HMA Weekly Roundup

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  • On January 30, 2019, the Centers for Medicare & Medicaid Services (CMS) issued Part II of the Advance Notice of Methodological Changes for Calendar Year (CY) 2020 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies Read More
    Roundup:

    Florida Governor Maintains ‘Status Quo’ on Medicaid Budget

    Kentucky Delays Start Date for Medicaid Work Requirements

    Maine Governor Orders Audit of State Medicaid Program

    North Carolina Announces Medicaid Managed Care Awards

    Ohio Medicaid to Rebid Managed Care Contracts

    Oregon Health Authority Receives 24 Letters of Intent for CCO 2.0 Contracts

    HHS Proposes Overhaul of PBM Drug Rebate Rules

  • This week, our In Focus reviews the Oregon Health Plan’s Coordinated Care Organizations (CCO) 2.0 request for applications (RFA), released by the Oregon Health Authority (OHA) on January 25, 2019. Under CCO 2.0, the CCOs will provide full-risk coordinated care Read More
    Roundup:

    Arizona Behavioral Health Providers Are Owed Millions in Unpaid Medicaid Claims

    Arkansas, Maine Appoint Medicaid Directors

    Florida Judge Rejects State Medicaid Contract in Southwest Region; AHCA Appeals

    Kentucky Medicaid Plan Passport Health Could Face Bankruptcy Given Rate Cuts, CEO Says

    New Jersey Governor Outlines Initiatives to Combat Opioid Epidemic

    Health Share of Oregon to Seek New Medicaid CCO 2.0 Contract

    Medicaid Expansion Developments In Kansas, Montana, Utah, West Virginia, Wyoming

  • This week, our In Focus section reviews Arkansas’ Provider-led Arkansas Shared Savings Entity (PASSE) model, scheduled to transition to full risk capitation in March 2019. The PASSE program provides care coordination to improve the health of Medicaid members with behavioral Read More
    Roundup:

    Arizona Wins Approval for Medicaid Work Requirements

    Georgia Considers Medicaid Waiver to Expand Coverage

    Kansas Governor to Submit Medicaid Expansion Plan to Legislature This Month

    Kentucky Medicaid Plan Passport Health May Exit Market

    Maine Governor Reverses Medicaid Work Requirements

    North Carolina Audit Finds Medicaid LME/MCO Capitation Rates Were Actuarially Sound

    West Virginia Lawmakers Seek Transition to Managed Health Care for Foster Kids

  • This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 29 states. Many state Medicaid agencies post monthly enrollment figures by health plan for their Medicaid managed care population to their websites. This Read More
    Roundup:

    Alabama Releases Coordinated Health Network RFP

    Arkansas Says 3 Provider-Led Entities Will Move to Full Risk in Next Phase of PASSE Program

    Colorado, New York, Ohio Release Budget Proposals

    Kentucky Medicaid Beneficiaries Again File Lawsuit to Block Work Requirements, Premiums

    Louisiana Releases RFP for Subscription-Based Hepatitis C Drug Purchasing Agreement

    Michigan Names Gordon to Lead State Health Department

    Wisconsin Governor to Push for Medicaid Expansion Despite Legislative Opposition

    Trump Administration Is Reportedly Preparing Medicaid Block Grant Guidelines

  • This week, our In Focus section reviews a report recently submitted to the Minnesota Legislature, Accounting for Social Risk Factors in Minnesota Health Care Program Payments. The report delivers Minnesota Department of Human Services (DHS) recommendations to reduce health disparities Read More
    Roundup:

    AZ, FL, NM Name Medicaid Directors

    California Governor Orders Transition of Medicaid Pharmacy Benefit from Managed Care to FFS

    Florida Rejects Rebid of Medicaid Managed Care Contract Award for HIV/AIDS

    Virginia Medicaid Director Calls for Overhaul of Forecasting, Rate-Setting Processes

    CMS Names Chris Traylor Acting Director of Center for Medicaid and CHIP Services

  • This week, our In Focus section is led by Matt Powers, a Principal in our Chicago office, who worked with HMA colleagues to summarize the factors that non-expansion states weigh when considering whether or not to expand Medicaid under the Read More
    Roundup:

    Arkansas Drops Another 4,655 Medicaid Beneficiaries for Failing to Meet Work Requirements

    New York DOH Announces Funding for Community-Based Organizations

    Indiana Releases PBM Administrative Services RFP

    Molina Healthcare to Cut Ties with Golden Shore Medical Group Clinics

    Ohio Medicaid Director Barbara Sears To Step Down

    Oregon Names Lori Coyner Medicaid Director

    Federal Judge Rules ACA Is Unconstitutional

    December MACPAC Meeting Focuses on State Innovations in Drug Pricing, Network Adequacy, DSH Funding

  • This week, our In Focus section reviews updated information issued by the Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) on Medicaid expansion enrollment from the “September 2018 Medicaid and CHIP Application, Eligibility Determination, Read More
    Roundup:

    Maine Judge Sets February 1 Deadline for Medicaid Expansion Enrollment

    Mississippi Awards CHIP Contracts to Molina, UnitedHealth

    New York to Sunset Duals Demo (FIDA)

    Oklahoma Seeks Federal Approval for Medicaid Work Requirements

    U.S. Health Spending Growth Slowed to 3.9 Percent in 2017, CMS Says

  • This week, our In Focus section comes to us from HMA Senior Consultant ErinMathies (Indianapolis), who reviews the premium assistance programs for the working adult population in Medicaid expansion states. Medicaid programs that pay for premiums in commercial insurance for Read More
    Roundup:

    CMS Approves Florida Request to Shorten Retroactive Medicaid Eligibility

    Massachusetts Receives CMS Approval for Flexible Services Program

    Massachusetts Approves Beth Israel-Lahey Health Merger

    New Hampshire Receives Federal Approval of Medicaid Expansion Work Requirements

    New York Provides DSRIP Update

    TennCare Director Accepts Health Care Post in Nashville

    Bipartisan Senate Bill Aims to Lower Drug Pricing

    Number of Uninsured Children Increased By 276,000 in 2017

  • This week, our In Focus section comes to us from HMA Senior Consultant Ryan Mooney (Austin), who reviewed the proposed rule on Health Reimbursement Arrangements (HRAs). On October 29, 2018, the U.S. Department of the Treasury, the Department of Labor, Read More
    Roundup:

    Judge Rejects Florida Medicaid Managed Care Contract Award for HIV/AIDS

    Kentucky Work Requirements Waiver Approved by CMS After Further Review

    Maine Judge Orders Implementation of Medicaid Expansion; LePage To Appeal

    New Mexico Judge Rejects Medicaid Contract Award Challenge By Molina

    Arkansas Delays Phase II of Medicaid Managed Care Transition Until March 2019

    Florida AHCA Secretary Justin Senior to Step Down

  • Among the biggest challenges facing clinicians today is keeping up to date with the latest medical advances, care models, and delivery system redesign efforts. The need for ongoing learning is especially true for safety net providers, where new approaches to Read More
    Roundup:

    Florida Closes ITN for Regions 3-7 of SMMC MMA PSN

    Maine Governor to Implement Medicaid Expansion Upon Taking Office

    Montana Voters Reject Tobacco Tax to Fund Medicaid Expansion

    New Jersey Creates Consumer Portal to Facilitate ACA Open Enrollment

    CMS Considers Allowing Hospitals to Use Medicaid Funds for Housing

    CMS Announces Short-Term IMD Exclusion Waivers for Serious Mental Illness

    CMS to Propose Rule Allowing States to Limit NEMT Services