HMA Weekly Roundup

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  • This week, our In Focus section looks at the voluntary Accountable Care Organization Primary Care Flex (ACO PC Flex) Model, which the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced on March 19, 2024. Read More
    Roundup:

    Introducing HMA's New Podcast: Vital Viewpoints on Healthcare Jump to section

    Alaska Receives Extension for Behavioral Health Reform 1115 Demonstration Jump to section

    California Approves Proposition 1 to Provide Funding Addressing Homelessness Crisis, Substance Misuse Jump to section

    Florida Governor Signs Legislative Package Aimed at Boosting Healthcare Workforce, Access Jump to section

    Georgia Submits Section 1115 Waiver Amendment for Personal Care Services Jump to section

    Maryland Submits Section 1115 Waiver Amendment for Pre-release Services Jump to section

    Maryland Submits AHEAD Model Application to CMS Jump to section

    Nebraska Legislature Passes Provider Tax Bill to Increase Medicaid Hospital Payment Rates Jump to section

    New York Announces RFP For Development of 13 Certified Community Behavioral Health Clinics Jump to section

    New York Governor Allocates $102 Million to Fund New Mental Health Care Programs Jump to section

    Rhode Island Senate Considers Bill to Establish a Prescription Drug Affordability Board Jump to section

    Rhode Island Receives CMS Approval for 1115 Waiver Amendment Permitting HCBS in Acute Hospital Settings Jump to section

    Vermont Submits AHEAD Model Application to CMS Jump to section

    Virginia Rescinds Notice of Intent to Award for Statewide Medicaid Managed Care Procurement Jump to section

    Biden Administration Issues Final Rule to Streamline Medicaid, CHIP Enrollment Jump to section

    HHS Announces Lower Coinsurance Rate for 41 Medicare Part B Drugs Jump to section

    CMS Signals New Guidance on Medicare Part D Coverage of Obesity Drugs Jump to section

    Kaiser, Town Hall Ventures Launch PACE Joint Venture Jump to section

    United/Optum to Acquire Steward Health Care’s Physician Network Jump to section

  • This week, our In Focus section highlights the Children’s Behavioral Health (CBH) State Policy Lab, held February 7−9, in Baltimore, MD. Read More
    Roundup:

    HMA Offers a New Way to Approach Grant Funding for Behavioral Health Providers

    California Names Tyler Sadwith Medicaid Director

    Colorado Plans to Submit 1115 Waiver Expanding SMI Inpatient Mental Health Services

    Georgia Senate Advances Bill to Relax Certificate-of-need Regulations, Form Health Commission

    Georgia Medicaid Work Requirements Program Faces Low Enrollment, Higher than Projected Admin Costs

    Kansas House, Senate Committees to Hold Hearings on Medicaid Expansion

    Kentucky Supreme Court Rules Medicaid Managed Care Contracts to Remain in Place

    Mississippi Senate Medicaid Expansion Bill Dies; Focus Shifts to House Bill

    New York Releases Self-directed Care Initiative RFI

    Ohio to Release RFA for FIDE SNPs in Coming Months

    HHS Announces New Model to Improve Primary Care Access for Medicare Beneficiaries

    U.S. Senators Introduce Bill to Streamline Care Coordination for Dual Eligibles

    CMS to Hasten Medicaid Reimbursements for Providers Affected by Cyberattack

    States Consider Medicaid Rate Hikes in Fiscal 2025

    MedPAC and MACPAC Release Respective March 2024 Reports to Congress

    Medicare Billed $101.4 Million for Remote Monitoring Services in 2021, KFF Finds

    Elevance to Acquire Kroger’s Specialty Pharmacy Business

    UnitedHealth Group Pays $2 Billion to Providers Affected by Cyberattack

  • This week, our In Focus section covers Congress’s and the Administration’s parallel efforts to finalize fiscal year (FY) 2024 spending bills and begin the budget process for FY 2025. Read More
    Roundup:

    Arizona Medicaid to Reimburse for Community Health Worker Organizations

    Arkansas Governor Approves Committee, Strategic Plan to Support Maternal Health

    Florida House Passes Bill to Establish Rural Emergency Hospitals

    Georgia Senate Committee Advances Bill to Relax Certificate-of-need Regulations

    Minnesota House Committee Holds Hearing on Bills to Support HRSNs Through Section 1115 Waiver

