HMA Weekly Roundup

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  • 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

  • On May 16, 2022, no announcements were made concerning the impending end of the COVID-19 Public Health Emergency (PHE) declaration. What does this mean for state Medicaid programs and stakeholders, including consumers? When will the PHE declaration expire? Read More
    Roundup:

    Illinois Expands Medicaid Hospital Assessment Program

    Kansas Governor Vetoes Bill to Delay Reprocurement of KanCare Contracts Until January 2023

    Medicaid Expansion News: Michigan, Missouri, North Carolina

    Medicaid Eligibility Redeterminations News: Montana, Virginia, MACPAC

    New Hampshire Governor to Sign Medicaid Adult Dental Legislation

    New Jersey Governor Proposes Expanding Medicaid Coverage to Undocumented Children

    Rhode Island to Restart Medicaid Managed Care Procurement Process

    Texas Proposes Medicaid Plan Case Management for Children, Pregnant Women

    Health Plans Call For Public Reporting of Private Equity Acquisitions

    Home Health Aides Can Have Health Premiums, Union Dues Deducted from Medicaid Paychecks

    Humana Joins Welsh, Carson, Anderson & Stowe in Primary Care Joint Venture

    Medicaid Managed Care Plan Leaders to Address Strategies, Opportunities, Concerns at HMA Conference, October 10-11

  • This week, our In Focus reviews the Kaiser Health Foundation (KFF) analysis, Fiscal and Enrollment Implications of Medicaid Continuous Coverage Requirement During and After the PHE Ends, published on May 10, 2022. Read More
    Roundup:

    Alabama Medicaid Faces Complaint Against Sobriety Requirement for Hepatitis C Treatment

    Florida Releases Medicaid Managed Care RFI Ahead of Statewide Procurement

    Louisiana Begins Statewide Rollout of Crisis Response Services for Medicaid Members

    Maryland Governor Increases Medicaid Rates to Match Medicare in Fiscal 2023 Budget

    Medicaid Redeterminations: Massachusetts, Texas

    Missouri Awards Medicaid Managed Care Contracts

    New York Governor Hopes to Expand Reach of PACE

    North Carolina Audit Finds Deficiencies in Medicaid Eligibility Process, Provider Payments

    Oklahoma Senate Rejects Medicaid Value-Based Contracting Measures

    Oregon Task Force Meets to Discuss Federal Funding Options for Medicaid Bridge Plan

    Pennsylvania Faces Lawsuit from Hospital Association Over Medicaid Managed Care Contract Language

    Federal Lawmakers Introduce Mental Health Legislation

    Kinderhook Invests in Smoky Mountain Urgent Care as Part of Multi-State, Rural Primary Care Plan

    Medicaid Directors from AZ, CA, IN, NC to Address Redeterminations, FMAP, TeleHealth, Equity, Other Key Topics at HMA Conference in Chicago, October 10-11

  • This year’s event, The New Normal: How Medicaid, Medicare, and Other Publicly Sponsored Programs Are Shaping the Future of Healthcare in a Time of Crisis, features leading experts from across the country. Read More
    Roundup:

    California Medicaid Plan to Pay Providers for Performance for Some Services

    California Exchange Automates Enrollment for Medicaid Members Losing Coverage

    Colorado Bills to Protect Medicaid Behavioral Health Providers from Clawbacks

    District of Columbia Mayor to Apply for Federal Funds for Health Disparities

    Georgia Proposal to Bypass Healthcare.gov Is Rejected by Federal Regulators

    Legislature Approves Bill to Delay Reprocurement of KanCare Contracts Until 2023

    Michigan Launches Initiative to Improve Behavioral Health Services for Children

    Minnesota Submits Request to Expand Self-Directed Personal Care Options

    Nebraska Establishes Advisory Committee for State Medicaid Program

    New Hampshire Legislature Passes Medicaid Adult Dental Bill

    North Carolina HCBS Medicaid Waiver Access Varies by Race, Study Finds

    Ohio Delays Launch of ‘Next Generation’ Medicaid Managed Care Program

    Rhode Island Senate Committee to Hear Medicaid Rate Legislation

    South Carolina Extends Telehealth Flexibilities Beyond PHE

    Tennessee House Panel Clears Bill to Renew D-SNP Contracts with Losing Bidders

    Texas Seeks Comment on Criteria for Selecting Medicaid Managed Care Plans

    Texas 10-Year Medicaid Waiver Extension to Survive

    MACPAC Announces New Executive Director, Member

    Bow River Capital Completes Investment in Amazing Care Home Health Services

    HCA Healthcare to Acquire BetterMed

  • This week, our In Focus section reviews the Nebraska Heritage Health request for proposals (RFP), released by the Nebraska Department of Health and Human Services (DHHS) on April 15, 2022. Read More
    Roundup:

    California Assembly Committee to Hold Hearing on Bill Allowing No-Bid Medi-Cali Contract

    Connecticut Seeks Medicaid Waiver to Address Coverage Gap

    Illinois Senate Passes Automatic Medicaid Renewal Legislation

    Kansas Lacks Effective System for Tracking HCBS Waiver Redeterminations, Audit Finds

    Mississippi Hires Analytics Firm to Investigate PBMs

    Missouri Senate Committee Advances Measure Aimed at Medicaid Expansion Funding

    Pennsylvania Delays Implementation of Modified Medicaid Managed Care Contracts

    Wisconsin Governor Vetoes Bills Aimed at Tightening Medicaid Eligibility Requirements

    CMS Proposes 3.2 Percent Increase to Fiscal 2023 Inpatient Hospital Payments

    Exchange Plan Premiums Fall 1.8 Percent, Study Finds

    FFL Partners Announces Investment in Perlman Clinic

  • This week, our In Focus section reviews the Biden Administration’s proposed rule revising eligibility standards for premium subsidies for families, released on April 5, 20221. Read More
    Roundup:

    Florida Governor Signs Medicaid Managed Care, Nursing Home Legislation

    Illinois Lawmakers Approve Medicaid Bill Expanding Certain Benefits, Coverage

    Louisiana Awards NEMT Contract

    Louisiana Legislature Passes Bill to Provide Medicaid Dental Coverage to Adults

    Massachusetts Releases Medicaid ACO RFR

    New York Files 1115 Waiver Amendment to Address Health Equity

    New York Medicaid Director Brett Friedman Steps Down

    Oregon Governor Establishes Taskforce to Develop Medicaid Bridge Plan

    Rhode Island Names Kristin Pono Sousa Medicaid Director

    HHS Extends Public Health Emergency for 90 Days to July 15

    Genuine Health Group Acquires Accountable Care Medical Group