HMA Weekly Roundup
Trends in Health Policy
This week's roundup:
- In Focus: Raising the Bar: Improving Health Equity through Actionable Frameworks
- Florida Announces Revised, Additional Awards for Statewide Medicaid Managed Care Procurement
- Illinois Governor Signs Bill Addressing Behavioral Workforce Shortage
- Massachusetts Senate Passes Bill to Strengthen Health Care System Oversight
- Pennsylvania Releases 1115 Demonstration HRSN Implementation Program Administrator RFI
- Vermont Sues PBMs Over Drug Pricing
- CMS Restricts ACA Broker Access to Regulate Unauthorized Plan Switches
- Molina to Acquire ConnectiCare for $350 Million
- More News Here
Special Registration Pricing for the Medicaid, Medicare, and Marketplace Conference Ends Next Week!
Panelists at the Unlocking Solutions in Medicaid, Medicare, and Marketplace Programs event are tackling the big issues in healthcare head on. Attendees will hear from respected leaders in healthcare who are adapting to the demands for value-based care; harnessing tools they have and exploring those still needed to deliver, measure, and improve on quality at the person level; and shaping the future of integrated care for Medicare and Medicaid dually eligible individuals. Expert speakers will cover a myriad of cross cutting topics including:
- Strategies for navigating through the headwinds of increased scrutiny on payment;
- Insights on approaches to chart a course for the transformative potential of AI in healthcare,
- Solutions for forging new partnerships to address health disparities, and other critical topics on the horizon.
Click here to see new agenda details and register before the fee increases.
Early bird registration ends July 31, 2024.
In Focus
Raising the Bar: Improving Health Equity through Actionable Frameworks
This week, our In Focus section highlights an initiative, Raising the Bar: Healthcare’s Transforming Role (RTB), which is designed to strategically address inequities in the healthcare system. Leading this effort is the National Alliance to Impact the Social Determinants of Health (NASDOH), an alliance convened by Leavitt Partners, a Health Management Associates (HMA) Company, with support from the Robert Wood Johnson Foundation (RWJF).
Overview
There is significant and increasing demand across health and human services to address health inequities and eliminate disparities in service delivery and positive health outcomes. Organizations are asked to provide healthcare in holistic ways that recognize both individual and population-level needs.
Raising the Bar is a framework and a call to action for the healthcare sector to embrace all levers, resources, and opportunities available to advance equity and excellence. Raising the Bar seeks to accelerate the healthcare sector’s efforts to achieve equity and to improve the healthcare experience and well-being of individuals, families, and communities.
The Framework for Driving Action
The RTB project worked with healthcare leaders and people who have experienced inequities in the system to develop an actionable framework for the entire healthcare sector, which would embed equity and excellence throughout its work. The NASDOH convened extensive discussions with providers, hospitals, payers, and community leaders to develop foundational principles, essential roles, and concrete actions for the sector to achieve equity goals, big and small.
Raising the Bar Principles. The project generated five principles that put the priorities of individuals, families, and communities at the center of healthcare. They were informed by discussion with organizations and people who give, get, and pay for care.
Raising the Bar also identified four essential roles for individual contributors to the healthcare system and provide concrete actions they can take to transform how care is delivered.
Embedding Approaches to Address Health Inequities
Now in the next phase of this work, HMA consultants are working one-on-one with five organizations committed to embedding approaches to address health inequities by implementing the framework within their own systems of care. Participating organizations include a multi-site, multi-state Catholic health system, an academic medical center, an independent health system, one certified community behavioral health clinic, and one county public health department. The entities vary by geography, demographics, population size, and rural and urban location.
Each of the following sites is using the Raising the Bar framework and individualized coaching to meet their equity goals:
- Charles County Department of Health, White Plains, MD
Charles County is working to develop and strengthen trusting partnerships with local community organizations representing diverse populations to address health inequities in the county.
- CHRISTUS Health, Texas, Arkansas, and Louisiana
CHRISTUS is developing an enterprise-wide six-year health equity road map that includes a strategy to build a community health worker sustainability.
