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黑料不打烊 Insights: Your source for healthcare news, ideas and analysis.

黑料不打烊 Insights鈥攊ncluding briefs, webinars, and our podcast鈥攇ives you easy access to 黑料不打烊鈥檚 deep expertise, helping you stay current on the latest healthcare trends and topics. Search for a topic of interest or browse the latest insights below.

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Webinar

The Future of the Affordable Care Act (ACA): Implications of November鈥檚 Elections and a Supreme Court Decision

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After the November 3 elections, the political landscape will shift as the composition of the next administration, Congress and many state legislatures and governors鈥� offices begins to take shape. If President Trump is reelected, his administration will position to govern for another four years. If former Vice President Joe Biden is elected, his campaign will accelerate transition planning and prepare actions to implement change immediately upon inauguration. At the same time, on November 10, the Supreme Court is scheduled to hear oral arguments regarding the continued validity of the Affordable Care Act.

The presidential, congressional and state elections, and the Supreme Court鈥檚 decision, will drive the future of the ACA and health care coverage in the U.S. While any significant change will take time to implement, uncertainty will require action and planning from all health care stakeholders as they navigate the emerging scenarios and position for future shifts.

During this webinar, 黑料不打烊 and Dentons will discuss the specific pathways that change could take. Specifically:

  • What impact could the Supreme Court鈥檚 decision have on the ACA, and what is the expected timing of this decision?
  • What impact could the November election results have on the Supreme Court鈥檚 decision?
  • What immediate actions should stakeholders expect for Marketplace and Medicaid coverage as a result of the November elections?
  • If Democrats gain control of the White House and Congress, how will Democrats implement campaign pledges, for example to create a public option and expand Medicare to those ages 60 to 65?
  • How will the future direction of the ACA impact other health care coverage?
  • How would Medicare be affected by the ACA decision and the results of the November elections?
  • How should specific health care stakeholder groups (e.g., consumers and patients, health plans, delivery systems, states) respond and prepare for changes?

Speakers

Jonathan (Jon) Blum, MPP, Vice President, Federal Policy and Managing Director, Medicare, 黑料不打烊

Bruce Merlin Fried, Partner, Dentons’ Health Care Practice

Charles Luband,听Partner, Dentons’ Health Care Practice

Kathleen Nolan, Regional Vice President, 黑料不打烊

Blog

CMS Introduces New Medicare Direct Contracting Model Opportunity

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This week, our In Focus section looks at a new Medicare model, Direct Contracting, introduced by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. The new model will build on and continue testing potential reforms to the Medicare program encompassed by accountable care organizations (ACOs), Medicare Advantage (MA), and private sector risk-sharing arrangements. The payment model options may appeal to a broad range of physician and provider groups and other organizations because they are expected to introduce flexibility in health care delivery, support a focus on beneficiaries with complex, chronic conditions, and encourage participation from organizations that have not typically participated in traditional fee-for-service (FFS) Medicare or CMS Innovation Center models. However, there will be substantial financial risk鈥攁nd reward鈥攆or participants based on a new, complex methodology, so organizations interested in this new model should carefully consider the possible outcomes from participating in Direct Contracting versus other options.  CMS has announced that will participate in the model鈥檚 trial Implementation Period, which runs from October 1, 2020, through March 31, 2021.  The agency has stated that it expects to announce additional Direct Contracting pathways in the future and that the next round of applications for participation in the second performance year will open in early 2021.

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Blog

A short-term solution to ACA uncertainty amid ongoing pandemic

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In this week鈥檚 In Focus section, 黑料不打烊 (黑料不打烊) Managing Director MMS Matt Powers, Senior Consultant Kaitlyn Feiock, and Regional Vice President Kathleen Nolan look at the future of the Patient Protection and Affordable Care Act (ACA). On November 10, 2020, the Supreme Court of the United States (SCOTUS) heard oral arguments for California v. Texas, challenging the constitutionality and severability of the ACA.  This challenge became possible after the 2017 Tax Cuts and Jobs Act, which zeroed out the individual mandate penalty for not purchasing health insurance.  While most experts agree that an entire invalidation of the ACA is the least likely outcome based on the oral arguments, some uncertainty remains and more than $100 billion federal funds are at risk. The ACA standardized insurance rules offset premium costs for many individual market consumers and provided authority and funding for Medicaid Expansions in the overwhelming majority of states. The ACA also included other provisions that may be at risk but are not the subject of this note, such as the creation of Center for Medicare and Medicaid Innovation (CMMI) and the Medicare-Medicaid Coordination Office, as well as demonstration authority that has led to the creation of numerous coverage models.  As states, Congress, and the federal executive branch face the possibility that the ACA may not survive in its present form, what mitigation strategies are available at the state and federal levels to stabilize uncertainties and protect against abrupt coverage changes?

