HMA Weekly Roundup

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  • After more than two decades, SAMHSA and its Center for Substance Abuse Treatment (CSAT) is revisiting regulations governing opioid treatment programs (OTPs), as required by the 2023 Consolidated Appropriations Act passed by Congress. Read More

    Save the Date: HMA Spring Workshop on Implementing Value-Based Care

    Alabama Receives Approval for Community-Based Mobile Crisis Services SPA

    Arizona Requests Section 1115 Waiver Amendment to Raise CHIP Eligibility Threshold

    California Governor Signs Bill to Simplify Billing, Increase Access for Medicaid School-based Health Programs

    Florida Bills Would Remove Step Therapy Requirement for Medicaid Beneficiaries with Mental Illness

    Georgia Legislators Discuss Coupling Full Medicaid Expansion, Relaxation of Certificate-of-Need Requirements

    Idaho Releases MMIS System Integrator Technical Advisory Services RFP

    Nevada Submits Section 1332 State Innovation Waiver Application For Market Stabilization, Public Option Program.

    New York Essential Plan Expansion Implementation Delayed to April 2024

    North Carolina Hospitals Will Receive $2.6 Billion As State Prepares to Start Medicaid Expansion

    Tennessee to Renew Existing TennCare Medicaid Managed Care Contracts for Now

    Wisconsin Insurers Fail to Meet Federal Access Standards for Exchange Program, Report Finds

    Average Time Spent on Medicaid HCBS Waiting Lists Has Decreased Since 2021

    ACA Exchange Enrollment Approaches 4.6 Million Through Three Weeks of Open Enrollment

    Medicare, Medicaid Improper Payment Rates Driven by Documentation Errors in Fiscal 2023, CMS Finds

    CMS Launches Medicare GUIDE Model Application

    CMS Issues Proposed Rule to Ensure Network Adequacy Standards For State-run Exchange Plans

    Humana, Cigna in Talks to Merge by End of Year

  • This week, our In Focus section reviews a wide-ranging proposed rule issued by the Centers for Medicare & Medicaid Services (CMS) on November 6, 2023. Read More

    HMA Report Shows First-of-Its-Kind Actual Comparisons of State-by-State Medicaid Disenrollments vs. Projections

    Medicaid Eligibility Redeterminations News: Arkansas, Idaho, Florida, Iowa, Kentucky, Maine, Maryland, Mississippi, Nevada, Texas, Washington

    Idaho Legislative Task Force Agrees State Should Stick with Medicaid Value Care Organizations

    Indiana Submits 1915c Waiver Request to Transition Medicaid LTSS to Managed Care

    Iowa to Award Medicaid Dental Services Contracts to Delta Dental of Iowa, DentaQuest USA

    CareSource Names Chad Moore Kansas Market President

    Missouri Extends Medicaid Postpartum Coverage to 12 Months

    South Dakota Enrolls Less than 20 Percent of Eligible Medicaid Expansion Population

    Tennessee Releases RFP for TennCare Select Prepaid Inpatient Health Plan for Children

    States Expect Medicaid Enrollment Decrease, Spending Increase in Fiscal 2024, KFF Medicaid Director Survey Finds

    Fourteen Insurers to Exit Medicare Advantage Markets in 2024, KFF Data Show

    Centene Names Susan Smith as Chief Operating Officer

  • This week, our In Focus section reviews several calendar year (CY) 2024 Medicare payment final rules that the Centers for Medicare & Medicaid Services (CMS) issued in recent weeks. Read More

    HMA Information Services Names Andrea Maresca as Managing Director

    Arizona to Award $47.5 Million to HCBS Providers in Second Round of ARP Grant Funding

    California Minimum Wage Increase for Healthcare Workers Estimated to Cost $4 Billion in Fiscal 2025

    Florida Releases Comprehensive IDD Managed Care Pilot Program ITN

    Idaho Health Data Exchange Lacked Accountability Measures, Report Finds

    Iowa Releases Medicaid Quality Improvement Organization Services RFP

    Missouri Disenrolls 52,000 Children From Medicaid During First Four Months of Redeterminations

    Nebraska Medicaid Director Resigns

    North Carolina Order Dissolves Sandhills Behavioral Management Entity, Consolidates Two Others

    GuideWell Names Thurman Justice President, CEO of Triple-S Management

    Medicare Advantage Plans Enjoy Higher Payments than FFS, MedPAC Reports

    Medicaid Disenrollments Top 10 Million Following Redeterminations

    Cigna Explores Sale of Medicare Advantage Business

  • This week, our In Focus section reviews the Michigan Medicaid Managed Care Comprehensive Health Care Program (CHCP) request for proposals (RFP), which the Michigan Department of Health and Human Services released on October 30, 2023. Read More

