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June 18, 2014
IN FOCUS: DUAL ELIGIBLE DEMONSTRATION ENROLLMENT UPDATE
ILLINOIS UPDATE ON MEDICAID MANAGED CARE PLANS BY REGION
NEW HAMPSHIRE MEDICAID EXPANSION TIMING FINALIZED
NEW JERSEY UPDATE ON MLTSS IMPLEMENTATION
INDIANA FSSA SECRETARY STEPS DOWN
NEW YORK MMIS RFP AWARD PROTESTED
WELLCARE APPOINTS PRESIDENT, COO
MEDIWARE ACQUIRES HARMONY INFORMATION SYSTEMS
GENOA HEALTHCARE AND QOL MEDS TO MERGE
UPCOMING APPEARANCE BY HMA’S MIKE NARDONE
HMA’S JACK MEYER PUBLISHES NEW BOOK
HMA EXPANDS CONSULTING REACH
DUAL ELIGIBLE DEMONSTRATION
ENROLLMENT UPDATE This week, our In Focus section reviews enrollment data available in five states that have launched their dual eligible financial alignment demonstrations – California, Illinois, Massachusetts, Ohio, and Virginia. These five states have begun either voluntary or passive enrollment for fully integrated Medicaid and Medicare benefits. For additional details on duals demonstration timing and potential enrollment in other states, please see the HMA Weekly Roundup’s Dual Eligibles Calendar.
Note on Enrollment Data
Three of the five states – California, Illinois, and Massachusetts – are reporting monthly enrollment in their duals demonstration plans. However, as with Medicaid managed care enrollment reporting, there is often a lag in published
IN FOCUS
RFP CALENDAR DUAL ELIGIBLES
CALENDAR HMA NEWS
Edited by: Greg Nersessian, CFA Email
Andrew Fairgrieve Email
Kartik Raju Email
THIS WEEK
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June 18, 2014
data. As of now, these three states have reported enrollment data through May 2014. Duals demonstration plan enrollment is also available through CMS’ Medicare Advantage monthly enrollment reports, which are published around the middle of the month. In the data table below, we provide May 2014 enrollment from state data, where available, and May 2014 and June 2014 enrollment from CMS data. The May 2014 numbers from CMS and from the states that have reported show some variation, possibly due to reporting timing discrepancies.
Duals Demonstration Enrollment Totals
According to the CMS enrollment data, across these five states – California, Illinois, Massachusetts, Ohio, and Virginia – around 64,000 dual eligibles were enrolled in a fully integrated Medicare-Medicaid Plan (MMP) as of June 2014. This represents less than 10 percent of the potential enrollment in these states, although enrollment should begin to increase significantly as states move from voluntary to passive enrollment periods.
More than 23,000 (around one-third) of these duals are enrolled in MMPs operated by publicly traded managed care organizations. The remaining two-thirds are in other private or local health plans. The table below details enrollment across all five states by health plan for May 2014 and June 2014.
Duals Demo Enrollment by Plan
(CA, IL, MA, OH, VA)
May 2014
(State Reported)
May 2014
(CMS Reported)
June 2014
(CMS Reported)
Molina Healthcare 3,104 3,865 5,819
Aetna 295 270 4,330
Humana 314 691 3,929
Cigna-HealthSpring 342 327 3,553
UnitedHealthcare NA 1,275 1,770
Health Net 1,210 1,435 1,706
Centene 170 648 1,221
WellPoint NA 657 753
Total Publicly Traded Companies 5,435 9,168 23,081
Commonwealth Care Alliance (MA) 7,621 7,313 7,657
Inlan Empire Health Plan (CA) 4,552 5,445 6,526
Health Care Service Corp. (IL) 1,149 1,065 4,950
Fallon Total Care (MA) 4,787 5,026 4,699
CareSource (OH) NA 3,153 4,050
Meridian Health Plan (IL) 117 103 3,002
Health Plan of San Mateo (CA) 2,914 2,963 2,882
Community Health Group (CA) 2,254 2,583 2,696
Care 1st Health Plan (CA) 1,338 1,692 1,964
Health Alliance (IL) 378 334 1,465
Network Health (MA) 866 805 842
Virginia Premier (VA) NA 117 172
L.A. Care (CA) 16 0 57
Total Other/Local Health Plans 25,992 30,599 40,962
Total Duals Demo Enrollment 31,427 39,767 64,043 Sources: State Enrollment Reporting, where available. CMS Monthly Medicare Advantage Enrollment by State/County/Contract.
Opt-Out Rate Observations
Capitated dual eligible demonstrations utilize passive enrollment to assign duals to a health plan in the absence of a plan selection. However, no individual may be mandatorily enrolled in a MMP. Thus, dual eligibles will be allowed to
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opt out of their enrollment in the demonstration at any time. Some states may still mandate managed care enrollment for Medicaid benefits in the case of an opt out.
In the table below, California and Massachusetts opt out rates by month are presented. Both states are showing opt out rates above 22 percent.
Opt Out Percentages Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14
California NA NA NA NA NA NA 8.4% 22.3%
Massachusetts 4.6% 11.3% 14.9% 16.6% 17.7% 18.7% 19.7% 22.5% Sources: State Enrollment Reporting
California
California’s duals demonstration, known as Cal MediConnect, began accepting voluntary opt-in enrollments on April 1, 2014, with three phases of passive enrollment beginning May 1, 2014, July 1, 2014, and January 1, 2015. There are an estimated 350,000 duals eligible for the demonstration. With an estimated 25 percent opt out rate, California is at around 7 percent of total anticipated enrollment as of June 2014.
California
May 2014
(State Reported)
May 2014
(CMS Reported)
June 2014
(CMS Reported)
Inland Empire Health Plan 4,552 5,445 6,526
Molina Healthcare 3,038 3,843 4,455
Health Plan of San Mateo 2,914 2,963 2,882
Community Health Group Partner 2,254 2,583 2,696
Care 1st Health Plan 1,338 1,692 1,964
Health Net 1,210 1,435 1,706
L.A. Care 16 0 57
Care More (WellPoint) 0 0 0
Total Enrollment 15,322 17,961 20,286
May 2014 State vs. CMS Diff. 17% Sources: State Enrollment Reporting, where available. CMS Monthly Medicare Advantage Enrollment by State/County/Contract.
