Radar on Medicare Advantage
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News Briefs: Centene Agrees to Pay $21.1 Million to Settle NH Medicaid Pharmacy Issues | Jan. 20, 2022
Centene Corp. this month agreed to pay $21.1 million to resolve inaccuracies related to the reporting of pharmacy benefit services costs for New Hampshire’s Medicaid Managed Care Management Program. In a Jan. 6 press release unveiling the settlement agreement, Attorney General John Formella said the state Dept. of Health and Human Services and Dept. of Justice began investigating Centene’s provision of pharmacy benefit services after similar probes in other states were made public. The agreement follows similar settlements in Arkansas, Illinois, Kansas, Mississippi and Ohio over the last year for a total of $214 million in payouts. Centene did not admit any liability, wrongdoing or violation of federal or state law. “This no-fault agreement reflects our commitment to prompt and transparent resolution of this matter and relentless focus on delivering high-quality healthcare outcomes to our members in the Granite State,” Centene said in a statement published by The Daily Journal.
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2022 Outlook: MAOs Face Payment-Related Unknowns, Increased Competition
For the Medicare Advantage industry, change wasn’t a major outcome of the Biden administration’s first year in office. But for 2022, MA organizations face a host of unknowns — such as potential risk adjustment and star ratings changes that could impact plan revenue — and challenges that include staying competitive in an increasingly rich benefits landscape. For AIS Health’s annual roundup of perspectives on the year ahead, industry experts weigh in on how doing business in 2022 might differ from previous years.
AIS Health: What do you view as some of the biggest challenges or uncertainties facing MAOs in 2022?
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2022 Outlook: Plethora of ‘Granular’ Changes Will Drive MAOs’ Stars Strategy
With continued emphasis on member experience, several new Part C measures and a directional shift to closing health care inequities, 2022 stands to be a landmark year in terms of changes to Medicare Advantage organizations’ star ratings strategies, industry experts tell AIS Health, a division of MMIT.
“There is so much earth-shattering change on the horizon that most plans are just not thinking about,” cautions Melissa Newton Smith, executive vice president, consulting and professional services with Healthmine, Inc. “We’re worried that COVID took up way too much airtime and that plans have lost sight of the forest through the trees in MA a little bit.”
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Medicaid MCOs Brace for Return of Churn, Other Challenges
As a condition of receiving enhanced federal funds during the COVID-19 public health emergency (PHE), states were required to take certain steps to ensure continuous Medicaid and CHIP coverage for most enrollees, leading to a nearly 18% jump in Medicaid enrollment. But with the latest PHE extension set to expire on Jan. 16, states will no longer receive such funds and will therefore no longer be required to maintain continuous coverage, although CMS has given them 12 months after the month in which the PHE ends to complete eligibility redeterminations. As a result, supporting states’ reverification efforts and ensuring that eligible members stay on the rolls or have a viable landing spot will be critical to Medicaid managed care organizations this year, industry experts tell AIS Health, a division of MMIT.
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InnovAge Replaces CEO After CMS Imposes Second Enrollment Freeze on the PACE Organization
Shortly after Denver-based InnovAge learned that CMS suspended enrollment in the company’s Colorado programs due to noncompliance, the leading Programs of All-Inclusive Care for the Elderly (PACE) provider unveiled the resignation of its longtime CEO, Maureen Hewitt. InnovAge serves more than 6,300 PACE participants, or 12% of PACE enrollees overall, and is in the midst of a major expansion. The company on Jan. 3 said Hewitt was leaving to “pursue other opportunities” and it promoted Patrick Blair, the current president, to president and CEO.
InnovAge in March 2021 began trading on the Nasdaq Global Select under the ticker symbol “INNV,” and at the time said it planned to expand its footprint of 16 centers in five states. The company in November said it expected to open three centers in fiscal year 2023 and was looking at additional locations and eyeing acquisitions in new markets.
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