    Nevada Receives Federal Approval Allowing Medicaid Funds to Cover Housing, Supportive Services

    Oregon Awards $17 Million to CBOs Supporting Health Equity

    Texas Announces Awards for STAR, CHIP RFP

    Texas FQHCs Receive $19.3 Million to Expand Services to Underserved, Uninsured Populations in 2023

    Virginia Postpones Several Caregiver Policies

    Redetermination Updates: Montana, Texas

    States Pause Nursing Home Staffing Penalties Amid Review of CMS Rule

    CMS Permits States to Expand Medicaid Behavioral Health Professionals, Claim Federal Match Funding for Nurse Advice Lines

    HHS to Investigate Cyberattack at UnitedHealth Group’s Change Healthcare

    White House Pressures UnitedHealth Group to Increase Funding for Providers Affected by Cyberattack

  • This week, our In Focus section analyzes preliminary 2023 Medicaid spending data collected in the annual CMS-64 Medicaid expenditure report. Read More
    Roundup:

    Colorado Receives Feedback on Behavioral Health Administrative Service Organizations; RFP Expected Spring 2024 Jump to section

    Idaho House Committee Advances Bill to Expand Postpartum Medicaid Coverage to 12 Months Jump to section

    Iowa Releases Health Link Medicaid Managed Care RFP to Reprocure One Contract Jump to section

    Maryland Faces $236 Million Medicaid Budget Shortfall Jump to section

    Minnesota Requests Additional Five-year Extension of Substance Use Disorder Reform Demonstration Jump to section

    Mississippi Legislature Passes Bill that Would Grant Early Medicaid Coverage for Pregnant Women Jump to section

    Nebraska Waiver Expands HCBS to 850 Children on Developmental Disabilities Registry Jump to section

    Nevada Holds Workshop on Medicaid Managed Care Procurement Jump to section

    New York Receives Federal Approval for Section 1332 State Innovation Waiver to Expand Essential Plan Eligibility Jump to section

    Oregon CCOs to Offer Grant Funding to Support Community Organizations in HRSN Delivery Jump to section

    Pennsylvania Releases Electronic Visit Verification Module RFP Jump to section

    Tennessee to Release Pharmacy Benefits Administrator RFP in Fourth Quarter of 2024 Jump to section

    Virginia Announces Awards for Statewide Medicaid Managed Care Procurement Jump to section

    Biden Administration Takes Steps to Prevent Corporate Overcharging of Consumers, Government Programs Jump to section

    Federal Regulators Launch Investigation into Private Equity Healthcare Deals Jump to section

    United Health Group Provides Temporary Funding, Pharmacy System During Cyber Attacks Jump to section

    The Ensign Group Acquires Skilled Nursing Facilities in Colorado, Kansas Jump to section

  • Last chance to register! Online registration closes February 28. Federal policy frameworks establishing alternative payment models in Medicare and Medicaid have been the kick-starter of value-based care (VBC) innovation in healthcare delivery. Read More
    Roundup:

    Wakely, an HMA Company, White Paper: Shadow Bundles are Coming Soon to MSSP and ACO REACH

    Alaska Receives CMS Approval to Extend Postpartum Medicaid Coverage to 12 Months

    California Awards More Than $10 Million to Residential SUD Treatment Facilities

    Florida House Agrees to Boost Physician Workforce, Increase Healthcare Innovation Grants, and Hospital At Home

    Indiana Plans to Transition 1,600 Children to Structured Family Caregiving Program

    Mississippi House Committee Advances Medicaid Expansion Bill with Work Requirement

    Montana Proposes Housing Assistance, Incentives, Re-entry Services for Medicaid Beneficiaries with Mental Health Disorders

    New Mexico Names Dana Flannery Medicaid Director

    North Carolina Legislators Push to Re-examine Law Granting Special Privileges to Hospital Authorities

    Ohio Nursing Home Associations Sue Medicaid Program Over Alleged Underfunding

    Oregon Receives Federal Approval for Limited HCBS for Seniors, Adults with Disabilities

    Texas Releases STAR Kids Draft RFP

    Washington House Considers Bill that Would Place Greater Oversight on Provider Consolidations

