March 19, 2025
This week's roundup:
- In Focus: New Insights on Medicaid Spending: HMA Analysis of Disaggregated Medicaid Managed Care Spending
- In Focus: Navigating CMS’s 2025 Marketplace Rule: What It Means for ACA Marketplaces, Insurers, and Consumers
- California Requests Supplemental $2.8 Billion for Medi-Cal Amid Budget Shortfall
- Indiana House Committee Advances Medicaid Work Requirement Bill Without HIP Enrollment Cap
- Kentucky Legislature Passes Medicaid Work Requirements Bill
- Oregon Legislature Passes Medicaid MCO, Hospital Tax Extension Bill
- Medicare Advantage 2025 Costs to Exceed Fee-for-Service by $84 Billion, MedPAC Finds
- HCSC Completes $3.3 Billion Acquisition of Cigna’s Medicare Advantage Business
- More News Here
In Focus
New Insights on Medicaid Spending: HMA Analysis of Disaggregated Medicaid Managed Care Spending
This week, our In Focus section highlights insights from a new Health Management Associates (HMA), issue brief, “New Insights on Medicaid Spending: An Analysis of Disaggregated Managed Care Spending.” Until now, most Medicaid cost data have focused on enrollees in fee-for-service (FFS) programs. HMA used the Centers for Medicare & Medicaid Services (CMS) Transformed Medicaid Statistical Information System (T-MSIS) database to analyze Medicaid managed care organization (MCO) spending in major categories of healthcare, including inpatient and outpatient hospital care, physician and other professional services, skilled nursing facilities (SNFs) and home and community-based services (HCBS), clinics, pharmaceuticals, and other services. HMA’s methodology can be applied to all 50 states and allows us to determine prices for these services, which, combined with data on the number of encounters, yields reliable cost figures.
Findings
Medicaid managed care accounted for $420 billion of the total $717 billion in Medicaid spending for federal fiscal year 2021. Professional claims accounted for the largest portion of Medicaid spending, totaling 25.1 percent, followed by SNFs at 19.7 percent, and inpatient claims at 15.4 percent.
Figure 1. T-MSIS Medicaid Spending by Service Category 2021 (MCO Disaggregated plus FFS)
What’s Next
This analysis can be replicated for subsequent years and will provide important information on Medicaid spending trends. This work also sets the stage for analyses and comparisons of cost categories by variables such as eligibility category (e.g., dual eligibles, children, parents, adults without children, the Medicaid expansion population, and designated as aged/frail/disabled); race and ethnicity; frequent users of hospital services; and people with multiple chronic illnesses. This type of analysis allows us to answer fundamental questions about the Medicaid program and can pinpoint areas of high need within the Medicaid population, such as:
- How much do we spend on services for people with diabetes?
- How much do we spend during childbirth/first year of life and in the last year of life?
- How much do we spend for Medicare-Medicaid dual eligibles?
Data-informed discussions on these and other topics can help identify opportunities for efficiencies and timely care management to slow the growth in total healthcare spending. This information will provide important context for the policy debate, offering a full view of the relative magnitude of the major categories of Medicaid spending.
Connect with Us
Medicaid providers, MCOs, states, and policymakers all have an interest in identifying high-cost drivers of Medicaid managed care. The methodology applied in the analysis for the HMA issue brief can be applied and adapted for future analysis.
For details about this analysis, its implications for state and local policies, and additional research using T-MSIS, contact Matt Powers and Shreyas Ramani.
Navigating CMS’s 2025 Marketplace Rule: What It Means for ACA Marketplaces, Insurers, and Consumers
This week, our In Focus section also reviews the 2025 Marketplace Integrity and Affordability Proposed Rule, released by the Centers for Medicare & Medicaid Services (CMS) on March 10, 2025. The proposed rule calls for enhancing program integrity protections in the Affordable Care Act (ACA) marketplaces through targeted changes to eligibility and enrollment policies and procedures.
This proposed rule aligns with the overarching policy priorities President Trump has identified, including reducing federal costs and reforming policies related to immigrants. It also takes aim at fraud, waste, and abuse practices in the ACA Marketplaces, which is the cornerstone from which the US Department of Health and Human Services explains and justifies its proposed initiatives.
