American Medical Group Association (AMGA)’s Post

LinkedIn Live: Recent CMS Managed Care Final Rule HMA's LinkedIn live details some items from the managed care final rule that the Centers for Medicare & Medicaid Services (CMS) filed for publication on April 22, 2024. Policy changes fall into the following major categories: in lieu of services and settings, the Medicaid and CHIP Quality Rating System, medical loss ratios, network adequacy, and state directed payments. These revised policies will affect Medicaid coverage and reimbursement for years to come. HMA experts will highlight their initial takeaways and insights for organizations affected by the new rules. Kathleen Nolan Joe Moser Michael Engelhard David Nater Jesse Eller

Centers for Medicare & Medicaid Services announces new model to advance integration in #BehavioralHealth. New model seeks to improve quality of care, access, and outcomes for people with #mentalhealth conditions and substance use disorders in Medicaid and Medicare. https://lnkd.in/dnrHkqeP #healthcare #UShealthcare

HCHB has authored a comment letter for CMS regarding the proposed rule. The comment letter shares data analysis based on HCHB's data which encompasses 44% of all Medicare Home Health visits. Find out more in our press release addressing the comment letter: https://bit.ly/46DVU7z #HomeHealth #HomeHealthAdvocacy Centers for Medicare & Medicaid Services

Only 10% of those eligible for both Medicare and Medicaid are in integrated managed care plans, leaving many to navigate disjointed services. With the Centers for Medicare and Medicaid Services (#CMS) Medicare-Medicaid Program (#MMP) demonstration ending in 2025, the #MLTSS Association proposes building on the existing Dual-Eligible Special Needs Plan (#DSNP) framework to overcome integration barriers and boost enrollment. By focusing on necessary statutory and regulatory changes, we pinpoint priority areas and short- and long-term solutions in our proposal to increase more holistic and accessible care, enhancing the care experience for our most vulnerable populations. Read more about our policy proposals to advance integrated care: https://lnkd.in/eARMaV8m 

Accessible care is huge! More focus is needed on meeting the member where they are. Holistic approaches to treating as a whole is critical in today’s world. Value based care, telehealth, rural health focus, SDOH, NHS Frameworks, HEDIS measures, etc. The list goes on and on and it’s imperative that members are being identified and receiving appropriate care and services. Many states have waiver waitlists years long. Changes are coming and need to happen.

The Centers for Medicare and Medicaid Services (#CMS) have finalized new services related to social determinants of health (#SDOH). Find out more in our NGL blog post by Carrie Nixon and Olivia Goldner. https://lnkd.in/gKT5SNmY #digitalhealth #healthcareinnovation

Regular primary care contributes to better health because it's regular, whole-person focused and relationship-based. CMS has been steadily building capacity for relationship-based care with monthly payments for ongoing care management for people with chronic conditions and patients transitioning from hospital to home. For the 2025 #Medicare Physician Fee Schedule, Centers for Medicare & Medicaid Services is proposing to bundle these monthly payments and simplify billing and documention. Learn more about the intent and vision to support primary care relationships with payments that enable care coordination, virtual patient check-ins, and more. There are also some exciting proposals for #ACOs. Comment and let the agency know what more they can do to make this vision for better care a reality. #primarycare #chroniccare Centers for Medicare & Medicaid Services https://lnkd.in/exakekhG

What do you think about the proposed Medicare Physician Fee Schedule rule? We are thankful that the Centers for Medicare & Medicaid Services is listening to stakeholder feedback in regard to #ACO Beneficiary Notification requirements. The newly proposed 2025 MPFS rule modifies two elements of the notification process: removes the "no later than the earlier of the beneficiary's next primary care service visit" language in regard to follow-up communication and adjusts the beneficiary population required to receive the notification from ACOs under preliminary prospective assignment with retrospective reconciliation.

"What we found was that 40% of people treated in the Mount Sinai CMMI demonstration lived in New York City public housing…we found that the advantages, in terms of reduced ED visits and rehospitalizations, actually were seen on the Medicaid eligible beneficiary side."   Through the hospital-at-home model, care teams have the unique opportunity to improve health equity by directly visualizing and addressing social determinants of health. Nine state Medicaid programs currently reimburse for hospital-at-home, and expansion is key to increasing access to underserved populations. https://lnkd.in/d5uzSnfq

ICYMI: Several flexibilities will be available to ease the burden on providers caused by Medicaid Managed Care expansion. + For medical PAs, health plans will honor existing NC Medicaid medical PAs through May 31, 2024 + For pharmacy PAs, Standard Plans and NC Medicaid Direct will honor existing pharmacy PAs + From December 1, 2023 to May 31, 2024, health plans must reimburse Medicaid-eligible out-of-network providers equal to those of in-network providers + Between December 1, 2023 and August 31, 2024, Medicaid beneficiaries may change their PCP for any reason + NC Medicaid is extending Appendix K temporary flexibilities until February 29, 2024 + Effective November 1, 2023, NC Medicaid Direct and NC Medicaid Managed Care will apply provider rate increases for durable medical equipment and ambulatory surgical centers Read all recent announcements: https://lnkd.in/gShEXcTn