This week, our In Focus section reviews the California fiscal 2019-20 budget. California Governor Gavin Newsom signed his first budget, and much of its related legislation on June 27, 2019. The budget appropriates $214.8 billion ($147.8 billion General Fund) in total spending with $19.2 billion in reserves. The total reserves includes $16.5 billion in the Rainy Day Fund, $1.4 billion in the Special Fund for Economic Uncertainties, $900 million in the Safety Net Reserve, and nearly $400 million in the Public School System Stabilization Account.
Government Programs & The Uninsured
Dual Eligible Financial Alignment Demonstration 2019 Enrollment Update
This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (“Duals Demonstrations”) 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 (“Medicare-Medicaid Plans,” or “MMPs”) under three-way contracts between the state, the Centers for Medicare & Medicaid Services (CMS), and the MMP. As of May 2019, approximately 372,600 duals were enrolled in an MMP. Enrollment was flat from May of the previous year.
HMA Collaborates on Connecticut HEC Initiative
The Connecticut Office of Health Strategy and Department of Public Health recently announced that the State Innovation Model (SIM) Healthcare Innovation Steering Committee has approved the Health Enhancement Community (HEC) initiative proposed framework. This blueprint is designed to build or expand collaborations across the state to improve healthy weight and physical fitness, advance child well-being, and strengthen health equity. The HEC initiative will further residents’ health and well-being by addressing both clinical need and the social determinants that impact overall health.
Texas 2020-21 Biennium Budget Overview
This week, our In Focus section reviews the Texas 2020-21 biennium budget. The Texas Legislature adjourned its biennial legislative session on May 27, 2019, after adopting a $250.6 billion budget (all funds). The total budget is 6.3 percent higher than the 2018-19 budget with an increase of $14.8 billion.
It Takes a Village: How to Coordinate and Pay for a Community Response to Health Inequities
This week, our In Focus section reviews the Pathways HUB model, an approach designed to help coordinate outreach by specialized community health workers who are incentivized to engage high-need populations. An HMA webinar, held May 9, 2019, with Mark Redding, co-developer of the Pathways HUB model, and Heidi Arthur, HMA can be viewed here.
HMA Conference to Feature Insights from 40+ Speakers, Including Health Plan CEOs, State Medicaid Directors, Providers
Pre-Conference Workshop: September 8, 2019
Conference: September 9-10, 2019
Location: Chicago Marriott Downtown Magnificent Mile
Health Management Associates is proud to announce its fourth annual conference on trends in publicly sponsored health care: The Next Wave of Medicaid Growth and Opportunity: How Payers, Providers, and States Are Positioning Themselves for Success.
The HMA conference has emerged as a premier informational and networking event, attracting more than 450 executives and policy experts. Speakers this year include state Medicaid directors and leaders from Medicaid managed care, hospitals, clinics, community-based organizations, and other providers.
Managing Principal Jonathon Blum Breaks Down Trump Administration’s Agenda for Pharmacy Rebates
Medicare policy expert and HMA Managing Principal Jonathan Blum weighed in on the Trump administration’s recently proposed rules for pharmacy rebates and plans to reduce prescription drug prices in a blog post for Health Affairs.
Blum provided insight to questions about implementation of the proposed drug rebate reforms and whether they will lead to lower drug prices. The fundamental changes proposed would govern how pharmaceutical manufacturers pay rebates to pharmacy benefit managers and managed care plans contracted with Medicare, as well as state Medicaid programs.
He also addressed the variables outlined in the administration’s 2018 plan, American Patients First, which aim to reduce out-of-pocket costs and lower drug prices.
Blum joined HMA in 2018. In his previous leadership role at the Centers for Medicare and Medicaid Services from 2009-2014 he had direct responsibility for administration of the Medicare program.
HMA Analysis of 2020 Medicare Advantage Rate Notice and Final Call Letter
This week, our In Focus reviews the Announcement of Calendar Year (CY) 2020 Medicare Advantage Capitation Rates and Medicare Advantage (MA) and Part D Payment Policies (Rate Announcement) and Final Call Letter, issued by the Centers for Medicare & Medicaid Services (CMS) on April 1, 2019. The Rate Announcement and Call Letter includes final updates to MA payment rates and guidance to plan sponsors as they prepare their bids for CY 2020. Bids for CY 2020 are due to CMS on or before Monday June 3, 2019. It is important to note that the Announcement and final Call Letter does not take into consideration the Health and Human Services (HHS) Office of Inspector General (OIG) proposed rule which seeks to remove anti-kickback protection for prescription drug rebates, which, if finalized as proposed, could have significant impacts on Part D plans’ bids. While the administration has not provided any guidance on how plans should construct their 2020 bids in response to the rebate changes, HHS could decide to delay the rule’s effective date to 2021 or CMS may allow plans to update their 2020 bids later this year.
CMS Increases Monitoring and Evaluation Requirements for Section 1115(a) Medicaid Demonstrations
This week, our In Focus reviews the implications of the new federal guidance for state waivers with community engagement, premiums, non-eligibility periods, and other personal responsibility provisions.
Background
On March 14, 2019, the Centers for Medicare & Medicaid Services (CMS) issued several new guidance documents that significantly increase the level of monitoring and evaluation required for Section 1115(a) Medicaid Demonstrations. These new requirements apply to community engagement, premiums, and other waiver provisions that impact eligibility and enrollment, and affect states currently with such waivers as well as any states proposing these ideas. Changes in reporting, data collection, and waiver monitoring processes will be necessary, and soon—as the materials details compliance dates for these significant new requirements.
Patient Protection and Affordable Care Act; 2020 Proposed Notice of Benefit and Payment Parameters
This week, our In Focus reviews the Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2020. The new proposed rule does not contain as many major changes as the 2019 rule, but there are requests for comment on potentially important rulemaking starting in 2021 and guidance on important policy, such as: