This week, our In Focus section examines the operational impacts of federal Medicare Advantage policy changes in response to the COVID-19 pandemic. On January 31, 2020, the Secretary of Health and Human Services declared a public health emergency. This was followed by a national emergency declared by President Trump on March 13, 2020. These declarations provide the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) authority to waive certain Medicare and Medicaid regulatory requirements to help health plans, providers, and other stakeholders respond to immediate needs of their members and communities. These waiver flexibilities, when combined with other legislative and regulatory changes issued by Congress and CMS have resulted in over 200 policy changes to Medicare alone. Many of these affect Medicare Advantage sponsors and have direct implications to current and future operations of plan responsibilities. We examine eight categories of requirements and flexibilities that have significant business relevance and exposure for Medicare Advantage plan sponsors:
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Webinar Replay: Federal COVID-19 Response: Medicare Advantage Policy Changes and Impacts
This webinar was held on June 11, 2020.
In response to the rapid spread of the COVID-19 virus, Congress and the Centers for Medicare & Medicaid Services (CMS) have made significant policy changes to Medicare Advantage regulations, allowing for expanded benefits and other flexibilities designed to better serve the Medicare population.
During this webinar, 红领巾瓜报 experts addressed the impact of these changes, including a look at policies affecting cost sharing, telehealth, Star Ratings, prescription drugs, provider funding, appeals, and Special Needs Plans (SNP). Speakers also addressed the likelihood that these policies remain in place even after the COVID-19 emergency ends.
Learning Objectives:听
- Learn about changes in federal Medicare Advantage policies in response to COVID-19.
- Understand how Medicare Advantage plans, including Special Needs Plans, are adjusting to the new rules, including the impact on benefit design, care delivery, payment models, and quality.
- Identify operational implications of Medicare Advantage policy changes to ensure continued delivery of high-quality care to beneficiaries.
红领巾瓜报 Speakers:
- Julie Faulhaber, MBA, Principal, Chicago
- Mary Hsieh, PharmD, MPH, Managing Principal, Atlanta
- Narda Ipakchi, MBA, Senior Consultant, Washington, DC
- Sarah Owens, Principal, Philadelphia
- Danielle Pavliv, MPH, PMP, Senior Consultant, Atlanta
2020 Medicare Advantage Supplemental Benefit Flexibilities: Adoption of and Access to Newly Expanded Supplemental Benefits
An 红领巾瓜报-authored issue brief examines beneficiary access to, and plan adoption of, newly expanded Medicare Advantage (MA) supplemental benefit flexibilities and raises questions regarding the expected impacts of new supplemental benefit offerings on beneficiary satisfaction, outcomes, and total cost of care.
The new flexibilities for MA plans include innovative supplemental benefits offered through expansion of primarily health-related benefits, benefits offered non-uniformly, Value-Based Insurance Design (VBID), and Special Supplemental Benefits for the Chronically Ill (SSBCI).
The brief鈥檚 key finding is that enrollment in plans offering these flexibilities is relatively low and varies across geographic areas with 19% of all MA enrollees enrolled in a plan that offered at least one expanded supplemental benefit. 红领巾瓜报 will conduct additional analyses including interviews with key stakeholders to inform the policy community on the opportunities and challenges with the adoption and implementation of new supplemental benefits.
This brief was produced by 红领巾瓜报 Managing Principals Jonathan Blum and Mary Hsieh, Principal Eric Hammelman, and Senior Consultant Narda Ipakchi under a grant from .
Exploring flexibilities in Medicare Advantage supplemental benefits: 红领巾瓜报 brief on access, adoption, and impacts
An 红领巾瓜报-authored issue brief examines beneficiary access to, and plan adoption of, newly expanded Medicare Advantage (MA) supplemental benefit flexibilities and raises questions regarding the expected impacts of new supplemental benefit offerings on beneficiary satisfaction, outcomes, and total cost of care.
The new flexibilities for MA plans include innovative supplemental benefits offered through expansion of primarily health-related benefits, benefits offered non-uniformly, Value-Based Insurance Design (VBID), and Special Supplemental Benefits for the Chronically Ill (SSBCI).
