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  • This week, our In Focus section comes to us from Senior Consultant Ryan Mooney, reviewing the Texas Medicaid and Children’s Health Insurance Program (CHIP) Evaluation report. The 85th Legislature of the State of Texa required the Texas Health and Human Services Commission (HHSC) to report on its findings for Rider 61, Evaluation of Medicaid Managed Care (the Report). HHSC recently published the Report, which includes the following:

    1. Rider 61(a) – A review of the current Medicaid and Children’s Health Insurance Program (CHIP) managed care delivery system and an assessment of the performance of managed care;

    2. Rider 61(b) – An assessment of Medicaid and CHIP managed care contract review and oversight;

    3. Rider 61(c) – A study of Medicaid Managed Care rate setting processes and methodologies in other states; and

    4. Rider 61(d) – An analysis of MCO administrative costs, including a survey of each MCO to determine the nature and scale of administrative resources devoted to the Texas Medicaid and CHIP programs and the identification of cost reduction opportunities.

    Roundup:

    Arizona Awards MMIS Contract to CNSI

    Massachusetts to Release One Care Duals RFP in 1-2 Months

    Montana Lawmakers Seek Medicaid Work Requirements

    Arizona, Hawaii Release Joint RFP for EVV Vendor

  • This week, our In Focus section provides a recap of the third annual HMA Conference, The Rapidly Changing World of Medicaid: Opportunities and Pitfalls for Payers, Providers and States, held this Monday, October 1, and Tuesday, October 2, in Chicago, Illinois. More than 450 leading executives representing managed care organizations, providers, state and federal government, community-based organizations, and other stakeholders in the health care field gathered to address the opportunities and challenges facing health plans, states, and providers as they strive to provide the best possible care to Medicaid beneficiaries and other vulnerable populations at a time of significant uncertainty and change. Conference participants heard from keynote speakers,engaged in panel discussions and connected during informal networking opportunities. Below is a summary of highlights from this year’s conference.

    Roundup:

    Texas Cancels, Re-Issues Medicaid, CHIP Solicitations

    Tennessee Releases Medicaid Work Proposal for Public Comment

    Alabama Receives CMS Approval for ICN Long-term Care Program

    CMS Administrator Defends Medicaid Work Requirements, Highlights New Initiatives

    Supreme Court to Hear Medicare DSH Payment Cas

  • This week, our In Focus section reviews Medicare-Medicaid integration opportunities through Dual Eligible Special Needs Plans (D-SNPs). States are motivated to expand their capacity to address the needs of dually eligible beneficiaries through integrated care. They are increasingly requiring health plans that operate Medicaid managed long-term services and supports (MLTSS) programs to become Medicare Advantage (MA) D-SNPs. A few states require D-SNPs to be Medicaid MLTSS health plans.

    Roundup:

    Hawaii Releases RFI for QUEST Integration Medicaid Managed Care Program

    New Mexico to Transition to State-based Health Insurance Exchange in 2021

    Virginia Files Waiver Request for Medicaid Work Requirements, Monthly Premiums

    Alabama Medicaid Work Requirement Proposal to Be Reviewed by CMS

    Medicaid Spending Rose 2.6 Percent to $592 Billion in 2017

    DHHS Awards More Than $1 Billion to Combat Opioid Crisis

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