Medicare and Medicaid

Datapoint: Anthem Plans New MA Joint Venture in Maine

August 26, 2019

Anthem, Inc. will partner with MaineHealth, a nonprofit health and hospital network, to offer Medicare Advantage (MA) plans in Maine in 2020. Just 318,278 Mainers currently receive Medicare benefits, with 37.2% enrolled in an MA plan. Martin’s Point Health Care, a Portland-based provider-sponsored organization, is currently the MA market leader in Maine, with 46,466 members.

Anthem, Inc. will partner with MaineHealth, a nonprofit health and hospital network, to offer Medicare Advantage (MA) plans in Maine in 2020. Just 318,278 Mainers currently receive Medicare benefits, with 37.2% enrolled in an MA plan. Martin’s Point Health Care, a Portland-based provider-sponsored organization, is currently the MA market leader in Maine, with 46,466 members.

Source: AIS’s Directory of Health Plans

Aetna, Centene Lose Louisiana Medicaid Contracts for 2020

August 22, 2019

It’s been a rough August in Medicaid managed care in various ways, as is perhaps best illustrated by two publicly traded giants in the field: CVS Health Corp.’s Aetna Medicaid unit and Centene Corp. Both Aetna Better Health of Louisiana and Centene’s Louisiana Healthcare Connections recently learned they lost out on Louisiana’s Medicaid plan contracts for 2020.

The Louisiana Dept. of Health on Aug. 5 announced its intent to contract with four Medicaid managed care organizations — AmeriHealth Caritas Louisiana, Community Care Health Plan of Louisiana (Healthy Blue), Humana Health Benefit Plan of Louisiana, and UnitedHealthcare Community Plan of Louisiana — following a state bid process that began in February.

By Judy Packer-Tursman

It’s been a rough August in Medicaid managed care in various ways, as is perhaps best illustrated by two publicly traded giants in the field: CVS Health Corp.’s Aetna Medicaid unit and Centene Corp. Both Aetna Better Health of Louisiana and Centene’s Louisiana Healthcare Connections recently learned they lost out on Louisiana’s Medicaid plan contracts for 2020.

The Louisiana Dept. of Health on Aug. 5 announced its intent to contract with four Medicaid managed care organizations — AmeriHealth Caritas Louisiana, Community Care Health Plan of Louisiana (Healthy Blue), Humana Health Benefit Plan of Louisiana, and UnitedHealthcare Community Plan of Louisiana — following a state bid process that began in February.

Out of 1,500 maximum points for the MCOs’ RFP, Centene’s subsidiary scored the lowest at 621 points, followed by Aetna’s 669 points, while the four winning plan bidders scored in the 700s or 800s, according to the state health agency’s summary score sheet.

Timing remains an issue as potential legal disputes could further complicate matters. State officials said Louisiana expects to execute the Medicaid contracts on or about Aug. 23. Open enrollment is slated to run from Oct. 15 through Nov. 30, when members can select new plans, but state officials acknowledged the implementation timeline could stall in the event of a protest.

In fact, Aetna and Centene filed protests with the state on Aug. 19 charging that the bidding process was tainted.

“We were shocked and confused by the state’s decision, and very concerned for our 450,000 members,” a Louisiana Healthcare Connections spokesperson told AIS Health on Aug. 15.

“Transitioning a half-million members within 45 days is a massive undertaking, and we are deeply concerned about that transition leading to disruptions in care for our members,” the spokesperson added.

Datapoint: New Hampshire Medicaid Expands Telehealth Access

August 20, 2019

New Hampshire Gov. Chris Sununu (R) last week signed a bill that will expand telehealth services covered by the state’s Medicaid program to include primary care, substance abuse treatment and remote patient monitoring. The law will go into effect in 2020. The state’s Medicaid program currently serves 175,234 people.

New Hampshire Gov. Chris Sununu (R) last week signed a bill that will expand telehealth services covered by the state’s Medicaid program to include primary care, substance abuse treatment and remote patient monitoring. The law will go into effect in 2020. The state’s Medicaid program currently serves 175,234 people.

