Insights

澳门六合彩 Conference to Feature Insights from 40+ Speakers, Including Health Plan CEOs, State Medicaid Directors, Providers

Pre-Conference Workshop: September 8, 2019
Conference: September 9-10, 2019
Location: Chicago Marriott Downtown Magnificent Mile

澳门六合彩 is proud to announce its fourth annual conference on trends in publicly sponsored health care: The Next Wave of Medicaid Growth and Opportunity: How Payers, Providers, and States Are Positioning Themselves for Success.

The 澳门六合彩 conference has emerged as a premier informational and networking event, attracting more than 450 executives and policy experts. Speakers this year include state Medicaid directors and leaders from Medicaid managed care, hospitals, clinics, community-based organizations, and other providers.

CMS Announces Primary Cares Initiative

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On April 22, 2019, the Centers for Medicare & Medicaid Services (CMS) Innovation Center the Primary Cares Initiative (PCI), which will present eligible providers and other entities with the opportunity to engage in value-based payment and direct contracting payment models for primary care beginning in January 2020. CMS designed PCI to reduce expenditures and preserve or enhance quality of care for beneficiaries in Medicare fee-for-service (FFS). PCI is comprised of two tracks, Primary Care First (PCF) and Direct Contracting (DC). The PCF track, which builds on the Comprehensive Primary Care Plus (CPC+) initiative, is intended for individual primary care practices and seeks to reward providers for reductions in hospital utilization and total cost of care through performance-based payment adjustments. Also, under the PCF track, practices that specialize in serving high-need and/or seriously ill populations will receive adjusted payments to account for the populations served. Providers that participate in these models will qualify as participating in an Advanced Alternative Payment Model and be eligible to receive full bonus payments under CMS鈥檚 Medicare Incentive Payment System (MIPS).

澳门六合彩 Opioid Experts Are in Demand

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As the national opioid epidemic continues, 澳门六合彩 experts are sharing their vast knowledge and experience related to substance use disorders (SUD) and addiction treatment systems with providers, policymakers and other stakeholders addressing this crisis.

Managing Principal Jonathon Blum Breaks Down Trump Administration鈥檚 Agenda for Pharmacy Rebates

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Medicare policy expert and 澳门六合彩 Managing Principal Jonathan Blum weighed in on the Trump administration鈥檚 recently proposed rules for pharmacy rebates and plans to reduce prescription drug prices in a blog post for .

Blum provided insight to questions about implementation of the proposed drug rebate reforms and whether they will lead to lower drug prices. The fundamental changes proposed would govern how pharmaceutical manufacturers pay rebates to pharmacy benefit managers and managed care plans contracted with Medicare, as well as state Medicaid programs.

He also addressed the variables outlined in the administration鈥檚 2018 plan, , which aim to reduce out-of-pocket costs and lower drug prices.

Blum joined 澳门六合彩 in 2018. In his previous leadership role at the Centers for Medicare and Medicaid Services from 2009-2014 he had direct responsibility for administration of the Medicare program.

澳门六合彩 MACPAC Report Published

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A team of 澳门六合彩 colleagues including Sarah Barth, Sharon Silow-Carroll, Esther Reagan, Mary Russell and Taylor Simmons completed a study for the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) to examine care coordination requirements for several Medicare-Medicaid integrated care models.

The study鈥檚 final report, Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries 鈥� Health Plan Standards, Challenges and Evolving Approaches, is posted to the MACPAC .

The final report details state and federal managed care contract requirements for care coordination, summarizes stakeholders鈥� perspectives on care coordination based on structured interviews, and highlights promising care coordination practices and challenges for ensuring effective care coordination for dually eligible beneficiaries.

Medicaid Managed Care Spending in 2018

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This week, our In Focus section reviews Medicaid spending data collected in the annual CMS-64 Medicaid expenditure report. After submitting a Freedom of Information Act request to 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) 2018. The final version of the report will be completed by the end of 2019 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 2018 exceeded $588 billion, with over half of all spending now flowing through Medicaid managed care programs. In addition, total Medicaid spending on administrative services was $27.8 billion, bringing total program expenditures to $616 billion.

澳门六合彩 Summary of 2020 Medicare Advantage and Part D Flexibility Final Rule

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This week, our In Focus reviews the Calendar Year (CY) 2020 Medicare Advantage (MA) and Part D Flexibility Final Rule (Final Rule) issued by the Centers for Medicare & Medicaid Services (CMS) on April 5, 2019. The Final Rule implemented various provisions contained in the Bipartisan Budget Act of 2018 (BBA), which required the expansion of MA telehealth benefits and established new criteria for Dual Eligible Special Needs Plans (D-SNPs) integration requirements and streamlined Medicare and Medicaid grievance and appeals processes. The Final Rule also established rules to improve MA and Part D program quality and accessibility, clarified program integrity policies, and established new rules for the MA and Part D Quality Rating System.