- Gaudenzia, Baltimore, MD
Gaudenzia is working to develop and implement a road map for establishing a Consumer Advisory Committee (a Substance Abuse and Mental Health Services Administration requirement for certified community behavioral health centers) that other Gaudenzia sites can use and spread nationwide.
- Jefferson Health, Philadelphia, PA
Jefferson is conducting an enterprise-wide assessment and creating a governance structure for its health equity initiatives across multiple healthcare and medical education sites throughout their catchment area, which crosses state lines.
- Sturdy Health, Attleboro, MA
Sturdy is creating an enterprise-wide health equity dashboard with measures that align with organizational goals and strategies and developing staff training to improve service delivery for populations who experience inequities in care.
The five entities are receiving individualized coaching from HMA health equity experts over a one-year period using the Raising the Bar framework and each organization’s self-identified goals and objectives. At the project’s completion, findings from the project will be published in the Raising the Bar implementation guidance, developed in partnership with the Health Care Transformation Taskforce.
Continue the Conversation
Raising the Bar will be featured in discussions during the HMA Fall conference in Chicago, October 7-9. In the opening plenary session on social determinants of health, Leticia Reyes-Nash and Sara Singleton will describe some of the work, and during a breakout session, speakers from some the organizations participating in this project will share their experiences. Register now.
For more information about Raising the Bar or the types of technical assistance that HMA can provide to organizations seeking to further develop equity in their practices and communities, contact project director Sara Singleton, Principal, Leavitt Partners, or any of the HMA coaching leaders on this project: Debra Carey, Principal; Akiba Daniels, Senior Consultant; Leticia Reyes-Nash, Principal; Maddy Shea, Principal; and Doris Tolliver, Principal.
Learn more at rtbhealthcare.org.
For details about HMA’s work in health equity, go to:
Continue the Conversation
Raising the Bar will be featured in discussions at Unlocking Solutions in Medicaid, Medicare, and Marketplace, a conference powered by HMA taking place in Chicago, October 7-9.
HMA Roundup
Arizona
Arizona Contracts with Health Management Systems to Conduct Medicaid Claim Reviews. The Arizona Health Care Cost Containment System (AHCCCS) announced on July 17, 2024, that it has contracted with Gainwell Technologies subsidiary, Health Management Systems, to conduct periodic reviews of Medicaid claims paid by AHCCCS as part of the Centers for Medicare & Medicaid Services Recovery Audit Program. The program aims to identify and recover payments made to Medicaid providers that do not meet state and federal requirements. AHCCCS will conduct a webinar on the Recovery Audit Contractors program in mid-August.
Arizona Medicaid Fraud Interventions Lower AIHP Utilization Back to Historical Trends. The Arizona Health Care Cost Containment System (AHCCCS) announced on July 19, 2024, that its interventions to combat sober living fraud within the state Medicaid program have resulted in a return to a historical trend in utilization levels. AHCCCS published information detailing the American Indian Health Program (AIHP) monthly paid amounts for all services for the time period October 2020 to March 2024, and monthly utilization represented on a per member per month basis. Read More
Florida
Florida Announces Revised, Additional Awards for Statewide Medicaid Managed Care Procurement. The Florida Agency of Health Care Administration announced on July 18, 2024, additional intents to award Statewide Medicaid Managed Care program contracts for three incumbent plans: CVS/Aetna, Molina Healthcare, and UnitedHealthcare. CVS/Aetna will serve regions D,E, and I; Molina will serve region I; and UnitedHealthcare will serve regions B, D, and I. Aetna and United will retain their current foothold, while Molina will serve Miami-Dade County and Monroe County, but no longer be in Region F. The state also revised awards for Florida Community Care and South Florida Community Care Network/Community Care Plan. Under the revised awards, Florida Community Care will serve statewide in long term care, in addition to as a comprehensive plan in Regions A, B, C, D, I. South Florida Community Care Network will serve regions E, F, G, H, and I as a Managed Medical Assistance Plus plan. Previously awarded plans include Humana, Elevance/Simply Healthcare Plans, and Centene/Sunshine State Health Plan. The program serves approximately 3.6 million individuals, and contracts are set to run from October 1, 2024, through December 31, 2030. Aetna, AmeriHealth Caritas, Florida Community Care, ImagineCare, Molina Healthcare, Sentara Care Alliance, and UnitedHealthcare all submitted protests in response to the first intents to award. AmeriHealth Caritas did not secure a contract in the revised awards, nor did Sentara Care Alliance or ImagineCare, a joint venture between CareSource and Spark Pediatrics. Read More
Florida Faces Lawsuit Over Medicaid Contract Awards. WUSF reported on July 23, 2024, that ImagineCare, a joint venture between CareSource and Spark Pediatrics. filed a lawsuit against the Florida Agency for Health Care Administration in the Leon County circuit court, seeking an injunction to stop the agency from proceeding with Medicaid managed care contracts until it addresses ImagineCare’s protest. ImagineCare intends to continue pursuing a protest through the legal system after being told it would not be offered a contract. The contracts are scheduled take effect in January. Read More
Illinois
Illinois Governor Signs Bill Addressing Behavioral Workforce Shortage. Health News Illinois reported on July 22, 2024, that Governor JB Pritzker signed several healthcare bills into law, including new policies addressing the behavioral healthcare workforce shortage. House Bill 5094, sponsored by Rep. Lindsay LaPointe (D-Chicago), creates a 15-person workgroup under the chief behavioral health officer that will identify inefficiencies, burdensome restrictions, and other administrative barriers preventing behavioral clinicians from providing services. The workgroup will report its findings to the Illinois General Assembly. Another bill will allow licensed advanced practice registered nurses who are also certified nurse midwives, clinical nurse specialists, or nurse practitioners to practice for up to six months under supervision while waiting for licensure approval. Pritzker also signed a bill that requires insurers to cover treatment for behavioral health conditions for individuals who have experienced miscarriages to the same extent as other covered conditions. Read More
Indiana
Indiana to Address Medicaid Budget Shortfall Using $255 Million from General Fund Reserves. Inside Indiana Business reported on July 23, 2024, that Indiana plans to use $255.2 million from the general fund reserves to bolster the Medicaid budget in an attempt to fix a $1 billion Medicaid miscalculation that the state discovered in December. The shortfall has caused Indiana to consider major budget cuts, including a $300 million cut to some of the Family and Social Services Administration’s programs. The amount could rise to $457.9 million next year. Read More
Maryland
Maryland Cuts $148 Million From State Agency Budgets to Support Medicaid, Child Care. The Associated Press reported on July 17, 2024, that the Maryland Board of Public Works approved $148.3 million in state spending reductions across several state agencies which will be redeployed to address a larger-than-projected participation in Medicaid and a state child care program. The state had nearly 1.7 million Medicaid enrollees as of June. Read More
Massachusetts
Massachusetts Senate Passes Bill to Strengthen Health Care System Oversight. The Associated Press reported on July 18, 2024, that the Massachusetts Senate approved a bill which would limit the amount of debt that private equity-owned businesses can take on and significantly strengthen reporting requirements around for-profit companies’ financial data. The bill, which aims to prevent situations like that of Steward Health Care, would also expand the authority of state agencies tasked with containing health care costs and improving care quality. Read More
Montana
Montana Disenrolls 115,302 Medicaid Beneficiaries During Redetermination Process. KTVH reported on July 17, 2024, that Montana has disenrolled 115,302 Medicaid beneficiaries and renewed coverage for 141,216 individuals, according to a state closeout report from its redetermination process which ran from April 2023 through February 2024. The state reviewed Medicaid eligibility for 280,180 individuals, with 56 percent of children and 62 percent of tribal members in the program maintaining coverage. The state has pending eligibility applications for 8 percent of beneficiaries. Read More
