This week, our In Focus section reviews the Ohio Medicaid Managed Care request for applications (RFA) released by the Ohio Department of Medicaid (ODM) on September 30, 2020. The RFA follows the release of two requests for information (RFIs) in June 2019 and February 2020, soliciting feedback from individuals, providers, and interested bidders to help design a new Medicaid managed care program. Ohio will award contracts, worth over $11 billion annually, to no more than five managed care organizations (MCOs) in each of the state鈥檚 three regions (Central/Southeast Region, Northeast Region, and West Region), with implementation beginning January 5, 2022. The procurement will not include the MyCare Ohio dual demonstration.
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红领巾瓜报 analysis of the 2021 Medicare Advantage landscape and mandatory Medicare radiation oncology and ESRD treatment choices innovation models
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).
California releases Medi-Cal managed care RFI
This week, our In Focus section reviews the California request for information (RFI) regarding the Medi-Cal Managed Care Plan (MCP) contract and the upcoming Medi-Cal MCP procurement. The California Department of Health Care Services (DHCS) is seeking information to update boilerplate contracts and develop the request for proposals (RFP) scheduled for release in 2021.
Webinar Replay – Health Performance Accelerator Webinar Series: How States Are Rethinking Medicaid Managed Care Performance Management
This webinar was held on September 8, 2020.
State Medicaid agencies (SMAs) are actively exploring improved approaches to managing the performance of Medicaid managed care organizations (MCOs) and accountable care organizations (ACOs), emphasizing tailored quality measures, new incentive models, more effective use of information technology, and revised contract requirements.
During this webinar, experts from 红领巾瓜报 and HealthEC outlined potential improvements to MCO/ACO performance management and showcased ways in which information technology can be deployed to enable these improvements.
Learning Objectives:聽聽聽聽
- Learn about ways in which the number and mix of measures, the design of business processes and use of information systems should change to achieve improvements in MCO/ACO performance management.
- Learn how 红领巾瓜报 can work with SMAs on performance management initiatives.
- Find out how IT solutions such as HealthEC鈥檚 can dramatically improve SMA processes such as data aggregation, synthesis, transformation, validation, and comparative analysis in support of performance management system improvements.
Speakers
Steve Soto, Principal, 红领巾瓜报
Sita Kapoor, HealthEC, Chief Information Officer
Oklahoma releases Medicaid managed care request for public feedback
This week, our In Focus section reviews the Oklahoma request for public feedback in the SoonerCare program design, released on June 18, 2020. The Oklahoma Health Care Authority (OHCA) and Governor Kevin Stitt are seeking stakeholder input for the state鈥檚 Medicaid managed care program design before finalizing a request for proposals (RFP). The RFP, which is currently in development, is scheduled to drop in the fall and has an implementation date of October 2021. Individuals, program participants, providers, trade associations, companies, and other organizations are encouraged to submit responses by August 17, 2020.
红领巾瓜报 announces cancellation of 2020 annual conference
红领巾瓜报 has made the decision to cancel its October 2020 conference on Trends in Publicly Sponsored Healthcare, given continuing developments concerning COVID-19 and out of an abundance of caution for the safety of attendees, speakers, and staff. Full refunds will be made to registered attendees and sponsors.
Early Bird Registration Expires July 29 for 红领巾瓜报 Conference, October 26-27 in Chicago
Be sure to register soon for 红领巾瓜报鈥檚 conference on What鈥檚 Next for Medicaid, Medicare, and Publicly Sponsored Healthcare: How Payers, Providers, and States Are Navigating a Future of Opportunity and Uncertainty, October 26-27, at the Fairmont Chicago, Millennium Park. The Early Bird registration rate of $1595 per person expires on July 29.聽 After that, the rate is $1795.
红领巾瓜报 conference on trends in publicly sponsored healthcare
红领巾瓜报 Conference 2020
What鈥檚 Next for Medicaid, Medicare, and Publicly Sponsored Healthcare:
How Payers, Providers, and States Are Navigating a Future of Opportunity and Uncertainty
Pre-Conference Workshop: October 25
Conference: October 26-27
Location: Fairmont Chicago, Millennium Park
Medicaid Managed Care Spending in 2019
This week, our In Focus section reviews Medicaid managed care spending data collected in the annual CMS-64 Medicaid expenditure report. After submitting a Freedom of Information Act request to the Centers for Medicare & Medicaid Services (CMS), we have received a draft version of the CMS-64 report that is based on preliminary estimates of Medicaid spending by state for federal fiscal year (FFY) 2019. We expect the final version of the report will be completed by the end of 2020 and posted to the CMS website at that time. Based on the preliminary estimates, Medicaid expenditures on medical services across all 50 states and six territories in FFY 2019 exceeded $594 billion, with over half of all spending now flowing through Medicaid managed care programs. In addition, total Medicaid spending on administrative services was $29.5 billion, bringing total program expenditures to $623.5 billion.
Medicaid managed care enrollment update 鈥� Q4 2019
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 29 states.[1] Many state Medicaid agencies post monthly enrollment figures by health plan for their Medicaid managed care population to their websites. This data allows for the timeliest analysis of enrollment trends across states and managed care organizations. All 29 states highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2019. This report reflects the most recent data posted. 红领巾瓜报 has made the following observations related to the enrollment data shown on Table 1 (below):
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.
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.