Updates On California Governor Newsom’s 2019-20 Medi-Cal Budget Proposal

Jan 28, 2019 | Legislation/ Budgets/ Macro, Medicaid

For FY2019-20, Governor Newsom’s Budget includes $158.6 billion for all Health and Human Services programs. The Budget allocates $100.7 billion to Medi-Cal, California’s Medicaid program, which is projected to cover approximately 13.2 million Californians in 2019-20. Currently, a large share of Medi-Cal spending occurs in the first year or last year of life, or among enrollees with serious mental illness, hypertension, and diabetes. The Budget proposes a series of changes and investments to improve the availability of health care and address the social determinants of health, which this...

Managed Care Friday

Jan 25, 2019 | Managed Care Friday

1. 7.7 Million: The number of adults who have co-occurring mental health and substance use disorders according to the National Institute on Drug Abuse. New information on comorbidity from a study done across the globe in Australia. The Queensland Brain Institute released a study this month with Aarhus University showing the risk of developing a second mental health disorder. People within the study who were younger than 20 at the onset of their mental disorder were more at risk than others for developing a second disorder in the next 10-15 years. This study is now the largest and most...

MedPAC Finalizes Payment Update Recommendations At January Meeting

Jan 23, 2019 | MedPAC

The Medicare Payment Advisory Commission (MedPAC) held its first public meeting of 2019 last week. MedPAC voted on recommendations for 2020 Medicare payment updates – most of which were discussed in its December meeting. This brief reviews these recommendations, and other topics discussed at last week’s public meeting. Click to read more.

Federal Court Decision Stops Cuts To 340B Reimbursement

Jan 22, 2019 | 340B, Hospitals

A judge for the US District Court of DC recently decided that CMS and HHS exceeded statutory authority when they implemented Part B payment cuts for 340B drugs beginning in 2018. The court issued a permanent injunction that returns the 2018 rates to 2017 levels, but the court has yet to decide on a financial remedy for the lower 2018 rates. The decision will likely be appealed by the administration and continue to develop. This brief provides an overview of the issue. Click to read more.

Federal Exchange Plan Selection Down 4% Due To Fewer New Consumers

Jan 16, 2019 | Exchanges

In the 39 states that use the Federal healthcare.gov website for Exchange enrollment, 3.8% fewer consumers selected a 2019 plan than last year. This decline – although lower than in prior years – was entirely due to fewer new consumers, rather than existing consumers. It likely reflects a combination of factors, including better accessibility of other coverage sources, less marketing and outreach from the Administration, and the elimination of the financial penalty associated with the individual mandate. Click to read more.

Autism CPT Codes Made Permanent In 2019

Jan 15, 2019 | Autism, Behavioral

Stakeholders worked with the American Medical Association (AMA) to make Applied Behavior Analysis (ABA) codes permanent, effective January 1, 2019. The change is viewed favorably by ABA providers. In addition to other small changes, it is expected that payers will have more difficulty challenging the legitimacy of service. This brief highlights some of the changes. Click to read more. 

Managed Care Friday

Jan 11, 2019 | Managed Care Friday

1. 307: That’s the amount of mass shootings in the U.S in 2018 up until November but there are signs that the market is trying to reverse the trend. Walt Disney Company is expanding a national program focused on helping kids who suffer from social isolation in elementary school. Parents of some of the children killed in the Sandy Hook shooting are involved. The program will be available to schools at no cost and aims to train 2.8 million students in 6,000 schools by 2022. 2. Cardiology The Next Target: Several cardiology procedures will now require pre-approval and post-service medical...

Enrollees’ Administrative Challenges Related To Medicaid Work Requirements

Jan 9, 2019 | Medicaid

Medicaid work requirements generally apply to an estimated 6% of adult enrollees who are not working and do not meet exemption criteria. Despite this narrow target population, coverage declines may also result from administrative barriers associated with reporting requirements. This brief discusses these barriers, the limited target population, and implications, as well as updates on disenrollments in Arkansas and the Medicaid work requirement landscape. Click to read more. 

BRG Study Shows Significant Spending Growth On Autism Services

Jan 8, 2019 | Autism, Behavioral

BRG analysis of national commercial data shows that spending on Applied Behavioral Analysis (ABA) services for autism grew significantly from 2015 to 2017, while the levels of spending vary significantly by geography. This brief explores these data findings and highlights reasons for this growth. Click to read more.