    Alabama Releases Modular Electronic Visit Verification RFP

    California Submits Section 1115 Medicaid Waiver Amendment to Provide Rental Assistance

    Florida Legislators File Bills to Study Impact of Potential Medicaid Expansion on Individuals Aged 18 to 26

    Georgia Bidding Conference for Medicaid Managed Care Contracts Is Attended by Several Health Plans

    Georgia Democratic Leaders Call on Governor to Implement Full Medicaid Expansion

    Mississippi Medicaid Managed Care Procurement Stalls Following Protests from UnitedHealthcare, Elevance

    New Hampshire Providers to Receive Another Increase in Medicaid Payment Rates

    Pennsylvania Bill Would Reinstate Medicaid Coverage of Most Dental Services

    CMS Releases Final Rule to Increase Payments to ESRD Facilities by 2.1 Percent

    Bright Health Group, Friday Health Plans Owe $1.1 Billion in Exchange Risk-Adjustment Payments

  • This week, our In Focus section summarizes the Medicaid Long-Term Services and Supports (LTSS) Annual Expenditures Report, which the Centers for Medicare & Medicaid Services (CMS) released on October 17, 2023 Read More

    Arizona Releases Fee-For-Service Pharmacy Benefits Management Services RFP

    Arkansas Releases Medicaid Enterprise Systems Independent Verification, Validation Services RFP

    Arkansas Releases Medicaid Dental Services RFP

    California Enacts Bills to Improve Treatment of Individuals with Mental, Behavioral Health Disorders

    Colorado Individual Plan Rates to Rise 9.7 Percent in 2024

    Florida Announces List of Bidders for Statewide Medicaid Managed Care ITN

    Florida Releases ITNs for 6 Behavioral Health Managing Entity Regions

    Georgia Pathways to Coverage Medicaid Expansion Enrollment is 1,343 Through September

    Medicaid Eligibility Redeterminations News: Iowa, Kentucky, Louisiana, Maryland, Michigan, Pennsylvania, South Dakota

    Maryland Cannot Document Receipt of Federal Funds, Shows $1.1 Billion Deficit in Medicaid Clearing Account, Audit Shows

    New Jersey Enacts Medicaid Rate Increase for Reproductive Health Care Providers

    New Mexico Releases Closed Loop Referral Service RFQ

    Pennsylvania Expands List of Medicaid Providers Eligible to Provide Street Medicine Services

    Previous Direct Contracting ACO Model Saved Medicare $371.5 Million in 2022

    UPMC, Washington Health System Sign Merger Agreement

  • This week, our In Focus section highlights a white paper that Wakely, a Health Management Associates company, released in October 2023, “Cut to the Point: A Summary of 2024 Star Rating Cut Point Changes”. Read More

    Arizona to Release Medicaid PBM RFP ‘in the Coming Weeks’

    Medicaid Eligibility Redeterminations News: Arizona, Florida, Georgia, Mississippi, North Carolina, Texas, Wyoming

    Florida Launches Dental Provider Incentive Program

    Minnesota Eliminates Parental Fees for Medicaid Coverage of Children With Disabilities

    Nevada Governor Proposes Exchange Reinsurance in ‘Revision’ to Public Option Law

    New York Medicaid Spending Exceed Expectations, Report Finds

    North Carolina Receives Final Federal Approval for Medicaid Expansion

    Oregon Announces 3.4 Percent Increase in 2024 Capitation Rates for Medicaid Coordinated Care Organizations

    Oregon Releases RFP to Expand PACE Services

    Long-term Services, Supports Spending Falls as Percentage of Total Medicaid Expenditures, CMS Reports

    State Medicaid Programs Disenroll 8.8 Million Beneficiaries During First 6 Months of Redeterminations, KFF Finds

    Alignment Health, Walgreens to Jointly Market Medicare Advantage Plans in 2024

  • This week, our In Focus section reviews the Florida Statewide Medicaid Prepaid Dental Program invitation to negotiate (ITN) released October 6, 2023, by the Florida Agency for Health Care Administration (AHCA). Read More

    Medicaid Eligibility Redeterminations News: Alabama, Alaska, Arizona, Arkansas, Florida, Maine, Missouri, New Mexico, Oregon, Texas, Wyoming