Illinois
Illinois’ duals demonstration, known as the Medicare-Medicaid Alignment Initiative (MMAI), began accepting voluntary opt-in enrollments on April 1, 2014, with passive enrollment beginning June 1, 2014. There are an estimated 136,000 duals eligible for the demonstration. With an estimated 25 percent opt out rate, Illinois is at around 20 percent of total anticipated enrollment as of June 2014.
Illinois
May 2014
(State Reported)
May 2014
(CMS Reported)
June 2014
(CMS Reported)
BCBS of Il l inois (HCSC) 1,149 1,065 4,950
Cigna HealthSpring 342 327 3,553
Humana 314 278 3,499
Aetna Better Health 295 270 3,334
Meridian Health Plan 117 103 3,002
Health Alliance 378 334 1,465
Molina Healthcare 66 22 773
Ill iniCare (Centene) 170 245 389
Total Enrollment 2,831 2,644 20,965
May 2014 State vs. CMS Diff. -7% Sources: State Enrollment Reporting, where available. CMS Monthly Medicare Advantage Enrollment by State/County/Contract.
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Massachusetts
Massachusetts’ duals demonstration, known as OneCare, began accepting voluntary opt-in enrollments on October 1, 2013, with passive enrollment beginning January 1, 2014. There are an estimated 90,000 duals eligible for the demonstration. With an estimated 25 percent opt out rate, Massachusetts is at around 19.5 percent of total anticipated enrollment as of June 2014.
Massachusetts
May 2014
(State Reported)
May 2014
(CMS Reported)
June 2014
(CMS Reported)
Commonwealth Care Alliance 7,621 7,313 7,657
Fallon Total Care 4,787 5,026 4,699
Network Health 866 805 842
Total Enrollment 13,274 13,144 13,198
May 2014 State vs. CMS Diff. -1% Sources: State Enrollment Reporting, where available. CMS Monthly Medicare Advantage Enrollment by State/County/Contract.
Ohio
Ohio’s duals demonstration, known as the MyCare Ohio, began enrolling dual eligibles in MMPs on a voluntary basis only on May 1, 2014. Passive enrollment for duals will begin on January 1, 2015. There are an estimated 114,000 duals eligible for the demonstration. With an estimated 25 percent opt out rate, Ohio is at around 10 percent of total anticipated enrollment as of June 2014.
Ohio
May 2014
(State Reported)
May 2014
(CMS Reported)
June 2014
(CMS Reported)
CareSource NA 3,153 4,050
UnitedHealthcare NA 1,275 1,770
Aetna Better Health NA 0 996
Buckeye Community HP (Centene) NA 403 832
Molina Healthcare NA 0 591
Total Enrollment NA 4,831 8,239
May 2014 State vs. CMS Diff. NA Sources: State Enrollment Reporting, where available. CMS Monthly Medicare Advantage Enrollment by State/County/Contract.
Virginia
Virginia’s duals demonstration, known as Commonwealth Coordinated Care, began accepting voluntary opt-in enrollments on March 1, 2014, with passive enrollment beginning May 1, 2014. There are an estimated 78,600 duals eligible for the demonstration. With an estimated 25 percent opt out rate, Virginia is at around 2 percent of total anticipated enrollment as of June 2014.
Virginia
May 2014
(State Reported)
May 2014
(CMS Reported)
June 2014
(CMS Reported)
Anthem Healthkeepers (WellPoint) NA 657 753
Humana NA 413 430
Virginia Premier Health Plan NA 117 172
Total Enrollment NA 1,187 1,355
May 2014 State vs. CMS Diff. NA Sources: State Enrollment Reporting, where available. CMS Monthly Medicare Advantage Enrollment by State/County/Contract.
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California
HMA Roundup – Alana Ketchel
California Legislature Passes Budget Revision. On June 16, 2014, the California Healthline reported that the state Legislature passed a 2014-2015 state budget agreement. The $156.4 billion budget plan:
Restored the Black Infant Health Program
Retained overtime pay for home health care workers
Did not restore a 7 percent cut in In-Home Supportive Services hours
Did not restore a 10 percent reduction in Medi-Cal reimbursements
Did not reinstate the Early Mental Health Initiative
Did not reinstate the Children's Dental Disease Prevention Program
Left out autism therapy as a Medi-Cal benefit
Denied matching federal funds from a California Endowment grant to help enroll and renew Medi-Cal beneficiaries.
The budget did include $438 million to expand Medi-Cal under the Affordable Care Act and $41.3 million in state and federal funding for technical assistance to Medi-Cal providers to implement electronic health records. The budget also increased Medi-Cal eligibility to 138 percent of the federal poverty level (FPL) for pregnant women and established wrap-around coverage such that women with incomes between 139 and 213 percent FPL can choose to have both Medi-Cal and Covered California coverage. The proposed budget also allocates funds to support catastrophic coverage for agricultural workers and to increase rates for the Program of All-Inclusive Care for the Elderly (PACE) starting April 1, 2015. Funding was also allocated to the Office of AIDS to incorporate the new Hepatitis C drugs to the ADAP formulary. The budget now goes to Governor Brown for approval by the end of June. Read more
Medi-Cal Autism Benefit Under Consideration. On June 11, 2014, the California Healthline reported that Medi-Cal may consider covering autism services (Applied Behavioral Analysis Treatment) after CMS approved the addition in Louisiana’s State Plan Amendment. The estimated cost for including the treatment as a Medi-Cal benefit is about $50 million per year. As noted above, the addition was not included in the recent budget agreement. Read more
Pharmacies Lose Appeal on Medi-Cal Rates. On June 11, 2014, the San Francisco Chronicle reported that the State Supreme Court rejected pharmacies’ challenge of Medi-Cal reimbursement rates set by their managed care network, Partnership Health Plan of California. The pharmacies appealed an initial court decision, claiming that the low rates would drive pharmacies out of business
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and decrease access for Medi-Cal patients. The Supreme Court supported the 9th Circuit Court’s ruling that “the law doesn't require states to take pharmacies' costs into account when determining how much to reimburse them for the drugs they provide.” Read more
Appeals Court Confirms Mental Health Parity Act’s Reach. On June 12, 2014, the California Healthline reported on the California Court of Appeals’ decision that insurance carriers are required to cover all medically necessary services for those with mental illness. Blue Shield of California, the defendant in the case, argued that the California Mental Health Parity Act does not require a plan to cover residential treatment for eating disorders when the plan does not already cover such treatment. The ruling overturned an initial decision by the Los Angeles County Superior Court. Read more
Anthem Blue Cross of California Anticipates Premium Increases Under 10 Percent for 2015. On June 12, 2014, the Los Angeles Times reported that premiums for individual coverage under Anthem Blue Cross of California will increase less than 10 percent on average next year. Anthem Blue Cross President Mark Morgan said last week that the age and projected medical costs of new enrollees are in line with the company’s expectations; therefore only modest rate increases are expected for next year. The insurer does not yet have data on how many of its California enrollees were previously uninsured. Read more
Colorado
HMA Roundup – Joan Henneberry
Colorado Duals Demo Receives $13.6 Million CMS Grant. On June 18, 2014, the Colorado Department of Health Care Policy and Financing announced it was one of six states to receive a CMS grant for the implementation of its dual eligible demonstration. The grant will aid the state in implementing the Accountable Care Collaborative (ACC) program to coordinate care for more than 50,000 dual eligibles. Colorado is implementing a managed fee-for-service model under the duals demonstration. The state completed a memoranda of understanding with CMS in February 2014.