Notably, the proposed changes will occur alongside other potential federal policy revisions, including the December 31, 2025, expiration of the ACA enhanced subsides for consumers, which led to historically high coverage levels—nearly 24 million people were enrolled in the Marketplace as of January 2025. The combined changes will have a varied but significant effect on all state health insurance markets, creating a need for scenario planning and preparation to start immediately.
CMS is providing the public 30 days to submit comments on the proposed rule. An overview of the proposed changes and key considerations follow.
Rule Components
Enrollment Timeline: CMS proposes shortening the open enrollment period for all individual market coverage, including for state-based marketplaces (SBMs), which traditionally have had flexibility to set later enrollment deadlines. If finalized, open enrollment will begin November 1 and end December 15, a month earlier than the current deadline of the following January 15.
Income Verification: The rule would require marketplaces to bolster their income verification processes to protect against manipulation of the authorization and calculation of advance premium tax credit (APTC) values. CMS policymakers believe these changes will be useful in addressing broker and consumer fraud and abuse of the APTC eligibility process. Proposed income verification changes include requirements that people provide the documentation of their income if they meet the following criteria:
- The income on their application is between 100 percent and 400 percent of the federal poverty level (FPL), but the income returned from external data sources show they make less than 100 percent of the FPL
- No tax data are available from external data sources to confirm the applicant’s self-attested income
Applicants who do not verify their income will have it adjusted to align with the income returned from external data sources, and their APTC eligibility will be updated accordingly. In some cases, such as when no returned income data are available, these individuals will become ineligible for the APTC.
CMS also plans to reinstate a 2015 policy that requires marketplaces to designate applicants or enrollees as ineligible for APTCs if they fail to file and reconcile their APTC on their federal income taxes. This requirement is known as the failure to file and reconcile (FTR). The Biden Administration changed the FTR requirements to find enrollees ineligible for APTCs if they fail to file and reconcile for two consecutive tax years.
Lastly, CMS proposes eliminating the additional 60 days consumers are granted to resolve income inconsistencies. Today, most marketplace consumers have up to 150 days to resolve income inconsistences. This proposal would return to the 90-day verification period that was in place prior to the Biden Administration.
CMS also requests input on alternative redetermination and re-enrollment policies for fully subsidized consumers, including whether $5 is the appropriate premium amount or should be higher or if fully subsidized consumers should be required to actively confirm their eligibility and reenroll every year.
Another proposal would remove the ability for marketplaces to automatically reenroll Bronze members who are eligible for a cost-sharing reduction (CSR) in a Silver plan if the Silver plan has the same provider network, is in the same product, and has a lower or equivalent net premium as the consumer’s Bronze plan.
Special Enrollment Period Changes: CMS is proposing multiple changes to special enrollment periods (SEPs), including the removal of monthly SEPs for individuals with household incomes that are projected to be at or below 150 percent of the FPL and a requirement that marketplaces verify eligibility for at least 75 percent of new enrollments during SEPs. CMS also proposes adopting a pre-enrollment income verification model for SEPs.
- Bar Deferred Action for Childhood Arrivals (DACA) recipients from QHPs in the Marketplace and basic health programs, making them ineligible for APTCs and CSRs and returning to pre-Biden era DACA eligibility rules
- Remove gender-affirming care as an essential health benefit
- Allow insurers to require payment of past due premiums before effectuating new coverage, if state law permits
- Increase cost sharing/lower premiums by increasing the maximum out-of-pocket limit and widening de minimis ranges
Implications
CMS is reverting to several policies that were put in place during President Trump’s first term, increasing the likelihood that CMS will finalize many of the changes as proposed or with minimal modification.
Insurers, SBMs, insurance departments and other stakeholders should engage in the federal policymaking process and begin planning immediately for the financial and operational changes that will be required to comply, as several of the requirements will take effect as soon as the rule is finalized. Stakeholders will also want to consider the direct impact on consumers.
Health Management Associates (HMA) Marketplace experts identified the six key considerations for stakeholders:
- Market share and risk. The proposed changes are projected to decrease Marketplace enrollment and Insurers and states need to plan for shifts in their market and consider approaches to manage these changes.