North Carolina
North Carolina Lawmakers Fail to Agree on Budget Revision, Leaving Medicaid Funds Strained. North Carolina Health News reported on July 18, 2024, that the North Carolina Legislature failed to pass a half-billion dollar budget adjustment requested by the North Carolina Department of Health and Human Services (DHHS) to help fund Medicaid’s rising costs. Part of the requested additional funding would also have been to move people who are eligible for both Medicare and Medicaid into managed care. The House and the Senate’s proposed fiscal 2025 budgets, if passed in November, would still leave DHHS with a $100 million shortfall. Read More
North Carolina Disenrolls 11,943 Medicaid Beneficiaries During June Redeterminations. The North Carolina Department of Health & Human Services announced that it has disenrolled 11,943 Medicaid beneficiaries during June redeterminations, with 10,076 being disenrolled due to procedural reasons. The state renewed coverage for 154,275 Medicaid beneficiaries. The state has 434,129 pending renewal applications. North Carolina’s rate of disenrollment was below the national average at 12 percent. Read More
Pennsylvania
Pennsylvania Releases 1115 Demonstration HRSN Implementation Program Administrator RFI. The Pennsylvania Department of Human Services released on July 18, 2024, a request for information (RFI) to help the department determine the scope of work for organizations that could become third party program administrators of health-related social needs (HRSN) services under the state’s pending Section 1115 demonstration, called “Bridges to Success: Keystones of Health.” The RFI will also inform the state’s approach to implementation for HRSN services, if the state receives federal approval for the demonstration program. Responses are due August 19. Read More
South Dakota
South Dakota Eliminates Cost Sharing for Medicaid Enrollees. KELO reported on July 23, 2024, that South Dakota is removing copays for Medicaid recipients currently subject to cost-sharing requirements. The change was approved by the legislature’s Rules Review Committee. Dropping the co-pay requirement is estimated to cost the federal government $1 million in the next year and about $310,000 in state funding. Read More
Vermont
Vermont Sues PBMs Over Drug Pricing. Reuters reported on July 18, 2024, that Vermont Attorney General Charity Clark has sued CVS Health’s Caremark and Cigna Group’s Express Scripts, arguing that the pharmacy benefit managers (PBMs) influenced patients to buy expensive medications when cheaper alternatives were available. The lawsuit, filed in the Washington County Superior Court, argues this practice violates a Vermont consumer protection law. Read More
National
CMS Releases Final Part Two Guidance of Medicare Prescription Drug Payment Plan. The Centers for Medicare & Medicaid Services (CMS) released on July 16, 2024, its final part two guidance of the Medicare prescription drug payment plan, which will give Medicare Part D beneficiaries the option of paying out-of-pocket costs in monthly installments over a year, beginning in 2025. The guidance specifically focuses on education and outreach efforts to engage various stakeholders, including Part D plans, pharmacies, providers, drug manufacturers, and beneficiary advocates, on program implementation. CMS also released the final Medicare Prescription Payment Plan model materials, which Medicare Part D plans can use to educate enrollees about the plan. Read More
CMS Releases Guidance on State Requirements for Incarcerated Youth Medicaid, CHIP Services. The Centers for Medicare & Medicaid Services (CMS) on July 23, 2024, issued guidance to states to address statutory requirements around the availability of certain state plan services for incarcerated youth in Medicaid and the Children’s Health Insurance Program (CHIP). Under the guidance, state Medicaid and CHIP programs are required to have a plan in place to provide certain services to eligible juveniles in the 30 days prior to release from incarceration. States also have the option to lift the Medicaid inmate payment and CHIP eligibility exclusions for eligible juveniles who are incarcerated and pending disposition of charges. States will need to submit Medicaid and CHIP state plan amendments with an effective date of no later than January 1, 2025. Read More