Premiums for Subsidized Health Plans More than 20 Percent Higher than Premiums for Unsubsidized Plans. On June 15, 2014, the Denver Post reported on new Connect for Health Colorado figures that show that average premiums for subsidized Health Exchange policies in Colorado are more than 20 percent higher than those for people who buy non-group coverage with no federal subsidy. While Exchange officials have not done any formal analysis yet, Exchange communications director Linda Kanamine suggests that people receiving subsidies may be selecting more expensive plans with increased coverage. Read more
Florida
HMA Roundup – Elaine Peters
ACA Marketplace Plans in Florida Cost Less than National Average. On June 18, 2014, Health News Florida reported that Floridians who bought health insurance on the ACA Marketplace spent an average of $68 per month, much lower than the national average of $82. According to federal data, 91 percent of these enrollees received subsidies for their health coverage; these subsidies
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averaged $278 per month. These subsidies, coupled with the relatively high number of insurers offering plans in the state, explain why state residents are getting such a bargain for their health coverage. Read more
Court Denies WellCare Restitution in Medicaid Fraud Case. On June 16, 2014, Health News Florida reported that the Court of Appeals has ruled that insurer WellCare is not entitled to seek restitution from former CEO Todd Farha, CFO Paul Behrens, or Vice President William Kale after the men were convicted for Medicaid fraud last month. Read more
Georgia
HMA Roundup – Mark Trail
Many Georgians Are Paying Bargain Prices for ACA Health Plans. On June 18, 2014, Georgia Health News reported that Georgians who qualified for subsidies or discounts for insurance coverage through the ACA Marketplace are paying an average of $54 per month, much lower than the national average. The low premiums in the state are largely due to relatively high number of residents qualifying for subsidies, as well as the high number of insurers and plans participating in the state’s exchange. Read more
Department of Community Health Holds Monthly Board Meeting on June 12,
2014. During the Board Meeting, Commissioner Clyde Reese stated that the ABD Care Coordination program was meant to be an intermediate step for that population between traditional FFS Medicaid and full-risk managed care. He reported that all of the bids for the ABD Care Coordination RFP came in over budget and all exceeded the dollars allocated for the program. Commissioner Reese said that a revised RFP would be re-issued on July 11 for thirty days, and that the revision would be more explicit on the expected savings.
He also said that the first meeting of the Rural Hospital Stabilization Committee, with 16 members, had been held. He said that some small rural hospitals were considering whether to re-organize as free-standing limited service emergency departments.
The next item of business was the request for final adoption of the Nursing Home Services Rate Increase. The vote was unanimous to approve.
Dr. Jerry Dubberly then presented other key budget issues for initial adoption:
A New Option Waiver (NOW) rate increase and addition of new services with rates. The rate increase is to effective July 1st in the amount of 1.5 percent. The new services are behavioral health support services, as well as unbundling skilled nursing services, which enables them to be delivered and billed independently.
A Comprehensive (COMP) waiver rate increase and addition of an additional service with a rate.
An Independent Care Waiver Program (ICWP) rate increase of 5 percent for personal support services, which will have no fiscal impact until FY16 and FY17.
An Elderly and Disabled Waiver rate increase and quality incentive payment program. The rate increase proposed is 5 percent, and the quality incentive can be up to 3 percent for outcomes achieved.
All four were approved to be released for public comment. Read more
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Illinois
HMA Roundup – Andrew Fairgrieve
Illinois Provides Update on Medicaid Managed Care Health Plans by Region. On June 17, 2014, Illinois’ Department of Healthcare and Family Services (HFS) updated their care coordination rollout map with additional details on which health plans will be available in each of the mandatory Family Health Plans (children and families) and ACA Health Plans regions. Across five mandatory managed care regions, most of the Family Health Plans population and the ACA Health Plans population will have a choice among at least two Medicaid managed care organizations (MCOs) and several provider-organized Accountable Care Entities (ACEs). Additionally, eligible populations in Cook County will also be able to enroll with CountyCare. Two health plans participating in the state’s duals demonstration and the Integrated Care Program expansion (Medicaid-only ABD managed care), Cigna-HealthSpring and Humana, are not included in the published list of plans serving the Family Health and ACA Health plans populations. The regions and health plans available in each are summarized below.
