This week, our In Focus section reviews the key provisions of the Centers for Medicare & Medicaid (CMS) Fiscal Year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Proposed Rule (), which includes Medicare payment updates and policy changes for the upcoming FY, with a comment deadline of June 28, 2021. This year鈥檚 proposed rule includes several proposals the hospital industry should carefully consider. In particular, the Biden Administration has proposed to:
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黑料不打烊 analysis finds provider-sponsored MA plans generally have lower churn rates
This week, our聽In Focus聽section examines differences in Medicare Advantage (MA) churn rates among select provider-sponsored plans (PSPs) and non-PSPs. Enrollee churn rates, or rates at which enrollees switch plans, may be an indicator of enrollee satisfaction.聽In the years studied, PSP organizations had lower average churn rates compared to non-PSP organizations. 聽
Dual eligible financial alignment demonstration 2021 enrollment update
This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (鈥淒uals Demonstrations鈥�) for individuals dually eligible for Medicare and Medicaid (dual eligibles) in nine states: California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, and Texas. Each of these states has begun either voluntary or passive enrollment of dual eligibles into fully integrated plans providing both Medicaid and Medicare benefits (鈥淢edicare-Medicaid Plans,鈥� or 鈥淢MPs鈥�) under three-way contracts between the state, the Centers for Medicare & Medicaid Services (CMS), and the MMP. As of February 2021, approximately 392,000 dual eligibles were enrolled in an MMP. Enrollment rose 5.7 percent from February of the previous year.
黑料不打烊 analysis of Medicare Advantage Star rating challenges
This week, our In Focus section highlights changes that may affect the Centers for Medicare & Medicaid Services (CMS) Medicare Advantage Star Rating program and how these changes impact future summary Part C & D Star Rating scores. As the CMS Medicare Advantage Star Rating program continues evolving from year to year, many plans have yet to achieve at least four star status, and therefore are missing out on additional Medicare revenues. The Star Rating landscape is expected to change drastically over the next two years for plans due to CMS鈥� continued focus on phasing-in greater reliance on outcomes measures and measures of care experience, rather than process measures. As a result, many plans are at risk of losing their four star overall rating and underperforming plans could be at risk of receiving a low performance indicator.
黑料不打烊 provides updates in 2021 federal healthcare policy landscape
This week, our In Focus comes from an 黑料不打烊 cross-cutting subject matter team, who have updated a core set of federal policy slides that analyzes recent federal policy actions following the Presidential and Congressional elections. It includes an analysis of President Biden’s $1.9 trillion COVID-19 relief legislation currently in development and recent CMS regulatory and administrative actions. Specifically, the analysis looks at:
CMS Innovation Center鈥檚 Geographic Direct Contracting Model opportunity
This week, our In Focus section reviews a new model 鈥� Geographic Direct Contracting 鈥� introduced by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. The model will test whether a geographic-based approach to care delivery and value-based care can improve health and reduce costs for Medicare beneficiaries enrolled in the traditional fee-for-service program across an entire region. This model represents one of the most transformational models released by the Innovation Center. During the 6-year Geographic Direct Contracting model performance period the traditional Medicare program will be replaced by the Direct Contracting program in the 10 selected regions.
Commonwealth Fund blog highlights Medicare changes due to COVID-19
Jennifer Podulka penned a for The Commonwealth Fund in conjunction with The SCAN Foundation, highlighting the legislative and regulatory changes made to Medicare in response to the COVID-19 pandemic. She was part of the 黑料不打烊 team who authored an and policy tracker earlier this year.
