Exploring the Feasibility of a Navajo Nation Medicaid Agency

Exploring the Feasibility of a Navajo Nation Medicaid Agency

Econometrica relied on secondary data and site visits to examine several issues.

State Medicaid administration has additional complexity when Tribal lands cross State lines. The Navajo Nation extends across three States, creating challenges for Medicaid beneficiaries and healthcare providers on Navajo lands.

The Navajo Nation advocated for the creation of a Navajo Nation Medicaid agency to reduce this complexity. The Navajo Nation’s boundaries extend across Arizona, New Mexico, and Utah, meaning residents of Navajo lands may be eligible for Medicaid programs in those States, depending on where they live. The Indian Health Care Improvement Act mandated the Secretary of the U.S. Department of Health & Human Services to study the financial and operational implications of the creation of a Medicaid agency for the Navajo Nation, affected States, and the Federal Government.

On the Navajo Nation Feasibility Study, awarded to Econometrica under the Small Business Research and Demonstration (SBRAD) indefinite delivery, indefinite quantity (IDIQ) contract, we assessed the feasibility of establishing a Navajo Nation Medicaid agency.

The study addressed several issues related to the feasibility of a Navajo Nation Medicaid agency. These included startup requirements and costs, requirements and costs of ongoing operations, cost implications for the Navajo Nation and the Federal Government, legal and regulatory issues, and the impacts on the three States currently serving Navajo Nation residents. The study also addressed potential models that could serve as a basis for a plan to design, implement, and operate a Navajo Nation Medicaid agency.

A new agency would provide consistent eligibility rules and benefit packages, provider participation and requirements standards, and claims submission processes for all residents of the Navajo Nation. In addition, a Navajo Nation Medicaid agency would be able to tailor Medicaid to increase cultural appropriateness and responsiveness to Navajo traditions, which, in turn, could improve healthcare use, preventive behaviors, and positive health outcomes.

The methodology for the study included analysis of secondary data and site visits. We used data from a variety of sources, including:

  • 2010 Census data.
  • Data from the States of Arizona, New Mexico, and Utah.
  • 2010 Federal Medical Assistance Percentage rates for each State.
  • A Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary report on 2010 spending.
  • Medicaid budgets and program spending for several small population States and U.S. territories.

We also conducted site visits and discussions with Navajo Nation leadership and the state Medicaid agencies of New Mexico, Arizona, and Utah. Through these discussions, we gathered information to structure the cost estimates, develop the assumptions used to produce the estimates, and understand the impact a Navajo Nation Medicaid agency would have on the affected states’ Medicaid systems. CMS used our Final Report on these topics to develop the Report to Congress on the potential costs and implications of a Navajo Nation Medicaid agency.

About Econometrica:
Founded in 1998, Econometrica is a research and management organization in Bethesda, MD, established to provide public- and private-sector clients with customized program support services. Econometrica works with multiple agencies to provide high-quality, cost-effective analyses, modeling, and economic evaluations. The company consistently receives exceptional scores from its clients and believes in three principles: technical capabilities, happy customers, and business development.

The study addressed several issues related to the feasibility of a Navajo Nation Medicaid agency. These included startup requirements and costs, requirements and costs of ongoing operations, cost implications for the Navajo Nation and the Federal Government, legal and regulatory issues, and the impacts on the three States currently serving Navajo Nation residents.

See our report here

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Econometrica to Help State Programs With Medicare–Medicaid Enrollees

Econometrica to Help State Programs With Medicare–Medicaid Enrollees

Econometrica will help CMS provide support services to State programs to improve the experience of Medicare–Medicaid enrollees

Bethesda, MD, September 2017

Econometrica, Inc., was recently awarded a contract by Centers for Medicare & Medicaid Services (CMS) to provide support for State programs to integrate care and ensure program integrity for Medicare–Medicaid enrollees.

In partnership with Acumen, LLC, Econometrica will help State programs integrate care for Medicare–Medicaid enrollees by (1) helping States access data and (2) aiding Medicare-Medicaid Plan access to Medicare historical claims data (Parts A, B, and D). In addition, Econometrica will assist CMS to process data requests, conduct reviews, maintain the tracking system, and find opportunities to improve efficiencies in the process.

“Econometrica has a long history of dedicating itself to improving healthcare processes. We are proud to build on our experience working with the Affordable Care Act (ACA) and look forward to continuing to support CMS and State programs with valuable services,” President and CEO Cyrus Baghelai said.

Currently, millions of individuals enrolled in the Medicare and Medicaid programs receive fragmented care. The ACA established the Medicare–Medicaid Coordination Office within CMS to advance quality, reduce costs, and improve the experience of Medicare–Medicaid enrollees.

Econometrica will assist State Medicaid agencies with technical advice, including providing information on linking databases, creating analytic databases, conducting training calls and webinars, and providing consultation and data support. To improve efficiency, Econometrica will guide States on ways to address the limitations in CMS data and help States optimize their use of available data.

About Econometrica:
Founded in 1998, Econometrica is a research and management organization in Bethesda, MD, established to provide public- and private-sector clients with customized program support services. Econometrica works with multiple agencies to provide high-quality, cost-effective analyses, modeling, and economic evaluations. The company consistently receives exceptional scores from its clients and believes in three principles: technical capabilities, happy customers, and business development.

The ACA established the Medicare–Medicaid Coordination Office within CMS to advance quality, reduce costs, and improve the experience of Medicare–Medicaid enrollees.

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Econometrica Partners With Acumen on RMADA Task Order

Econometrica Partners With Acumen on RMADA Task Order

Econometrica is partnering with Acumen, LLC, as a subcontractor on the RMADA Episode Payment Model (EPM) and Cardiac Rehabilitation (CR) Payment Contractor Task Order for the Centers for Medicare & Medicaid Services (CMS). CMS is implementing two new EPMs to test the use of episode-based payment for an episode of care during and after a hospital stay related to cardiac disease. The models will provide retrospective, bundled payments to hospitals for episodes of care consisting of inpatient hospital stays followed by post-acute care. Specifically, these new models will apply to acute myocardial infarction treated either medically or with revascularization and a coronary artery bypass graft. A third model that falls under this project will test the effectiveness of incentive payments in increasing the use of CR and intensive cardiac rehabilitation (ICR) services.

The team’s work on this contract will involve developing the payment calculation methodologies, calculating payment amounts for both EPMs, and calculating incentive amounts for the CR and ICR service provision. Econometrica will provide technical assistance and support to model participants and work to ensure that the participating hospitals are confident in the calculation methods used for the episode-based payments and understand the processes in place for payment reconciliation under the models. Econometrica will provide a variety of services to achieve this goal, including developing clear and concise resources (e.g., factsheets, FAQ documents, and scenario sheets) and distributing them to model participants. Further, we will offer on-demand support by responding to inquiries from hospitals on a flow basis and produce monthly webinars to disseminate the information hospitals need for the model to be successful.

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