Greater Chicago Region
Six Medicaid MCOs:
Aetna Better Health
Blue Cross Blue Shield of Illinois
Family Health Network
Harmony (WellCare)
IlliniCare (Centene)
Meridian
CountyCare (Managed Care Community Network)
Eight ACEs (not all available in all counties/zip codes within region):
Advocate Accountable Care
Better Health Network
Community Care Partners
HealthCura
Illinois Partnership for Health
Loyola Family Care
MyCare Chicago
UI Health Plans
Rockford Region
Three Medicaid MCOs:
Aetna Better Health
Family Health Network
IlliniCare (Centene)
Two ACEs (not all available in all counties/zip codes within region):
Advocate Accountable Care
Illinois Partnership for Health
Quad Cities Region
Two Medicaid MCOs:
IlliniCare (Centene)
Meridian
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One ACE:
Illinois Partnership for Health
Central Illinois Region
Three Medicaid MCOs:
Health Alliance Connect
Molina Healthcare
Meridian (select counties only)
Two ACEs (not all available in all counties/zip codes within region):
Illinois Partnership for Health
SmartPlan Choice
Metro East Region (East St. Louis)
Two Medicaid MCOs:
Molina Healthcare
Harmony (WellCare)
Additionally, Harmony (WellCare) and Meridian Health Plan will continue to operate as voluntary enrollment MCOs in their current voluntary geographies outside of the new mandatory regions listed above. Several of the ACEs will also operate on a voluntary basis in non-mandatory counties. According to the revised rollout map, 77 out of 102 counties in the state will have at least one ACE and/or MCO option. Read more
Alexian Brothers and Adventist Hospital Systems to Pursue Partnership. On June 17, 2014, the Chicago Tribune reported that Alexian Brothers Health System and Adventist Midwest Health are pursuing an affiliation that would create the second largest hospital system in Illinois. Both systems have signed a letter of intent to form a joint system that would oversee nine Chicagoland hospitals in total. The news comes after several recent hospital consolidations in the Chicago area that were fueled by the ACA, which encourages collaboration as a means of improving coordination of patient care. Read more
Indiana
FSSA Secretary Debra Minott Steps Down. On June 16, 2014, the Indiana Business Journal reported that Indiana Family and Social Services Administration Secretary Debra Minott is stepping down. Minott will transition out of the position over the next month; she stated that she will be working closely with Governor Mike Pence to “ensure an orderly transition to new leadership” as the state negotiates with the federal government over Pence’s “Healthy Indiana” Medicaid expansion plan. Read more
Iowa CoOportunity Health and Coventry Health Care Plan to Increase Premiums
for Individual Policies in 2015. On June 13, 2014, the Des Moines Register reported that thousands of Iowans who purchased individual policies from CoOportunity Health or Coventry Health Care are receiving letters informing them that the insurers are proposing steep premium hikes for 2015. CoOportunity Health COO Cliff Gold explains that about half of this company’s proposed rate increase is due to the federal governments’ decision to let insured
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individuals and families extend their previous policies through 2016. This decision has driven up premium prices for individuals purchasing new plans. The Iowa Insurance Division will hold hearings next month to consider the proposed premium increases from the two insurers and a third carrier, Time Insurance. Read more
Kansas Non-Expansion States Reporting Varying Changes to Medicaid-CHIP Enrollment. On June 16, 2014, the Kansas Health Institute reported that Kansas is seeing significant increases in Medicaid and CHIP enrollment, despite the state’s rejection of ACA Medicaid expansion. The state Department of Health and Environment reported that enrollment in the two programs reached a historic high of 426,642 people in April. Nearly 22,500 Kansans signed up for Medicaid or CHIP between October and March, far more than in several other non-expansion states. State officials attribute the growth to the “woodwork effect” as residents learned they are in fact eligible for Medicaid.. Read more
Massachusetts
Massachusetts Health Connector to Face Major Assessment in Early July. On June 12, 2014, the Boston Globe reported that the new software for the Massachusetts Health Connector exchange website will be assessed in early July to determine whether the state will be ready to run its insurance Marketplace in 2015 or if it will have to default to the federal system. Amidst technological and operational problems with its Exchange software, the state opted one month ago to pursue a “dual track” effort in which it adapted new software successfully used in other states, while simultaneously preparing to join the federal insurance Marketplace in case the former effort fails. If state and federal officials assess that the Health Connector revamp is going well, the state will continue on its dual track approach. If not, the state will focus on preparing to join the federal Marketplace for one year. Read more
Massachusetts Repeals Play-or Pay and Section 125 Plan Rules for Employers. On June 12, 2014, Business Insurance reported that the Massachusetts Health Connector board formally repealed regulations of the state’s 2006 health reform law, which required employers to either offer health care coverage to their employees or pay a fine. The board also voted to repeal rules requiring employers to provide employees access to Section 125 plans, which allow employees to pay for health care premiums with pretax dollars. Both sets of regulations were repealed because of changes in federal regulations that were put in place by the new federal health care reform law. Read more
Minnesota Minnesota Sees Massive Drop in Uninsured, Largely Driven by Medicaid Expansion. On June 11, 2014, Vox Media, Inc., reported on new findings from the State Health Access Data Assistance Center that show that Minnesota’s uninsured rate has fallen by more than 40 percent. The report shows that Minnesota’s uninsured dropped from 445,000 in September 2013 to 264,500 in May 2014. Most of the increase in coverage was through public programs, most notably Minnesota Medical Assistance (the state Medicaid program) and
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Minnesota Care (a subsidy program from low-income residents). In comparison, just 36,000 residents enrolled for coverage in the private individual market. Read more
New Hampshire
Medicaid Expansion Coverage Will Start on August 15. On June 16, 2014, New Hampshire Public Radio reported that the state’s Medicaid expansion program for 50,000 low-income residents will kick off on August 15, with an enrollment period beginning July 1. Applicants who already have employer-sponsored insurance will be kept on these plans if the state determines it to be cost-effective. In 2016, all newly eligible Medicaid recipients will transition into the Health Insurance Exchange and will be able to select a private health plan. Read more
New Jersey
HMA Roundup – Karen Brodsky
NJFamilyCare Enrollment Expansion Update. On June 11, 2014, the Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) provided the public with an update on its Medicaid expansion experience at a quarterly meeting of the Medical Assistance Advisory Committee (MAAC). As reported in last week’s HMA Roundup, New Jersey has close to 1.5 million Medicaid and CHIP enrollees. DMAHS reports there are 175,134 newly eligible adults who qualify under the Medicaid expansion eligiblity rules and an additional 29,498 new Medicaid enrollees that it attributes to the “woodwork,” or “welcome mat,” effect. New Jersey’s enrollment broker, Xerox, has seen a spike in call center activity since Medicaid expansion applications began, with more than double the regular number of calls between January and May 2014, as illustrated below:
Xerox has fewer than 3,000 pending applications. In addition, the County Welfare Agencies (CWA) continue to process applications for Medicaid enrollment. To improve DMAHS’ ability to handle the increased application volume, CMS approved DMAHS giving CWAs the option of suspending redeterminations for the rest of 2014 and extending presumptive eligibility
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periods. DMAHS continues to process federal marketplace flat files to enroll approved applicants every two weeks. It estimates that an additional 20,000 individuals will be enrolled through the marketplace.
New Jersey Medicaid Managed Care Program is Developing a Single Credentialing Application. The State’s Medicaid medical director, Thomas Lind, is leading a credentialing task force to streamline health plan credentialing and recredentialing activities into a single application to ease the administrative burden for providers. Medical, dental, behavioral health, and non-traditional providers (for MTLSS) will be able to submit a single credentialing application to satisfy the credentialing requirements of any health plan that contracts with the state’s Medicaid program. To date, the task force has compiled feedback from medical and dental providers, the health plans, and the state’s Department of Banking and Insurance and Medicaid Fraud Division. It is currently obtaining comments from behavioral health providers through the New Jersey Association of Mental Health and Addiction Agencies, and plans to obtain input from non-traditional providers. The taskforce will also review the credentialing processes of other states and prepare a set of final recommendations to frame a single application approach.