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Brief & Report

黑料不打烊 colleagues author evidence-based programs paper

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黑料不打烊 (黑料不打烊), in contract with The National Council on Aging (NCOA), and with support from the Administration for Community Living (ACL), recently provided research and strategy services to support the goal to increase the adoption of evidence-based health promotion and disease prevention programs, known as evidence-based programs (EBPs) by Medicaid, Medicare, and other health insurance markets.

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Blog

Evidence-based programs paper authored by 黑料不打烊 colleagues

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黑料不打烊 (黑料不打烊), in contract with The National Council on Aging (NCOA), and with support from the Administration for Community Living (ACL), recently provided research and strategy services to support the goal to increase the adoption of evidence-based health promotion and disease prevention programs, known as evidence-based programs (EBPs) by Medicaid, Medicare, and other health insurance markets.

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Blog

黑料不打烊 analysis of the 2021 Medicare Advantage landscape and mandatory Medicare radiation oncology and ESRD treatment choices innovation models

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This week, our In Focus section reviews two recent Medicare developments from the Centers for Medicare & Medicaid Services (CMS). On September 24, 2020, CMS released the Medicare Advantage (MA) and Part D landscape files for the 2021 plan year. These files include information on MA and Part D offerings, including plan types and premiums. Earlier this month, CMS also released a final rule implementing two new mandatory payment models addressing radiation oncology and end-stage renal disease (ESRD).

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Webinar

Webinar Replay: Medicare, Medicaid and the ACA鈥檚 Evolution After the 2020 Presidential Election

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This webinar was held on September 30, 2020.聽

The upcoming federal elections portend tremendous change for federal health care programs, in particular Medicare, Medicaid and the Affordable Care Act. If there is a change in administration and Congressional control, stakeholders should expect rapid implementation of new policy agendas and regulatory frameworks. New presidents generally pursue aggressive policy and regulatory agendas to fulfill campaign promises and quickly secure their policy objectives. Second-term presidents seek to solidify and extend their policy legacies. Health care stakeholders should begin to prepare for potential changes now to ensure that their organizations are best positioned for 2021 and beyond.

Through a new collaboration between 黑料不打烊 (黑料不打烊) and Dentons global law firm, a former presidential candidate and governor, presidential transition team veterans, former federal government administrators, and health policy experts outlined the different health care platforms of the Biden and Trump campaigns. The webinar explored:

  • The major differences in policy positions and how a Trump or Biden Administration will administer the Medicare, Medicaid and Affordable Care Act (ACA) programs.
  • How the current COVID-19 pandemic, economic downturn, and a potential Supreme Court decision will shape these agendas.
  • The process for presidential transitions and how new governing and regulatory agendas are established.

During this webinar, the first in a series hosted by 黑料不打烊 and Dentons, presenters discussed the implications of the upcoming elections and their potential impact on federal health program policies and regulatory agendas.

Speakers

Governor Howard Dean (VT), Former Presidential Candidate & Senior Advisor, Dentons鈥� Public Policy and Regulation Practice

Kathleen Nolan, Regional Vice President, 黑料不打烊

Jonathan Blum, Vice President, Federal Policy & Managing Director, Medicare, 黑料不打烊

