California Health Care Foundation released a new study authored by the Edrington Health Consulting, an 黑料不打烊 company, Investing in Primary Care: Why it Matters for Californians with Medi-Cal Coverage, that highlights the critical role primary care plays for patients in Medi-Cal. The study encompasses 5.4 million Californians enrolled in Medi-Cal managed care, or nearly half of all Medi-Cal enrollees in 2019, and finds greater investment in primary care is generally associated with better quality of care, patient experience, and plan rating. Furthermore, the study provides an 聽important baseline for understanding how greater investment in primary care can improve quality and equity; this is particularly important as California expands Medi-Cal to include all income-eligible Californians, regardless of immigration status. This analysis comes as California is taking significant steps toward ensuring primary care teams, including physicians, nurse practitioners, physician assistants, community health workers, behavioral health staff and others play a greater role in the health care delivery system.
342 Results found.
Indiana releases MLTSS RFP
This week, our In Focus section reviews the Indiana Medicaid managed long-term services and supports (MLTSS) request for proposals, released by the Indiana Department of Administration on behalf of the Family and Social Services Administration on June 30, 2022. Indiana is seeking three managed care organizations (MCOs) that will serve an estimated 106,000 enrollees, beginning January 1, 2024, for a period of four years, with two one-year renewal options.
MLTSS Program
Indiana began forming a plan to reform the state鈥檚 Medicaid LTSS services in 2019 by holding stakeholder meetings. The state estimated that from 2010 to 2030 the proportion of Hoosiers over age 65 will grow from 13 percent to 20 percent, and that the state鈥檚 system would need to be reformed to meet the growing demand. The state set an objective to shift the LTSS program to a managed care model and to move a higher percentage of new LTSS members into home and community-based settings.
The new statewide, risk-based MLTSS program will serve Medicaid beneficiaries who are aged 60 years and older and are classified as aged, blind, or disabled. These beneficiaries will include individuals who are dually eligible for Medicare and Medicaid, those in a nursing facility, and those who are receiving LTSS in a home or community-based setting.
Beneficiaries in this program will receive all traditional Medicaid services, delivered through a capitated managed care arrangement. Those who meet a specified level of care will be eligible to receive home and community-based services (HCBS) waiver services. The Medicaid Rehabilitation Option (MRO), Adult Mental Health Habilitation Services Program (AMHH), and Behavioral and Primary Care Coordination (BPHC) will be carved out of the capitated arrangement. For dually eligible beneficiaries, Medicare will be the first payer for all Medicare covered services, including services that are covered by both Medicare and Medicaid.
Indiana seeks to contract with MCOs that can address complex and chronic health conditions of the program population and integrate care along the continuum and settings of LTSS in the state. Program goals include simplifying access to HCBS and expanding the HCBS provider network, especially in rural areas; using a person-centered approach; improving quality outcomes and consistency of care across the delivery system; promoting caregiver support and skill development; in addition to others.
Timeline
The first part of the proposals is due September 19, with the second part due September 23. Awards are expected in February 2023.
Evaluation
After ensuring proposals meet the mandatory requirement, proposals will be scored out of a total possible 103 points, as shown in the table below.
Preliminary Capitation Rate Summary
Based on the preliminary calendar year 2024 capitation rate development, contracts are estimated to be worth $3.8 billion annually.
Early bird registration discount expires July 11 for 黑料不打烊 conference on the future of publicly sponsored healthcare, October 10-11 in Chicago
Be sure to register for 黑料不打烊鈥檚 2022 Conference by Monday, July 11, to get the special early bird rate of $1,695 per person. After July 11, the rate is $1,895.
Nearly 40 industry speakers, including health plan executives, state Medicaid directors, and providers, are confirmed for 黑料不打烊鈥檚 The New Normal: How Medicaid, Medicare, and Other Publicly Sponsored Programs Are Shaping the Future of Healthcare in a Time of Crisis conference, October 10-11, at the Fairmont Chicago, Millennium Park.