    Redetermination Updates: Arkansas, Iowa, Mississippi

    CMS Releases Second Evaluation of Integrated Care for Kids Model

    CareSource Seeks to Enter Wisconsin Marketplace, Acquire Local ACA Co-op Plan

  • This week, our In Focus section reviews the statewide North Carolina request for proposals (RFP) for the new Children and Families Specialty Plan (CFSP), which the North Carolina Department of Health and Human Services (DHHS) released on February 7, 2024. Read More
    Roundup:

    Florida Delays Awards for Medicaid Managed Care ITN

    Georgia Proposes Bill to Establish Study Committee to Examine Private Option Medicaid Expansion Waiver

    Iowa Senate Advances Bills Altering Postpartum Medicaid Coverage, MOMS Program

    Kentucky Senate Advances Bill to Cover Midwife Services Under Medicaid

    Maryland Awards Behavioral Health ASO Contract to Elevance

    Missouri Supreme Court Rules Against Blocking Medicaid Payments to Planned Parenthood

    Nebraska Legislature Considers Bill to Expand Medicaid Coverage of Anti-obesity Medications

    Pennsylvania Submits Section 1115 Waiver Application Addressing Health-related Social Needs

    CMS Issue Brief Finds Doulas, Community Health Workers Improve Postpartum Outcomes

    CMS Releases Preliminary CMS-64 2023 Medicaid, CHIP Expenditure Report

    CMS Issues Final Rule Imposing Restrictions on DSH Payments

    Point32Health to Acquire Health New England

    Bon Secours Mercy Health Enters Joint Venture with Compassus

    Brightside Announces New Medicaid, Medicare Partnerships to Expand Telehealth for Mental Health Services

  • This week, our In Focus section reviews the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule, published on January 17, 2024. Read More
    Roundup:

    HMA Keynote Speakers Preview Themes, Imperatives for March 5-6 Value Based Care Workshop

    Arizona Releases Housing, Health Opportunities Services Program Administrator RFP

    Arizona Selects 57 Providers to Extend Medicaid Services to Incarcerated Individuals Prior to Release

    Connecticut Governor Calls for Increased Hospital, Pharmaceutical Oversight in Fiscal 2025 Spending Plan

    Florida Announces Intent to Award Florida Community Care Comprehensive IDD Managed Care Pilot Program Contract

    Georgia Governor’s Budget Proposal Increases Health Services Spending by $485 Million

    Kansas Governor Proposes $23 Million for IDD, Physical Disability Waiver Waitlists

    Minnesota Announces $8 Million RFP for Live Well At Home Program

    Mississippi Medicaid Requesting $83 Million Increase in State Support in Fiscal 2025

    Montana Grant Program to Increase Residential Bed Capacity for Individuals with SMI, Developmental Disability

    Pennsylvania Extends Medicaid to Cover Perinatal Doula Care

    Oregon Receives Federal Approval for HRSN Benefits Framework Under Section 1115 Waiver

    HHS Partners with Eight States, District of Columbia to Address Homelessness

    States Continue to Impose Regulations Around Prior Authorization Practices

    BCBS-LA Withdraws from Planned Merger with Elevance

    KKR to Buy Stake in Cotiviti from Veritas Capital

  • This week, our In Focus section reviews the Centers for Medicare & Medicaid Services (CMS) Calendar Year (CY) 2025 Advance Notice for the Medicare Advantage (Part C) and Part D Prescription Drug Programs published on January 31, 2024. Read More
    Roundup:

    Colorado Hospital Transparency Reports Reveal Increased Operating Expenses, Reimbursements

    Florida House, Senate Consider Bills to Establish Rural Emergency Hospitals

    Georgia Releases PBM RFP in Partnership with Alaska, Montana, and Vermont

    Hawaii Requests Five-year Extension of Hawaii QUEST Integration Waiver

    Iowa Lawmakers Advance Bill to Extend Postpartum Medicaid Coverage to 12 Months

    Minnesota Seeks Section 1115 Medicaid Waiver Amendments to Expand Eligibility for Children

