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Lauren Flynn Kelly

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Trends That Matter for Kansas Medicaid Expansion

Posted by Lauren Flynn Kelly on Feb 13, 2020

Kansas Gov. Laura Kelly (D) and Republican Senate Majority Leader Jim Denning on Jan. 9 said they’d reached a compromise proposal to extend Medicaid coverage to an estimated 130,000 more low-income Kansans, AIS Health reported.

If approved, Kansas will pursue a full expansion of Medicaid to 138% of the Federal Poverty Level (FPL) with a 90/10 funding match. The state will also seek Section 1332 waiver approval to establish a reinsurance program and Section 1115 waiver approval to transition individuals whose incomes fall between 100% and 138% of the FPL from Medicaid to the exchange no later than Jan. 1, 2022, although expansion is not dependent on those waivers. If CMS denies either waiver, full Medicaid expansion will be implemented on Jan. 1, 2021, according to a summary of the pending legislation.
 
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Topics: Industry Trends, Market Access, Data & Analytics

Perspectives on MA Supplemental Benefits

Posted by Lauren Flynn Kelly on Jan 23, 2020

Despite Medicare Advantage insurers' enthusiasm for increased flexibility in allowable supplemental benefits and a slew of recent plan press releases touting goodies such as pest control and "Papa Pals" for the 2020 plan year, uptake of more "resource intensive" benefits geared toward seriously ill seniors remains relatively modest, according to a new report from the Duke Margolis Center for Health Policy.

The December report, "Improving Serious Illness Care in Medicare Advantage: New Regulatory Flexibility for Supplemental Benefits," showed that a total of 507 standard MA plans in 2019 offered one of five types of benefits addressing serious illness, accounting for roughly 11% of the approximately 4,500 standard MA plans in 2019, AIS Health reported. By contrast, 377 in 2020 offered at least one of the five benefits highlighted in the report, while no plans in 2019 offered more than one of these benefits. But that drop was mainly driven by one major carrier abandoning its caregiver support benefit for 2020. Meanwhile, about 175 plans offered at least two of these types of these benefits, according to Robert Saunders, research director and one of the report's authors.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar on Market Access: Kansas Works Out Medicaid Expansion Deal

Posted by Lauren Flynn Kelly on Jan 21, 2020

Kansas Gov. Laura Kelly (D) and Republican Senate Majority Leader Jim Denning on Jan. 9 said they’d reached a compromise proposal to extend Medicaid coverage to an estimated 130,000 more low-income Kansans, AIS Health reported.

If approved, Kansas will pursue a full expansion of Medicaid to 138% of the Federal Poverty Level (FPL) with a 90/10 funding match. The state will also seek Section 1332 waiver approval to establish a reinsurance program and Section 1115 waiver approval to transition individuals whose incomes fall between 100% and 138% of the FPL from Medicaid to the exchange no later than Jan. 1, 2022, although expansion is not dependent on those waivers. If CMS denies either waiver, full Medicaid expansion will be implemented on Jan. 1, 2021, according to a summary of the pending legislation.

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Topics: Industry Trends, Provider, Payer

Perspectives on Dual Eligible SNPs

Posted by Lauren Flynn Kelly on Dec 26, 2019

Through strategic acquisitions, product launches and geographic expansions, Medicare Advantage insurers across the U.S. are offering new Special Needs Plans (SNPs) aimed at improving the lives of members who are dually eligible for Medicare and Medicaid, AIS Health reported.

According to an analysis of the 2020 "landscape" files posted by CMS in September, Chicago health care consultancy Clear View Solutions, LLC, estimates that there are 171 net new SNP IDs, up from 60 net new plans in 2019. And 97 of those net new plans are dual eligible SNPs, compared with 47 D-SNPs that were introduced for 2019.
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Uptake of New MA Supplemental Benefits Remains Modest in 2020, Report Says

Posted by Lauren Flynn Kelly on Dec 24, 2019

Despite Medicare Advantage insurers' enthusiasm for increased flexibility in allowable supplemental benefits and a slew of recent plan press releases touting goodies such as pest control and "Papa Pals" for the 2020 plan year, uptake of more "resource intensive" benefits geared toward seriously ill seniors remains relatively modest, according to a new report from the Duke Margolis Center for Health Policy.