Personal Care Attendent (PCA) Assessment Tool update. On April 16, 2014, HMA Roundup reported on a process New Jersey Medicaid is taking to replace the existing PCA tools in use by its contracted health plans. At the June 11, 2014, MAAC meeting, Valerie Harr, the Medicaid Director, explained that a new PCA tool was tested by the health plans in April. The test revealed a significant amount of variation in PCA hour determinations between assessors and health plans testing the new tool. Some of the variation was attributed to simple math errors, while some was due to assessor misunderstanding of the PCA benefit. DMAHS will work with the health plans to improve PCA tool instructions and the training that supports the tool. The original start date of July 2014 to begin using the new tool has been put on hold. Ms. Harr is hopeful that the new tool will be ready to use in September 2014.
Transportation Broker RFP to be Released Soon. In a few weeks, New Jersey Medicaid will release an RFP to solicit bids for a new medical transportation broker. DMAHS has been contracting with LogistiCare since 2009 to serve NJFamilyCare/Medicaid enrollees. Services include all non-emergency transportation, such as mobile assistance vehicles, and non-emergency basic life support ambulances (stretcher) for any NJ FamilyCare/Medicaid service whether it is a contractor-covered service or non-contractor covered service. Livery transportation services, such as bus and train fare or passes, car service, and reimbursement for mileage, are a covered service for Medicaid enrollees only. The RFP will be posted to the Department of Treasury, Division of Purchase and Property web page for a three week public comment period.
MLTSS Countdown Begins for July 1, 2014 Implementation. After more than two years of planning with its sister agencies, contracted health plans, and the stakeholder community, DMAHS is in high gear to launch Managed Long Term Services and Supports (MLTSS) on July 1, 2014. The health plans have hired more than 270 care managers to serve members who receive long term services and supports. In addition to provider training made available by DMAHS as described in HMA’s Roundup from May 28, 2014, each MCO is offering provider training:
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Four of the five health plans currently under contract with DHS will provide MLTSS. Healthfirst NJ is under an asset purchase agreement with WellCare and will not implement MLTSS.
DHS Deputy Commissioner, Lowell Arye, updated the MAAC on June 11, 2014, with additional information:
1. 217-like program. The HCBS Medically Needy “hypothetical” spend down program based on the statewide average cost of institutional care will not be implemented when MLTSS begins. This feature of the Comprehensive Medicaid Waiver, also referred to as “217-like” eligibility, is a reference to a federal regulation that allows states to apply a special income rule under the 1115 waiver (income up to 300% of the SSI standard). It effectively extends Medicaid and MLTSS benefits to individuals who would otherwise need to enter an institutional setting and spend down their assets to qualify.
DMAHS is working with AARP’s New Jersey chapter and the Center for Health Care Strategies to consider structuring the 217-like program under Miller Trusts. Also referred to as a Qualified Income Trust, a Medicaid applicant whose income exceeds the financial eligibility criteria and who otherwise qualifies as medically needy places their income in trust to be disposed of in accordance with DMAHS rules once Medicaid eligibility is approved. The beneficiary can spend down their income to $2,163 under the Miller Trust. They can retain a small sum per month for incidentals. The Miller Trust also enables a spouse to retain some of the income if their income falls below $1,938.75 per month (as of July 1, 2013). Medicaid is entitled to reimbursement from the Miller Trust if there are excess funds in the account after the beneficiary dies.
DMAHS plans to issue a Public Notice for comment on its website by the end of June 2014 and submit a State Plan Amendment to CMS for retroactive implementation. Details on the effective date and terms of this new Medicaid and MLTSS eligibility opportunity will be shared at the next MAAC meeting scheduled for October 6, 2014.
2. Quality Strategy. DMAHS has been working on an updated Quality Strategy to incorporate MLTSS and new Medicaid managed care performance metrics and reporting requirements. The Quality Strategy is required by CMS and will become a public document.
3. Provider Network Adequacy. DMAHS is beginning MLTSS with a basic provider network access standard that will require health plans to contract with at least two providers by type per county for services where the member must go to the provider to receive the service. There are no national MLTSS provider network adequacy standards. New Jersey has been in conversation with South Carolina’s Medicaid agency, which will soon share the results of its HCBS provider network standards.
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New York
HMA Roundup – Denise Soffel
New York Considers Potential Costs of Sovaldi. On June 16, 2014, Capital New York reported on the state’s progress in figuring out how to pay for treatment using the extremely efficacious and expensive new hepatitis C drug, Sovaldi. Hepatitis C virus often affects the poorest individuals, whose healthcare is often at least partially subsidized by taxpayers in the form of Medicaid or other financial assistance. Since New York is the state with the most expensive Medicaid program in the country and one of the largest hepatitis C populations, the cost of treating infected individuals could significantly impair the state’s Medicaid budget. Read more
Ellis Medicine and St. Peter’s Health Partners Collaboration. On June 17, 2014, Ellis Medicine and St. Peter’s Health Partners announced the creation of a new regional alliance to explore a variety of collaborative opportunities. The two health systems serve the Capital region. The collaboration will include establishing a Clinically Integrated Network (CIN), partnering with physicians, hospitals and health systems to improve quality and control costs. It will potentially apply to become an ACO under the Medicare Shared Savings Program. The press release announcing the collaboration emphasizes that this is not a merger; it is a partnership to allow for greater cooperation between the two health systems.
Medicaid Redesign Team Work Group. The Medicaid Redesign Team has established a new work group that will focus on the social determinants of health. The primary charge of the work group is to focus on issues related to employment, including workforce development, expanded Medicaid coverage to promote employment of people with mental, physical or developmental disabilities, and work wellness programs targeted to low-wage workers likely to be covered by Medicaid. The work group will identify strategies and programs related to employment that could decrease disparities in access, utilization, and health outcomes.
