HMA Weekly Roundup

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  • This week, our In Focus section is the next in our series highlighting significant developments in the Medicare program. Read More
    Roundup:

    California Medicaid Plans Eye State Exchange in 2024

    Delaware Submits 1115 Waiver Amendment for Federal Approval

    Michigan Releases RFP for EVV System for Medicaid Personal Care, Home Care

    Montana Medicaid to Cover Applied Behavioral Therapy for Children With Autism

    New York Proposes Rule For Medicaid Plans to Bolster Special Investigations Units

    North Carolina Medicaid Expansion Negotiations Slow

    CMS Releases Voluntary HCBS Quality Measure Set

    Amazon to Buy 1LifeHealthcare in $3.9 Billion Deal

    Vistria Group Is Investing Upwards of $200 Million in Sandstone Care

  • Over the course of three weeks CMS has made a series of Medicare announcements that arguably contain the most sweeping changes to the Medicare program proposed thus far by the Biden Administration. Read More
    Roundup:

    California Governor Signs Bill to Establish No-Bid Contract with Medicaid Plan

    Colorado Policy Restricts Use of Behavioral Health Interns, Unlicensed Therapists

    Florida Considers Denying Medicaid Coverage for Gender-Affirming Care for Transgender Youth

    Georgia Receives Federal Renewal of 1915 HCBS Waiver for Five Years

    Idaho Releases Medicaid Dual Programs RFI

    Illinois Accepting Medicaid Applications for Individuals 42 and Up, Regardless of Immigration Status

    Massachusetts Releases Request for Responses for Behavioral Health, LTSS Community Partners

    New York HCBS Children’s Waiver Providers to Receive Temporary 25 Percent Rate Increase

    Oregon Medicaid CCO Program ‘Helped Slow Cost Growth,’ State Says

    Pennsylvania Physical HealthChoices Beneficiaries Must Choose New Plan Before August 16

    Tennessee Drafts Amendment to TennCare Block Grant Waiver

    Washington Seeks 5-Year Renewal of Medicaid Transformation 1115 Waiver

    COVID-19 Is Associated with Increased Incidence of Future Medicaid Conditions, Costs, Wakely Study Finds

    CMS Awards $49 Million in Grants to Boost Medicaid, CHIP Enrollment of Children

    CMS Proposes 2.7 Percent Increase in Medicare Reimbursement Rate for Outpatient, Ambulatory Surgical Center Services

    Pediatric Home Service Acquires Craig HomeCare, Cherub Medical Supply

    Health Plan Joins Hospital Systems as Co-Owner of Delaware Regional Medicare ACO

  • This week, our In Focus reviews the Indiana Medicaid managed long-term services and supports (MLTSS) request for proposals, released by the Indiana Department of Administration on behalf of the Family and Social Services Administration on June 30, 2022. Read More
    Roundup:

    California Legislature Considers Bill Allowing Medi-Cal Reimbursement for Eyeglasses from Retail Labs

    Delaware Awards Medicaid Managed Care Contracts to 3 Plans

    Florida Governor Issues Order Increasing Audits of PBMs, Preventing Clawbacks in Future Contracts

    Maine Expands Medicaid, CHIP Coverage to Individuals Under 21, Pregnant Women Regardless of Immigration Status

    Massachusetts Selects 25 Community Behavioral Health Centers to Expand Treatment for Mental Health Conditions

    Minnesota Releases RFP for Medicaid, MinnesotaCare Accountable Care Model

    Montana Receives Approval for 1115 HEART Demonstration

    Nebraska Receives Five Bids for Medicaid Managed Care Contracts

    New Hampshire Releases Adult Medicaid Dental Benefit RFI

    Oklahoma Proposes 25 Percent Rate Increase for Medically Fragile Medicaid Services

    Pennsylvania Governor Approves Nursing Home Medicaid Reimbursement Rate Increase

    South Dakota Medicaid Expansion Ballot Campaigns to Join Forces

    Texas Health Plan Awards $2.1 Million in Grants to Address Social Determinants of Health

    Insurers Propose Exchange Plan Premium Rate Hike of 10 Percent in 2023, Says ACASignups.net

