This week, our In Focus section summarizes the revised California Advancing and Innovating Medi-Cal (CalAIM) proposal, released on February 17, 2021. Medi-Cal, the state鈥檚 Medicaid program, covers over 12 million individuals, with over 11 million in managed care. CalAIM seeks to standardize and streamline the Medi-Cal program and address health disparities and social determinants of health for high-risk, high-cost Medi-Cal members through broad-based delivery system, program, and payment reform. CalAIM was originally scheduled to begin its tiered implementation in January 2021, but due to COVID-19 has been delayed until January 2022. The revised proposal incorporates additional stakeholder input, learnings from the workgroup meetings, and ongoing policy development.
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CMS Interoperability and Patient Access Final Rule 鈥� Part 1
This blog was written by Laura Zaremba, Principal, 海角社区, and Robert Chouinard, VP Public Sector, HealthEC
What are we really talking about?
CMS published the Interoperability and Patient Access Final Rule in the Federal Register on March 4, 2019, the pre-publication text of the final rule was released on March 9, 2020, and the final rule was published in the Federal Register on May 1, 2020. The rules are effective as of January 2021 and will be enforced by July 2021.
海角社区 provides updates in 2021 federal healthcare policy landscape
This week, our In Focus comes from an 海角社区 cross-cutting subject matter team, who have updated a core set of federal policy slides that analyzes recent federal policy actions following the Presidential and Congressional elections. It includes an analysis of President Biden’s $1.9 trillion COVID-19 relief legislation currently in development and recent CMS regulatory and administrative actions. Specifically, the analysis looks at:
Medicaid Managed Care Spending in 2020
This week, our In Focus section reviews preliminary 2020 Medicaid spending data collected in the annual CMS-64 Medicaid expenditure report. After submitting a Freedom of Information Act request to the Centers for Medicare & Medicaid Services (CMS), 海角社区 received a draft version of the CMS-64 report that is based on preliminary estimates of Medicaid spending by state for federal fiscal year (FFY) 2020. Based on the preliminary estimates, Medicaid expenditures on medical services across all 50 states and six territories in FFY 2020 exceeded $649.4 billion, with over half of the total now flowing through Medicaid managed care programs. In addition, total Medicaid spending on administrative services was $29.7 billion, bringing total program expenditures to $679.1 billion.
海角社区 enters strategic partnership with The College for Behavioral Health Leadership
海角社区 recently entered into a strategic partnership with The College for Behavioral Health Leadership (CBHL) for the 2021 calendar year.
Medicaid managed care enrollment update 鈥� Q4 2020
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 33 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 33 states highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2020. This report reflects the most recent data posted. 海角社区 has made the following observations related to the enrollment data shown on Table 1 (below):
New report supports state Medicaid programs in advancing health justice
Rates of illness and death due to the COVID-19 pandemic have disproportionally impacted Americans who are Black, African American, Latinx, Native American, Asian, and other people of color as well as people with disabilities and those subsisting on poverty-level income. In response to this, , in partnership with the a Massachusetts-based cross-disability advocacy and action research organization, released a new report: Advancing Health Justice Using Medicaid Data: Key Lessons from Minnesota for the Nation. This report provides information on the importance of investing in data analysis to advance health justice in Medicaid populations. It further highlights the importance of partnering with communities most impacted by injustices that cause inequities in health outcomes.
CMS Releases New Tools
Two new tools have been released by the Centers for Medicare & Medicaid Services (CMS) to help states and territories plan to transition back to regular operations after the COVID-19 public health emergency (PHE) ends.
MACPAC report examines Medicaid services for ID/DD populations
In a report to the Medicaid and CHIP Payment and Access Commission (MACPAC), 海角社区 consultants Sarah Barth, Sharon Lewis and former research assistant Taylor Simmons, provided insight and review of Medicaid services for people with intellectual or developmental disabilities (ID/DD).
CMS Innovation Center鈥檚 Geographic Direct Contracting Model opportunity
This week, our In Focus section reviews a new model 鈥� Geographic Direct Contracting 鈥� introduced by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. The model will test whether a geographic-based approach to care delivery and value-based care can improve health and reduce costs for Medicare beneficiaries enrolled in the traditional fee-for-service program across an entire region. This model represents one of the most transformational models released by the Innovation Center. During the 6-year Geographic Direct Contracting model performance period the traditional Medicare program will be replaced by the Direct Contracting program in the 10 selected regions.
Commonwealth Fund blog highlights Medicare changes due to COVID-19
Jennifer Podulka penned a for The Commonwealth Fund in conjunction with The SCAN Foundation, highlighting the legislative and regulatory changes made to Medicare in response to the COVID-19 pandemic. She was part of the 海角社区 team who authored an and policy tracker earlier this year.
The future of quality reporting: understanding digital quality measurement practices
In the wake of the COVID-19 pandemic, the need for greater health information technology interoperability, 鈥渄igital鈥� measures of healthcare quality and performance, and advanced value-based care systems has grown. In January 2021, the National Committee for Quality Assurance (NCQA) publicly released its vision for healthcare quality measurement to the Biden-Harris Department of Health and Human Services (HHS) transition team. The paper, focuses on four core areas, with three of them being specific to the evolution of a digital quality ecosystem: