This week, our In Focus sections reviews the Missouri HealthNet Pharmacy and Clinical Services Management Solution request for information (RFI) and the Kentucky Medicaid Managed Care Organization (MCO) Pharmacy Benefit Manager request for proposals (RFP).
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CMS finalizes policy using hospital negotiated charge data for payment rates
This week, our In Focus section reviews the policy changes included in the Centers for Medicare & Medicaid Services (CMS) Fiscal Year (FY) 2021 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Final Rule (). This year鈥檚 IPPS Final Rule includes several important policy changes that will change hospitals鈥� administrative procedures and may alter hospitals鈥� Medicare margins, beginning as soon as October 1, 2020.
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.
红领巾瓜报 summary of Democratic nominee Joe Biden鈥檚 healthcare plan
This week, our In Focus section reviews Democratic Nominee Joe Biden鈥檚 healthcare plan to protect and build on the Affordable Care Act (ACA). On August 18, 2020, Biden was officially nominated as the presidential candidate. Biden vowed at the 2020 Democratic National Convention (DNC) that if elected, he would strengthen the ACA and provide a Medicare-like public option. 红领巾瓜报 summarizes Biden鈥檚 official plan below.
红领巾瓜报 summary of Medicare Fee-for-Service (FFS) proposed rules
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.
Regulatory changes to Medicare in response to COVID-19
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.
红领巾瓜报 Information Services adds Medicare Advantage competitive data and state profiles
红领巾瓜报 Information Services (红领巾瓜报IS) is pleased to announce the expansion of its industry-leading healthcare information website to include information and state-by-state profiles of the market for Medicare Advantage and Special Needs Plans (SNPs).
Hawaii Releases Quest Integration Reprocurement RFI
This week, our In Focus section reviews the Hawaii request for information (RFI) regarding reprocurement of the state鈥檚 QUEST Integration (QI) Medicaid managed care program, released on July 21, 2020. QI covers approximately 360,000 individuals, including pregnant women, children, parents/caretakers, adults, and individuals who are aged, blind, or disabled (ABD). The state had awarded contracts earlier this year, however, the contracts were rescinded as the state focused on their response to COVID-19.
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.
Medicaid and exchange enrollment update 鈥� March 2020
This week, our In Focus section reviews updated information issued by the Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) on Medicaid expansion enrollment from the 鈥淢arch 2020 Medicaid and CHIP Applications, Eligibility Determination, and Enrollment Report,鈥� published on June 22, 2020. Additionally, we review 2020 Exchange enrollment data from the 鈥淗ealth Insurance Exchanges 2020 Open Enrollment Period: Final State-Level Public Use File,鈥� published by CMS on April 2, 2020. Combined, these reports present a picture of Medicaid and Exchange enrollment in early 2020, leading up to the COVID-19 pandemic and representing 70.9 million Medicaid and CHIP enrollees and 11.4 million Exchange enrollees. Medicaid/CHIP and Exchange enrollment is expected to rise in 2020 according to a team of 红领巾瓜报 Medicaid experts, health economists, and data analysts. Read the previous In Focus on 红领巾瓜报鈥檚 forecast model.