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.
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Medicare and Medicaid Telehealth Coverage in Response to COVID-19
Telehealth service expansions by Medicare and most Medicaid programs aim to rapidly increase access to care and reduce transmission, but also provide a natural experiment for policymakers.
This week, our In Focus section examines the extensive scope of flexibilities Federal and State governments have made to Medicare and Medicaid telehealth coverage in response to the COVID-19 national emergency. In March and April 2020, federal and state policymakers responded to the COVID-19 emergency by temporarily and aggressively expanding the definition of and reimbursement for telehealth services—moves intended to improve access to care and reduce virus transmission. Under the Medicare and Medicaid programs, these temporary expansions have been rapid and historic in scope, and will have substantial implications for patients, providers, payers, and federal/state financing. For policymakers, this temporary expansion may serve as a natural experiment for assessing which forms of telehealth services successfully expand access to care and should become permanent healthcare policy.
Webinar Replay: Reflecting on HCBS Policies and Practices in Response to COVID-19
This webinar was held on April 17, 2020.
Medicaid-covered home and community-based services (HCBS) are critical to the health and well-being of millions of individuals with intellectual or developmental disabilities, physical disabilities, and/or behavioral health conditions.
In response to COVID-19, the Centers for Medicare and Medicaid Services (CMS) has provided state Medicaid programs with increased flexibility to modify HCBS programs to continue to provide timely high-quality care. State Medicaid programs have secured approval for new initiatives through a combination of Section 1135 Waivers, 1115 Emergency Amendments, Emergency State Plan Amendments, and Appendix K amendments to HCBS 1915(c) waivers.
During this webinar, our HMA experts outlined what these changes mean for states, providers, and individuals who rely on HCBS. Speakers provided an overview of key flexibilities, offered examples of promising practices, and shared insights about the present and the future of HCBS as reshaped by COVID-19.
Learning Objectives
- Learn how state Medicaid programs have used CMS-approved waivers and amendments to temporarily modify HCBS policies and practices to protect people during the COVID-19 pandemic.
- Understand how new HCBS flexibilities impact HCBS providers on-the-ground.
- Understand what these changes mean for individuals who receive services and supports.
- Learn more about how the pandemic may be changing the future of HCBS.
HMA Speakers
Sarah Barth, JD, Principal, New York, NY
Ellen Breslin, MPP, Principal, Boston, MA
Sharon Lewis, Principal, Portland, OR
Susan Tucker, CPA, Tallahassee, FL
HMA experts provide guide to California county behavioral health programs
A team of HMA behavioral health experts have developed a webinar and white paper addressing changes to California’s county behavioral health programs and provide a guide to help counties and stakeholders determine the best path forward.
HMA Model Provides Forecast of COVID-19 Impact on Medicaid, Marketplace, Uninsured
A model developed by Health Management Associates (HMA) assesses COVID-19’s potential impact on health insurance coverage for each state and forecasts Medicaid enrollment could increase by 11 to 23 million across all states over the next several months.
HMA Review of State Appendix K Waivers in Response to COVID-19
This week, our In Focus section comes from HMA Principals Ellen Breslin (MA) and Sharon Lewis (OR). In direct response to COVID-19, the Centers for Medicare & Medicaid Services (CMS) has encouraged states to maximize Medicaid flexibilities to protect people during the pandemic emergency. This includes state flexibilities for people receiving home and community-based services. States may temporarily amend their Home and Community-Based Services (HCBS) 1915(c) waivers through an expedited process by submitting an Appendix K request. As of March 31, 2020, CMS had approved Appendix K submissions for thirteen states with effective periods ranging from four months to one year.[1] The thirteen states are: Alaska, Connecticut, Colorado, Hawaii, Iowa, Kentucky, Minnesota, New Mexico, Pennsylvania, Rhode Island, Washington, West Virginia and Wyoming.
Webinar Replay: Treatment of Substance Use Disorders During the COVID-19 Pandemic
This webinar was held on April 2, 2020.
The COVID-19 pandemic has significantly impacted the treatment of individuals with substance use disorder (SUD), including changes in the administration of Medications for Addiction Treatment (MAT), new telehealth rules and billing procedures, and other emerging protocols and regulations designed to ensure individuals with SUD continue to receive the best care possible.
During this webinar, HMA addiction experts Scott Haga and Shannon Robinson outlined how providers and patients can best navigate this changing landscape, with a special emphasis on the opportunities and risks associated with treating SUD during the pandemic.
Learning Objectives
- Find out how the COVID-19 pandemic significantly increases the risk of SUD relapse and overdose-related fatalities.
- Understand federal regulatory changes to the practice of prescribing MAT for opioid use disorder, including changes from DEA, SAMHSA, Office of Civil Rights and more.
- Obtain best practices and billing guidelines for the use of telehealth to treat individuals with SUD remotely.
HMA Speakers
Scott Haga, MPAS PA-C, Senior Consultant, Lansing, MI
Shannon Robinson, MD, FASAM, Principal, Costa Mesa, CA
As mentioned in the webinar, the Telehealth Readiness Questionnaire is also available.
Webinar Replay: Telehealth and the COVID-19 Response: Policy Changes and Implementation Strategies
This webinar was held on March 31, 2020
Telehealth services have become a key strategy for expanding access to care during the COVID-19 pandemic, driven in part by significant changes in laws and regulations to encourage the adoption of technologies that support telehealth. With these rapid changes, providers are struggling to understand how to best serve their patients using telehealth technologies.
During this webinar, HMA experts described the different modalities of telehealth and laid out the policy and reimbursement implications for the Medicare and Medicaid programs. Speakers detailed changes to HIPAA enforcement and policy changes that ensure ongoing support for prescribers and recipients of controlled substances. The webinar also reviewed how recent policy changes impact key provider decisions with regards to selecting, implementing, and building a business case for new telehealth services to support patients during the pandemic.
As mentioned in the webinar, the Telehealth Readiness Questionnaire is also available.
Learning Objectives
- Understand the different modalities of telehealth services and how to bill for them.
- Find out about recent changes in Medicare and Medicaid reimbursement policy stemming from the COVID-19 response.
- Learn the key steps in selecting a telehealth platform, building a business case, adapting workflows, and other implications for physician practices.
HMA Speakers
Jean Glossa, MD, Managing Principal for Clinical Services, Washington, DC
David Bergman, MPA, Principal, New York
Zach Gaumer, Senior Consultant, Washington, DC