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Study: Low income beneficiaries negatively impact star ratings
Inside Health Policy (Subscription required)
A new study finds Medicare Advantage plans serving low income beneficiaries may be providing higher quality care
than their star ratings suggest. The study, done by Inovalon, a healthcare and technology analytics company, and the Special Needs Plan Alliance, found that "disadvantaged beneficiaries — such as dual eligible beneficiaries covered by both Medicare and Medicaid — have worse health outcomes that cannot be attributed to a health plan's quality of service," according to a release about the study.
The study particularly pinpoints dual eligible beneficiaries and their socioeconomic status as negatively impacting
Medicare Advantage plans' ratings, something the authors say could lead to lower-quality care for the population in the
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Supreme Court: Providers can't sue over low Medicaid rates
Medicaid providers cannot sue the government seeking to raise their reimbursement rates, the Supreme Court ruled Tuesday. "Spending Clause legislation like Medicaid 'is much in the nature of a contract,'" wrote Justice Antonin Scalia, speaking for himself and Justices Stephen Breyer, Clarence Thomas, Samuel Alito, and Chief Justice John Roberts in the 5-4 decision.
GOP senator: Medicare deal should be offset
A freshman Republican senator is urging GOP Senate leadership to take a tougher stand on the House Medicare "doc fix" deal, highlighting a split within the party that could hold up the bill's passage.
MHPA's Legislative Fly-In | May 11 | Washington, DC
Join us for MHPA's Legislative Fly-In, scheduled May 11 and 12 at the Liaison Capitol Hill Hotel, to educate lawmakers on our industry and its key issues.
Click here for reservation information.
For details, please contact Nikida Levy via email or by phone at 202-857-5720.
Medicaid expansion plans rejected by multiple states
More Republicans tried to expand state Medicaid programs this year, but their colleagues haven't bitten. Legislators in Tennessee, Utah, Idaho and Wyoming have rejected alternative plans proposed by Republican governors, and some GOP legislators in Florida and Montana are struggling to advance alternate plans, as well.
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The red-state solution on Medicaid: Georgia's not part of it
The Atlanta Journal-Constitution via Kaiser Health News
A growing number of red states are intensely debating — and some actively pursuing — Republican-friendly ways to extend health insurance to their poorest citizens under the Affordable Care Act, a law they've long reviled. Georgia isn't one of those states. Indeed, the issue remains so politically toxic here that many Georgia Republicans are loath even to utter the phrase "Medicaid expansion" under the Gold Dome.
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Despite hundreds of supporters at Capitol, Insure Tennessee dies again
Chattanooga Times Free Press
Tennessee Republican Gov. Bill Haslam's proposed Insure Tennessee plan flopped for a second time Tuesday in a Senate committee and that's thrown the House effort into confusion with two top supporters disagreeing over whether to try to move it in a subcommittee there.
House, Senate advance budgets as Florida Medicaid scuffle looms
The House and Senate advanced competing budgets Wednesday, setting up what could be a weeks-long showdown between the two chambers over Florida Medicaid funding. The Senate's $80.4 billion spending plan is about $4.2 billion more than the House version. That's largely because the Senate includes a Medicaid expansion plan that draws $2.8 billion from the federal government and an alternative Low Income Pool program within Medicaid of $2.2 billion.
House health committee passes Alaska governor's Medicaid expansion bill
Alaska Dispatch News
A Republican-controlled House committee Tuesday night easily moved forward Alaska Gov. Bill Walker's bill to expand the public Medicaid health program, but the measure still has many more stops in the legislature, including some in hostile territory.
Missouri Senate votes to raise caps for some to get Medicaid
The Associated Press via The Kansas City Star
Missouri's Republican-controlled Senate has advanced a bill to expand eligibility for persons with disabilities to receive Medicaid. Senators advanced the bill in a voice vote Tuesday and will vote a second time before it moves to the House.
Lawsuit aims to stop Ohio from dropping people from Medicaid
The Associated Press via The Charlotte Observer
An Ohio group wants a federal judge to block state officials from ending the Medicaid health coverage of tens of thousands of low-income residents. The request comes as the state's Medicaid agency works to "redetermine" eligibility for recipients of the federal-state program, as required by the federal government.
Florida health officials propose Medicaid enrollment change
The Associated Press via The Baltimore Sun
Florida health officials want to remove Medicaid's 30-day wait period so people can automatically enroll for health insurance once they're deemed eligible. The proposed amendment would also get patients information more quickly about their plan options to encourage them to choose their own plan instead of being automatically enrolled in one.
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New Jersey doctors least willing to accept Medicaid
patients under Obamacare
The Affordable Care Act has provided a path for 420,500 low-income New Jersey residents to gain insurance through the Medicaid program, but a new study says the state ranks last in the nation in doctors willing to treat them.
Cleveland Clinic reports 40 percent drop in charity care after
WCPN-FM via Kansas Health Institute
The Cleveland Clinic, one of the largest hospitals in the country, has cut its charity care spending — or the cost of free care provided to patients who can't afford to pay — to $101 million in 2014 compared with $171 million in 2013. Hospital officials credited the federal health law for the improvement.
New York doctors allegedly offered free shoes in $7 million plot to
Nearly a dozen doctors in New York City are facing felony charges for allegedly baiting poor people to take unneeded tests with the promise of free shoes. A total of 23 defendants, including nine doctors, were charged with running a $7 million Medicaid scheme that preyed on people from homeless shelters, welfare offices and soup kitchens, according to the Brooklyn District Attorney's Office.
Did you miss Webinar Wednesday: 'Medication Monitoring & Pharmacogenetic Testing (PGT): Helping Clinicians to Individualize Safer Opioid Management' by Millennium Health?
To request a copy of the presentation or for additional information, please contact Naissan Hussainzada, or visit www.millenniumhealth.com.
For copies of other past webinars, visit here.
April 15 Webinar Wednesday: 'The Role of Medicaid Managed Care Organizations in State Innovation Models'
The State Innovation Model grants are being widely used to develop and test multipayer payment and service delivery reform. These models can have a significant effect on Medicaid managed care organizations (MCOs). This webinar will explore the potential roles of Medicaid MCOs in a State Innovation Model (SIM) driven reform initiative.
Please join Director Randolph Gordon and Specialist Leader Jim Hardy for Deloitte Consulting LLP who will discuss challenges related to provider contracting, care management, information technology, market positioning and strategies for success.
Pay for success, social impact bonds: Request for proposals
Green & Healthy Homes Initiative
The Green & Healthy Homes Initiative released a request for proposals from asthma-related service providers to develop asthma social impact bond/pay for success projects. GHHI and its partner Calvert Foundation will provide technical assistance to five selected service providers in the catchment areas of the previously selected healthcare organizations:
Please review the RFP; proposals are due Wednesday, April 8.
- Baystate Health (Springfield, MA)
- Le Bonheur Children's Hospital (Memphis, TN)
- Monroe Plan for Medical Care (Buffalo/Rochester, NY)
- Spectrum Health (Grand Rapids, MI)
- University of Utah Health Plans (Salt Lake, UT)
Medicaid Managed Care Congress: May 20-22 in Baltimore
Medicaid Managed Care Congress
At the Medicaid Managed Care Congress, government officials, health plan executives and other key players of the healthcare ecosystem come together to hear new case studies from industry peers and expert insights from state and federal regulatory bodies. This event will discuss the successes and challenges of implementation of major ACA provisions, delivery reform and payment reform and states pursuing better value. Use code XP2026MHPAB for a 15-percent discount.
Job opportunity: Clinical director, Homecare & Managed Care
First Quality, a leading manufacturer of disposable home healthcare products, is seeking a clinical director for our Homecare & Managed Care Business. This candidate will provide leadership and have a focus on clinical education, utilization management protocols and programs and operational program development within homecare and managed care markets.
Job opportunity: Physician contract negotiator | Chicago
Negotiates, re-negotiates and executes physician and/or provider contracts in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals. Medicaid and Medicare contracting experience strongly preferred. Enter Requisition #22158.
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