Source: AIS’s Directory of Health Plans

CMS Updates Medicare Marketing Guidelines, Opening Additional Doors to Plan Sponsors

August 19, 2019

CMS’s newly updated Medicare Communications and Marketing Guidelines (MCMG) contain multiple flexibilities that were previously unavailable to plan sponsors. These include a loosening of rules around co-branding, educational events and marketing of rewards and incentives programs (RI programs), as well as the ability to operate a call center dedicated to prospective enrollees.

By Lauren Flynn Kelly

CMS’s newly updated Medicare Communications and Marketing Guidelines (MCMG) contain multiple flexibilities that were previously unavailable to plan sponsors. These include a loosening of rules around co-branding, educational events and marketing of rewards and incentives programs (RI programs), as well as the ability to operate a call center dedicated to prospective enrollees.

Although CMS at press time hadn’t posted a redlined version of the complete 2020 document, an Aug. 6 memorandum from the CMS Medicare Drug & Health Plan Contract Administration Group highlighted the various updates, including the deletions from 2019, and urged plans to cross-reference the memo with the existing MCMG.

“The deletions are more important than the insertions,” says Michael Adelberg, a principal with Faegre Baker Daniels Consulting and a former top CMS MA official. “Probably the most important deletion concerns the prohibition on holding back-to-back educational and marketing events. This seems to open the door to piggybacking marketing sessions on educational events.”

Last year’s MCMG expanded what can happen at educational events by allowing plan representatives to set up future marketing appointments and hand out business cards and contact information for beneficiaries to initiate communications. But by deleting the word “future” and the stipulation that representatives “may not conduct a marketing/sales event immediately following an educational event in the same general location,” it appears that CMS may allow plans to set up marketing appointments immediately after an educational event, says Kelli Back, a health care attorney in Washington, D.C.

Another example of important “deletions” is around RI programs, for which marketing no longer has to be done “in conjunction with information about plan benefits,” nor does it have to include information about all RI programs offered by the MA plan.

Average Medicare Part D Base Beneficiary Premium Declines for Third Straight Year

August 16, 2019

CMS said on July 30 that the Part D base beneficiary premium for 2020 will be $32.74, down from $33.19 in 2019, and the de minimis amount is $2. The Part D national average monthly bid amount also dropped slightly, from $51.28 in 2019 to $47.59 in 2020. Regional low-income premium subsidy amounts fluctuated over the past six years, but all states are projected to see a decrease in 2020.

by Jinghong Chen

CMS said on July 30 that the Part D base beneficiary premium for 2020 will be $32.74, down from $33.19 in 2019, and the de minimis amount is $2. The Part D national average monthly bid amount also dropped slightly, from $51.28 in 2019 to $47.59 in 2020. Regional low-income premium subsidy amounts fluctuated over the past six years, but all states are projected to see a decrease in 2020.


SOURCE: CMS. Visit https://go.cms.gov/2arFZfX. Infographic compiled by AIS Health.

Datapoint: Illinois Gov. Revamps Medicaid Program With New Reforms

August 14, 2019

Illinois Gov. J.B. Pritzker (D) last week signed a bill that will improve administrative problems in the state’s Medicaid managed care program, including a more streamlined eligibility process and automatic renewal for members. The new legislation requires contracted payers to pay claims within 30 days, and prioritize payments to providers that serve large numbers of Medicaid beneficiaries. Illinois currently serves 2,097,951 people in its Medicaid managed care program, with WellCare Health Plans, Inc. as the market leader, enrolling 37.9% of the managed care population.

Illinois Gov. J.B. Pritzker (D) last week signed a bill that will improve administrative problems in the state’s Medicaid managed care program, including a more streamlined eligibility process and automatic renewal for members. The new legislation requires contracted payers to pay claims within 30 days, and prioritize payments to providers that serve large numbers of Medicaid beneficiaries. Illinois currently serves 2,097,951 people in its Medicaid managed care program, with WellCare Health Plans, Inc. as the market leader, enrolling 37.9% of the managed care population.

Source: AIS’s Directory of Health Plans