    Mississippi Senate Passes Bill to Streamline Prior Authorization Requests

    Montana Releases Medicaid NEMT Program RFI

    Nevada Medicaid Managed Care RFP Release Expected by January 2025

    New Mexico Receives Federal Approval for Use of Mobile Crisis Intervention Teams

    Cityblock, Fidelis Care Form Partnership to Increase Health Services For New York Medicaid Members

    North Carolina Releases Foster Care Specialty Plan RFP

    North Carolina Medicaid to Launch Behavioral Health IDD Tailored Plans on July 1

    Several States Direct Medicaid Funding to Provide Housing Aid Amidst Disenrollments

    HHS Issues Final Rule Permitting Use of Telehealth for Opioid Treatment Programs

    CMS Outlines Guidelines for Use of Artificial Intelligence in Medicare Advantage

    Cigna Indicates Plans to Grow its Evernorth Health Services Unit

  • This week, our In Focus section highlights a new report released on January 25, 2024, Analyzing the Expanded Landscape of Value-Based Entities: Implications and Opportunities of Enablers for the CMS Innovation Center and the Broader Value Movement. The second In Read More
    Roundup:

    HMA Press Release: Nine States to Participate in Children’s Behavioral Health Policy Lab

    California Plan Offers Medi-Cal Enrollees GED Services

    Colorado Legislative Committee Approves Increase in Medicaid Reimbursement for Pediatric Behavioral Care

    Indiana Intellectual, Developmental Disabilities Task Force Calls for Pause to Proposed Aged, Disabled Waiver Cuts

    Kentucky House Passes Bill Requiring Medicaid to Cover At-home Blood Test Kits

    Minnesota Releases Medicaid Dental Administrator RFI

    New Jersey Enacts Law to Expand Hospital at Home Services to Medicaid Beneficiaries

    New York Legislature Considers Bill to Transition Home Care Services From Managed Medicaid to Fee-For-Service

    Federal Government Issues Lawsuit to Block Novant Health’s Acquisition of North Carolina Hospitals

    South Dakota to Include Doula Services in New Medicaid Pregnancy Health Home

    Vermont Releases MMIS Procurement Assistance Vendor RFP

    Wisconsin Releases IRIS Self-Directed Personal Care Services RFP

    Medicaid Redetermination Updates: Louisiana, Ohio

    Medicare ACO Shared Savings Program Participation Increases in 2024

    CMS Cell and Gene Therapy Access Model to Focus on Sickle Cell Disease

    MACPAC Releases Medicaid Payment Policies Report for Home and Community-based Services

    Health Care Services Corporation to Acquire Cigna Medicare, CareAllies Businesses

  • This week, our In Focus section highlights the Innovation in Behavioral Health (IBH) model, which the Centers for Medicare & Medicaid Services (CMS) announced January 18, 2023. Read More
    Roundup:

    Connecticut Proposes to Extend Medicaid Services to Incarcerated Individuals Prior to Release

    Florida to Submit Section 1115 Waiver Request to Expand CHIP Eligibility

    Florida Senate Passes Bill to Expand Healthcare Access, Resources

    Idaho House Committee Proposes Bill Setting Requirements on Medicaid Expansion

    Indiana Alters Waivers, Enhances Budget Monitoring to Address Medicaid Budget Shortfall

    Kansas Governor’s Proposed Fiscal 2025 Budget Includes Medicaid Expansion Funds

    Kentucky Senate Advances Bill to Limit Number of Managed Care Organizations

    Michigan Extends Due Date for Medicaid Managed Care Proposals

    New Hampshire Awards Medicaid Managed Care Contracts to Incumbents

    New York MCOs Oppose Proposed Competitive Medicaid Managed Care Procurement Process

    North Carolina Medicaid Expansion Enrollment Surpasses 314,000

    Rhode Island Medicaid State-directed Payments Approved by CMS

    Texas Extends Medicaid Postpartum Coverage to 12 Months

    Washington Updates State Action Plan to Remove Barriers to Health Services

    Medicaid Redetermination Updates: Florida, Georgia, Indiana, Mississippi, New Hampshire, Oklahoma, Vermont

    More Than 21.3 Million Have Selected ACA Marketplace Plans Since Enrollment Period Began

    Combined Medicaid, Medicare Spending on Dual Eligibles was $493.4 Billion in 2021, MACPAC, MedPAC Report Finds

    Centene Names Michael Carson as President, CEO of Medicare Business