- Administrative operations. A shorter enrollment period and additional eligibility and enrollment requirements may increase administrative actions for enrollees, insurers, and marketplaces. Examples include:
- Marketplaces will need to make system and operational changes to comply with the new income verification, SEP, and open enrollment period requirements.
- Departments of Insurance may need to adjust their rate and form filing instructions and timelines to give insurers the clarity and time they need to comply with new requirements.
- Consumer education. Insurers and marketplaces will need to consider the effectiveness of their marketing and outreach and education strategies, given the shorter open enrollment period.
- Interactions with the expiration of the enhanced subsidies in 2026. The Congressional Budget Office estimates that the uninsured population will increase by 2.2 million in 2026 and up to 3.8 million by 2028 if the enhanced ACA subsidies expire. While it is too early to project or measure the impact of this proposed rule and the expiring subsidies, together they undoubtedly will have direct impacts on eligibility, enrollment levels, market dynamics including pricing and risk mix, and the overall stability of the Marketplaces in the long term. Congress may also take action on other policies related to Marketplace stability for which stakeholders should prepare.
- State-level mitigation. States interested in mitigating the impacts of this proposed rule, as well as the expiring subsidies, will need to consider legislation to address the resulting affordability gaps and coverage losses. For example, states may look to state-funded subsidy wraps or reinsurance programs to minimize the net premium rate increases that most Marketplace plan members will experience when the enhanced subsidies expire in 2026.
- Federal engagement. CMS is providing the public 30 days to comment on the proposed rule. This provides stakeholders the opportunity to voice their positions on the impact of this and future Marketplace policies. Comments on the proposed rule may also be shared with congressional policymakers and staff to help shape future legislative proposals.
HMA experts have considerable experience working with marketplaces, Departments of Insurance, insurers, and federal policymakers with jurisdiction over the Marketplace. They work with these entities to inform, analyze, and influence federal policies and conduct impact analyses on pricing, enrollment, administration, and operations. HMA also provides strategic and project management support for the implementation of finalized policies.
To learn more about how the proposed rule and the scheduled sunsetting of enhanced subsidies may affect your organization contact HMA Marketplace experts Zach Sherman, Michael Cohen, and Liz Wroe.
HMA Roundup
Arizona
Arizona Releases Final Notice for CYE 2026 Differential Adjusted Payments. The Arizona Health Care Cost Containment System (AHCCCS) released on March 18, 2025, its final notice for the Contract Year End (CYE) 2026 Differential Adjusted Payments (DAP), with rate adjustments effective from October 1, 2025, through September 30, 2026. The DAP provides higher payments to providers that commit to improving patient care, health outcomes, and cost efficiency. AHCCCS health plans must pass these increases through to contracted providers, ensuring payment rates align with Fee-for-Service adjustments.
California
California Requests Supplemental $2.8 Billion for Medi-Cal Amid Budget Shortfall. Politico reported on March 17, 2025, that California Governor Gavin Newsom is requesting an additional $2.8 billion immediately for its Medi-Cal program, on top of a $3.44 billion loan, to cover unexpected costs through the end of the year. The biggest contributor to the budget shortfall is the insurance of undocumented immigrants, which exceeded projections by $2.7 billion, along with rising prescription drug costs and higher-than-expected enrollment. The 2025-26 budget proposes an extra $4.4 billion, with most of it tied to Proposition 35’s managed care tax revenue changes.
California to Borrow $3.4 Billion Amid Medicaid Budget Shortfall. Politico reported on March 12, 2025, that California Governor Gavin Newsom will need to borrow $3.44 billion to help the state close a Medicaid budget shortfall. The additional funding, which is the maximum amount the state can borrow, will cover Medi-Cal bills through the end of the month, according to the state Department of Finance. California’s Medicaid budget shortfall is due to various factors, including higher-than-anticipated costs to cover undocumented immigrants, an increase in the number of seniors enrolled in the program, rising pharmacy costs, and general rising medical costs. The state expects Medi-Cal will cost around $42 billion in state funds in 2025-26, a $4.5 billion increase from the previous budget.