In addition to keynote sessions featuring some of the nation鈥檚 top Medicaid and Medicaid executives, attendees can choose from multiple breakout and plenary sessions on behavioral health, dual eligibles, healthcare investing, technology-enabled integrated care, social determinants of health, eligibility redeterminations, staffing, senior care, and more.
There will also be a Pre-Conference Workshop on The Future of Payment Reform: Delivering Value, Managing Risk in Medicare and Medicaid, on Sunday, October 9.
. Group rates and sponsorships are available. The last 黑料不打烊 conference attracted 500 attendees.
State Medicaid Speakers to Date (In alphabetical order)
- Cristen Bates, Interim Medicaid Director, CO Department of Healthcare Policy & Financing
- Jacey Cooper, Medicaid Director, Chief Deputy Director, California Department of Health Care Services
- Kody Kinsley, Secretary, North Carolina Department of Health and Human Services
- Allison Matters Taylor, Medicaid Director, Indiana
- Dave Richard, Deputy Secretary, North Carolina Medicaid
- Debra Sanchez-Torres, Senior Advisor, Centers for Disease Control and Prevention
- Jami Snyder, Director, Arizona Health Care Cost Containment System
- Amanda Van Vleet, Associate Director, Innovation, NC Medicaid Strategy Office, North Carolina Department of Health & Human Services
Medicaid Managed Care Speakers to Date (In alphabetical order)
- John Barger, National VP, Dual Eligible and Medicaid Programs, Humana, Inc.
- Michael Brodsky, MD, Medical Director, Behavioral Health and Social Services, L.A. Care Health Plan
- Aimee Dailey, President, Medicaid, Anthem, Inc.
- Rebecca Engelman, EVP, Medicaid Markets, AmeriHealth Caritas
- Brent Layton, President, COO, Centene Corporation
- Andrew Martin, National Director of Business Development (Housing+Health), UnitedHealth Group
- Kelly Munson, President, Aetna Medicaid
- Thomas Rim, VP, Product Development, AmeriHealth Caritas
- Timothy Spilker, CEO, UnitedHealthcare Community & State
- Courtnay Thompson, Market President, Select Health of SC, an AmeriHealth Caritas Company
- Ghita Worcester, SVP, Public Affairs & Chief Marketing Officer, UCare
- Mary Zavala, Director, Enhanced Care Management, L.A. Care Health Plan
Provider Speakers to Date (In alphabetical order)
- Daniel Elliott, MD, Medical Director, Christiana Care Quality Partners, eBrightHealth ACO, ChristianaCare Health System
- Taylor Nichols, Director of Social Services, Los Angeles Christian Health Centers
- Abby Riddle, President, Florida Complete Care; SVP, Medicare Operations, Independent Living Systems
- David Rogers, President, Independent Living Systems
- Mark Sasvary, Chief Clinical Officer, CBHS, IPA, LLC
- Jim Sinkoff, Deputy Executive Officer, CFO, SunRiver Health
- Tim Skeen, Senior Corporate VP, CIO, Sentara Healthcare
- Efrain Talamantes, SVP & COO, Health Services, AltaMed Health Services Corporation
Featured Speakers to Date (In alphabetical order)
- Drew Altman, President and CEO, Kaiser Family Foundation
- Cindy Cota, Director of Managed Medicaid Growth and Innovation, Volunteers of America
- Jesse Hunter, Operating Partner, Welsh, Carson, Anderson & Stowe
- Bryant Hutson, VP, Business Development, MedArrive
- Martin Lupinetti, President, CEO, HealthShare Exchange (HSX)
- Todd Rogow, President, CEO, Healthix
- Joshua Traylor, Senior Director, Health Care Transformation Task Force
- James Whittenburg, CEO, TenderHeart Health Outcomes
- Shannon Wilson, VP, Population Health & Health Equity, Priority Health; Executive Director, Total Health Care Foundation
Oklahoma to transition to Medicaid managed care
This week, our In Focus section reviews a new Oklahoma law to implement Medicaid managed care by October 1, 2023. The law, signed by Governor Kevin Stitt on May 26, 2022, requires the state to issue a request for proposals and to award at least three Medicaid managed care contracts to health plans or provider-led entities like accountable care organizations.