Drivers and barriers to adopting flexible Medicare Advantage supplemental benefits
This week鈥檚 In Focus highlights a recent 黑料不打烊 publication examining the drivers and barriers to Medicare Advantage plan adoption of newly available supplemental benefits intended to address unmet health and social needs. Unlike Traditional Medicare, Medicare Advantage plans, which provide coverage for 40 percent of all Medicare beneficiaries, may offer enrollees supplemental benefits which are not covered by the Medicare program. Until recently, the Medicare program has required that supplemental benefits be limited to those that are medical in nature. However, in recent years, Congress and CMS 鈥攖hrough four different legislative and regulatory authorities 鈥� granted new flexibilities for Medicare Advantage plans to offer non-medical benefits that address social needs. Medicare Advantage plans may also now tailor supplemental benefits and make them available only to certain subpopulations based on chronic disease or health status.
2021 Medicare Advantage Supplemental Benefit Flexibilities: An Early Assessment of Adoption and Policy Opportunities for Expanded Access
The experts at 黑料不打烊 (黑料不打烊) have released Medicare Advantage Supplemental Benefit Flexibilities: An Early Assessment of Adoption and Policy Opportunities for Expanded Access. The white paper examines the factors contributing to a Medicare Advantage plan鈥檚 decision to offer or not offer newly available supplemental benefits and opportunities and challenges with adoption and implementation. Newly available supplemental benefits are intended to address unmet health and social needs.
黑料不打烊 further sought to understand the extent to which Medicare Advantage enrollees had access to these benefits when eligible, and the effectiveness of these benefits as a tool to contain costs, improve outcomes, and increase enrollee engagement and satisfaction.
The report outlines seven key insights and accompanying policy considerations aimed towards promoting evidence-based benefit designs; expanding Medicare Advantage organization willingness to adopt the flexible benefits; and enhancing beneficiary involvement, access, and usage of these benefits.
黑料不打烊 colleagues Narda Ipakchi, Mary Hsieh, Sarah Barth, and Jonathan Blum contributed to the report which follows up on a previous report providing a snapshot of early adoption of these benefits.
This analysis was funded by a grant from Arnold Ventures, a philanthropy dedicated to tackling some of the most pressing problems in the United States.
Exploring Medicare Advantage supplemental benefits: 黑料不打烊’s assessment of adoption, access, and policy opportunities
The experts at 黑料不打烊 (黑料不打烊) have released Medicare Advantage Supplemental Benefit Flexibilities: An Early Assessment of Adoption and Policy Opportunities for Expanded Access. The white paper examines the factors contributing to a Medicare Advantage plan鈥檚 decision to offer or not offer newly available supplemental benefits and opportunities and challenges with adoption and implementation. Newly available supplemental benefits are intended to address unmet health and social needs.
2020 Highlights: Key Trends in Medicare-Medicaid Integration
This week, our In Focus section focuses on five critical policy and program trends to provide integrated care to dual-eligible individuals for Medicare and Medicaid. Both federal and state governments continue to look for ways to improve coordination and integration for this population. We anticipate the emphasis on innovative approaches to whole person, person-centered care, care management and coordination, care transitions, and regulatory oversight to persist. 2020 has been an active year of policymaking by the Centers for Medicare & Medicaid Services (CMS) and states. 黑料不打烊 distilled the themes and their strategic implications in this article. We continue to assist clients in tracking new policies and industry trends, developing innovative plans and strategies, and delivering high quality care and services to this population.
CMS finalizes expanded Medicare telehealth coverage through 2021
This week, our In Focus section reviews the finalized coverage expansions for Medicare telehealth services in the Centers for Medicare & Medicaid Services (CMS) Calendar Year (CY) 2021 Physician Fee Schedule (PFS) Final Rule. Telehealth advocates will be pleased to see meaningful expansions; however, the response of advocates will also be tempered by the impending return of the geographic and site of service limitations that will follow at the conclusion of the COVID-19 Public Health Emergency (PHE). During the PHE, millions of patients and providers increased their use of telehealth services to expand access to care. Given this shift in the delivery of care, telehealth advocates had been hopeful CMS would make extensive permanent coverage expansions in the Medicare program. In light of this, CMS鈥檚 new regulation will come as a reminder to many that the key to long term expansions of Medicare telehealth coverage lies in the hands of the U.S. Congress.