Connecticut
Connecticut Medicaid Faces $290 Million Funding Shortfall. CT News Junkie reported on March 17, 2025, that Connecticut Medicaid enrollment remains above pre-pandemic levels, with hospital visits accounting for the largest expenditure at 27 percent in fiscal 2025. The state projects a $290 million deficit due to rising per-member costs from fiscal 2024 to fiscal 2025: Husky A increased from $373 to $395, Husky C from $3,105 to $3,339, and Husky D from $667 to $746. Connecticut’s Medicaid costs accounted for 23.6 percent of the state budget in fiscal year 2024, lower than the peer-state average and national average.
Delaware
Delaware Newly Formed Hospital Cost Review Board Meets Amid Lawsuit from ChristianaCare. Delaware Public Media reported on March 17, 2025, that Delaware’s Diamond State Hospital Cost Review Board held its first meeting while facing a lawsuit from ChristianaCare. The lawsuit challenges the board’s authority, claiming it infringes on constitutional rights and imposes unlawful price caps. The board was established to address escalating healthcare costs and is tasked with reviewing hospital budgets to ensure alignment with annual spending benchmarks. The state is awaiting a decision from the Court of Chancery on whether to dismiss the case, with a ruling expected by May 31.
Idaho
Idaho Budget Committee Proposes Fiscal 2026 Medicaid Budget. The Idaho Capital Sun reported on March 17, 2025, that the state Joint Finance Appropriations Committee has set its fiscal 2026 Medicaid budget close to what Governor Brad Little requested in his executive budget. The budget allocates nearly $674.2 million for Medicaid enhancement funds—an 11.5 percent increase from fiscal 2025 and $12 million less than the governor’s request—including $376.1 million in enhancement funds for Medicaid Population Forecast Adjustments. The committee also proposes reducing the Medicaid budget by $15.9 million in trustee and benefit expenses due to savings anticipated from a recently passed bill that will add Medicaid work requirements and move the state toward managed care. The budget bills will now need to be considered by both chambers. In addition, the committee approved a $415.2 million supplemental Medicaid budget for the current fiscal year.
Indiana
Indiana House Committee Advances Medicaid Work Requirement Bill Without HIP Enrollment Cap. The Indiana Capital Chronicle reported on March 18, 2025, that the state House Public Health Committee voted in favor of advancing a bill that would require the Indiana Family and Social Services Administration to seek federal approval to implement Medicaid work requirements for certain Healthy Indiana Plan (HIP) enrollees, the state’s Medicaid expansion population. Initially, Senate Bill 2, sponsored by Senator Ryan Mishler (R-Mishawaka), also sought to cap HIP enrollment at 500,000, but the committee amended the bill to remove the explicit cap and instead would allow FSSA to stop enrolling new HIP beneficiaries once state appropriations run out. Additionally, the bill would require FSSA to check for all Medicaid eligibility quarterly instead of annually.
Indiana Hospitals Diverted $2.6 Billion in Medicaid Funds Away from Nursing Homes. The Indianapolis Star reported on March 18, 2025, that over the past 15 years, 21 Indiana county-owned hospitals diverted nearly $2.6 billion of the $5.6 billion in supplemental Medicaid payments generated by nursing homes back into the hospitals instead of the nursing homes, according to data obtained for an investigative piece. The 500 nursing homes affected were all acquired by one of the public hospitals. The diverted funds went toward new hospital facilities, renovations, ambulances, and equipment.
Kentucky
Kentucky Legislature Passes Medicaid Work Requirements Bill. WHAS11 reported on March 16, 2025, that the Kentucky Legislature passed House Bill 695, adding Medicaid work requirements and creating a new oversight board to improve budgeting, reduce system abuse, and increase accountability in Medicaid spending. Governor Andy Beshear is expected to veto the bill, with a likely legislative override.
Kentucky to Submit Two HCBS Section 1915c Demonstration Renewal Requests. The Kentucky Department for Medicaid (DMS) announced on March 13, 2024, that Kentucky plans to submit requests to the Centers for Medicare & Medicaid Services (CMS) to renew the state’s Section 1915(c) Home and Community-based (HCB) and Modell II Waiver (MII) demonstrations. The HCB demonstration application proposes to change the patient liability standard from 100 percent federal poverty level (FPL) to 300 percent FPL; allow waiver services to be provided to individuals in acute hospital settings when the hospital cannot meet certain needs; and update case management standards. There are no significant changes to the Model II waiver, which provides assistance to individuals who use a ventilator for 12 or more hours a day. Public comments will be accepted through April 13.
