Integrated Care: A Guide for Effective Implementation is co-edited by HMA’s Lori Raney, MD and Gina Lasky, PhD, MAPL and Collaborative Care Consulting’s Clare Scott, LCSW. The book provides a detailed, thoughtful, and experience-based guide to effective implementation of integrated behavioral healthcare. Using evidence and on the ground experience, the authors share practical and actionable advice for a complex model of care.
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States Receive More Time to Bring HCBS Settings into Compliance
Here is an update on The Centers for Medicare & Medicaid Services (CMS) extending the timeline for states to comply with a 2014 rule defining the settings for Medicaid home and community-based services (HCBS). On May 9, 2017, the CMS Center for Medicaid and CHIP Services issued an Informational Bulletin extending the deadline for states to demonstrate compliance with the settings criteria by three years, to March 17, 2022. It does not extend the deadline for final CMS approval of Statewide Transition Plans, which must still be approved by March 17, 2019. The bulletin makes no changes to the underlying rule, nor indicates plans to do so.
Depression Mapping and “Hot-Spotting” Reveals Potential Best Practices
This topic comes to us from HMA’s Anissa Lambertino, PhD, of our Chicago office, and Lori Raney, MD, of our Denver office, and Sarah Arvey, PhD, of our Austin office. May is Mental Health Month, and the first week in May is recognized as National Anxiety and Depression Awareness week. Anissa, Lori, and Sarah’s work, highlighted below, utilized geospatial mapping of prevalence of depression among Medicaid beneficiaries and treatment with FQHC locations in rural southeastern Ohio, revealing potential best practices.
Report Examines State Medicaid Coverage of Perinatal and Maternal Benefits
Medicaid Coverage of Pregnancy and Perinatal Benefits: Results from a State Survey
This report, authored by the Kaiser Family Foundation and Health Management Associates (HMA), analyzes the status of Medicaid benefit policies for perinatal and family planning services in 40 states and the District of Columbia.
While inpatient and outpatient hospital care must be covered for pregnant women under the federal scope of Medicaid, it is up to the discretion of states to define which other maternal benefits are included. Most states cover a broad range of perinatal services such as ultrasounds and prenatal vitamins. Other services are less likely to be covered by the states, including parenting classes and breastfeeding education.
Key findings in the report are presented in the areas of:
- Perinatal services
- Counseling and support services
- Delivery and postpartum care
- Breastfeeding services
HMA’s Kathleen Gifford co-authored the report along with Usha Ranji, Alina Salganicoff and Ivette Gomez of the Kaiser Family Foundation and Jenna Walls. This report serves as a companion report to Medicaid Coverage of Family Planning Benefits: Results from a State Survey, released in September 2016 by the same authors.
Quarterly Medicaid Managed Care Enrollment Update – Q1 2017
This week, we reviewed recent Medicaid enrollment trends in capitated, risk-based managed care in 25 states.[1] Many state Medicaid agencies elect to post monthly enrollment figures by health plan for their Medicaid managed care population to their websites. This data allows for the timeliest analysis of enrollment trends across states and managed care organizations. Nearly all 25 states have released monthly Medicaid managed care enrollment data through the first quarter (Q1) of 2017. This report reflects the most recent data posted.
Report Shares Lessons as Affordable Housing Providers, MMC Programs Forge Partnerships
A growing body of literature continues to validate the importance of addressing the social and structural determinants of health to improve health outcomes, and promote opportunity and economic mobility. Affordable, service-enriched housing plays a vital role in this work, with a growing momentum to collaborate across the health and housing sectors through lessons learned from research and demonstration projects across the nation.
Stewards of Affordable Housing for the Future (SAHF) members are experienced nonprofit housing providers that have collaborated with healthcare stakeholders for many years. However, few have had direct partnerships with insurers. Beginning in 2014, SAHF engaged its members in efforts to “match-make” business relationships with Medicaid payers to implement joint initiatives that would demonstrate and assess the contributions of service-enriched housing to the healthcare system.
On April 24, SAHF, in partnership with Health Management Associates (HMA), and with support from the Kresge Foundation, released its report, The Path to Partnership: Lessons Learned in the Pursuit of Joint Initiatives between Affordable Housing Providers and Medicaid Managed Care Programs. SAHF members who participated in this matchmaking activity included Mercy Housing, Volunteers of America (VOA) and National Church Residences. HMA worked with SAHF members on market scans, and HMA initiated outreach to potential health plan partners, which resulted in joint initiatives in Atlanta, Denver and Pittsburgh.