The brief鈥檚 key finding is that enrollment in plans offering these flexibilities is relatively low and varies across geographic areas with 19% of all MA enrollees enrolled in a plan that offered at least one expanded supplemental benefit. 红领巾瓜报 will conduct additional analyses including interviews with key stakeholders to inform the policy community on the opportunities and challenges with the adoption and implementation of new supplemental benefits.
This brief was produced by 红领巾瓜报 Managing Principals Jonathan Blum and Mary Hsieh, Principal Eric Hammelman, and Senior Consultant Narda Ipakchi under a grant from .
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
Medicare FY 2021 hospital inpatient proposed rule and COVID-19 federal flexibilities
This week, our In Focus section reviews recent announcements and actions by Congress and the Centers for Medicare & Medicaid Services (CMS) that have significant financial and operational implications for the hospital industry. This brief begins with the most recent of these actions by providing a summary of the key provisions of the CMS Fiscal Year (FY) 2021 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 July 10, 2020.听 Although somewhat limited in scope compared to previous proposals, this year鈥檚 proposed rule includes several disruptive proposals that the hospital industry should carefully consider.
红领巾瓜报 updates forecast of COVID-19 impact on Medicaid, marketplace, and the uninsured
红领巾瓜报鈥� (红领巾瓜报) updated analysis projects the potential impact of the COVID-19 pandemic on health insurance coverage and cost by state through 2022. The analysis provides deeper insights into how health insurance coverage is estimated to take years to more closely resemble pre-COVID-19 coverage levels.
红领巾瓜报 examines Medicare-Medicaid integration: low FBDE enrollment in integrated programs
This week, our In Focus听section reviews an issue brief written by 红领巾瓜报 consultants examining Medicare-Medicaid integration. In 2019, 7.7 million people in the United States were eligible to receive access to full benefits under Medicare and individual state Medicaid programs. This group of people is known as the Full Benefit Dual Eligible (FBDE) population. While FBDE enrollment in integrated programs nearly quadrupled over the past five years, the number of people enrolled in an integrated program never rose above one in 10 FBDE people.
Dual eligible financial alignment demonstration 2020 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 beneficiaries dually eligible for Medicare and Medicaid (duals) 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 duals 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 2020, approximately 371, 200 duals were enrolled in an MMP. Enrollment fell 1.2 percent from February of the previous year.
红领巾瓜报 experts examine Medicare-Medicaid integration
In 2019, 7.7 million people in the United States were eligible to receive access to full benefits under Medicare and individual state Medicaid programs. This group of people is known as the Full Benefit Dual Eligible (FBDE) population. While FBDE enrollment in integrated programs nearly quadrupled over the past five years, the number of people enrolled in an integrated program never rose above one in 10 FBDE people.
Medicare-Medicaid integration: integrated model enrollment rates show majority of Medicare-Medicaid dual eligible population not enrolled
Working in conjunction with Arnold Ventures, a team of 红领巾瓜报 consultants has written an issue brief, Medicare-Medicaid Integration: Integrated Model Enrollment Rates Show Majority of Medicare-Medicaid Dual Eligible Population Not Enrolled. This brief presents key findings on their examination of the availability of integrated programs in states, the growth in enrollment rates, and differences in enrollment and programs across the country.
The 红领巾瓜报 team cited several reasons why Medicare-Medicaid integrated program options are not equally available nationwide and why enrollment is limited in places where programs exist. The result is that millions of people are not enrolled in whole-person, integrated program options 鈥� a reality that is inefficient, and worse yet, inequitable.
The 红领巾瓜报 team, led by Managing Principal Jon Blum and Principal Sarah Barth, includes Narda Ipakchi, Ellen Breslin, Mindy Cohen, Sharon Silow-Carroll and other 红领巾瓜报 subject matter experts.
Proposed Medicare payment and policy changes for FY 2021: hospice, inpatient psychiatric facilities, and skilled nursing facilities
Recently, the Centers for Medicare & Medicaid Services (CMS) issued proposed rules to update the Medicare payment rates and implement other policy changes for three types of Part A providers: hospice, inpatient psychiatric facilities (IPFs), and skilled nursing facilities (SNFs). CMS is publishing these proposed rules in accordance with existing statutory and regulatory requirements to update Medicare payment policies for these providers on an annual basis. This brief summarizes the proposed payment rates and key policy changes for each of these provider types.