Two MMIS Vendors Protest Xerox MMIS Contract Award. On June 18, 2014, Capitol Confidential reported that two national MMIS vendors, Hewlett Packard (HP) and Computer Sciences Corp. (CSC), filed protests on the New York MMIS RFP contract award to Xerox. HP was an unsuccessful bidder on the RFP, while CSC holds the current MMIS contract, yet declined to bid, citing the unrealistic timeframe for implementation. State health department officials have indicated that the contract, worth an estimated $550 million, has yet to be finalized. Read more
Oregon
Cover Oregon Hires Aaron Patnode as Executive Director. On June 12, 2014, the Oregonian reported that the Cover Oregon board has hired Aaron Patnode to lead the Exchange as Executive Director. The decision comes in the midst of Cover Oregon’s efforts to join the federal Exchange and hire a new information technology company to assist in this process. The Exchange has experienced significant technological failures and application backlogs since its launch last year. Patnode currently works on reform implementation and strategic planning for Kaiser Permanente. Read more
PAGE 15
June 18, 2014
State Considers Restricting Oregon Health Plan Patients’ Access to Pricey Hepatitis C Drugs. On June 11, 2014, the Oregonian reported that the high estimated cost of treating Oregon Health (OHP) consumers with Hepatitis C with pricey new drugs has prompted the state to consider restrictions on who has access to such drugs. Covering the new drugs for just one-third of infected OHP members would cost the state $168 million a year, or nearly half of OHP’s annual funds for all pharmaceutical spending. Based on an evidence review by researchers for the Center for Evidence Based Policy at Oregon Health & Science University, studies on the efficacy of Sovaldi and Olyssio are not well substantiated, and this justifies limiting the drugs’ use to only the sickest patients. The state also has incentive to limit spending on the drug because of its agreement with the federal government to limit its spending on drugs. Read more
Pennsylvania
HMA Roundup – Matt Roan
State Budget Challenges Expected to Delay Passage of Spending Plan. With a June 30 deadline looming for passage of the State Budget, Governor Corbett and Legislative leaders have admitted that a budget deal is not likely to arrive until July. According to the Philadelphia Inquirer, disagreement on the best ways to address an estimated $1.2 billion to $1.5 billion budget deficit have inhibited progress towards the passage of the State’s spending plan for Fiscal Year 2014-2015. The estimated deficit is largely the result of state revenue collections falling short of projections. Revenue collections in the current fiscal year are approximately $600 million lower than expected, leaving the Legislature with the task of closing the current year budget gap and decreasing revenue projections for the next budget year. Budget negotiators are looking at ways to enhance revenue, which include raising some taxes. The Governor and Republican leaders in the Legislature have said that raising the personal income tax is off the table; proposals are being floated to raise the state’s cigarette tax and impose an extraction tax on natural gas drillers. The Governor has also said that he will not support new taxes unless the Legislature takes action on privatizing the state’s liquor stores and passing meaningful public pension reform. Read more
Rhode Island Advocates Voice Concern Over $10 Million Cut to Mental Health and
Substance-Abuse Services for Next Year. On June 11, 2014, the Providence Journal reported that mental-health advocates are voicing their objection over a proposed $10 million cut in the state’s budget for mental health and substance-abuse services for next year’s budget. The advocates say the cuts will force providers to scale back services to at least 1,000 patients who are not eligible for Medicaid. Read more
PAGE 16
June 18, 2014
Texas HHSC Releases Details on DSRIP Funding and Projects in the Medicaid 1115
Waiver. June 16, 2014, the Texas Health and Human Services Commission released an update on the Medicaid 1115 waiver Delivery System Reform Incentive Payment (DSRIP) project related to Behavioral Health. The five-year Medicaid demonstration waiver includes an $11.4 billion DSRIP pool to support coordinated care and quality improvements through 20 regional healthcare partnerships. Ten percent of these funds have been earmarked for community mental health centers. Overall, there were 1,277 active DSRIP projects as of March 2014. More than 200 additional three-year DSRIP projects received initial federal approval in late May 2014. Read more
HHSC Awards Enterprise Data Warehouse RFP to Truven Health Analytics. On June 13, 2014, the Texas Health and Human Services Commission announced the award made in response to the RFP issued last year for the Enterprise Data Warehouse/Business Intelligence (EDW/BI) Solution to Truven Health Analytics, Inc. Truven will be tasked with providing data and analytical tools to help improve the delivery of Medicaid services. HHSC hopes to use the EDW/BI solution to gain insights on health conditions and outcomes of the Medicaid population in order to find patterns and anticipate future needs. Read more
Utah Herbert Aims to Roll Out Medicaid Expansion Alternative Plan by January 2015. On June 14, 2014, the Deseret News reported that Governor Gary Herbert hopes to have his “Healthy Utah” Medicaid expansion alternative plan approved and rolled out by January 2015. After meeting with new HHS Secretary Sylvia Burwell, Herbert was optimistic that his administration and state lawmakers can agree on a model that can be incorporated into the ACA and his Medicaid expansion alternative. Many providers of the 110,000 low-income Coloradans expected to gain coverage say that the federal dollars are sorely needed to maintain health services for the poor. Read more
Vermont OptumInsight, Inc., Hired as Remedial Contractor for Vermont Health
Connect Exchange. On June 11, 2014, the Burlington Free Press reported that Vermont has signed a contract with contractor OptumInsight, Inc., to provide evaluation, remediation, and operations support to the Vermont Health Connect online insurance Marketplace. Vermont Health Connect has experienced a host of operational and technical issues since its rollout last October; many of these issued have yet to be resolved by CGI, the state’s primary contractor for the Exchange. OptumInsight will be tasked with creating a stabilization plan for the Exchange by June 27. The contractor will also have to provide operational and management staff to improve the Exchange’s functionality and process backlogged applications. Read more
PAGE 17
June 18, 2014
Virginia