Provider-led entities would receive preferential treatment, with at least one targeted to receive a contract. However, if no provider-led entity submits a response, the state will not be required to contract with one.
Goals of the legislation include:
- Improve health outcomes for Medicaid members and the state as a whole;
- Ensure budget predictability through shared risk and accountability;
- Ensure access to care, quality measures, and member satisfaction;
- Ensure efficient and cost-effective administrative systems and structures; and
- Ensure a sustainable delivery system that is a provider-led effort and that is operated and managed by providers to the maximum extent possible.
Plans would provide physical health, behavioral health, and prescription drug services. Covered beneficiaries would include traditional Medicaid members and the state鈥檚 voter-approved expansion population, but not the aged, blind, and disabled population eligible for SoonerCare.
Plans will need to contract with at least one local Oklahoma provider organization for a model of care containing care coordination, care management, utilization management, disease management, network management, or another model of care as approved by OHCA.
Oklahoma will also issue separate RFPs for a Medicaid dental benefit manager plan and a Children鈥檚 Specialty plan.
Background
Oklahoma currently does not have a fully capitated, risk-based Medicaid managed care program. The majority of the state鈥檚 more than 1.2 million Medicaid members are in SoonerCare Choice, a Primary Care Case Management (PCCM) program in which each member has a medical home. Other programs include SoonerCare Traditional (Medicaid fee-for-service), SoonerPlan (a limited benefit family planning program), and Insure Oklahoma (a premium assistance program for low-income people whose employers offer health insurance). Prior efforts to transition to Medicaid managed care have encountered roadblocks, starting in 2017 with a failed attempt to move aged, blind, and disabled members to managed care.
More recently, in June 2021, the Oklahoma Supreme Court struck down a planned transition of the state鈥檚 traditional Medicaid program to managed care, ruling that the Oklahoma Health Care Authority does not have the authority to implement the program without legislative approval.
Contracts had been awarded to Blue Cross Blue Shield of Oklahoma, Humana, Centene/Oklahoma Complete Health, and UnitedHealthcare. Centene/Oklahoma Complete Health also won an award for the SoonerSelect Specialty Children鈥檚 Health Plan program, covering foster children, juvenile justice-involved individuals, and children either in foster care or receiving adoption assistance.
Link to
Behavioral health crises drive bipartisan action in Congress
Agreement about the severity of the nation鈥檚 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 House and Senate committees with jurisdiction over behavioral health programs and policies this year.
On May 18, the U.S. House of Representatives Energy and Commerce Committee unanimously approved the 鈥淩estoring Hope for Mental Health and Well-Being Act of 2022鈥� (H.R. 7666). This legislation incorporates a collection of bipartisan bills to update and reauthorize over 30 Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA) programs addressing the mental health and substance use disorder (SUD) crisis. The bill also advances initiatives to strengthen the 9-8-8 National Suicide Prevention Lifeline implementation efforts, invest in the crisis response continuum of care, and support strategic opioid crisis response plans among numerous other policies. Energy and Commerce is one of several House committees planning to advance behavioral health bills this year.
