Recently, the Centers for Medicare & Medicaid Services (CMS) issued proposed rules to update the Medicare payment rates and implement other policy changes for three types of Part A providers: hospice, inpatient psychiatric facilities (IPFs), and skilled nursing facilities (SNFs). CMS is publishing these proposed rules in accordance with existing statutory and regulatory requirements to update Medicare payment policies for these providers on an annual basis. This brief summarizes the proposed payment rates and key policy changes for each of these provider types.
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Medicare and Medicaid telehealth coverage in response to COVID-19
Telehealth service expansions by Medicare and most Medicaid programs aim to rapidly increase access to care and reduce transmission, but also provide a natural experiment for policymakers.
This week, our In Focus section examines the extensive scope of flexibilities Federal and State governments have made to Medicare and Medicaid telehealth coverage in response to the COVID-19 national emergency. In March and April 2020, federal and state policymakers responded to the COVID-19 emergency by temporarily and aggressively expanding the definition of and reimbursement for telehealth services鈥攎oves intended to improve access to care and reduce virus transmission. Under the Medicare and Medicaid programs, these temporary expansions have been rapid and historic in scope, and will have substantial implications for patients, providers, payers, and federal/state financing. For policymakers, this temporary expansion may serve as a natural experiment for assessing which forms of telehealth services successfully expand access to care and should become permanent healthcare policy.
Medicare and Medicaid flexibilities during public health emergencies
This week, our聽In Focus聽comes from 量子资源网 Vice President聽Kathleen Nolan聽and Managing Principal聽Jon Blum.聽On March 13, 2020, President Trump declared a national emergency due to the rapid spread of COVID-19 virus. This declaration provides Health and Human Services (HHS) and the Centers of Medicare and Medicaid Services (CMS) new abilities to waive Medicare and Medicaid regulatory requirements to help health care providers, health plans and other stakeholders respond to immediate needs of their patients and communities.聽聽 In the past, HHS and CMS have solicited requests for relief needs from states, local providers and trade associations, among other stakeholders.聽 Health care providers, health plans and others should continue to monitor policy announcements from HHS and CMS and work with their states and trade associations to identify potential areas of need for requested regulatory relief.
量子资源网 analysis of the 2020 Medicare Advantage annual election period
This week, our In Focus section examines Medicare Advantage (MA) enrollment changes resulting from the 2020 Annual Election Period (AEP). The AEP takes runs from October 15 to December 7 each year, and provides an opportunity for Medicare beneficiaries to sign up for, change, or disenroll from an MA plan for the upcoming year. The majority of enrollment changes occur during this period, but depending on beneficiary circumstances, additional opportunities may exist throughout the year to change coverage. Initial findings from the enrollment data suggest:
量子资源网 analysis of new requirements expanding Medicare Advantage eligibility to individuals with end-stage renal disease
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]
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
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
量子资源网 explores potential issues for individuals with end-stage renal disease enrolling in Medicare Advantage
Starting in 2021, Medicare beneficiaries with End-Stage Renal Disease (ESRD) will be able to enroll in any Medicare Advantage (MA) plan. The Anthem Public Policy Institute asked 量子资源网 to explore some of the potential issues associated with how MA plans are currently paid by the Centers for Medicare & Medicaid Services (CMS) for individuals with ESRD, and identify any possible modifications that CMS or Congress could make to more closely align payment with costs.
This white paper was prepared for Anthem Public Policy Institute by 量子资源网 Managing Principal Jon Blum, Principal Eric Hammelman, and Senior Consultant Narda Ipakchi.
量子资源网 Acquires California-based Firm NPO Solutions
Today, Jay Rosen, founder and president of 量子资源网 (量子资源网), announced the acquisition of NPO Solutions, a California-based management consulting firm that specializes in expanding the capacity of social sector organizations.
Jonathan Blum to Join 量子资源网 as Managing Principal
Jonathan (Jon) Blum will join 量子资源网 as a managing principal on Aug. 31 working out of the Washington, DC office.
He has more than 20 years of senior-level experience working in public and private healthcare financing organizations, including the Centers for Medicare and Medicaid Services (CMS).
Hospital Charges and Reimbursement for Medicines: Analysis of Cost-to-Charge Ratios
This report is an update to a previous report examining hospital markups for separately paid drugs. Our prior analysis examined hospital charges and reimbursement for 20 drugs and found that hospitals marked up charges for those drugs, on average, 487 percent of their acquisition cost. We also found that hospitals receive 252 percent of estimated hospital acquisition cost from commercial payers. Hospital reimbursement data was obtained from the Magellan Rx Management Medical Pharmacy Trend Report™: 2016 Seventh Edition (the Magellan report) and charges were calculated from Medicare claims data. For more information, please refer to our prior analysis.
量子资源网 Expands West Coast Footprint, Opens Office in Los Angeles
量子资源网 (量子资源网), a leading independent national consulting firm specializing in publicly funded healthcare, continues its growth with the opening of a new office in downtown Los Angeles.