Kentucky Senate Committee Amends Bill to Ban Medicaid Coverage for Gender-affirming Care. The Kentucky Lantern released on March 12, 2025, that the Kentucky Legislature amended a bill aimed at overturning Governor Andy Beshear’s restrictions on conversion therapy to also prohibit Medicaid from covering gender-affirming medical care. The bill advanced in the Senate Health Services Committee and now awaits full Senate approval.
Maine
Maine Budget Bill Passes Committee with Medicaid Clause. The Maine Morning Star reported on March 14, 2025, that Maine’s Appropriations and Financial Affairs Committee approved a biennial budget that includes funding to address a $118 million Medicaid shortfall. The bill contains an emergency clause requiring two-thirds support from the full Legislature for immediate funding. If this majority vote is not met, funding allocations will be delayed until July 1, 2025, unless a majority in both chambers approve the bill by March 31. The failure of the prior supplemental budget has already caused delays in MaineCare payments.
Nebraska
Nebraska Budget Shortfall Increases $90.3 Million After Drop in FMAP. The Nebraska Examiner reported on March 6, 2025, that Nebraska’s budget shortfall has increased $90.3 million after legislative staff discovered an overlooked revision to the state’s Federal Medical Assistance Percentage (FMAP) that will increase the share the state must pay for its Medicaid program. In February, lawmakers on the Senate Appropriations Committee identified $171 million in cuts to help alleviate the shortfall in its preliminary budget, which will have to be approved by committee and the full Senate. Without the cuts identified by the committee, Nebraska faces a $457 million shortfall for fiscal years 2025-27.
Oregon
Oregon Legislature Passes Medicaid MCO, Hospital Tax Extension Bill. Oregon Public Broadcasting reported on March 18, 2025, that the Oregon Senate voted 22-5 to pass a bill looking to extend two Medicaid taxes through 2032. House Bill 2010, sponsored by Speaker of the House Representative Julie Fahey (D-Eugene), would extend the 2 percent assessment tax on Medicaid managed care organizations and the 6 percent assessment tax on net hospital revenue. The bill now moves to Governor Tina Kotek for signature.
Pennsylvania
Pennsylvania Medicaid Fraud Control Unit Recovered $11.3 Million During Fiscal 2024, HHS OIG Finds. The Pennsylvania Attorney General announced on March 17, 2025, that its Medicaid Fraud Control Unit recovered more than $11.3 million in misused Medicaid funds in federal fiscal year 2024, according to the U.S. Department of Health and Human Services Office of the Inspector General’s (HHS OIG) annual report. The state also filed more fraud charges against individuals than any other state and secured the third most convictions relating to Medicaid fraud.
National
Medicare Advantage 2025 Costs to Exceed Fee-for-Service by $84 Billion, MedPAC Finds. Health Payer Specialist reported on March 17, 2025, that Medicare Advantage is set to cost 20 percent—or $84 billion—more than fee-for-service Medicare in 2025, according to the Medicare Payment Advisory Commission’s (MedPAC) most recent report to Congress. In addition, MA and Part B premiums will rise an estimated $13 billion in 2025. The commission’s report cites favorable selection and coding intensity as the main factors leading to higher costs. MedPAC also claimed the MA Star Rating System is ineffective in improving quality and providing meaningful information to beneficiaries choosing plans.
Congress Passes Stopgap Funding Measure Extending Telehealth, Excluding Medicare Rate Increase. Modern Healthcare reported on March 14, 2025, that Congress passed a continuing resolution to fund government operations through fiscal 2025, ending September 30. The measure reauthorizes Medicare reimbursements for telehealth and hospital-at-home service, delays cuts to disproportionate share hospitals, and extends low-volume hospital Medicare payment adjustments. The measure does not reverse a pay cut to Medicare physician reimbursement rates. President Donald Trump signed the measure into law.
