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CMS releases advance notice of methodological changes for MA capitation rates and Medicare Part C and Part D payment policies

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This week, our In Focus section reviews the Centers for Medicare & Medicaid Services (CMS) Calendar Year (CY) 2025 Advance Notice for the Medicare Advantage (Part C) and Part D Prescription Drug Programs published on January 31, 2024. Alongside the advance notice, CMS published draft CY 2025 Part D Redesign Program Instructions. This guidance includes CY 2025 payment updates as … Read More

CMS Seeks New Direction for Medicare Advantage and Part D Markets on Health Equity, Dual Eligible Integration

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This week, our In Focus section highlights the Centers for Medicare & Medicaid Services (CMS) proposed changes to the Medicare Advantage (MA) and Part D programs for contract year 2023 and how these changes may impact plan applications, bid submissions, and market dynamics for future years. The analysis and insight reflect the combined expertise of … Read More

Roles and Responsibilities in a Value Based Payment World

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This week, our In Focus section, written by HMA Principal Denise Soffel, reviews New York’s Medicaid Redesign Team Structural Roadmap: Roles and Responsibilities in a Value Based Payment World, released by the state’s Department of Health on March 19, 2018. New York is committed to the transformation of its health care delivery system. Its Delivery … Read More

Medicaid managed care final rule: what to watch for

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Our second In Focus section provides a refresher on the Medicaid and Children’s Health Insurance Program managed care access, finance, and quality proposed rule that the Centers for Medicare & Medicaid Services (CMS) published in May 2023. As Health Management Associates, Inc. (HMA), has noted, the final rule is expected to be published later this month. If finalized as proposed, several provisions in … Read More

D-SNP 2021 Integration Requirements: Opportunities for Plans, States to Partner on Medicare-Medicaid Integration

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This week, our In Focus section provides a high-level overview of the new Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) integration requirements in the Centers for Medicare & Medicaid Services (CMS) April 16, 2019, final rule[1] for calendar year (CY) 2021. CMS recently released two publications providing guidance and technical assistance to assist with the … Read More

2022 HMA Conference Presentations

Sunday, October 9, 2022 Pre-Conference Workshop-The Future of Payment Reform: Delivering Value, Managing Risk in Medicare and Medicaid Monday, October 10, 2022 Keynote AddressPolitics and the ‘New Normal’ for U.S. Healthcare The COVID-19 pandemic may have led to a “new normal” for the U.S. healthcare industry, but one thing remains the same: the politics around … Read More