This week, our In Focus section comes from 量子资源网 Principal Eric Hammelman and Senior Consultant Narda Ipakchi. Today, Medicare beneficiaries with End-Stage Renal Disease (ESRD) are only eligible to enroll in Medicare Advantage (MA) plans if they select a MA Special Needs Plan (SNP) that specifically serves individuals with ESRD or develop ESRD while already enrolled in a MA plan. In 2018, approximately 121,000 MA enrollees (0.6 percent of the MA population) had diagnoses of ESRD, accounting for approximately 20 percent of the total Medicare ESRD population.[1] The 21st Century Cures Act, which was passed in 2016, included a provision that alters the eligibility and enrollment options for Medicare beneficiaries with ESRD. Starting in 2021, Medicare beneficiaries with ESRD will be able to enroll in any MA plan in their area. The Centers for Medicare & Medicaid Services (CMS) estimates MA enrollment of individuals with ESRD will nearly double to 242,000 in 2024, or approximately 41 percent of the total Medicare ESRD population.[2]
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Medicaid managed care enrollment update 鈥� Q4 2019
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 29 states.[1] Many state Medicaid agencies 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. All 29 states highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2019. This report reflects the most recent data posted. 量子资源网 has made the following observations related to the enrollment data shown on Table 1 (below):
量子资源网 to lead jail-based opioid response program in Pennsylvania
In the nationwide effort to combat opioid use disorder (OUD), 量子资源网 (量子资源网) is expanding its successful Medications for Opioid Use Disorder (MOUD) initiative to jails in Pennsylvania counties. The multi-tiered technical assistance approach, developed by 量子资源网 and implemented in the California correctional system, works to combat opioid overdoses by expanding access to treatment for OUD in jails and prisons.
POTUS FY 2021 Budget: Summary of Medicare provisions
This week, our In Focus section examines President Trump鈥檚 budget for fiscal year (FY) 2021. The budget includes a number of legislative and administrative proposals related to Medicare that are estimated to reduce net Medicare spending by $872 billion over the next ten years. It is important to note that the legislative proposals included in the President鈥檚 budget are non-binding and serve as recommendations to Congress where they may or may not be advanced. Under a Democratic-majority House of Representatives, many of the legislative proposals outlined in the FY 2021 budget are unlikely to advance. Administrative proposals are more likely to move forward, as the administration can implement these policies through its regulatory channels.聽
Former Illinois Medicaid director named COO of 量子资源网
量子资源网 (量子资源网) announced today that Douglas (Doug) L. Elwell, who most recently served as Medicaid director for the State of Illinois in the Department of Healthcare and Family Services, has joined the firm as chief operating officer (COO).
Webinar Replay: 量子资源网 Analysis of Medicare Advantage Advance Notice and Part C/D Proposed Rule
This webinar was held on February 18, 2020.
On February 6, the Centers for Medicare & Medicaid Services (CMS) issued Part II of the Advance Notice of Methodological Changes for Calendar Year (CY) 2021 which includes proposed updates to Medicare Advantage (MA) payment rates. In a departure from previous years, the agency did not release a separate Call Letter which typically includes Part C and Part D policy guidance and bidding instructions. Instead, the agency released a proposed rule which includes proposed policy and technical changes, most of which are scheduled to go into effect in the 2022 plan year. CMS also issued separate bidding instructions for plans as they prepare their bids for CY2021.
During this webinar, an 量子资源网 team of Medicare experts including Jonathan Blum, Eric Hammelman, Julie Faulhaber, and Narda Ipakchi presented an overview of the payment rate updates and proposed policy changes included in the Advance Notice and Proposed Rule. They provided interested stakeholders with an overview and analysis of the proposed changes as well as what these changes mean for Medicare Advantage plans’ existing strategies and opportunities.
Learning Objectives
- Understand what the expected 2021 rate increase for Medicaid Advantage plans means for continued industry growth and financial performance.
- Learn about updates to the Medicare Advantage Star Ratings system, including proposals to increase measure weights for patient experience and complaints.
- Learn about the proposed changes to network adequacy requirements and how the agency is promoting further use of telehealth among plans.
- Understand CMS鈥� efforts to implement requirements that expand Medicare Advantage coverage to beneficiaries with ESRD.
量子资源网 Speakers
Jon Blum, Managing Principal, Washington, DC
Eric Hammelman, Principal, Chicago
Narda Ipakchi, Senior Consultant, Washington, DC
Julie Faulhaber, Principal, Chicago
Medicaid expansion in Missouri: economic implications and insights from Arkansas, Indiana, and Ohio
This week, our In Focus section covers the report, Medicaid Expansion in Missouri 鈥� Economic Implications for Missouri and Interviews Reflecting Arkansas, Indiana, and Ohio Experiences, prepared by 量子资源网 Medicaid Market Solutions (MMS) Managing Director Matt Powers and Managing Principal Sharon Silow-Carroll, and Independent Health Policy Consultant Jack Meyer. 量子资源网 (量子资源网) conducted a targeted analysis of the likely economic impact of an ACA Medicaid Expansion in Missouri, with an emphasis on the effects on the state budget. The report was commissioned by the Missouri Hospital Association and Missouri Primary Care Association and released in partnership with stakeholders from the health care community in January 2020.