    Molina to Acquire My Choice Wisconsin

    Ensign Group Acquires Skilled Nursing Facilities in Texas, Nevada, California

  • This week, our In Focus section reviews the new Center for Medicare and Medicaid Innovation (CMMI) model named the Enhancing Oncology Model (EOM), released on June 27, 2022, by the Centers for Medicare & Medicaid Services (CMS). Read More
    Roundup:

    This week's roundup:

    In Focus: CMS Releases the Enhancing Oncology Model

    In Focus: CMS Proposes Regulation for Rural Emergency Hospitals

    Delaware Delays Medicaid Managed Care Contract Awards

    Florida Awards Unified Operations Center Contract to Automated Health Systems

    Florida Releases RFI for Children’s Medical Services Managed Care Plan

    Indiana Releases MLTSS RFP

    Maine Extends Dental Coverage to Medicaid Beneficiaries

    Missouri Governor Signs Fiscal 2023 Budget with Funding for Medicaid Expansion

    Nevada Requests 1115 Waiver to Expand Access to Behavioral Health Services

    New Hampshire Governor Signs Legislation to Provide Adult Medicaid Dental Coverage

    North Carolina House Committee Considers Legislation to Create Statewide Medicaid Managed Care Plan for Foster Children

    Tennessee Advised by CMS to Make Changes to Medicaid Block Grant Program

    Washington State Plan Aimed at Lowering Medicaid Pharmacy Payments Is Rescinded

    HHS Releases New Resources to Improve Oversight of Medicaid, CHIP Managed Care Programs

    CMS Releases 2021 Open Payments Data

    Medicaid, CHIP Enrollment Nears 87.9 Million; Medicare Nears 64.4 million

    Francisco Partners Completes Acquisition of IBM Watson Healthcare Data, Analytics Assets

  • Be sure to register for HMA’s 2022 Conference by Monday, July 11, to get the special early bird rate of $1, 695 per person. After July 11, the rate is $1, 895. Read More
    Roundup:

    California Extends Medicaid Coverage to Undocumented Residents

    Colorado Receives Federal Approval to Establish Standardized Exchange Plan Option

    Hawaii to Restore Medicaid Dental Benefits to Adults in 2023

    Indiana Awards MMIS Maintenance, Operations Contract to Gainwell Technologies

    Louisiana Enacts Bill Prohibiting Medicaid Plans from Conducting Provider Prepayment Reviews

    Massachusetts Is Granted Temporary Extension of Existing 1115 Medicaid Waiver

    Nebraska is Seeking Not-for-profit Organizations to Provide Housing Stability Services

    North Carolina Legislative Budget Agreement Does Not Contain Provisions for Medicaid Expansion

    Oregon Low-Income, Undocumented Residents To Gain Health Insurance July 1

    Pennsylvania Governor Proposes Fiscal 2023 Nursing Home Rate Increase

    Vermont is Granted 1115 Waiver Extension Through 2027

    Virginia Enacts 30 Percent Increase in Medicaid Dental Reimbursement Rates

    HHS Releases RFI to Strengthen Primary Care System

    CMS to Launch New Risk-Based Payment Model for Medicare Cancer Care

    Evolent Health to Acquire IPG from TPG Growth

  • This week, our In Focus section highlights a presentation from HMA and Wakely, an HMA company, titled “Staying Ahead of the Star Rating Curve – A Case Study, ” which was given at the 12th Medicare Stars, HEDIS, Quality Assurance, Read More
    Roundup:

    California Lawmakers Pass Spending Proposal to Increase Medi-Cal Reimbursement Rate for Doula Coverage

    Montana Medicaid Director Has ‘Not Had Conversations’ Regarding a Potential Transition to Managed Care

    North Carolina Foster Care Carve-Out Bill Faces Obstacles

    Ohio Medicaid Plan to Offer Members Access to Walgreens Health Corner

    CMS Approves 12-Month Postpartum Medicaid Coverage in District of Columbia, Maine, Minnesota, New Mexico

    Pharmaceutical Company to Pay $233 Million in Medicaid Fraud Settlement

  • On June 3, 2022, the Centers for Medicare & Medicaid Services (CMS) notified states that they will have an additional year, until March 31, 2025, to use funding from the American Rescue Plan Act (ARPA) to strengthen their Medicaid Read More
    Roundup:

