This week, our In Focus section comes from HMA Medicaid Market Solutions (MMS) Managing Director Matt Powers and Senior Consultant Desmond Banks. On January 30, 2020, the Centers for Medicare & Medicaid Services (CMS) convened an event titled, Transforming Medicaid: A New Opportunity for Better Health, in Washington, DC, during which CMS Administrator Seema Verma announced the Healthy Adult Opportunity (HAO), an optional Section 1115 Medicaid Demonstration initiative. Commonly referred to as, 鈥渂lock grant鈥� or 鈥渟pending cap鈥� model, the HAO seeks to provide states with enhanced flexibility to design and administer parts of their Medicaid program. Administrator Verma articulated the HAO to be an important step to support the fiscal sustainability of Medicaid and invited state Medicaid directors to submit waiver applications.
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HMA Principal authors chapter in AJN Book of the Year
Recently, the book, Nursing Informatics for the Advanced Practice Nurse: Patient Safety, Quality, Outcomes, and Interprofessionalism, which features a chapter written by HMA Principal David Bergman, was awarded first place in the 2019 American Journal of Nursing Book of the Year Awards in the Informatics category.
Conservative states鈥� Medicaid expansion offers model for Missouri expansion
A new analysis of conservative state Medicaid expansion in Arkansas, Indiana and Ohio clarifies many of the questions raised about state-level costs and budget savings of a potential Missouri expansion. Researchers at 黑料网 interviewed leaders directly involved with expansion in these states to evaluate the policy and operational adjustments they undertook to design a budget-conscious program while maximizing state value.
Exploring value-based payment opportunities for long-term care providers
This week, our In Focus section reviews value-based payment (VBP) opportunities for long-term care providers. HMA Principal Dana McHugh authored the article, 鈥淟ife Plan Communities and Value-Based Payments: Aligning Incentives So Everyone Benefits鈥�, for LeadingAge national magazine, discussing how life plan communities can establish value-based payment arrangements with managed care organizations (MCOs) to maximize value and add additional revenue streams.
New NCQA scoring – what health plans should know
Starting in 2020, a systemic shift will change the way health plans prepare for, and are scored, during National Committee for Quality Assurance (NCQA) accreditation. With the focus on quality of care, this transition means keeping up with new requirements is important now more than ever.
DC and Kentucky Medicaid Managed Care RFPs
This week, our In Focus section reviews two Medicaid managed care requests for proposals (RFPs) released on January 10, 2020. The District of Columbia Department of Health Care Finance (DHCF) issued an RFP for the DC Healthy Families Program (DCHFP); the District of Columbia Healthcare Alliance Program (Alliance); and the Immigrant Children鈥檚 Program (ICP) as part of a broader effort to fully transition Medicaid to managed care over the next five years. The new contracts will cover approximately 224,000 lives. Meanwhile, the Kentucky Cabinet for Health and Family Services (CHFS), Department for Medicaid Services (DMS) released a statewide Medicaid managed care RFP to serve approximately 1.2 million lives. In December 2019, Kentucky announced that it will cancel and rebid the current Medicaid managed care contracts.
Texas STAR Kids 鈥� Dallas Service Area RFP
This week, our In Focus section reviews the Texas STAR Kids Medicaid Managed Care in the Dallas Service Area (SA) request for proposals (RFP) released by the Texas Health and Human Services Commission (HHSC) on December 13, 2019. The RFP comes after Children鈥檚 Medical Center, which covers approximately 9,000 members under the program, said it would be leaving the market. The contracts for the SA are worth approximately $500 million. Anthem/Amerigroup will remain in the Dallas SA and continue to provide services. STAR Kids provides Medicaid coverage to individuals with disabilities under age 21.
West Virginia releases Medicaid managed care RFP
This week, our In Focus section reviews the West Virginia Mountain Health Trust request for proposals (RFP) released by the West Virginia Department of Administration (DOA) for the Department for Health and Human Resources (DHHR) on December 17, 2019. Mountain Health Trust (MHT) is the statewide physical and behavioral Medicaid managed care program. West Virginia will award contracts, worth over $1.5 billion, to three managed care organizations (MCOs), with implementation beginning July 1, 2020.