General Assembly Passes State Budget with Medicaid Restriction. On June 13, 2014, the AP/Washington Post reported that the Virginia General Assembly passed the state budget, which includes an amendment that prohibits Governor Terry McAuliffe from expanding Medicaid without legislative approval. The new budget also slashes $900 million in spending and requires a withdrawal from the state’s savings account to close a $1.6 billion budget shortfall. The budget now heads to Governor McAuliffe, who has previously stated he would not sign a budget that does not include Medicaid expansion. Read more
Washington HCA Awards Community of Health Planning Grants to Ten Awardees as Part of State Health Care Innovation Plan. On June 13, 2014, the Washington Health Care Authority announced grant awards of nearly $485,000 to help communities statewide to achieve better health, better care, and lower costs as part of plan to improve overall health in the state. Ten applicants received Community of Health Planning grants; in July they will begin six months of planning for the anticipated Accountable Community of Health initiative, which is a major part of the State Health Care Innovation Plan. The initiative aims to help clinical, community, and government entities work together to improve whole-person health for every Washingtonian. Read more
National Sovaldi Discussions Continue Among Providers and Plans – Is It Worth the
Price? On June 17, 2014, AP/the Tampa Tribune reported on the healthcare industry’s reaction to the highly effective but prohibitively expensive new hepatitis C treatment, Sovaldi. Sovaldi costs around $84,000 per treatment, prompting some insurance companies and state Medicaid programs to consider limiting how many low-income patients can get the drug. The drug’s manufacturers argue that its pricing is a relative bargain, considering liver transplants for patients with hepatitis C-induced liver failure could cost upwards of $500,000. Evaluations of current hepatitis C treatments have yielded mixed conclusions about whether Sovaldi is priced reasonably relative to its competitors. Read more
More Insurers to Join ACA Marketplaces in 2015. On June 15, 2014, the Hill reported that more insurers are planning on participating in the ACA insurance Marketplaces in 2015. With the rocky launch year out of the way, many insurers are recognizing the financial gains to be had by offering plans in the Marketplace. So far, the Exchanges in Michigan, New Hampshire, Indiana, Ohio, Washington, Illinois, Maryland, Kentucky, and Connecticut will be gaining at least one new insurer in 2015. Read more
PAGE 18
June 18, 2014
Kindred Healthcare to Commence Offer to Acquire All Outstanding Shares of Gentiva Health Services. On June 16, 2014, Kindred Healthcare announced that it will commence a cash tender offer to acquire all of the outstanding shares of common stock of Gentiva Health Services, Inc., together with the associated preferred share purchase rights, for $14.50 per share in cash, for a total equity value of approximately $573 million. Read more
WellCare Appoints President, COO. On June 18, 2014, WellCare Health Plans announced that Kenneth A. Burdick has been named the company's president and chief operating officer (COO). Burdick joined WellCare on January 27, 2014 as president of national health plans. Read more
Mediware Information Systems Acquires Harmony Information Systems. On June 11, 2014, health care software company Mediware Information Systems, Inc., announced that it has acquired long-term care software company Harmony Information Systems, Inc. Harmony’s software solutions help federal, state and local agencies serve consumers with home- and community-based approaches to long-term care. Mediware acquired the company into expand its reach in the post-acute care market. Read more
Univita Sells Insurance Administration Services Division to Stone Point
Capital. On June 11, 2014, home-based care manager Univita Health announced it is selling its Insurance Administration Services division to private equity firm Stone Point Capital. The company reports that “the sale of (its) division will allow Univita to continue to expand its proven integrated home care delivery model as the single source solution for the post-acute care continuum.” The terms of the agreement have not been disclosed. The company also announced it has named Michael Muchnicki as its next CEO. Muchnicki previously held management positions at United Health Group and Cigna Healthcare. Read more
Aetna Announces Premium Increases for 2015 will be under 20 Percent. On June 11, 2014, Reuters reported that premium rates for Aetna’s 2015 insurance plans will generally increase less than 20 percent from 2014. CEO Mark Bertolini explained that about half of the rate increases that Aetna submitted are related to changes since the creation of the Affordable Care Act. Read more
Genoa Healthcare and QoL Meds to Merge. On May 20, 2014, specialty pharmacy providers Genoa Healthcare and QoL Meds announced the signing of an agreement to combine their businesses. The combined company will provide specialty behavioral health and long-term care pharmacy services to more than 200,000 individuals annually in 34 states and growing. The combined company will be one of the leading providers of pharmacy services dedicated to the behavioral health community and parties affiliated with managing the cost and quality of their care. Read more
PAGE 19
June 18, 2014
Date State Event Beneficiaries
TBD Delaware Contract awards 200,000
June 26, 2014 Texas STAR Health (Foster Care) Proposals Due 32,000
June, 2014 Indiana ABD RFP Release 50,000
June, 2014 Washington Foster Care RFP Release 23,000
June 30, 2014 Rhode Island (Duals) Proposals due 28,000
July 1, 2014 Florida acute care (Regions 10,11) Implementation 828,490
July 1, 2014 South Carolina Duals Implementation 68,000
July 16, 2014 Texas NorthSTAR (Behavioral) Contract Awards 840,000
Mid-July 2014 Texas STAR Kids RFP Released 200,000
August 1, 2014 Florida acute care (Regions 1,7,9) Implementation 750,200
September 1, 2014 Texas Rural STAR+PLUS Implementation 110,000
October 1, 2014 Washington Duals Implementation 48,500
Late October 2014 Texas STAR Kids Proposals Due 200,000
January 1, 2015 Michigan Duals Implementation 70,000
January 1, 2015 Maryland (Behavioral) Implementation 250,000
January 1, 2015 Delaware Implementation 200,000
January 1, 2015 Hawaii Implementation 292,000
January 1, 2015 Tennessee Implementation 1,200,000
January 1, 2015 New York Behavioral (NYC) Implementation NA
January 1, 2015 Texas Duals Implementation 168,000
April 1, 2015 Rhode Island (Duals) Implementation 28,000
September 1, 2015 Texas NorthSTAR (Behavioral) Implementation 840,000
September 1, 2015 Texas STAR Health (Foster Care) Implementation 32,000
September 1, 2016 Texas STAR Kids Implementation 200,000
RFP CALENDAR
PAGE 20
June 18, 2014
Below is a summary table of the progression of states toward implementing dual eligible financial alignment demonstrations in 2014 and 2015.