    Delaware Delays Medicaid Managed Care Contract Awards to July

    Florida Names Bidders In Modular MMIS Procurement

    Louisiana Names Additional Medicaid Managed Care Contract Winner

    Maryland Releases Draft Medicaid 1115 Waiver Amendment to Cover Ambulance, Dental

    North Carolina Senate Committee Considers Carve-Out of Foster Care from Managed Care

    North Carolina Senate Passes Medicaid Expansion Bill

    Texas Health Plan Did Not Meet Fraud, Abuse Detection Requirements, State Report Says

    West Virginia Submits SUD Continuum of Care 1115 Waiver Renewal for Federal Approval

    MACPAC Recommends New System for Monitoring Medicaid Access

    AMA Looks to Block Expansion of Non-Physician Scope of Practice

    Medicaid Managed Care Enrollment Approaches 68 Million in 2020, CMS Reports

    Sverica Capital Management Invests in SG Homecare

  • This week, our In Focus highlights a white paper from Wakely, an HMA Company, exploring the potential design elements and expected effects of a public option or a low-cost plan being newly introduced in the Affordable Care Act (ACA) individual Read More
    Roundup:

    Alaska Releases Behavioral Health Information Management System RFI

    Delaware Releases Proposed 1115 Waiver Amendment

    Florida Can Recoup Medicaid Payments in Personal Injury Case, Supreme Court Rules

    Florida to Begin Medicaid Managed Care Procurement as Early as October 2022

    Florida Delays Award Announcements for Modular MMIS Vendors

    Georgia Releases Medicaid Managed Care RFI

    Illinois Increases Medicaid Funding for Nursing Homes by $700 Million

    Missouri Is Still Processing Medicaid Expansion Applications Slower than Federal Law Allows

    North Carolina Senate Gives Initial Approval to Medicaid Expansion Bill

    Oregon Medicaid CCO Completes Corrective Action Plan

    South Dakota Voters Deal Blow to Opponents of Medicaid Expansion

    Tennessee Issues RFI for Roadmap to Improve Oversight, Planning of D-SNPs

    FTC to Begin Inquiry Into PBM Practices

    Health Plans to Issue $1 Billion in MLR Rebates in 2022, KFF Projects

    Medical Transportation Management to Acquire Veyo

    UnitedHealth’s Optum Acquires Healthcare Associates of Texas

  • This week, our In Focus section reviews a new Oklahoma law to implement Medicaid managed care by October 1, 2023. Read More
    Roundup:

    Arizona Awards Contract to Provide Healthcare in State Prison System to NaphCare

    California to Apply for IMD Exclusion Waiver

    California Governor Proposes Alternative Payment Model for Federally Qualified Health Centers

    Montana Appoints Mike Randol as Medicaid Director

    North Carolina Senate Introduces Medicaid Expansion Bill with Work Requirements

    Pennsylvania Removes Collective Bargaining Language from Medicaid Managed Care Contracts

    CMS to Reduce 2023 Medicare Part B Premiums

    CMS Approves 12-Month Postpartum Medicaid Coverage in California, Florida, Kentucky, Oregon

    CareMax to Acquire Medicare Value-Based Care Business of Steward Health Care System

    Sun Life Financial Completes Acquisition of DentaQuest

  • Agreement about the severity of the nation’s mental health and substance use disorder crises is rising above the partisan politics in Congress. In fact, these are among a handful of issues driving work on bipartisan legislation across all the key Read More
    Roundup:

    Kansas to Delay Reprocurement of Medicaid Contracts After Legislature Overrides Veto

    North Carolina Senate Republicans to Propose Medicaid Expansion

    Oklahoma Legislature Approves Move to Medicaid Managed Care

    Rhode Island Governor Proposes MMIS Modernization Project in Fiscal 2023 Budget

    Virginia Director of the Department of Medical Assistance Services Steps Down

    Washington Appoints Charissa Fotinos as Medicaid Director

    West Virginia Lawmakers Evaluate DHHR Ahead of Possible Reorganization

    U.S. Senators Introduce Bipartisan Legislation to Integrate Care for Dual Eligibles

    Enhanced Healthcare Partners Invests in Howard J. Chudler & Associates