U.S. Senate committee leaders have been similarly engaged in developing bipartisan proposals to address mental health and substance use disorders. Senate Health, Education, Labor and Pensions () and committee leaders are expected to reveal their proposals as soon as this summer. The Finance Committee鈥檚 proposal will focus on Medicare, Medicaid, and Children鈥檚 Health Insurance Program (CHIP) policies and could reflect findings from the committee鈥檚 , 鈥淢ental Health Care in the United States: The Case for Federal Action.鈥� Similarly, HELP members Sens. Chris Murphy (D-CT) and Bill Cassidy (R-LA) the Mental Health Reform Reauthorization Act to extend several expiring mental health programs, which could be incorporated in that Committee鈥檚 comprehensive proposal. Across committees, there has been an interest in strengthening parity, supporting integration of primary and behavioral health care, increasing access to youth mental health screenings, scheduling fentanyl analogues, and easing requirements for prescribing Medication Assisted Treatment.
What To Expect
Congressional leaders have consistently expressed their desire to advance bipartisan legislation to address the urgent needs and gaps in the mental health and SUD care delivery systems, as well as support education and research. While these are key areas to watch, the diminishing number of legislative days on the congressional calendar and climate surrounding November鈥檚 mid-term elections create uncertainty for the timing and scope of Congress鈥� work. It remains to be seen whether a package of health care proposals, such as reauthorization of the U.S. Food and Drug Administration鈥檚 user fee programs, the Cures 2.0 legislation to advance biomedical research, mental health and substance use disorder legislation, and the PREVENT Act could be sent to President Biden鈥檚 desk before the end of September.
黑料不打烊 companies are supporting clients impacted by the policy changes being discussed and the program funding addressed in these legislative proposals. Understanding the landscape for federal change allows state and local governments and stakeholders to plan for and shape these opportunities. For more information, please contact our experts below.
The PHE is continuing鈥攚hat鈥檚 next for Medicaid?
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?
KFF predicts Medicaid implications of end of PHE
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.
黑料不打烊 conference on “The New Normal for Medicaid, Medicare, and Other Publicly Sponsored Programs” to feature insights from health plan leaders, state Medicaid directors, and providers
Pre-Conference Workshop: October 9, 2022
Conference: October 10-11, 2022
Location: Fairmont Chicago, Millennium Park
黑料不打烊 Conference on the New Normal for Medicaid, Medicare, and Other Publicly Sponsored Programs to Feature Insights from Health Plan Leaders, State Medicaid Directors, Providers
Early Bird registration is now open for 黑料不打烊鈥檚 fifth national conference on trends in publicly sponsored healthcare. Early Bird Registration Ends July 11th.
Nebraska releases Medicaid managed care RFP
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. DHHS will award statewide contracts to two or three Medicaid managed care organizations (MCOs) to serve approximately 342,000 individuals. Implementation is set to begin July 1, 2023. Contracts are currently worth $1.8 billion annually.
黑料不打烊 Acquires Cirdan Health Systems and Consulting
Today, Jay Rosen, founder, president, and co-chairman of 黑料不打烊 (黑料不打烊), announced the firm鈥檚 acquisition of Cirdan Health Systems and Consulting (Cirdan).
Public Healthcare Leader Assumes VP Position at 黑料不打烊
Learning from COVID-19-related flexibilities: moving toward more person-centered Medicare and Medicaid programs
A new person-centered assessment framework and issue brief, authored by 黑料不打烊 experts in conjunction with Manatt Health, examine the temporary regulatory Medicare and Medicaid flexibilities implemented during the COVID-19 public health emergency (PHE) and aimed at ensuring access to care for older adults and people with chronic conditions and disabilities.
As these temporary flexibilities are currently set to expire in April 2022, the report provides insight and guidance for policymakers as they assess the impact these regulatory policy changes are having on advancing person- and community-centered care and consider possible permanence of these changes.
The framework is designed to help facilitate these conversations and decisions and assess the potential for continuation of the regulatory flexibilities to advance person- and community-centered care, facilitate access to care in the least intensive or least restrictive setting, and better align Medicare and Medicaid program rules.
黑料不打烊 colleagues Jennifer Podulka, Yamini Narayan, and Keyan Javadi contributed to the framework and research.