The December report, "Improving Serious Illness Care in Medicare Advantage: New Regulatory Flexibility for Supplemental Benefits," showed that a total of 507 standard MA plans in 2019 offered one of five types of benefits addressing serious illness, accounting for roughly 11% of the approximately 4,500 standard MA plans in 2019, AIS Health reported. By contrast, 377 in 2020 offered at least one of the five benefits highlighted in the report, while no plans in 2019 offered more than one of these benefits. But that drop was mainly driven by one major carrier abandoning its caregiver support benefit for 2020. Meanwhile, about 175 plans offered at least two of these types of these benefits, according to Robert Saunders, research director and one of the report's authors.

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Topics: Data & Analytics, Provider, Payer

Radar On Market Access: CMS Struggles With New Medicare Plan Finder 'Glitches'

Posted by Lauren Flynn Kelly on Dec 12, 2019

Despite a major overhaul to the Medicare Plan Finder (MPF) that was readied in time for the Annual Election Period that concluded on Dec. 7, multiple reports at press time indicated that the online tool was providing inaccurate cost estimates for users, especially relating to prescription drugs, AIS Health reported.

CMS dropped the new MPF, which reportedly cost $11 million, on Aug. 27 — just seven weeks before the Oct. 15 start of the AEP.
 
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Topics: Provider, Payer

Radar On Market Access: Amid Budget Standoff, North Carolina Delays Medicaid Transformation

Posted by Lauren Flynn Kelly on Dec 3, 2019

In the middle of an epic budget standoff between the state's Democratic governor and the Republican-controlled legislature over Medicaid expansion and teacher pay, North Carolina's plan to transfer some 1.6 million Medicaid enrollees into managed care in February is now indefinitely delayed, the North Carolina Dept. of Health and Human Services (DHHS) said on Nov. 19.

Because the North Carolina General Assembly adjourned on Nov. 15 without providing the needed funds and program authority for a Feb. 1, 2020, managed care start date, said DHHS, it has suspended implementation and open enrollment, which began for part of the state in July and went statewide in October.
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: National and Regional Players Make Dual Eligible SNP Moves

Posted by Lauren Flynn Kelly on Nov 26, 2019

Through strategic acquisitions, product launches and geographic expansions, Medicare Advantage insurers across the U.S. are offering new Special Needs Plans (SNPs) aimed at improving the lives of members who are dually eligible for Medicare and Medicaid, AIS Health reported.

According to an analysis of the 2020 "landscape" files posted by CMS in September, Chicago health care consultancy Clear View Solutions, LLC, estimates that there are 171 net new SNP IDs, up from 60 net new plans in 2019. And 97 of those net new plans are dual eligible SNPs, compared with 47 D-SNPs that were introduced for 2019.
 
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Topics: Industry Trends, Provider, Payer

Trends That Matter for 2020 Star Quality Ratings

Posted by Lauren Flynn Kelly on Nov 21, 2019

According to CMS's recent release of the 2020 star quality ratings, many Medicare Advantage beneficiaries continue to enroll in plans with 4 or more stars. There was also a notable shift of membership into highly rated Prescription Drug Plans, some of which made meaningful improvements on an individual basis even though PDP performance on average was stagnant, AIS Health reported.

More than half of Medicare Advantage Prescription Drug plans (210 contracts) that will be offered in 2020 earned overall star ratings of 4 or higher, compared with 46% of MA-PDs (172 contracts) offered in 2019, CMS reported on Oct. 11. Weighted by enrollment, approximately 81% of MA-PD enrollees are currently in contracts that will have 4 or more stars in 2020, up from about 75% in 2019.
 
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Topics: Industry Trends, Data & Analytics

Perspectives on Pelosi Drug Pricing Legislation

Posted by Lauren Flynn Kelly on Oct 31, 2019

Although there is bipartisan support for drug pricing reform and recent bills introduced in the House and the Senate share some concepts, conservatives and pharmaceutical manufacturers have found plenty to dislike about the drug pricing legislation unveiled in September by House Speaker Nancy Pelosi (D-Calif.), AIS Health reported.

In addition to restructuring the Part D benefit to include an out-of-pocket cap, the Lower Drug Costs Now Act (H.R. 3) would allow the HHS secretary to negotiate drug prices for at least 250 drugs where there is no effective competition. Manufacturers would be subject to certain transparency requirements and a "noncompliance fee." Moreover, the bill would require that the negotiated price should be no more than 1.2 times the weighted average of the price in six other countries.
 
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Topics: Industry Trends, Provider, Payer