This week, our In Focus section comes from 海角社区 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]
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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. 海角社区 has made the following observations related to the enrollment data shown on Table 1 (below):
海角社区 to lead jail-based opioid response program in Pennsylvania
In the nationwide effort to combat opioid use disorder (OUD), 海角社区 (海角社区) is expanding its successful Medications for Opioid Use Disorder (MOUD) initiative to jails in Pennsylvania counties. The multi-tiered technical assistance approach, developed by 海角社区 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 海角社区
海角社区 (海角社区) 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 海角社区 Medicaid Market Solutions (MMS) Managing Director Matt Powers and Managing Principal Sharon Silow-Carroll, and Independent Health Policy Consultant Jack Meyer. 海角社区 (海角社区) 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 海角社区 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.
海角社区 Principal authors chapter in AJN Book of the Year
Recently, the book, Nursing Informatics for the Advanced Practice Nurse: Patient Safety, Quality, Outcomes, and Interprofessionalism, which features a chapter written by 海角社区 Principal David Bergman, was awarded first place in the 2019 American Journal of Nursing Book of the Year Awards in the Informatics category.
Conservative states鈥� Medicaid expansion offers model for Missouri expansion
A new analysis of conservative state Medicaid expansion in Arkansas, Indiana and Ohio clarifies many of the questions raised about state-level costs and budget savings of a potential Missouri expansion. Researchers at 海角社区 interviewed leaders directly involved with expansion in these states to evaluate the policy and operational adjustments they undertook to design a budget-conscious program while maximizing state value.
Exploring value-based payment opportunities for long-term care providers
This week, our In Focus section reviews value-based payment (VBP) opportunities for long-term care providers. 海角社区 Principal Dana McHugh authored the article, 鈥淟ife Plan Communities and Value-Based Payments: Aligning Incentives So Everyone Benefits鈥�, for LeadingAge national magazine, discussing how life plan communities can establish value-based payment arrangements with managed care organizations (MCOs) to maximize value and add additional revenue streams.
New NCQA scoring – what health plans should know
Starting in 2020, a systemic shift will change the way health plans prepare for, and are scored, during National Committee for Quality Assurance (NCQA) accreditation. With the focus on quality of care, this transition means keeping up with new requirements is important now more than ever.
DC and Kentucky Medicaid Managed Care RFPs
This week, our In Focus section reviews two Medicaid managed care requests for proposals (RFPs) released on January 10, 2020. The District of Columbia Department of Health Care Finance (DHCF) issued an RFP for the DC Healthy Families Program (DCHFP); the District of Columbia Healthcare Alliance Program (Alliance); and the Immigrant Children鈥檚 Program (ICP) as part of a broader effort to fully transition Medicaid to managed care over the next five years. The new contracts will cover approximately 224,000 lives. Meanwhile, the Kentucky Cabinet for Health and Family Services (CHFS), Department for Medicaid Services (DMS) released a statewide Medicaid managed care RFP to serve approximately 1.2 million lives. In December 2019, Kentucky announced that it will cancel and rebid the current Medicaid managed care contracts.