CMS Administrator Nominee Dr. Oz Discusses Medicare Advantage Upcoding, Changes to CMS During Committee Hearing. Health Payer Specialist reported on March 14, 2025, that President Donald Trump’s pick to lead the Centers for Medicare & Medicaid Services (CMS), Dr. Mehmet Oz, discussed Medicare Advantage (MA), pharmacy benefit managers (PBMs), and potential changes he would make to the agency if confirmed at a Senate Finance Committee hearing. Oz discussed his concerns about upcoding in Medicare Advantage and indicated that overseeing upcoding will be key to controlling CMS spending. The nominee also indicated he would make significant changes to CMS and would meet with senators to discuss a transformation. Additionally, Oz expressed support for more transparency surrounding pharmacy benefit managers, the usage of artificial intelligence for prior authorizations, and multi-year MA plans to limit switching. Oz did not give a clear answer when asked about which Medicaid cuts he supports.
Federal Judge Orders Trump Administration to Reinstate Most Terminated Probationary Federal Workers. Fierce Healthcare reported on March 14, 2025, a federal judge has ordered the government to reinstate most of the probationary employees it terminated at the U.S. Department of Health and Human Services and other federal agencies by March 17. The judge determined that the mass layoffs were not conducted legally due to a lack of advanced notice. The order applied to most departments except for the Department of Defense, the Office of Personnel Management, and the National Archives and Records Administration. The judge also granted a temporary restraining order against the federal government from laying off more employees unless they comply with federal law.
Senate Committee Advances Trump’s FDA and NIH Nominees, CDC Pick Withdrawn. Modern Healthcare reported on March 13, 2025, that a Senate committee voted to advance President Donald Trump’s nominations for Marty Makary for the Food and Drug Administration (FDA) and Jay Bhattacharya for the National Institutes of Health (NIH). Meanwhile, the White House withdrew Dave Weldon’s nomination for the Centers for Disease Control and Prevention (CDC) before his hearing. A hearing for Mehmet Oz, Trump’s nominee to lead the Centers for Medicare & Medicaid Services, was held March 14.
HHS Closes Six Regional Legal Offices Enforcing Health Standards. Fierce Healthcare reported on March 12, 2025, that the Department of Health and Human Services (HHS) is closing six of its 10 regional legal offices, consolidating them into four locations to cut costs. It is uncertain how employees will be impacted, but lawyers in these offices are responsible for enforcing nursing home and hospital standards. The federal government is also planning widespread lease terminations affecting health agencies such as the Centers for Medicare & Medicaid Services, the Food and Drug Administration, and Indian Health Services.
State Medicaid Fraud Units Recovered $1.4 Billion in 2024, OIG Report Finds. The U.S. Department of Health and Human Services Office of Inspector General released on March 14, 2024, a report showing that state Medicaid Fraud Control Units recovered $1.4 billion in civil actions and criminal convictions for fraud and patient abuse in 2024. Recoveries increased by $200 million, up from $1.2 billion in 2023.
MACPAC Releases Report on External Quality Reviews, HCBS in Medicaid. The Medicaid and CHIP Payment and Access Commission (MACPAC) released on March 13, 2025, a report to Congress on the role of external quality reviews and home and community-based services (HCBS) in Medicaid and the Children’s Health Insurance Program (CHIP). The report makes recommendations to improve the external quality review process of managed care organizations and to improve timely access to HCBS. Additionally, the report analyzes HCBS federal administrative requirements and recommends ways to streamline Medicaid Section 1915 authorities to alleviate administrative burdens.
Industry News
HCSC Completes $3.3 Billion Acquisition of Cigna’s Medicare Advantage Business. Health Care Service Corporation (HCSC) announced on March 19, 2025, that it has completed its acquisition of Cigna’s Medicare Advantage business for $3.3 billion, significantly expanding its geographic footprint from five states to 34 states and the District of Columbia. With this acquisition, HCSC will now serve 4.3 million Medicare Advantage members nationally. Cigna’s Evernorth division will continue serving Medicare members through Medicare Supplement, prescription drug plans, and supplemental services, and will provide pharmacy benefits and related services to HCSC for at least four years.
