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量子资源网 Insights: Your source for healthcare news, ideas and analysis.

量子资源网 Insights 鈥� including our new podcast 鈥� puts the vast depth of 量子资源网鈥檚 expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.

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Webinar

Webinar Replay: Medicare, Medicaid and the ACA鈥檚 Evolution After the 2020 Presidential Election

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This webinar was held on September 30, 2020.聽

The upcoming federal elections portend tremendous change for federal health care programs, in particular Medicare, Medicaid and the Affordable Care Act. If there is a change in administration and Congressional control, stakeholders should expect rapid implementation of new policy agendas and regulatory frameworks. New presidents generally pursue aggressive policy and regulatory agendas to fulfill campaign promises and quickly secure their policy objectives. Second-term presidents seek to solidify and extend their policy legacies. Health care stakeholders should begin to prepare for potential changes now to ensure that their organizations are best positioned for 2021 and beyond.

Through a new collaboration between 量子资源网 (量子资源网) and Dentons global law firm, a former presidential candidate and governor, presidential transition team veterans, former federal government administrators, and health policy experts outlined the different health care platforms of the Biden and Trump campaigns. The webinar explored:

  • The major differences in policy positions and how a Trump or Biden Administration will administer the Medicare, Medicaid and Affordable Care Act (ACA) programs.
  • How the current COVID-19 pandemic, economic downturn, and a potential Supreme Court decision will shape these agendas.
  • The process for presidential transitions and how new governing and regulatory agendas are established.

During this webinar, the first in a series hosted by 量子资源网 and Dentons, presenters discussed the implications of the upcoming elections and their potential impact on federal health program policies and regulatory agendas.

Speakers

Governor Howard Dean (VT), Former Presidential Candidate & Senior Advisor, Dentons鈥� Public Policy and Regulation Practice

Kathleen Nolan, Regional Vice President, 量子资源网

Jonathan Blum, Vice President, Federal Policy & Managing Director, Medicare, 量子资源网

Bruce Fried, Partner, Dentons鈥� Health Care Practice

Blog

量子资源网 summary of Medicare Fee-for-Service (FFS) proposed rules

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This week, our In Focus section reviews two Medicare fee-for-service (FFS) proposed rules recently issued by the Centers for Medicare & Medicaid Services (CMS). On August 3, 2020, CMS released a proposed rule that includes updates to services furnished under the Medicare Physician Fee Schedule (PFS). On August 4, CMS released the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule. These proposed regulations include payment rate and policy changes for the upcoming calendar year. Key features in this year鈥檚 PFS proposed rule include: policies to retain, extend, or end certain telehealth flexibilities implemented in response to the novel COVID-19 public health emergency (PHE), changes to enable certain health care professionals to practice at the top of their licenses, modifications to opioid treatment programs (OTPs), and updates to the Medicare Shared Savings Program (MSSP). View additional information on the PFS Proposed Rule. Among the most notable policy changes in the OPPS and ASC proposed rule are: 1) transitioning services to lower cost settings by eliminating the inpatient-only list to enable more services to be provided in the outpatient settings and increasing the scope of procedures that can be provided in ASCs, 2) further reducing payments for the 340B drug program, and 3) modifying the formula for calculating Hospital Star Ratings, and expand the use of prior authorization for outpatient services. Find additional information about these proposals.

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Brief & Report

量子资源网 examines current state of Medicare-Medicaid integration programs

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The experts at 量子资源网 (量子资源网) have released the Medicare-Medicaid Integration: Reflecting on Progress to Date and Charting the Path to Making Integrated Programs Available to all Dually Eligible Individuals issue brief and companion bibliography appendix, the second in a series of issue briefs examining Medicare-Medicaid integrated programs.

Based on 量子资源网’s review of the literature and available public information, this brief summarizes the elements for success and barriers encountered by integrated programs. It concludes with essential questions and next steps to move forward with federal and state public policies and care delivery options centered around, informed by, and available to, more dually eligible individuals.

量子资源网 colleagues Sarah Barth, Jon Blum, Elaine Henry, Narda Ipakchi and Sharon Silow-Carroll contributed to the research and final brief.

For the next phase of research, 量子资源网 will convene and interview individuals, their families and other caregivers, providers, payers, community-based organizations, state government, and other stakeholders in select regions across the country.

The project was funded by a grant from , a philanthropy dedicated to tackling some of the most pressing problems in the United States.聽聽

Blog

Regulatory changes to Medicare in response to COVID-19

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This week, our In Focus section examines how the federal government implemented changes to the Medicare program in response to COVID-19.聽 As the COVID-19 pandemic began in the United States, Congress and the Administration responded with a series of legislative, regulatory, and sub-regulatory changes to the Medicare program that were designed to provide relief from certain Medicare rules to assist health care providers, Medicare Advantage organizations, and Part D plans in responding to the pandemic. Some of these changes waived conditions of Medicare participation to enable patients to be treated in alternative care settings. Others permitted physicians and other providers to receive Medicare reimbursements for telemedicine services.

