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HMA Insights – including our new podcast – puts the vast depth of HMA’s expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.

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Webinar

The Future of the Affordable Care Act (ACA): Implications of November’s Elections and a Supreme Court Decision

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After the November 3 elections, the political landscape will shift as the composition of the next administration, Congress and many state legislatures and governors’ offices begins to take shape. If President Trump is reelected, his administration will position to govern for another four years. If former Vice President Joe Biden is elected, his campaign will accelerate transition planning and prepare actions to implement change immediately upon inauguration. At the same time, on November 10, the Supreme Court is scheduled to hear oral arguments regarding the continued validity of the Affordable Care Act.

The presidential, congressional and state elections, and the Supreme Court’s decision, will drive the future of the ACA and health care coverage in the U.S. While any significant change will take time to implement, uncertainty will require action and planning from all health care stakeholders as they navigate the emerging scenarios and position for future shifts.

During this webinar, HMA and Dentons will discuss the specific pathways that change could take. Specifically:

  • What impact could the Supreme Court’s decision have on the ACA, and what is the expected timing of this decision?
  • What impact could the November election results have on the Supreme Court’s decision?
  • What immediate actions should stakeholders expect for Marketplace and Medicaid coverage as a result of the November elections?
  • If Democrats gain control of the White House and Congress, how will Democrats implement campaign pledges, for example to create a public option and expand Medicare to those ages 60 to 65?
  • How will the future direction of the ACA impact other health care coverage?
  • How would Medicare be affected by the ACA decision and the results of the November elections?
  • How should specific health care stakeholder groups (e.g., consumers and patients, health plans, delivery systems, states) respond and prepare for changes?

Speakers

Jonathan (Jon) Blum, MPP, Vice President, Federal Policy and Managing Director, Medicare, HMA

Bruce Merlin Fried, Partner, Dentons’ Health Care Practice

Charles Luband, Partner, Dentons’ Health Care Practice

Kathleen Nolan, Regional Vice President, HMA

Blog

North Carolina releases RFA for behavioral health, IDD tailored plans

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This week, our In Focus section reviews the statewide North Carolina request for applications (RFA) for Behavioral Health and Intellectual/Developmental Disability (BH IDD) Tailored Plans released by the North Carolina Department of Health and Human Services (DHHS) on November 13, 2020. BH IDD Tailored Plans are part of the statewide effort to transition to Medicaid managed care and are one of the four types of integrated Medicaid managed care plans the state will contract with to serve Medicaid and NC Health Choice beneficiaries. The other three are Standard Plans, the Statewide Specialized Foster Care Plan, and the Eastern Band of Cherokee Indians Tribal Option.

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Blog

CMS Introduces New Medicare Direct Contracting Model Opportunity

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This week, our In Focus section looks at a new Medicare model, Direct Contracting, introduced by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. The new model will build on and continue testing potential reforms to the Medicare program encompassed by accountable care organizations (ACOs), Medicare Advantage (MA), and private sector risk-sharing arrangements. The payment model options may appeal to a broad range of physician and provider groups and other organizations because they are expected to introduce flexibility in health care delivery, support a focus on beneficiaries with complex, chronic conditions, and encourage participation from organizations that have not typically participated in traditional fee-for-service (FFS) Medicare or CMS Innovation Center models. However, there will be substantial financial risk—and reward—for participants based on a new, complex methodology, so organizations interested in this new model should carefully consider the possible outcomes from participating in Direct Contracting versus other options.  CMS has announced that 51 organizations will participate in the model’s trial Implementation Period, which runs from October 1, 2020, through March 31, 2021.  The agency has stated that it expects to announce additional Direct Contracting pathways in the future and that the next round of applications for participation in the second performance year will open in early 2021.

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Blog

HMA colleagues author case studies on two-generation approach to addressing inequities in D.C. and Maryland

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Focused on addressing inequities and building more sustainable and vital futures for low-income families in Washington, D.C., and the state of Maryland, colleagues from Health Management Associates (HMA) authored two case studies under the auspices of Ascend at the Aspen Institute, a hub for breakthrough ideas and collaborations that move children and their parents toward educational success and economic security.

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Blog

A short-term solution to ACA uncertainty amid ongoing pandemic

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In this week’s In Focus section, Health Management Associates (HMA) Managing Director MMS Matt Powers, Senior Consultant Kaitlyn Feiock, and Regional Vice President Kathleen Nolan look at the future of the Patient Protection and Affordable Care Act (ACA). On November 10, 2020, the Supreme Court of the United States (SCOTUS) heard oral arguments for California v. Texas, challenging the constitutionality and severability of the ACA.  This challenge became possible after the 2017 Tax Cuts and Jobs Act, which zeroed out the individual mandate penalty for not purchasing health insurance.  While most experts agree that an entire invalidation of the ACA is the least likely outcome based on the oral arguments, some uncertainty remains and more than $100 billion federal funds are at risk. The ACA standardized insurance rules offset premium costs for many individual market consumers and provided authority and funding for Medicaid Expansions in the overwhelming majority of states. The ACA also included other provisions that may be at risk but are not the subject of this note, such as the creation of Center for Medicare and Medicaid Innovation (CMMI) and the Medicare-Medicaid Coordination Office, as well as demonstration authority that has led to the creation of numerous coverage models.  As states, Congress, and the federal executive branch face the possibility that the ACA may not survive in its present form, what mitigation strategies are available at the state and federal levels to stabilize uncertainties and protect against abrupt coverage changes?

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Brief & Report

HMA prepares NCQA distinction in multicultural health care report

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Health Management Associates (HMA) was engaged by Covered California to evaluate and make recommendations about whether the state’s Marketplace should require Qualified Health Plan (QHP) Issuers to gain National Committee for Quality Assurance (NCQA) Distinction in Multicultural Health Care.

With a mission to increase insurance coverage in California and improve quality of care while reducing costs and health disparities, Covered California sought to learn how achieving Distinction in Multicultural Health Care has helped Issuers promote meaningful change and reduce disparities to advance health equity, in order to determine whether requiring the Distinction would help the Marketplace assure QHP Issuers effectively deliver quality care and improve population health.

The HMA team reviewed the Distinction’s standards and guidelines within Attachment 7, Article 3interviewed four Issuers that have earned the Distinction. They recommended Covered California update its language in Article 3.04, requiring Issuers to achieve NCQA Distinction in Multicultural Health Care and allocate resources to deliberately address disparities and health equity, increasing infrastructure and reinforcing organizational commitment to this work.

HMA consultants Michael Anderson-Nathe, Nora Leibowitz and Michele Melden completed the assessment.