澳门六合彩 Analysis of 2020 Medicare Advantage Rate Notice and Final Call Letter

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This week, our In Focus reviews the Announcement of Calendar Year (CY) 2020 Medicare Advantage Capitation Rates and Medicare Advantage (MA) and Part D Payment Policies (Rate Announcement) and Final Call Letter, issued by the Centers for Medicare & Medicaid Services (CMS) on April 1, 2019. The Rate Announcement and Call Letter includes final updates to MA payment rates and guidance to plan sponsors as they prepare their bids for CY 2020. Bids for CY 2020 are due to CMS on or before Monday June 3, 2019. It is important to note that the Announcement and final Call Letter does not take into consideration the Health and Human Services (HHS) Office of Inspector General (OIG) proposed rule which seeks to remove anti-kickback protection for prescription drug rebates, which, if finalized as proposed, could have significant impacts on Part D plans鈥� bids. While the administration has not provided any guidance on how plans should construct their 2020 bids in response to the rebate changes, HHS could decide to delay the rule鈥檚 effective date to 2021 or CMS may allow plans to update their 2020 bids later this year.

NOVA 鈥淎ddiction鈥� Screening and Panel

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澳门六合彩 Principal Dr. Corey Waller joins a panel of national opioid and addiction experts for a discussion following a private screening of a PBS NOVA documentary, .

CMS Increases Monitoring and Evaluation Requirements for Section 1115(a) Medicaid Demonstrations

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This week, our In Focus reviews the implications of the new federal guidance for state waivers with community engagement, premiums, non-eligibility periods, and other personal responsibility provisions.

Background

On March 14, 2019, the Centers for Medicare & Medicaid Services (CMS) issued several new guidance documents that significantly increase the level of monitoring and evaluation required for Section 1115(a) Medicaid Demonstrations. These new requirements apply to community engagement, premiums, and other waiver provisions that impact eligibility and enrollment, and affect states currently with such waivers as well as any states proposing these ideas.聽 Changes in reporting, data collection, and waiver monitoring processes will be necessary, and soon鈥攁s the materials details compliance dates for these significant new requirements.

Patient Protection and Affordable Care Act; 2020 Proposed Notice of Benefit and Payment Parameters

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This week, our聽In Focus聽reviews the Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2020. The new proposed rule does not contain as many major changes as the 2019 rule, but there are requests for comment on potentially important rulemaking starting in 2021 and guidance on important policy, such as:

Analysis of Key Medicare Proposals in the President’s FY 2020 Budget

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This week, our聽In Focus聽comes to us from 澳门六合彩 Senior Consultant Narda Ipakchi. On March 11, 2019, the White House released President Trump鈥檚 budget for fiscal year (FY) 2020, which includes a number of legislative and administrative proposals related to Medicare that would reduce net Medicare spending by $811 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 2020 budget are unlikely to advance. Several of the policies, however, such as reductions to Medicare bad debt and implementing site neutral payment systems were also proposed by the previous administration. Administrative proposals are more likely to move forward, as the administration can implement these policies through its regulatory channels.

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澳门六合彩 Conference to Feature Insights from 40+ Speakers, Including Health Plan CEOs, State Medicaid Directors, Providers

CMS Announces Primary Cares Initiative

澳门六合彩 Opioid Experts Are in Demand

Managing Principal Jonathon Blum Breaks Down Trump Administration鈥檚 Agenda for Pharmacy Rebates

澳门六合彩 MACPAC Report Published

Medicaid Managed Care Spending in 2018

澳门六合彩 Summary of 2020 Medicare Advantage and Part D Flexibility Final Rule

澳门六合彩 Analysis of 2020 Medicare Advantage Rate Notice and Final Call Letter

NOVA 鈥淎ddiction鈥� Screening and Panel

CMS Increases Monitoring and Evaluation Requirements for Section 1115(a) Medicaid Demonstrations

Background

Patient Protection and Affordable Care Act; 2020 Proposed Notice of Benefit and Payment Parameters

Analysis of Key Medicare Proposals in the President’s FY 2020 Budget

Featured Services:

澳门六合彩 Insights: Your source for healthcare news, ideas and analysis.

Receive timely expert insights on topics you care about.

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