With insurers increasingly relying on new network design strategies to compete for Marketplace consumers, and state and federal regulators coming into closer alignment with regard to standards for network adequacy, an understanding of the issues surrounding provider networks and the Affordable Care Act is critical. This three-part webinar series, presented by Manatt Health, addressed a variety of topics related to the regulation of provider networks.
Partnerships Between Brokers and Marketplaces: An Assessment of Minnesota’s Broker-Operated Enrollment Centers
As health insurance marketplaces continue to approach the fourth open enrollment period, the development of innovative models and partnerships for reaching consumers becomes increasingly important. During the third open enrollment period, MNsure, Minnesota's state-based marketplace, designated and supported twenty broker-operated enrollment centers around the state, which made a series of special commitments to promote enrollment through the marketplace. Determining the efficiency and effectiveness of such efforts is critical for the planning and development of future efforts undertaken by marketplaces.
Recent guidance issued by the Centers for Medicare and Medicaid Services (CMS) expanded the circumstances under which states can receive full federal funding for services received through the Indian Health Service (IHS) and tribal health facilities. This webinar, presented by the State Network team at Manatt Health, provided an overview of the CMS guidance, as well as the financial implications for states and tribes.
Tricky Problems with Small Numbers: Methodological Challenges and Possible Solutions for Measuring PCMH and ACO Performance
With health care providers increasingly being rewarded based on changes in cost of care, it is critical that sufficient statistical safeguards are in place to ensure that payment arrangements fairly reflect provider performance rather than random variation in medical utilization. The underlying changes in cost of care for populations served by patient-centered medical homes (PCMHs) and accountable care organizations (ACOs) are difficult to accurately assess when there are a small number of attributed patients.
The State Network 1332 Waivers Affinity Group continued with a presentation on potentially broader reforms that states may pursue through the Section 1332 State Innovation Waivers process. This discussion followed a prior presentation focused on narrower, more targeted reforms that several states are seeking to implement through the waiver process. This presentation, prepared by the State Network team at Manatt Health, included information on waiver considerations in California and Minnesota.
Since the passage of the Affordable Care Act (ACA), thirty-one states plus the District of Columbia have expanded Medicaid, providing a substantial base of evidence for the impact of Medicaid expansion, from a variety of perspectives. Data available from these states and a growing research base provide key information about the benefits and the strategic value of expansion.
Changes in population-based payment models in health care delivery have spurred enhanced efforts toward closer integration between state purchasers of health care and state, county, and local public health officials. This issue brief, developed by Bailit Health Purchasing LLC and Dr. Karen Hacker, investigates approaches that state agencies might employ in order to better integrate public health and health care delivery as a means of improving health and the value of health care, and it is organized according to seven features of integration. The issue brief is accompanied by three case studies providing additional detail to some of the examples cited in the brief.
Medicaid and the Indian Health Service: New Guidance Explains How States May Secure Additional Federal Funds
Recent guidance released by the Centers for Medicare and Medicaid Services (CMS) in February 2016 increases the range of Medicaid services and providers for which states may claim full federal funding. States with significant American Indian and/or Alaska Native (AI/AN) populations stand to benefit from this increased federal Medicaid funding. This issue brief, developed by Manatt Health, summarizes the new policy expanding federal funding for state Medicaid services provided to AI/AN populations, and explains the ways in which these additional funds reduce the cost of Medicaid expansion for states.
Provider assessments, fees, and taxes are tools available to states to generate funds to cover the non-federal share of Medicaid payments. This issue brief, developed by the State Network team at Manatt Health, examines two revenue sources that states may utilize to fund the non-federal share of Medicaid expansion: provider assessments and provider donations. Both of these are authorized by federal law and have been used by states in connection with Medicaid expansion. The issue brief summarizes the rules regarding their use and describes the ways in which they have been utilized in several states.
In addition to the impact that state decisions to expand Medicaid have had on coverage rates across the country, there is an increasing body of evidence showing consistent economic benefits among these states. This report, prepared by Manatt Health, is an update to an April 2015 State Network report, and examines data regarding Medicaid expansion in eleven states, demonstrating that states continue to realize budget savings and revenue gains as a result of expanding Medicaid.