This week, our In Focus section reviews two Medicare fee-for-service (FFS) proposed rules recently issued by the Centers for Medicare & Medicaid Services (CMS). On August 3, 2020, CMS released a proposed rule that includes updates to services furnished under the Medicare Physician Fee Schedule (PFS). On August 4, CMS released the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule. These proposed regulations include payment rate and policy changes for the upcoming calendar year. Key features in this year鈥檚 PFS proposed rule include: policies to retain, extend, or end certain telehealth flexibilities implemented in response to the novel COVID-19 public health emergency (PHE), changes to enable certain health care professionals to practice at the top of their licenses, modifications to opioid treatment programs (OTPs), and updates to the Medicare Shared Savings Program (MSSP). Additional information on the PFS Proposed Rule can be found here. Among the most notable policy changes in the OPPS and ASC proposed rule are: 1) transitioning services to lower cost settings by eliminating the inpatient-only list to enable more services to be provided in the outpatient settings and increasing the scope of procedures that can be provided in ASCs, 2) further reducing payments for the 340B drug program, and 3) modifying the formula for calculating Hospital Star Ratings, and expand the use of prior authorization for outpatient services. Additional information about these proposals can be found here.
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Regulatory changes to Medicare in response to COVID-19
This week, our In Focus section examines how the federal government implemented changes to the Medicare program in response to COVID-19.听 As the COVID-19 pandemic began in the United States, Congress and the Administration responded with a series of legislative, regulatory, and sub-regulatory changes to the Medicare program that were designed to provide relief from certain Medicare rules to assist health care providers, Medicare Advantage organizations, and Part D plans in responding to the pandemic. Some of these changes waived conditions of Medicare participation to enable patients to be treated in alternative care settings. Others permitted physicians and other providers to receive Medicare reimbursements for telemedicine services.
海角社区 Information Services adds Medicare Advantage competitive data and state profiles
海角社区 Information Services (海角社区IS) is pleased to announce the expansion of its industry-leading healthcare information website to include information and state-by-state profiles of the market for Medicare Advantage and Special Needs Plans (SNPs).
Hawaii Releases Quest Integration Reprocurement RFI
This week, our In Focus section reviews the Hawaii request for information (RFI) regarding reprocurement of the state鈥檚 QUEST Integration (QI) Medicaid managed care program, released on July 21, 2020. QI covers approximately 360,000 individuals, including pregnant women, children, parents/caretakers, adults, and individuals who are aged, blind, or disabled (ABD). The state had awarded contracts earlier this year, however, the contracts were rescinded as the state focused on their response to COVID-19.
Oklahoma releases Medicaid managed care request for public feedback
This week, our In Focus section reviews the Oklahoma request for public feedback in the SoonerCare program design, released on June 18, 2020. The Oklahoma Health Care Authority (OHCA) and Governor Kevin Stitt are seeking stakeholder input for the state鈥檚 Medicaid managed care program design before finalizing a request for proposals (RFP). The RFP, which is currently in development, is scheduled to drop in the fall and has an implementation date of October 2021. Individuals, program participants, providers, trade associations, companies, and other organizations are encouraged to submit responses by August 17, 2020.
海角社区 announces cancellation of 2020 annual conference
海角社区 has made the decision to cancel its October 2020 conference on Trends in Publicly Sponsored Healthcare, given continuing developments concerning COVID-19 and out of an abundance of caution for the safety of attendees, speakers, and staff. Full refunds will be made to registered attendees and sponsors.
Early Bird Registration Expires July 29 for 海角社区 Conference, October 26-27 in Chicago
Be sure to register soon for 海角社区鈥檚 conference on What鈥檚 Next for Medicaid, Medicare, and Publicly Sponsored Healthcare: How Payers, Providers, and States Are Navigating a Future of Opportunity and Uncertainty, October 26-27, at the Fairmont Chicago, Millennium Park. The Early Bird registration rate of $1595 per person expires on July 29.听 After that, the rate is $1795.
Medicaid and exchange enrollment update 鈥� March 2020
This week, our In Focus section reviews updated information issued by the Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) on Medicaid expansion enrollment from the 鈥淢arch 2020 Medicaid and CHIP Applications, Eligibility Determination, and Enrollment Report,鈥� published on June 22, 2020. Additionally, we review 2020 Exchange enrollment data from the 鈥淗ealth Insurance Exchanges 2020 Open Enrollment Period: Final State-Level Public Use File,鈥� published by CMS on April 2, 2020. Combined, these reports present a picture of Medicaid and Exchange enrollment in early 2020, leading up to the COVID-19 pandemic and representing 70.9 million Medicaid and CHIP enrollees and 11.4 million Exchange enrollees. Medicaid/CHIP and Exchange enrollment is expected to rise in 2020 according to a team of 海角社区 Medicaid experts, health economists, and data analysts. Read the previous In Focus on 海角社区鈥檚 forecast model.
GAO 50-state Medicaid survey on federal policy challenges
This week our In Focus section summarizes the United States Government Accountability Office (GAO) Medicaid report, State Views on Program Administration Challenges, released earlier this year. GAO conducted interviews with Medicaid officials from 50 states and the District of Columbia to identify challenges related to federal Medicaid policies. 听
CMS updates Medicare Advantage and Section 1876 cost plan network adequacy
This week, our In Focus section examines new guidance issued by the Centers for Medicare & Medicaid Services (CMS) regarding Medicare Advantage (MA) plan network adequacy requirements. On June 17, 2020, CMS released updated Medicare Advantage and 1876 Cost Plan Network Adequacy Guidance for Medicare Advantage (MA) health plans to use now for Contract Year 2021 network submission.
New report highlights IEHP鈥檚 establishment of 50 care teams for Health Homes Program services
A new report has been released outlining Inland Empire Health Plan鈥檚 (IEHP) efforts to establish 50 care teams to support the delivery of core Health Homes Program services for IEHP鈥檚 most vulnerable members with complex health conditions.
海角社区 contributed to the new report and has supported implementation of IEHP鈥檚 Health Homes Program since 2018, providing consultation in the development and implementation of a clinical model of care,听the design and deployment of a population health management tool, the creation and delivery of a multi-modal training program, and the provision of practice coaching to over 50 care teams.
海角社区-developed medications for addiction treatment (MAT) training for justice and child welfare now available online
Focused on ongoing support and solutions for those living with opioid use disorder (OUD), 海角社区 (海角社区) has developed a robust web-based training program about addiction and its treatment in the criminal justice and child welfare systems, including access to, and continued use of, medications for addiction treatment (MAT).