New proposed regulation from CMS contain many new and updated requirements for states, Medicaid managed care plans, and providers intended to improve beneficiary access to care, quality, and health outcomes in both fee-for-service (FFS) and managed care delivery systems while advancing CMS’ goals.

In November 2022, United States Senators Cassidy, Carper, Scott, Warner, Cornyn, and Menendez issued a request for information (RFI) regarding approaches for improving coverage for individuals who are dually eligible for Medicare and Medicaid. Dual eligible beneficiaries are more likely to have  complex health needs that are difficult and often expensive to treat. Too often, they experience a lack of integration and coordination that often results in confusing encounters with the health care system and negative health outcomes.

In November 2022, United States Senators Cassidy, Carper, Scott, Warner, Cornyn, and Menendez issued a request for information (RFI) regarding approaches for improving coverage for individuals who are dually eligible for Medicare and Medicaid. Dual eligible beneficiaries are more likely to have  complex health needs that are difficult and often expensive to treat. Too often, they experience a lack of integration and coordination that often results in confusing encounters with the health care system and negative health outcomes.

On Tuesday, June 28, 2022, Aurrera Health Group and Milliman experts gave an in-depth presentation to applicants of the CMS ACO REACH model and/or current Direct Contracting Entities.

A core element of all Medicaid Section 1115 “research and demonstration” waivers is an evaluation of the demonstration program and its efficacy in meeting the demonstration’s goals. Historically, however, Section 1115 waiver evaluations have been an afterthought for states and CMS, limiting their ability to inform future Medicaid policy and financing approaches.

Last year, Aurrera Health Group teamed up with the California Department of Health Care Services to provide early education and targeted technical assistance for providers on implementing Enhanced Care Management and Community Support services, two key parts of the CalAIM initiative. This experience revealed several promising practices for other states pursuing whole-person approaches to health care delivery.

California’s Federally Qualified Health Centers experienced many financial challenges as a result of the COVID-19 pandemic.

The enhanced care management benefit (ECM) and in lieu of services (ILOS) proposed under the California Advancing and Innovating Medi-Cal (CalAIM) proposal build upon the successes of California’s 25 Whole Person Care (WPC) pilots.

Launched in 2015, the Drug Medi-Cal Organized Delivery System (DMC-ODS) is nation’s first Medicaid Section 1115 waiver to expand access to substance use disorder (SUD) treatment services.