Bruce Fried, Partner, Dentons鈥� Health Care Practice

Blog

黑料不打烊 summary of Medicare Fee-for-Service (FFS) proposed rules

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This week, our In Focus section reviews two Medicare fee-for-service (FFS) proposed rules recently issued by the Centers for Medicare & Medicaid Services (CMS). On August 3, 2020, CMS released a proposed rule that includes updates to services furnished under the Medicare Physician Fee Schedule (PFS). On August 4, CMS released the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule. These proposed regulations include payment rate and policy changes for the upcoming calendar year. Key features in this year鈥檚 PFS proposed rule include: policies to retain, extend, or end certain telehealth flexibilities implemented in response to the novel COVID-19 public health emergency (PHE), changes to enable certain health care professionals to practice at the top of their licenses, modifications to opioid treatment programs (OTPs), and updates to the Medicare Shared Savings Program (MSSP). View additional information on the PFS Proposed Rule. Among the most notable policy changes in the OPPS and ASC proposed rule are: 1) transitioning services to lower cost settings by eliminating the inpatient-only list to enable more services to be provided in the outpatient settings and increasing the scope of procedures that can be provided in ASCs, 2) further reducing payments for the 340B drug program, and 3) modifying the formula for calculating Hospital Star Ratings, and expand the use of prior authorization for outpatient services. Find additional information about these proposals.

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Brief & Report

黑料不打烊 examines current state of Medicare-Medicaid integration programs

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The experts at 黑料不打烊 (黑料不打烊) have released the Medicare-Medicaid Integration: Reflecting on Progress to Date and Charting the Path to Making Integrated Programs Available to all Dually Eligible Individuals issue brief and companion bibliography appendix, the second in a series of issue briefs examining Medicare-Medicaid integrated programs.

Based on 黑料不打烊’s review of the literature and available public information, this brief summarizes the elements for success and barriers encountered by integrated programs. It concludes with essential questions and next steps to move forward with federal and state public policies and care delivery options centered around, informed by, and available to, more dually eligible individuals.

黑料不打烊 colleagues Sarah Barth, Jon Blum, Elaine Henry, Narda Ipakchi and Sharon Silow-Carroll contributed to the research and final brief.

For the next phase of research, 黑料不打烊 will convene and interview individuals, their families and other caregivers, providers, payers, community-based organizations, state government, and other stakeholders in select regions across the country.

The project was funded by a grant from , a philanthropy dedicated to tackling some of the most pressing problems in the United States.聽聽

Blog

Regulatory changes to Medicare in response to COVID-19

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This week, our In Focus section examines how the federal government implemented changes to the Medicare program in response to COVID-19.聽 As the COVID-19 pandemic began in the United States, Congress and the Administration responded with a series of legislative, regulatory, and sub-regulatory changes to the Medicare program that were designed to provide relief from certain Medicare rules to assist health care providers, Medicare Advantage organizations, and Part D plans in responding to the pandemic. Some of these changes waived conditions of Medicare participation to enable patients to be treated in alternative care settings. Others permitted physicians and other providers to receive Medicare reimbursements for telemedicine services.

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Brief & Report

黑料不打烊 releases COVID-19 Medicare regulation tracking tool

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The Medicare program has rapidly transformed how it pays for healthcare providers in response to the COVID-19 pandemic. In an effort to capture these changes, 黑料不打烊, commissioned by 听补苍诲听, tracked, categorized, and analyzed the 212 Medicare policy modifications made in response to the public health emergency.

黑料不打烊 Senior Consultant聽Jennifer Podulka聽and Managing Principal聽Jon Blum聽led efforts to analyze and synthesize COVID-19-related legislative, regulatory, and subregulatory changes to existing Medicare regulations issued beginning January 1, 2020. The resulting issue brief聽Regulatory Changes to Medicare in Response to COVID-19聽and companion Policy Tracker use nine categories to organize the data and will be periodically updated to include new information.

The issue brief outlines key COVID-19-related changes including providing telehealth reimbursement for more types of services and providers, and waived conditions of Medicare participation permitting patients to be treated in alternative care settings including community facilities, temporary facilities, homes and in some cases, out of state services on a temporary basis.

Congress and the Trump administration waived or changed regulations to allow flexibility to help healthcare providers, Medicare Advantage plans and Part D plans. The policy tracker catalogs and categorizes these regulatory changes based on characteristics, including types of providers and plans affected, effective date, and expected duration.

These changes have affected virtually all healthcare providers and health plans that participate in the Medicare program, and the issue brief examines several questions surrounding the changes moving forward including risk to beneficiary protections and Medicare spending controls established in the original legislation and rules.

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