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Brief & Report

量子资源网 releases COVID-19 Medicare regulation tracking tool

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The Medicare program has rapidly transformed how it pays for healthcare providers in response to the COVID-19 pandemic. In an effort to capture these changes, 量子资源网, commissioned by 听补苍诲听, tracked, categorized, and analyzed the 212 Medicare policy modifications made in response to the public health emergency.

量子资源网 Senior Consultant聽Jennifer Podulka聽and Managing Principal聽Jon Blum聽led efforts to analyze and synthesize COVID-19-related legislative, regulatory, and subregulatory changes to existing Medicare regulations issued beginning January 1, 2020. The resulting issue brief聽Regulatory Changes to Medicare in Response to COVID-19聽and companion Policy Tracker use nine categories to organize the data and will be periodically updated to include new information.

The issue brief outlines key COVID-19-related changes including providing telehealth reimbursement for more types of services and providers, and waived conditions of Medicare participation permitting patients to be treated in alternative care settings including community facilities, temporary facilities, homes and in some cases, out of state services on a temporary basis.

Congress and the Trump administration waived or changed regulations to allow flexibility to help healthcare providers, Medicare Advantage plans and Part D plans. The policy tracker catalogs and categorizes these regulatory changes based on characteristics, including types of providers and plans affected, effective date, and expected duration.

These changes have affected virtually all healthcare providers and health plans that participate in the Medicare program, and the issue brief examines several questions surrounding the changes moving forward including risk to beneficiary protections and Medicare spending controls established in the original legislation and rules.

Webinar

Webinar Replay: Exploring Medicare Advantage Plans as a New Business Strategy

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This webinar was held on August 6, 2020.

The COVID-19 pandemic shined a spotlight on funding pressures on providers and systems that rely largely on fee-for-service payment. This, along with additional stressors brought on by the pandemic, has led many health systems and providers to consider revenue diversification and service expansion strategies. During this webinar, 量子资源网 Medicare Advantage experts addressed the option of using Medicare Advantage as a strategy to better manage care of patients and provide a steady stream of predictable revenues.

Learning Objectives:

  • Evaluate the benefits and risks of exploring a Medicare Advantage business strategy.
  • Understand the evolving national Medicare Advantage policy landscapes and competitive marketplace.
  • Assess various Medicaid Advantage plan options and strategic business considerations.
  • Find out about the unique market opportunities of Medicare Advantage Special Needs Plans.
  • Learn what needs to be done for a successful Medicare Advantage launch or expansion in 2022.

量子资源网 Speakers

Jon Blum, Managing Principal, Washington, DC
Mary Hsieh, Managing Principal, Atlanta, GA

Blog

Early Bird Registration Expires July 29 for 量子资源网 Conference, October 26-27 in Chicago

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Be sure to register soon for 量子资源网鈥檚 conference on What鈥檚 Next for Medicaid, Medicare, and Publicly Sponsored Healthcare: How Payers, Providers, and States Are Navigating a Future of Opportunity and Uncertainty, October 26-27, at the Fairmont Chicago, Millennium Park. The Early Bird registration rate of $1595 per person expires on July 29.聽 After that, the rate is $1795.

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Webinar

Webinar Replay: Nursing Home Revenue Diversification and Care Options Series: Exploring Medicare Advantage as an Alternative Revenue Source for Post-Acute Providers

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This webinar was held on July 17, 2020.

Even before COVID-19, post-acute providers such as nursing homes struggled with inadequate reimbursement rates and declining occupancy rates. This, along with additional stressors brought on by the pandemic, has led many nursing homes to consider revenue diversification and service expansion strategies. During this webinar (the first in a series), 量子资源网 Medicare Advantage and long-term care experts addressed two such options for nursing homes: Medicare Advantage Institutional Special Needs Plans (I-SNP) and Institutional-Equivalent Special Needs Plans (IE-SNP).

Learning Objectives

  • Understand Medicare Advantage, its significance and its growth
  • Identify types of Medicare Advantage options for residents and community-based beneficiaries
  • Explore how Medicare Advantage can serve as a potential revenue diversification strategy
  • Learn about the benefits and risks of 聽聽Medicare Advantage, in particular for I-SNPs
  • Identify how to assess if an I-SNP or an IE-SNP is the right opportunity for your organization

量子资源网 Speakers

Mary Hsieh, Managing Principal, Atlanta, GA
Susan Tucker, Principal, Tallahassee, FL

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