HMA Weekly Roundup

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  • This week, our In Focus section identifies steps that Medicare and Medicaid plans and providers can undertake to effectively return to normal operations after the end of the COVID-19 public health emergency (PHE) declaration. Read More

    Arkansas Seeks Federal Approval to Offer Full Medicaid Coverage to Pregnant Women

    California Awards $340 Million Population Health Management Contract to Gainwell Technologies

    California Medi-Cal Contract Awards Face Appeals

    Iowa Awards NEMT Contract to MTM

    Maryland Releases Dental Benefits Administrator RFP

    Maryland Releases Medicaid NEMT Broker RFP

    New Mexico Delays Medicaid Managed Care RFP Release to Third Quarter of 2022

    Oklahoma Releases Medicaid Dental Managed Care RFP

    Tennessee Proposes PMPM Medicaid Spending Cap to Replace Proposed Aggregate Cap

    Texas Delays Releases of STAR/CHIP, STAR Kids RFPs

    MedPAC Eyes Potential Standardized Benefit Options for Medicare Advantage

    CMS Proposes Rule to Standardize Medicaid, CHIP Eligibility and Enrollment

    CVS to Acquire Signify Health

    Maximus Retains Contract to Support CMS Contact Center Operations

  • This week, our In Focus section reviews preliminary 2021 Medicaid spending data collected in the annual CMS-64 Medicaid expenditure report. Read More

    California Awards Medi-Cal Managed Care Contracts to Three Health Plans

    District of Columbia Medicaid Managed Care Contract Awards Await Mayor’s Recommendations

    Florida Medicaid Providers to Pay Long-Term Care Staff $15 Per Hour

    Illinois Enacts Legislation to Increase Nursing Home Pay

    Iowa Awards Medicaid Managed Care Contracts to Two Health Plans

    Louisiana Awards Single, Statewide PBM Contract to Magellan

    Louisiana Medicaid Begins Using State Directed Payment Model for Hospitals

    Mississippi Medicaid Managed Care Bidders File Protests

    Nebraska Delays Medicaid Managed Care Awards to September 23

    New Hampshire Releases Adult Medicaid Dental Managed Care RFP

    New York Removes Barrier to Home Care M&A Activity With New Licensure Process

    CMS Awards $98.9 Million to Navigators to Assist in 2023 Exchange Open Enrollment

    8.8 Million Medicaid Beneficiaries Received LTSS in 2019, CMS Report Finds

    Medicare Advantage Accounts for Nearly Half of All Medicare Beneficiaries, KFF Analysis Finds

    Walgreens Boots Alliance Completes Acquisition of 55 Percent Stake in CareCentrix

  • This week, our In Focus section highlights an HMA Issue Brief, Bolstering the Youth Behavioral Health System: Innovative State Policies to Address Access & Parity, published in August 2022. Read More

    California Releases Mobile Crisis Intervention Services RFI

    California Exchange Plans Must Resubmit 2023 Rates to Reflect Impact of Inflation Reduction Act

    Florida Medicaid Enrollment to Increase 5.5 Percent, Surplus to Top $1.25 Billion in Fiscal 2023

    Georgia Can Reinstate Medicaid Expansion Work Requirements, Federal Judge Rules

    Nebraska Awards Maxmius Contract for MMIS Provider Services Module

    New York Legislators Introduce Bill to Ease Burden of Medicaid Provider Audits, Recoveries

    North Carolina Healthy Opportunities Pilot Struggles to Gain Traction

    Ohio Counties Win $600 Million in Damages in Opioid Lawsuit

    Oregon Health Plan to Use Tech Platform to Connect Medicaid Members to Social Services

    Texas Dual Eligible Demonstration Shows Cost Reductions, Study Finds

    Utah Releases Medicaid Dental Managed Care RFP

    U.S. Senate Panel Investigates Medicare Advantage, Part D Marketing Tactics

    Sonas Home Health Care Acquires Focus Forward Skilled Care

    Wakely, An HMA Company, White Paper: 2021 Supplemental Claims Impact

  • This week, our In Focus section reviews the Inflation Reduction Act of 2022 (IRA), signed by President Biden on August 16, 2022. Read More

    Arizona Works on New Health Plan Contracts for ALTCS-EPD Program

    Delaware Judge Denies Motion to Quash Audit of Medicaid Program

    District of Columbia Accepts Bids from 2 Medicaid Managed Care Plans

    Florida Medicaid Plan Capitated Rates to Fall, Driven by Lower Utilization

    Illinois Announces PACE Program Awardees

    Massachusetts Seeks Input on Improving Medicaid MCO/ACO Risk Adjustment Model

    Minnesota Releases RFP for School-Linked SUD Services for Students

    Missouri Medicaid Software Vendor Wins $23 Million in Lawsuit Against State

    Nebraska Delays Medicaid Managed Care Awards to August 31

    North Carolina Legislators Fail to Reach an Agreement on Medicaid Expansion

    CMS Proposes Rule to Expand Medically Necessary Dental Services Covered by Medicare

    Medicare Rates Expected to Rise 2.5 Percent for Inpatient Psychiatric Facilities in Fiscal 2023

    Humana to Acquire Wisconsin-based MCO Inclusa

    LHC Group Agrees to Acquire Three Rivers Home Health

  • As the urgent needs of COVID-19 Public Health Emergency (PHE) continue to subside, state Medicaid agencies are exploring pathways and concepts to further address the historic inequities and health disparities laid bare by the pandemic. Read More

    California Delays Medi-Cal Managed Care Program Awards

    Connecticut HUSKY Health to Cover Additional Maternity Benefits in 2023

    Florida Medicaid Managed Care RFI Responses Stress Social Determinants, Providers, HCBS

    Georgia Proposal to Bypass Is Again Rejected by CMS

    Idaho Releases Quality Improvement Organization RFP

    Mississippi Awards MississippiCAN, CHIP Medicaid Managed Care Contracts to 3 Health Plans

    Missouri Commits to Trimming Medicaid Applications Backlog Under Federal Plan

    Ohio Pharmacists Express Concern Over Single PBM Program

    West Virginia Medicaid Must Cover Gender-Affirming Care, Federal Judge Rules

    U.S. Senate Passes Legislation Allowing Medicare to Negotiate Drug Prices, Extending Enhanced Exchange Subsidies

    CVS Is Reportedly Interested in Acquiring Signify Health

    UnitedHealth/Optum Acquires CareMount Medical

  • This week, our In Focus section reviews the request for information (RFI) on ways to strengthen the Medicare Advantage (MA) program, released by the Centers for Medicare & Medicaid Services (CMS) on July 28, 2022. Read More

    Alabama Releases SMI Independent Evaluator RFP

    Arkansas Withdraws Previously Released PBM RFP To ‘Start from Scratch’

    Georgia Receives Approval for 2 Percent Rate Increase for HCBS Waivers

    Michigan Seeks Another Year to Implement SPA for Community Support Services

    Mississippi Delays Medicaid Managed Care Awards to August

    Missouri Submits Substance Use Disorder 1115 Waiver Application

    New York Attorney General Files Antitrust Lawsuit Against CVS Over 340B Program

    Ohio Releases Medicaid IV&V Services RFP

    Oregon Seeks Medicaid Coverage for Individuals Up to 200 Percent of Poverty After PHE Ends

    South Carolina to Convene Working Group on Emergency Mental Health

    National Uninsured Rate Hits a Record Low of 8 Percent

    Biden Administration May Allow Medicaid Waivers to Cover Out-of-State Abortions

    Medical Transportation Management Finalizes Acquisition of Veyo

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

    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

    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

    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

    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

    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