This week, our In Focus section examines the operational impacts of federal Medicare Advantage policy changes in response to the COVID-19 pandemic. On January 31, 2020, the Secretary of Health and Human Services declared a public health emergency. This was followed by a national emergency declared by President Trump on March 13, 2020. These declarations provide the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) authority to waive certain Medicare and Medicaid regulatory requirements to help health plans, providers, and other stakeholders respond to immediate needs of their members and communities. These waiver flexibilities, when combined with other legislative and regulatory changes issued by Congress and CMS have resulted in over 200 policy changes to Medicare alone. Many of these affect Medicare Advantage sponsors and have direct implications to current and future operations of plan responsibilities. We examine eight categories of requirements and flexibilities that have significant business relevance and exposure for Medicare Advantage plan sponsors:
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Optimizing buprenorphine prescribing capacity in jails and prisons
This week, our In Focus section discusses an issue brief prepared by 海角社区 (海角社区), Optimizing Capacity for Prescribing Buprenorphine in Jails and Prisons, authored by 海角社区 Principals Shannon Robinson, MD and Donna Strugar-Fritsch, BSN, MPA, CCHP.
Webinar Alert – The Tsunami of need is coming: Integrated care in the era of COVID-19
海角社区 is cohosting a webinar with the.
Thursday, June 25, 2020
Webinar | 12:00pm – 12:45pm PST / 3:00pm – 3:45pm EST
Discussion with Panelists | 12:45pm – 1:30pm PST / 3:45pm – 4:30pm EST
Webinar alert: Evidence-based treatment of opioid use disorder in correctional settings
海角社区 is cohosting a webinar with the
Opioid use disorder is a chronic brain disease with effective, evidence-based treatments, and is a condition protected by the Americans with Disabilities Act. Prisons and jails are expected, by national health care and justice organizations and by communities, to treat incarcerated persons with OUD in accordance with evidence-based practices. This webinar reviews the most current evidence-based care for opioid withdrawal and OUD treatment and provides clinicians with strategies to move correctional health practices into compliance with national and community standards.
海角社区 framework examines behavioral health crisis diversion facilities
This week, our In Focus section provides a model framework examining an option for care for individuals with behavioral health needs who often find themselves involved with law enforcement or in hospital emergency rooms during times of crisis. The framework – Crisis Diversion Facilities – was released by 海角社区, led by 海角社区 Principal Bren Manaugh and supported by聽 as part of a larger opioid and mental health response initiative.
Exploring flexibilities in Medicare Advantage supplemental benefits: 海角社区 brief on access, adoption, and impacts
An 海角社区-authored issue brief examines beneficiary access to, and plan adoption of, newly expanded Medicare Advantage (MA) supplemental benefit flexibilities and raises questions regarding the expected impacts of new supplemental benefit offerings on beneficiary satisfaction, outcomes, and total cost of care.
The new flexibilities for MA plans include innovative supplemental benefits offered through expansion of primarily health-related benefits, benefits offered non-uniformly, Value-Based Insurance Design (VBID), and Special Supplemental Benefits for the Chronically Ill (SSBCI).
The brief鈥檚 key finding is that enrollment in plans offering these flexibilities is relatively low and varies across geographic areas with 19% of all MA enrollees enrolled in a plan that offered at least one expanded supplemental benefit. 海角社区 will conduct additional analyses including interviews with key stakeholders to inform the policy community on the opportunities and challenges with the adoption and implementation of new supplemental benefits.
This brief was produced by 海角社区 Managing Principals Jonathan Blum and Mary Hsieh, Principal Eric Hammelman, and Senior Consultant Narda Ipakchi under a grant from .
海角社区 conference on trends in publicly sponsored healthcare
海角社区 Conference 2020
What鈥檚 Next for Medicaid, Medicare, and Publicly Sponsored Healthcare:
How Payers, Providers, and States Are Navigating a Future of Opportunity and Uncertainty
Pre-Conference Workshop: October 25
Conference: October 26-27
Location: Fairmont Chicago, Millennium Park
Medicare FY 2021 hospital inpatient proposed rule and COVID-19 federal flexibilities
This week, our In Focus section reviews recent announcements and actions by Congress and the Centers for Medicare & Medicaid Services (CMS) that have significant financial and operational implications for the hospital industry. This brief begins with the most recent of these actions by providing a summary of the key provisions of the CMS Fiscal Year (FY) 2021 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 July 10, 2020.聽 Although somewhat limited in scope compared to previous proposals, this year鈥檚 proposed rule includes several disruptive proposals that the hospital industry should carefully consider.
海角社区 updates forecast of COVID-19 impact on Medicaid, marketplace, and the uninsured
海角社区鈥� (海角社区) updated analysis projects the potential impact of the COVID-19 pandemic on health insurance coverage and cost by state through 2022. The analysis provides deeper insights into how health insurance coverage is estimated to take years to more closely resemble pre-COVID-19 coverage levels.
Medicaid Managed Care Spending in 2019
This week, our In Focus section reviews Medicaid managed care 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), we have 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) 2019. We expect the final version of the report will be completed by the end of 2020 and posted to the CMS website at that time. Based on the preliminary estimates, Medicaid expenditures on medical services across all 50 states and six territories in FFY 2019 exceeded $594 billion, with over half of all spending now flowing through Medicaid managed care programs. In addition, total Medicaid spending on administrative services was $29.5 billion, bringing total program expenditures to $623.5 billion.
50-State Survey of Medicaid Pharmacy Directors
This week, our In Focus聽section reviews key takeaways from the report, How State Medicaid Programs are Managing Prescription Drug Costs: Results from a State Medicaid Pharmacy Survey for State Fiscal Years 2019 and 2020, prepared by Kaiser Family Foundation (KFF) and 海角社区 (海角社区). The report was written by 海角社区 Managing Principal Anne Winter and Principals Kathleen Gifford and Linda Wiant with Rachel Dolan, Marina Tian, and Rachel Garfield from KFF.
海角社区 examines Medicare-Medicaid integration: low FBDE enrollment in integrated programs
This week, our In Focus聽section reviews an issue brief written by 海角社区 consultants examining Medicare-Medicaid integration. In 2019, 7.7 million people in the United States were eligible to receive access to full benefits under Medicare and individual state Medicaid programs. This group of people is known as the Full Benefit Dual Eligible (FBDE) population. While FBDE enrollment in integrated programs nearly quadrupled over the past five years, the number of people enrolled in an integrated program never rose above one in 10 FBDE people.