The report identifies the following lessons learned from the efforts to date:
- Joint initiatives must address the problem of scale;
- Housing providers must be willing to adapt services to meet the requirements of the healthcare system;
- Housing providers must present a business case to potential health plan partners that includes primary and secondary benefits;
- HIPAA compliance needs to be addressed as a potential barrier; and
- Healthcare partners and housing providers need to be realistic about joint initiative resource requirements.
Alabama, Ohio Provide Details on Medicaid MLTSS Program Designs
This week, we reviewed two proposed statewide Medicaid managed long-term services and supports (MLTSS) program designs. Alabama is currently accepting public comments on a plan to implement provider-driven Integrated Care Networks (ICNs) to provide MLTSS statewide to roughly 25,000 beneficiaries who are residing in nursing facilities or receiving home and community based services (HCBS) through three of the state’s Medicaid HCBS waiver programs. Meanwhile, Ohio Governor John Kasich proposed in his upcoming state budget to implement a statewide MLTSS program for more than 100,000 beneficiaries in the state. We review both states’ plans for MLTSS, including market sizes, implementation timing, and existing Medicaid managed care plans in the states.
Medicaid and Health Policy Highlights from Governors’ Proposed Budgets
Governor’s Proposed Budgets for FY 2018: Focus on Medicaid and Other Health Priorities
This issue brief, authored by the Kaiser Family Foundation and Health Management Associates (HMA), analyzes governors’ proposed budgets for state fiscal year (FY) 2018.
Despite nearly half of the states facing budget challenges for FY 2018, many governors are recommending enhancements to Medicaid and increasing the use of managed care and community-based long-term services and supports. With ongoing debate of the Affordable Care Act at the federal level, several governors still view Medicaid expansion as a solution to addressing top health priorities, including the opioid epidemic and healthcare for those involved with the criminal justice system.
This issue brief reviews 48 proposed state budgets. Key findings are presented in the areas of:
• Provider payment rates and taxes
• Eligibility changes
• Benefits, premiums and cost-sharing
• Delivery system and managed care reforms
• Community-based long-term services and supports
• Medicaid administration
• Initiatives to fight the opioid epidemic
• Initiatives to enhance behavioral health services
• Health-related corrections and criminal justice initiatives
HMA’s Kathleen Gifford and Nicole McMahon co-authored the issue brief along with Larisa Antonisse, Elizabeth Hinton and Robin Rudowitz of the Kaiser Family Foundation.
Relationship-Centered Care: Empathy and Healing
This blog post was authored by HMA clinicians
Margaret Kirkegaard, MD, MPH, and Jeffrey Ring, PhD.
Patient: I am anxious about my results, Doctor.
Doctor: Let’s take a look … Yes, you do indeed have cancer. I will refer you to the surgeon for an evaluation as fast as possible. You must have questions.
Patient: (Silent, in shock)
Doctor: OK, well hang out here for a few minutes, and our medical assistant will bring you contact information for the surgeon. We are backed up with patients today, so this may take a short while.
This brief exchange illustrates missed opportunities for healthcare clinicians to provide empathic relationship-centered care.
Early Bird Registration Now Open for HMA’s 2017 Conference on the Future of Medicaid
Health Management Associates is pleased to announce that Early Bird Registration is now open for our second conference on Trends in Publicly Sponsored Healthcare, September 11-12, at the Renaissance Chicago Downtown Hotel. The theme of this year’s event is The Future of Medicaid is Here: Implications for Payers, Providers and States.
Featured speakers already include some of the nation’s most innovative healthcare leaders. Visit the conference website to receive the Early Bird rate and stay up to date on the latest conference news.
HMA Completes Acquisition of SVC
SVC, founded by CMS Administrator Seema Verma, is now part of Health Management Associates (HMA). The acquisition, announced March 13 by HMA founder Jay Rosen, was finalized late Friday, March 31. SVC now becomes HMA Medicaid Market Solutions (HMA MMS), a subsidiary of HMA.
Puerto Rico Health Care Update
This week, HMA Principal Juan Montanez, of our Washington, D.C. office, provides an update on the fiscal crisis in Puerto Rico, the relationship between the fiscal crisis and Puerto Rico’s Government Health Plan (GHP), as well as what may lie ahead for the GHP. Puerto Rico has been in the news over the last couple of years, primarily because of the central government’s inability to meet its debt obligations. In 2015 the central government’s finances reached a point where it could have literally run out of cash to service its debt and fund regular operations. A significant contributor to this fiscal crisis is the cost of and associated funding for the GHP, known colloquially on the island as Mi Salud (“My Health”). This article provides some history and context on the GHP, in addition to outlining current proposals for addressing the program’s impending funding “cliff.”