DispatchHealth Signs Definitive Agreement to Acquire Medically Home. Modern Healthcare reported on March 18, 2025, that Denver-based hospital-at-home provider DispatchHealth has signed a definitive agreement to acquire Medically Home, expanding operations across 23 states and Washington, D.C. The deal, expected to close by mid-year pending regulatory approval, will integrate DispatchHealth’s home-based care services with Medically Home’s hospital-at-home technology and logistics. DispatchHealth CEO Jennifer Webster will lead the combined company. Financial terms of the agreement were not disclosed.
Cigna Names Brian Evanko President, COO. Modern Healthcare reported on March 13, 2025, that Cigna Group has named Brian Evanko as president and chief operating officer (COO), effective March 31, 2025. Evanko previously served as vice president and chief financial officer of Cigna, and president and CEO of the Cigna Healthcare subsidiary. Additionally, Eric Palmer will leave his role as president and chief executive of Cigna’s Evernorth Health Services subsidiary on April 26.
RFP Calendar
HMA News & Events
HMA Webinar
Survey Readiness: Prepare, Respond, Succeed, a 5-part Virtual Series. Every Wednesday in April 1:00 PM to 2:30 PM ET.
In today’s complex healthcare environment, navigating the scrutiny of regulatory and accreditation bodies like The Centers for Medicare & Medicaid Services (CMS), Department of Health (DOH), The Joint Commission, and Det Norske Veritas (DNV) Healthcare is critical for the success of every hospital and health system. Unexpected surveys, triggered by recertification, validations or even complaints, can occur at any time.
HMA has partnered with the Healthcare Association of New York State (HANYS) to develop the content for Survey Readiness: Prepare, Respond, Succeed, a 5-part virtual series on Wednesdays in April from 1- 2:30pm ET. HMA’s expert faculty will also co-teach the sessions. Attendees will dive deep into organizational strategies and tactics to prepare, manage and respond to surveyors effectively – and get the essential skills to excel in survey readiness.
While some examples in the program will address issues from the New York state perspective, attendees from organizations nationwide should attend. Hospital and long-term care executive team and leaders in quality and compliance, survey coordinators, and risk management will benefit from attending.
Survey Readiness: Prepare, Respond, Succeed
Virtual Series | April 2 – 30
- April 2: Survey readiness 101: Overview and getting started
- April 9: Preparation: How to mitigate risk and prepare for upcoming surveys
- April 16: They’re here: Establishing a survey response and management protocol
- April 23: Responding to survey findings: How to develop a strong correction plan and knowing your options
- April 30: What’s next: Leveraging survey findings and strengthening organizational quality and compliance
The cost to attend this series is $475.
State hospital associations and their members can enjoy $50 off when using this code when registering: SHADISCOUNT25
To learn more and to register, visit http://hanys.org/events/survey-readiness.
Wakely, an HMA Company, Playbook
Providers Taking Medicare Advantage Risk: Financial Forecast Playbook. Wakely, an HMA Company, offers supports for providers, from fully outsourcing a data, actuarial, or financial function to very specialized expertise for a niche problem. Wakely recently developed a Provider Playbook that outlines steps that providers participating with Medicare Advantage (MA) plans can use to monitor their risk arrangements. Read More
NEW THIS WEEK ON HMA INFORMATION SERVICES
(Exclusive Access for HMAIS Subscribers):
HMAIS Reports
- HMAIS analysis of awards of the Illinois Dual Eligible-Special Needs Plan (D-SNP) RFP to transition the state to a fully integrated dual-eligible special needs plan (FIDE-SNP) model. The analysis includes key differences between the 2013 and 2024 RFP, notable takeaways, and what to watch going forward.
- Updated Illinois, Minnesota, Nevada, and Washington State Overviews
Medicaid Data
Medicaid Enrollment and Financial data from Florida, Illinois, Kansas, Nevada Oregon, Pennsylvania, Virginia, West Virginia, Wisconsin.
Public Documents:
Medicaid RFP documents from Illinois, Minnesota, and West Virginia.
Medicaid Quality Strategies, External Quality Review Reports, Budget Variance Reports, MCO Financial Reports, HCBS Waiver Documents, Behavioral Annual Reports, Council Meeting Materials, and other key documents from the following states: Connecticut, Nebraska, Nevada, Ohio, Tennessee, Texas, Utah, Vermont, and Wisconsin.
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].