This week鈥檚 澳门六合彩 Weekly Roundup features an In Focus article from 澳门六合彩 Senior Consultants Amber Swartzell and Stephanie Baume (Indiana), who reviewed the Centers for Medicare & Medicaid Services (CMS) proposed Medicaid managed care regulations. On November 8, 2018, CMS released a proposed rule that would update several sections of the Medicaid and Children鈥檚 Health Insurance Program (CHIP) managed care rules, which were most recently amended in 2016. This much anticipated proposal, scheduled to appear in the Federal Register on November 14, 2018, focuses on 鈥減romoting flexibility, strengthening accountability, and maintaining and enhancing program integrity.鈥 The key provisions of the proposed regulations are summarized below.
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Florida Statewide Medicaid Managed Care (SMMC) Awards
This week, our In Focus section comes to us from Principal Elaine Peters (澳门六合彩 鈥 Florida), who reviews the recent re-procurement by the Florida Agency for Health Care Administration (AHCA) of its Statewide Medicaid Managed Care (SMMC) health and dental plans.聽 The SMMC program currently has two key program components:聽 Long-Term Care (LTC) and Managed Medical Assistance (MMA).聽 The new SMMC program changes the two components to: Integrated MMA and LTC and Dental.聽 The 2016 Legislature 鈥渃arved out鈥 dental services from MMA plans and new dental plans will be responsible for providing dental services to eligible members.
A Deeper Look Into Highlights From the Kaiser/澳门六合彩 50-State Medicaid Director Survey
This week, our In Focus section reviews highlights and shares key takeaways from the 18th annual Medicaid Budget Survey conducted by The Kaiser Family Foundation (KFF) and 澳门六合彩 (澳门六合彩). Survey results were released on October 25, 2018, in two new reports: States Focus on Quality and Outcomes Amid Waiver Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019 and Medicaid Enrollment & Spending Growth: FY 2018 & 2019. The reports were prepared by Kathleen Gifford, Eileen Ellis, Barbara Coulter Edwards, and Aimee Lashbrook from 澳门六合彩, and by Elizabeth Hinton, Larisa Antonisse, and Robin Rudowitz from the Kaiser Family Foundation. The survey was conducted in collaboration with the National Association of Medicaid Directors.
50-State Medicaid Director Survey Released: States Focus on Quality and Outcomes Amid Waiver Changes
Results of the 18th annual Medicaid Budget Survey were released Oct. 24, 2018 and examine changes taking place in Medicaid in all 50 states and the District of Columbia. and 澳门六合彩 conduct the survey in partnership with the National Association of Medicaid Directors.
CMS Guidance on ACA Section 1332 Waivers
This week, our In Focus section comes to us from Principal Nora Leibowitz, reviewing the Centers for Medicare & Medicaid Services (CMS) guidance on Section 1332 waivers. The State Relief and Empowerment Waivers guidance, published in the Federal Register on October 24, 2018, updates the guidance related to Section 1332 of the Patient Protection and Affordable Care Act (PPACA) and its implementing regulations. Section 1332 establishes State Innovation Waivers, the authority by which a state can make changes impacting:[1]
CMS Section 1115 Medicaid Demonstration Evaluation Requirements: Implications for Designing Consumerism & Personal Responsibility Waivers
This week, our In Focus section highlights 澳门六合彩 Medicaid Market Solutions鈥 (MMS) efforts to support state flexibility in designing and implementing Section 1115 Demonstration Waivers promoting member engagement and personal responsibility. Over the coming weeks, 澳门六合彩 MMS will present a series of articles providing in-depth analyses of the many facets of these new Medicaid models. This week, we examine the implications for designing consumerism and personal responsibility waivers.
