CMS Introduces Advance Notice of Methodological Changes for MA Capitation Rates and Medicare Part C and Part D Payment Policies

September 4, 2024February 9, 2023 by Kristin Allen

This week, our In Focus section reviews recently announced major policy updates from the Centers for Medicare & Medicaid Services (CMS) that affect the Medicare Advantage (MA) and Part D programs. First, on January 30, CMS released the final Risk Adjustment Data Validation Final Rule, a highly anticipated and controversial policy that establishes the agency’s … Read More

The Uninsured

The Uninsured: Improving lives for 30 million Americans. Our team of experts comes from top positions in government, health plans and other key areas. They can help your team turn challenges into results by identifying new partners and new ideas. With knowledge drawn from the front lines of health reform, we can provide the analysis … Read More

Tim Reilly

As founder and partner of Pacific Health Consulting Group, Tim Reilly brings over 35 years of experience in managed care administration and consulting. Tim provides the health care industry with financial, product development, licensure, and rate negotiations with a focus on the safety net and Medi-Cal. He has represented 11 Medi-Cal Plans in rate negotiations … Read More

New experts join HMA in October 2023

HMA is pleased to welcome new experts to our family of companies in October 2023. Anika Alvanzo- PrincipalHMA Dr. Anika Alvanzo is a distinguished healthcare executive with over 20 years of experience in specialty addiction treatment, behavioral health integration and quality improvement. Kristine Malana Barrientos – Senior ConsultantHMA Kristine Malana Barrientos brings expertise in the … Read More

Aaron Ramthun

Aaron Ramthun is a financial professional with more than 20 years of experience working across the healthcare finance field, including Medicare bids, Medicaid rate book reviews, and budgeting. Aaron has a demonstrated track record of improving operational efficiency and implementing innovative forecasting practices. He is skilled in financial modeling, determining the financial viability of entering … Read More

Chris Dickerson

A credentialed and experienced, actuary, Chris Dickerson has expertise in Medicaid managed care, risk adjustment, and capitation rate development as well as rate development for long-term services and supports, physical and behavioral health. Before joining HMA, he was a senior consultant with Optumas where he developed complex Excel models for actuarial topics including rate adequacy, … Read More

Prepare Now: New Codes for Integrating Primary Care and Behavioral Health

April 26, 2024August 10, 2016 by Health Management Associates

Integrating primary care and behavioral health is a central focus in health care delivery reform for many states and payers as they work towards addressing quality and cost containment. Significant research demonstrating the effect of co-morbid behavioral health conditions on overall health outcomes, and the subsequent cost increases, has led to exploring the implementation of … Read More

New Mexico Issues Centennial Care 2.0 Medicaid Managed Care RFP

May 17, 2022September 8, 2017 by Health Management Associates

This week, our In Focus section reviews the request for proposals (RFP) released by the New Mexico Human Services Department (HSD) to reprocure contracts for the state’s Medicaid managed care program in its second phase, Centennial Care 2.0. Centennial Care provides integrated Medicaid managed care coverage, including long-term services and supports (LTSS) and behavioral health, … Read More

New Report Supports State Medicaid Programs to Advance Health Justice

May 17, 2022February 10, 2021 by Kristin Allen

Rates of illness and death due to the COVID-19 pandemic have disproportionally impacted Americans who are Black, African American, Latinx, Native American, Asian, and other people of color as well as people with disabilities and those subsisting on poverty-level income. In response to this, AcademyHealth, in partnership with the Disability Policy Consortium (DPC), a Massachusetts-based … Read More

Webinar Replay: What New Medicaid Managed Care Regulations Mean for Health Plan Quality, Performance Measurement

On June 17, 2015, HMA Information Services hosted the webinar, “What the New Medicaid Managed Care Regulations Mean for Health Plan Quality and Performance Measurement.” The proposed Medicaid managed care regulations released last month by CMS include fundamental changes in the way quality and performance is measured among health plans in state-sponsored programs. The rules … Read More

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