State Model
Duals eligible
for demo
RFP
Released
RFP
Response
Due Date
Contract
Award Date
Signed MOU
with CMS
Opt- in
Enrollment
Date
Passive
Enrollment
Date
Arizona 98,235
California Capitated 350,000 X 3/1/2012 4/4/2012 3/27/2013 4/1/2014
5/1/2014
7/1/2014
1/1/2015
Colorado MFFS 62,982 2/28/2014 7/1/2014
Connecticut MFFS 57,569 TBD
Hawaii 24,189
Illinois Capitated 136,000 X 6/18/2012 11/9/2012 2/22/2013 4/1/2014 6/1/2014
Iowa 62,714
Idaho 22,548
Massachusetts Capitated 90,000 X 8/20/2012 11/5/2012 8/22/2013 10/1/2013 1/1/2014
Michigan Capitated 105,000 X 9/10/2013 11/6/2013 4/3/2014 1/1/2015 4/1/2015
Missouri 6,380
Minnesota 93,165
New Mexico 40,000
New York Capitated 178,000 8/26/2013 10/1/2014 1/1/2015
North Carolina MFFS 222,151 TBD
Ohio Capitated 114,000 X 5/25/2012 6/28/2012 12/11/2012 5/1/2014 1/1/2015
Oklahoma MFFS 104,258 TBD
Oregon 68,000
Rhode Island Capitated 28,000 X 5/12/2014 9/1/2014 4/1/2015
South Carolina Capitated 53,600 X 10/25/2013 7/1/2014 1/1/2015
Tennessee 136,000
Texas Capitated 168,000 5/23/2014 3/1/2015 4/1/2015
Virginia Capitated 78,596 X 5/15/2013 TBD 5/21/2013 3/1/2014 5/1/2014
Vermont 22,000
Capitated 48,500 X 5/15/2013 6/6/2013 11/25/2013 10/1/2014 1/1/2015
MFFS 66,500 X 10/24/20127/1/2013;
10/1/2013
Wisconsin Capitated 5,500-6,000 X
Totals11 Capitated
6 MFFS
1.35M Capitated
513K FFS12 11
Humana; Health Keepers; VA Premier
Health
Regence BCBS/AmeriHealth; UnitedHealth
Health Plans
Alameda Al l iance; Ca lOptima; Care 1st
Partner Plan, LLC; Community Health
Group Partner; Health Net; Health Plan of
San Mateo; Inland Empire Health Plan; LA
Care; Mol ina; Santa Clara Fami ly Health
Plan; Wel lPoint/Amerigroup (CareMore)
Aetna; Centene; Health Alliance; Blue
Cross Blue Shield of IL; Health Spring;
Humana; Meridian Health Plan; Molina
Aetna; CareSource; Centene; Molina;
UnitedHealth
Commonwealth Care Alliance; Fallon
Total Care; Network Health
Absolute Total Care (Centene); Advicare;
Molina Healthcare of South Carolina;
Select Health of South Carolina
(AmeriHealth); WellCare Health Plans
AmeriHealth Michigan; Coventry; Fidel i s
SecureCare; Meridian Health Plan;
Midwest Health Plan; Mol ina Healthcare;
UnitedHealthcare; Upper Peninsula
Health Plan
Amerigroup, Health Spring, Molina,
Superior, United
* Phase I enrollment of duals only includes Medicaid benefits. Medicare-Medicare integration to occur within 12 months.‡ Capitated duals integration model for health homes population.
Not pursuing Financial Alignment Model
Not pursuing Financial Alignment Model
Not pursuing Financial Alignment Model
Not pursuing Financial Alignment Model
Not pursuing Financial Alignment Model
Not pursuing Financial Alignment Model
Not pursuing Financial Alignment Model
Washington
Not pursuing Financial Alignment Model
Not pursuing Financial Alignment Model
Not pursuing Financial Alignment Model
Not pursuing Financial Alignment Model
DUAL ELIGIBLE FINANCIAL ALIGNMENT
DEMONSTRATION CALENDAR
PAGE 21
June 18, 2014
HMA Upcoming Appearance:
“Health Plans Taking on Social Determinants”
Association for Community Affiliated Plans 2014 CEO Summit
Mike Nardone – Presenter
June 24, 2014
Washington, D.C.
HMA Expands Consulting Reach with HMA Community Strategies
Health Management Associates (HMA) is pleased to announce the creation of a new operating division, HMA Community Strategies (HMACS).
The new division is based in HMA’s Denver office. HMA Managing Principal Joan Henneberry is the managing director.
HMACS is designed to complement and enhance HMA’s consulting services, with a focus on supporting the efforts of a broad range of community stakeholders working to develop healthy, equitable, and sustainable communities.
There is growing recognition that the vision of healthier people and communities will require new partnerships and dedication of resources to population health and social determinants of health, including education, housing, environment, food, economic security, and safety. As experts in health and health care, HMA recognized the need to expand its reach to include these social determinants that so clearly influence individual and community health.
HMA Community Strategies provides research, evaluation, policy work, and program development and implementation to support the crucial work being done on the front lines of health and human services. We know our clients aspire to solve social, economic, and health problems through community-generated solutions that are sustainable. That’s why our services support and build stronger connections among stakeholders to help advance those community goals. HMACS serves as a support system for communities as they build the partnerships necessary to sustain and promote a broad vision of health for all of its members.
HMACS is designed to assist community-based organizations; city, county, and local municipalities; foundations; or groups of individuals with a shared goal of community health. We offer a depth and breadth of experience and expertise that is unmatched, yet HMACS was purposely designed to be accessible to these groups, which we know often have limited resources.
HMACS offers an array of services provided by consultants who are health and human services leaders, with a fee structure crafted to reflect the needs of our clients.
HMA NEWS
PAGE 22
June 18, 2014
HMA's Jack Meyer Publishes Book: 'Investing In Public Health: A
Life-Cycle Approach'
A new book by health economist Jack Meyer, “Investing in Public Health: A Life-Cycle Approach,” proposes sound investments to achieve these twin goals. Dr. Meyer, who has authored several prior books and about 100 reports and articles on health reform, is a Managing Principal in the Washington, D.C. office of Health Management Associates.
This book presents the concept of a “positive life spiral,” in which carefully targeted investments result in better health outcomes, health care savings, and more people working productively. This lowers public assistance costs and broadens the tax base. A portion of the savings is plowed back into high-value investments in health, continuing the upward spiral.
For more information on “Investing in Public Health: A Life-Cycle Approach,” see HealthManagement.com
Health Management Associates (HMA) is an independent health care research and consulting firm, specializing in the fields of health system restructuring, health care program development, health economics and finance, program evaluation, and data analysis. HMA is widely regarded as a leader in providing technical and analytical services to health care purchasers, payers, and providers, with a special concentration on those who address the needs of the medically indigent and underserved. Founded in 1985, Health Management Associates has offices in Atlanta, Georgia; Austin, Texas; Boston, Massachusetts; Chicago, Illinois; Denver, Colorado; Harrisburg, Pennsylvania; Indianapolis, Indiana; Lansing, Michigan; New York, New York; Olympia, Washington; Sacramento, San Francisco, and Southern California; Tallahassee, Florida; and Washington, DC. http://healthmanagement.com/about-us/
Among other services, HMA provides generalized information, analysis, and business consultation services to investment professionals; however, HMA is not a registered broker-dealer or investment adviser firm. HMA does not provide advice as to the value of securities or the advisability of investing in, purchasing, or selling particular securities. Research and analysis prepared by HMA on behalf of any particular client is independent of and not influenced by the interests of other clients.