    Arizona Receives Five Bids for Medicaid Managed Long-term Care Contracts

    California Enacts Law Advancing State Toward Universal Healthcare System Such as Single-payer

    Idaho Medicaid Value-based Care Organizations Ask State to Stick with Current Model

    Kentucky Reports Savings Following Removal of PBMs from Medicaid Program

    Nevada Extends Deadline for Medicaid Managed Care RFI

    New York to Launch Medicaid Social Care Networks to Address Health-related Social Needs

    Dual Demos in New York, Ohio, Washington Show Mixed Results, CMS Reports

    Cigna Purchases Digital Health Company

  • This week, our In Focus section reviews the KanCare Medicaid capitated managed care request for proposals (RFP), released October 2, 2023, by the Kansas Department of Health and Environment and Department for Aging and Disability Services. Our second In Focus Read More

    Alaska Pauses Procedural Medicaid Disenrollments

    Florida Agencies to Report on Medicaid Redeterminations to State Senate

    CareSource to Partner with Pediatric Care Provider to Bid on Florida Medicaid Contract for Children, Teens with Special Needs

    Illinois Head of Healthcare, Family Services to Step Down

    Indiana Drops Molina from Medicaid MLTSS Contract

    Indiana Medicaid MLTSS Contracts to Begin July 2024

    Indiana Awards Hoosier Rx Program Contracts to Three Companies

    Iowa to Develop HCBS for Children With Severe Behavioral Health Needs in Lawsuit Settlement

    Elevance, Blue Cross Louisiana Withdraw Merger Application

    Louisiana Lawmakers Push to Reexamine Medicaid Technology Contract

    Michigan Releases State Action Plan to Improve Birth Outcomes

    North Carolina Medicaid Expansion to Launch on December 1

    Ohio Estate Recovery Program Recovers Less Than One Percent of Fiscal 2023 Medicaid Costs

    Oklahoma Receives Federal Waiver Approval Enabling Transition to Medicaid Managed Care

    Texas Implements Vendor Contracts for Medicaid FFS Prior Authorization, Enrollment, Other Functions

    CMMI Value-based Models Result in $5.4 Billion Increase in Federal Spending, Report Finds

    Carlyle Group in Talks to Acquire Majority of 2 Medtronic Medical Device Businesses

  • This week, our In Focus section reviews the new States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model, which the Centers for Medicare & Medicaid Services (CMS) Center for Medicaid and Medicare Innovation (the Innovation Center) announced on Read More

    Help at Home to Cease Operations in Alabama

    Arkansas Working Group Makes Recommendations Aimed at Improving Foster Care System

    Florida Delays Bidding for Medicaid Managed Care Contract

    AmeriHealth Caritas Names Melody Bonomo as Florida Market President

    Medicaid Eligibility Redeterminations News: Florida, Kansas, Louisiana, Mississippi, Nevada, North Carolina, Texas, Virginia

    Nebraska Launches Program to Enroll Inmates Nearing Release in Medicaid

    Nevada Medicaid Plan Aims to Improve Maternal Health-related HEDIS Scores

    New Mexico Seeks Public Comments on Section 1115 Waiver Renewal Application Addendum

    North Dakota Seeks Public Comments on IDD HCBS Waiver Renewal Application

    Utah Considers Carve Out of Medicaid ACO Pharmacy Benefits to Fee-for-Service

    Vermont Releases HCBS Business Supports RFP

    NCQA Includes Equity Measure in 2023 Health Plan Quality Ratings

    CVS Health/Aetna Promotes Mark Santos to Head of Medicaid

  • This week, our In Focus section reviews the New Hampshire Medicaid Care Management (MCM) request for proposals (RFP), which the state’s Department of Health and Human Services released on September 8, 2023. Read More

    California Medicaid Director Jacey Cooper Is Leaving to Join CMS

    District of Columbia Receives Approval for Community-Based Mobile Crisis Services SPA

    Florida Renews Medicaid Utilization Management Contract with Acentra Health

    Hawaii Receives $4 Million Project LAUNCH Federal Grant to Improve Children’s Behavioral Health

    Michigan Expects Medicaid Community Health Worker Benefit to Impact 50,000 Residents If Approved

    BCBS-NC Names Angela Boykin CEO of Medicaid Plan

    Oregon to Seek Federal Approval for Basic Health Plan

    Pennsylvania to Review Rates for Providers Serving Individuals with Intellectual Disabilities, Autism

    CMS to Lower Cost of 34 Prescription Drugs Beginning October 1

    Walmart May Buy Majority Stake in ChenMed