CMS Restricts ACA Broker Access to Regulate Unauthorized Plan Switches. The Centers for Medicare & Medicaid Services (CMS) announced on July 19, 2024, that it is putting additional regulations in place to restrict insurance brokers’ access to the federal marketplace to prevent unauthorized changes to consumers’ Affordable Care Act (ACA) plans. Brokers are now only able to make plan changes if they are already associated with a customer’s policy, and unassociated agents must take additional steps to prove their association even if they have a customer’s permission. The regulations are a result of an uptick in unauthorized plan switches, with CMS reporting that during the first six months of 2024, 200,000 consumers were enrolled in a marketplace plan or switched from one plan to another without their consent. The new rules are effective immediately. Read More
House Committee Questions PBM Executives on Rising Prescription Drug Costs. Modern Healthcare reported on July 23, 2024, that the House Committee on Oversight and Accountability questioned pharmacy benefit manager (PBM) executives from CVS Caremark, Express Scripts, and Optum Rx on rising prescription drug costs, which have steadily increased each year for the past 15 years. Lawmakers and executives took opposing views on whether PBMs led to higher or lower costs and if they forced closures of or supported independent pharmacies. The committee cited a recent report released by the Federal Trade Commission that reinforced some of their criticisms. Read More
MACPAC Releases Issue Brief Showing Translated Medicaid Materials Varied by State. The Medicaid and CHIP Payment and Access Commission (MACPAC) released an issue brief in July 2024 analyzing the availability of translated materials for individuals with limited English proficiency in Medicaid, which varied among states and document type, with paper applications being more likely to be translated into non-English languages than electronic application portals. The brief also provides an analysis on state experiences providing translated materials and interpretation services based on stakeholder interviews. Read More
Industry News
Molina to Acquire ConnectiCare for $350 Million. Molina Healthcare announced on July 23, 2024, that it will acquire ConnectiCare, a health plan in Connecticut which serves approximately 140,000 members across Marketplace, Medicare, and certain commercial products. ConnectiCare is a wholly owned subsidiary of EmblemHealth. The transaction, valued at $350 million, is expected to close in the first half of 2025. Read More
UnitedHealth Group Faces Class Action Lawsuit Over Change Healthcare Cyberattack. Modern Healthcare reported on July 22, 2024, that the National Community Pharmacists Association, representing more than 19,000 independent pharmacies, joined 39 providers in a class action lawsuit against Change Healthcare. The lawsuit, filed in U.S. District Court in Minnesota on July 19, alleges that the plaintiffs have not received payments or have received late payments for their healthcare services and that UnitedHealth Group failed to take actions to prevent the ransomware attack. Read More
Senate HELP Committee Launches Investigation into Steward Healthcare Bankruptcy. Fierce Healthcare reported on July 18, 2024, that the Senate Health, Education, Labor and Pensions (HELP) Committee is launching an investigation into the bankruptcy of Texas-based Steward Health Care System and its chief executive. The investigation aims to address executive compensation and the company’s ties to Cerberus Capital Management, which made a reported $800 million profit when it exited the company in the years leading up to its bankruptcy. Read More
Steward Health Cancels Ohio, Pennsylvania Hospital Auctions After Not Receiving Qualified Bids. WKBN reported on July 22, 2024, that Steward Health Care has canceled auctions for its locations in Ohio and Pennsylvania, amid the company’s Chapter 11 bankruptcy reorganization. The company canceled the auctions due to not receiving qualified bids. Read More
Steward Healthcare Receives Qualified Bids for All Massachusetts Hospitals. NBC reported on July 23, 2024, that Steward Health Care’s Massachusetts hospitals all received qualified bids, according to Massachusetts Governor Maura Healey. A sales hearing is scheduled for the seven hospitals in U.S. Bankruptcy Court on July 31. Read More
