CMS Finalizes Radiation Oncology Model for 2021

CMS finalized the model with limited changes compared to the proposal. The final rule reduced the amount of radiation treatment (RT) episodes included in the demo from 40% to 30%, slightly reduced discount factors, and removed one cancer type. Click to read more.

CMS Announces Modest MA Participation in Hospice Demo

CMS announced that nine MA organization have elected to participate in the voluntary hospice demo starting in January 2021, covering nearly 575,000 enrollees in 2020, or about 2.5% of overall MA enrollment. The demonstration program allows MA plans to cover hospice services, which under current statute are covered only under fee-for-service (FFS) Medicare. Congress would need to act to make hospice a permanent part of the MA benefit. Click to read more.

Managed Care Friday

68: Percent of older adults exactly one year ago who said the quality of care during a telehealth encounter would not be as good as a face-to-face visit, according to a University of Michigan poll on aging, with half saying they did not feel personally connected to the healthcare professional and four in ten reporting difficultly seeing or hearing. The poll asked a national sample of 2,200 adults, ages 50 to 80, about their ‘tele’ experience and, welp, things sure have changed. By May, according to our own poll of 1,362 adult parents aged 35-55, 51% preferred virtual over in-person as...

Weekly Medicaid Update

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: •  AL: State expands coverage of genetic testing for pregnant women •  FL: $1M in USDA funding, mainly to support telemedicine in rural areas • MD: University of Maryland Medical System (UMMS) and CareFirst BlueCross Blue Shield announce new five-year partnership •  TX: US Department of Education informs HHSC of failure to provide appropriate Early Intervention services to all infants and toddlers with disabilities Click to read...

SCOTUS Impact on ACA Likely Modest

The Supreme Court is scheduled for oral arguments on the constitutionality of the individual mandate on November 10, 2020. A final decision will likely be made in the summer of 2021, with the preponderance of potential outcomes having only modest impacts on the healthcare sector. Hospitals, Medicaid MCOs, and behavioral providers are at risk of the downside scenarios. Click to read more.