Texas Medicaid and CHIP Managed Care Final Comprehensive Report
This week, our In Focus section comes to us from Senior Consultant Ryan Mooney, reviewing the Texas Medicaid and Children’s Health Insurance Program (CHIP) Evaluation report. The 85th Legislature of the State of Texas required the Texas Health and Human Services Commission (HHSC) to report on its findings for Rider 61, Evaluation of Medicaid Managed Care (the Report). HHSC recently published the Report, which includes the following:
- Rider 61(a) – A review of the current Medicaid and Children鈥檚 Health Insurance Program (CHIP) managed care delivery system and an assessment of the performance of managed care;
- Rider 61(b) – An assessment of Medicaid and CHIP managed care contract review and oversight;
- Rider 61(c) – A study of Medicaid Managed Care rate setting processes and methodologies in other states; and
- Rider 61(d) – An analysis of MCO administrative costs, including a survey of each MCO to determine the nature and scale of administrative resources devoted to the Texas Medicaid and CHIP programs and the identification of cost reduction opportunities.
Highlights From This Week’s 澳门六合彩 Conference On The Rapidly Changing World Of Medicaid
This week, our In Focus section provides a recap of the third annual 澳门六合彩 Conference, The Rapidly Changing World of Medicaid: Opportunities and Pitfalls for Payers, Providers and States, held this Monday, October 1, and Tuesday, October 2, in Chicago, Illinois. More than 450 leading executives representing managed care organizations, providers, state and federal government, community-based organizations, and other stakeholders in the health care field gathered to address the opportunities and challenges facing health plans, states, and providers as they strive to provide the best possible care to Medicaid beneficiaries and other vulnerable populations at a time of significant uncertainty and change. Conference participants heard from keynote speakers, engaged in panel discussions and connected during informal networking opportunities. Below is a summary of highlights from this year鈥檚 conference.
Companion Medicaid and Medicare Advantage Dual Eligible Special Needs Plans
This week, our In Focus section reviews Medicare-Medicaid integration opportunities through Dual Eligible Special Needs Plans (D-SNPs). States are motivated to expand their capacity to address the needs of dually eligible beneficiaries through integrated care. They are increasingly requiring health plans that operate Medicaid managed long-term services and supports (MLTSS) programs to become Medicare Advantage (MA) D-SNPs. A few states require D-SNPs to be Medicaid MLTSS health plans.[1]
Texas Health and Human Services Commission Submits Legislative Appropriations Request
This week, our In Focus section reviews Texas’ biennial legislative appropriations request (LAR) for fiscal years 2020-21, submitted by the Texas Health and Human Services Commission (HHSC). The document, which totals 1358 pages, includes summary program data as well as budget breakouts by agency strategies, priorities, and source of funds.
Dual Eligible Financial Alignment Demonstration 2018 Enrollment Update
This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (鈥淒uals Demonstrations鈥) for beneficiaries dually eligible for Medicare and Medicaid (duals) in nine states: California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, and Texas. Each of these states has begun either voluntary or passive enrollment of duals into fully integrated plans providing both Medicaid and Medicare benefits (鈥淢edicare-Medicaid Plans,鈥 or 鈥淢MPs鈥) under three-way contracts between the state, the Centers for Medicare & Medicaid Services (CMS), and the MMP. As of August 2018, nearly 369,000 duals were enrolled in an MMP. Enrollment dropped by 6.7 percent from August of the previous year after Virginia鈥檚 dual demonstration ended in December.
North Carolina and District of Columbia Medicaid Managed Care RFPs
This week, our In Focus reviews North Carolina鈥檚 much-anticipated Prepaid Health Plan Services request for proposals (RFP), released by the Department of Health and Human Services, Division of Health Benefits on August 9, 2018, and District of Columbia鈥檚 Medicaid Managed Care RFP released on August 14, 2018. North Carolina is transitioning its Medicaid fee-for-service program to Medicaid managed care through its procurement. DC is reprocuring its managed care program, covering the District of Columbia Healthy Families Program (DCHFP), Alliance program, and the Immigrant Children鈥檚 Program (ICP).