ABA Connect Acquires ABA Therapy of Houston. ABA Connect announced on July 22, 2024, that it has acquired ABA Therapy of Houston, which delivers applied behavior analysis therapy to children with autism spectrum disorder. The acquisition adds a second clinic location in Katy, Texas, and expands ABA Connect’s network to 12 clinics across Texas and Colorado. Read More
RFP Calendar
Company Announcements
MCG White Paper:
Whole-Person Care and the Link Between Physical and Mental Health: In this new downloadable white paper, MCG Physician Editor for Behavioral Health, João Ramos, MD, discusses the complex interplay between physical and mental health. The document explores the correlation between patients with severe mental illness (SMI) or other mental health disorders and their higher risk of 30-day hospital readmissions. Successful real-world examples of “whole person care” models from the U.S. Department of Veterans Affairs, Geisinger Health System, and Kaiser Permanente are also explored. Read More
HMA News & Events
HMA Podcasts:
How Can We Better Transition Healthcare Services for People Leaving Incarceration? Linda Follenweider, Managing Director, Justice Involved Services at HMA is an advanced practice registered nurse and board-certified family nurse practitioner with extensive experience in correctional healthcare. In this episode, she discusses the critical gaps in continuity of care for incarcerated individuals. She emphasizes how many receive necessary medical care while in jail or prison but struggle to maintain this care upon release. Highlighting the significant health risks and economic costs associated with this disconnect, she advocates for integrating correctional healthcare into the broader healthcare continuum. The episode showcases the opportunities presented by adopting routine screening questions about incarceration history to ensure better health outcomes and resource utilization. Listen Here
NEW THIS WEEK ON HMA INFORMATION SERVICES
(Exclusive Access for HMAIS Subscribers):
HMAIS Reports
- Updated Florida State Overview
- Updated Georgia State Overview
Medicaid Data
Medicaid Enrollment:
- California Medicaid Managed Care Enrollment is Up 3.9%, May-24 Data
- Michigan Medicaid Managed Care Enrollment is Down 10.2%, May-24 Data
- Minnesota Medicaid Managed Care Enrollment is Down 13.7%, Jun-24 Data
- Mississippi Medicaid Managed Care Enrollment is Up 5.6%, Jun-24 Data
- Missouri Medicaid Managed Care Enrollment is Down 8.5%, May-24 Data
- Nevada Medicaid Managed Care Enrollment is Flat, Feb-24 Data
- New Mexico Medicaid Managed Care Enrollment is Flat, Feb-24 Data
- North Carolina Medicaid Managed Care Enrollment is Up 4.5%, Mar-24 Data
- Oregon Medicaid Managed Care Enrollment is Down 0.5%, Mar-24 Data
- South Carolina Medicaid Managed Care Enrollment is Down 2.3%, Feb-24 Data
- South Carolina Dual Demo Enrollment is Down 8.4%, Feb-24 Data
- Tennessee Medicaid Managed Care Enrollment is Down 7.8%, Apr-24 Data
Public Documents:
Medicaid RFPs, RFIs, and Contracts:
- Florida Statewide Medicaid Managed Care (SMMC) Program ITN and Awards, 2023-24
- Illinois IV&V Medicaid Management System (MMIS) RFP and Related Documents, 2019-24
- Oregon Medicaid Care Coordination Services RFP and Related Documents, 2024
- Pennsylvania Section 1115 Demonstration Keystones of Health HRSN Implementation Program Administrator, Jul-24
Medicaid Program Reports, Data, and Updates:
- Indiana Medicaid Managed Care Quality Strategy Plan, 2017-24
- Indiana CHIP Annual Reports to CMS, 2017-23
- Kentucky PHE Medicaid Redeterminations Monthly Report to CMS, May-24
- Michigan PHE Medicaid Redeterminations Monthly Reports to CMS, May-24
- Montana PHE Medicaid Unwind Data Report and Overview, 2024
- New Hampshire External Quality Review Organization (EQRO) Technical Reports, SFY 2018-23
A subscription to HMA Information Services puts a world of Medicaid information at your fingertips, dramatically simplifying market research for strategic planning in healthcare services. An HMAIS subscription includes:
- State-by-state overviews and analysis of latest data for enrollment, market share, financial performance, utilization metrics and RFPs
- Downloadable ready-to-use charts and graphs
- Excel data packages
- RFP calendar
If you’re interested in becoming an HMAIS subscriber, contact Andrea Maresca at [email protected].