MCCA's December 2023 Newsletter

December 2023

Dear Valued Clients and Partners,

As we reflect on the year gone by, Managed Care Consultants of America extends a heartfelt thank you to every one of you for contributing to yet another remarkable year of growth and success.

In 2023, we underwent significant transformations, and one of the most noteworthy changes was our rebranding from Managed Care Consultants of Florida to Managed Care Consultants of America. This shift was driven by our expanding presence across the nation, and we take great pride in the positive evolution of our organization.

A major highlight of the year was the launch of our updated Client Portal, designed to provide you with seamless access to client contracts, tools, and health plan resources in a user-friendly web-based format. Your satisfaction is paramount to us, and we eagerly anticipate your valuable feedback on the portal through an upcoming survey that will be sent to your email. Your insights are crucial as we continue to enhance and refine our services.

Looking ahead to 2024, we are enthusiastic about the prospects of continued growth and collaboration with our clients. Your partnership has been instrumental in our achievements, and we remain committed to providing unparalleled support to your organization and team. Please do not hesitate to reach out and let us know how we can best assist you on your journey.

As the holiday season approaches, we extend warm wishes for a joyful and festive celebration. May the coming year bring you success, prosperity, and fulfillment. Thank you for being an integral part of Managed Care Consultants of America's success.

Wishing you a wonderful Holiday Season and a joyous New Year!

Sincerely,

Destiny Quinones

President/CEO

Managed Care Consultants of America

HEALTHCARE TRENDS IN 2023

Healthcare in America is a moving target with constant twists and turns. We, at Managed Care Consultants of America, have noted a few items that may be of interest to you or your team.

As of the end of November, the Medicare program has over 66.2 million* enrollees with Fee for Service at nearly 34 million participants. While Medicare Advantage is close behind at 32.3 million. Medicaid & CHIP has over 89 million* enrollees, of those, 7 million are in CHIP.

*12+ million individuals qualify for both Medicare and Medicaid and are counted in both sets of numbers. The Marketplace has over 16.3 million consumers enrolled.

CMS has made it clear that it is pursuing the objective of all Medicare members being enrolled in an ACO by 2030. Currently, there are 13.2+- million fee-for-service Medicare beneficiaries assigned to an ACO.

Healthcare is also seeing some trends nationally that will possibly impact how we receive our healthcare. National retailers are diversifying into new healthcare provider roles. Walmart, Walgreens, CVS, Amazon and Best Buy are just a few giants that are switching up their game. Retailers are buying primary care practices and placing them within their retail locations, expanding into home-based care and investing in technology for hospital at home programs.

CMS is noting positive outcomes and numbers related to their Acute Hospital at Home waiver program. From November 2021 to March 2023, just over eleven thousand patients received care in their home instead of the hospital. CMS is pleased with the impact as less than 7.5% of those patients resulted in RTH. CMS is encouraging more hospitals to participate. Currently, there are approximately 304 hospitals in 37 States involved in the waiver program.

What will 2024 bring? It is hard to say but keep on eye on changes in telehealth, increasing services offered in the home and an increase in Medicare Advantage Plans.

PASRR and KEPRO

Kepro is the online provider for the Florida PASRR (Preadmission Screening and Resident Review) system FL PASRR I & II | Homepage (kepro.com). Almost all admissions to a nursing home facility are required to have at minimum Level 1 screen done and some will require a Level 2. Per Kepro, there has been a significant increase in the request for Level 2 screening. As a result of the increased screen requests, Kepro has initiated some new training on the process and when it is actually required. We encourage your team to review the training available to ensure compliance FL PASRR I & II | TRAINING MATERIALS (kepro.com).

OPEN ENROLLMENT REMINDER

As we approach the new year, it will bring changes for everyone, including our residents. Your residents have been bombarded by advertisements regarding Medicare open enrollment and choosing a Medicare Advantage plan. Medicare open Enrollment was October 15^th, 2023 to December 7^th 2023. During this timeframe, Medicare eligible people have the option to switch from Traditional Medicare to a Medicare Advantage Plan, switch Medicare Advantage Plans or change their stand-alone Part D Plan. It is important to validate all of your resident’s insurance coverage, attain their deductibles, out of pockets and new copays as of January 1^st,2024. Something to remember: all Medicare Advantage deductibles and out of pocket expenses reset on January 1^st. It is also important to notate the Medicare Advantage Open Enrollment Period, which runs from January 1^st, 2024 to March 31^st2024. This timeframe allows a member that is enrolled in a Medicare Advantage plan to: switch to a different Medicare Advantage plan, drop their Medicare Advantage plan and return to Original Medicare, or signup for a stand-alone Part D Drug Plan (if they return to Original Medicare). Medicare Open Enrollment | CMS

Also note, that your residents covered by Medicaid and the Affordable Care Act programs also had recent open enrollments that take effect on January 1^st. It is important to also validate these polices to make sure that your organization is in network or if a letter of agreement is required.

It is a best practice to run Medicare Verifications on ALL skilled members on the 1st and 15th of the month to catch potential changes.

2024 EXPANSION: V-BID Hospice and Medicare Advantage plans

CMS’s Innovation Center initiated a demonstration model to have Medicare Advantage Organizations (MAO) provide the Part A Hospice Benefit. VBID Model Hospice Benefit Component Overview | CMS This model has been continued into 2024, with 69 participating MAOs in 19 States. A list of participating MAOs and the specific Medicare Advantage plans per area are listed here: vbid-cy2024-hospice-contact-info-geo.xlsx (live.com) It is important to note both the Contract ID and the Plan ID (Plan ID is specific to the geographic area / counites of coverage) to determine if a specific MA product is participating in the model.

A few key points for Hospice providers:

All notices and claims must be sent to both the MAO and assigned MAC. The MAO is the payer while the MAC processes for CMS informational purposes.
Hospices will continue to receive payments no less than Original Medicare rates for the Medicare covered hospice services. Hospices have the option of contracting with MAO plans BUT are not required to do so and may still provide services to those MA beneficiaries.
Hospice services will not require a prior authorizations or approvals on care changes from the MAOs but notices are still required to go to them.

A key point for providers caring for Hospice beneficiaries:

Beneficiaries are permitted to choose any Hospice provider of their choice regardless of their MAO’s contracted providers.
If a beneficiary revokes Hospice and their specific MA plan is in the V-BID Hospice program, the provider will bill the MA plan for all services post the revocation. Payment for services after revocation will NOT revert back to original Medicare; it does not matter if an in or out of network Hospice provider was used, all billing will go back to the participating V-BID Hospice MA plan. Therefore, if a provider is servicing post revocation, the provider will need to follow typical authorization process if in network or obtain a Letter of Agreement if not a contracted provider. Providers will be paid their typical MA contracted rates.
Validate participating MA plans via this CMS link vbid-cy2024-hospice-contact-info-geo.xlsx (live.com)

Educational Webinars Hosted by MCCA

December

End of Year to Do's hosted by: Destiny Quinones

January

Portal Review hosted by: Nanette Johnson-Smith

Please reach out to your liaison for invitations to join.

Paying Attention To The Details!

Housekeeping Items

Verify benefits every 1st and 15th of the month as a best practice
New employees, please let our liaisons know so we can setup training
Discharge Summaries should be sent to the health plans and patient's PCP upon discharge
Have you registered for our new portal? Register here!

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