瓜报 and implemented in the California correctional system, works to combat opioid overdoses by expanding access to treatment for OUD in jails and prisons.
POTUS FY 2021 Budget: Summary of Medicare provisions
This week, our In Focus section examines President Trump鈥檚 budget for fiscal year (FY) 2021. The budget includes a number of legislative and administrative proposals related to Medicare that are estimated to reduce net Medicare spending by $872 billion over the next ten years. It is important to note that the legislative proposals included in the President鈥檚 budget are non-binding and serve as recommendations to Congress where they may or may not be advanced. Under a Democratic-majority House of Representatives, many of the legislative proposals outlined in the FY 2021 budget are unlikely to advance. Administrative proposals are more likely to move forward, as the administration can implement these policies through its regulatory channels.聽
Former Illinois Medicaid director named COO of 红领巾瓜报
红领巾瓜报 (红领巾瓜报) announced today that Douglas (Doug) L. Elwell, who most recently served as Medicaid director for the State of Illinois in the Department of Healthcare and Family Services, has joined the firm as chief operating officer (COO).
Medicaid expansion in Missouri: economic implications and insights from Arkansas, Indiana, and Ohio
This week, our In Focus section covers the report, Medicaid Expansion in Missouri 鈥� Economic Implications for Missouri and Interviews Reflecting Arkansas, Indiana, and Ohio Experiences, prepared by 红领巾瓜报 Medicaid Market Solutions (MMS) Managing Director Matt Powers and Managing Principal Sharon Silow-Carroll, and Independent Health Policy Consultant Jack Meyer. 红领巾瓜报 (红领巾瓜报) conducted a targeted analysis of the likely economic impact of an ACA Medicaid Expansion in Missouri, with an emphasis on the effects on the state budget. The report was commissioned by the Missouri Hospital Association and Missouri Primary Care Association and released in partnership with stakeholders from the health care community in January 2020.
CMS Unveils Healthy Adult Opportunity
This week, our In Focus section comes from 红领巾瓜报 Medicaid Market Solutions (MMS) Managing Director Matt Powers and Senior Consultant Desmond Banks. On January 30, 2020, the Centers for Medicare & Medicaid Services (CMS) convened an event titled, Transforming Medicaid: A New Opportunity for Better Health, in Washington, DC, during which CMS Administrator Seema Verma announced the Healthy Adult Opportunity (HAO), an optional Section 1115 Medicaid Demonstration initiative. Commonly referred to as, 鈥渂lock grant鈥� or 鈥渟pending cap鈥� model, the HAO seeks to provide states with enhanced flexibility to design and administer parts of their Medicaid program. Administrator Verma articulated the HAO to be an important step to support the fiscal sustainability of Medicaid and invited state Medicaid directors to submit waiver applications.