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MHPA's Myers: New Medicaid rules could be 'epic'; compares them to Pacquiao-Mayweather fight
Some time very soon, the Obama administration is going to propose federal regulations for Medicaid managed care for the first time since 2002. It is, in the immortal words of Vice President Joe Biden, a BFD within this world, where upwards of 40 million Americans receive health coverage through Medicaid that is administered by private insurers. The rules could touch almost every area of managed care, which pays plans on a per-member basis instead of the traditional fee-for-service that just pays for each procedure, test, office visit and so on.
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AP: Insurer tax passed along to states; MHPA provides
story background info
The New York TImes
There's more than a touch of absurdity in the way an industry fee in President Barack Obama's healthcare law is being passed along to state taxpayers. As Alice in Wonderland might say, a curious tax just got more curious. The burden to states could mount to $13 billion in less than a decade.
Sanders takes aim at high drug prices
Vermont Sen. Bernie Sanders and Maryland Rep. Elijah Cummings on Monday introduced a bill aimed at lowering the taxpayer burden for rising generic drug prices. Brand-name drug manufacturers are required by law to pay a rebate to Medicaid when their drug prices rise faster than inflation. Sanders and Cummings' bill would extend this requirement to generic drug manufacturers.
University of Maryland Medical System to acquire Medicaid
managed care firm
The Baltimore Sun
The University of Maryland Medical System is poised to enter the Medicaid and Medicare managed care market in the state with an agreement to acquire Riverside Health Inc. The University of Maryland Medical System is poised to enter the Medicaid and Medicare managed care market in the state with an agreement to acquire Riverside Health Inc.
Soaring Medicaid enrollment could hit state budgets
The Fiscal Times
Under the Affordable Care Act's Medicaid expansion, enrollment in the program is soaring past expectations in a handful of states, raising some concerns about whether states will have trouble covering the costs down the road. So far, some 12 million people have enrolled in Medicaid through the expansion — with most states that expanded their program seeing sign-ups significantly surpass their expectations. At least seven states saw massive waves in enrollment totaling about 1.4 million more people than originally estimated, Politico first reported.
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Herbert, Dunnigan confident Utah Medicaid expansion plan on track for
The Salt Lake Tribune
Some fresh ideas about how to expand Medicaid have "percolated" since the legislative session ended, but one of the chief architects continued to speak only in broad terms Thursday. "There's a lot of nuanced ideas we can put together and come up with a good solution," House Majority Leader Jim Dunnigan said after a luncheon at the Capitol Rotunda.
Dunnigan was one of five panelists invited by the Utah Breakfast Club to discuss prospects for expansion of the health care system for the poor. He declined to be more specific with the 27 people attending, including five other lawmakers.
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Florida governor orders lists of critical state needs, hints at July 1 shutdown
Tampa Bay Times
Gov. Rick Scott directed all state agencies Thursday to draw up lists of "critical service needs ... in the event Florida is forced into a government shutdown on July 1." Scott's memos to agencies carry an alarming tone and were released the day after the legislature's chief budget writers, Sen. Tom Lee and Rep. Richard Corcoran, struck a hopeful tone and said they had made progress toward a compromise after an all-day negotiating session in the Capitol.
St. Louis clinic buckles in for another year without Medicaid expansion
St. Louis Public Radio
Despite the efforts of healthcare advocates, hospitals and notable former legislators, the Missouri legislature did not pass Medicaid expansion this year, or even bring it to the debate floor. That means an estimated 147,000 Missourians will have another year without health coverage, and the community health clinics that care for the uninsured will continue trying to bridge the gap.
Alaska House Finance Committee says it won't advance Medicaid expansion
Alaska Dispatch News
While legislators remain deadlocked on budget negotiations, debate continues on another topic of Alaska Gov. Bill Walker's special session call: Medicaid expansion. Republican legislative leaders appear unwilling to back down on the issue of expansion — one of Walker's campaign promises — as demonstrated by legislative action and inaction this week.
Georgia studying design for Medicaid waiver plan
Georgia Health News
The state of Georgia's main health agency says it's analyzing a new plan to cover more uninsured Georgians through a special Medicaid "waiver" program. Gov. Nathan Deal "has asked us to work on it," Clyde Reese, commissioner of the state Department of Community Health, said Thursday.
Alabama House panel approves budget cutting Medicaid, prisons,
An Alabama state budget plan that would force cuts in Medicaid, mental health, prisons and other services was passed by a House of Representatives committee today after the chairman said there's little support for tax increases. Alabama Gov. Robert Bentley said he would veto the plan in its current form.
Study: States with no exchange or Medicaid expansion have most to lose in King v. Burwell
The Fiscal Times
Next month, the Supreme Court will decide whether Obamacare enrollees in states that did not set up their own exchanges will continue to have access to federal subsidies. If the Court rules against the administration in the high-stakes case of King v. Burwell, an estimated 9.8 million could become uninsured in states that rely on the federal exchange, Healthcare.gov, says a new study from the Urban Institute and the Robert Wood Johnson Foundation.
May 27 Webinar Wednesday: 'Continence Management: Opportunities to Improve Care and Reduce Costs Beyond Per Unit Savings'
As your health plan cares for increasing numbers of adult members, as well as dual eligibles and other populations with long term care needs, disposable incontinence products are a growing cost. Please join, Christine Pruneau, RN, BSN, RAC-CT, director of clinical programs and Julie Hyer, director of Medicaid health plan programs for First Quality, to learn about the negative effect to members when they do not get the products that they need to manage their incontinence on a daily basis.
June 10 Webinar Wednesday: 'Integrating High-Risk Member Care with Risk Adjusted Revenue for Medicaid Members and Dual Eligibles'
Taking a holistic approach to integrated programs in high-risk population management can provide true value to members, the plans and the providers serving them. Please join Eddie Gilmartin, vice president, product and business development for PopHealthCare, who will offer groundbreaking programs in high-risk population management that drive rapid, large and demonstrable improvements in member quality of life and satisfaction, while helping its partnering health organizations realize appropriately enhanced revenues, enhanced quality scores and reduced medical costs.
June 17 Webinar Wednesday: 'The Latest Trends in OHI Discovery and Cost Avoidance for Payers of Last Resort'
Why "pay and chase" when you can cost avoid? It's not easy to discover if a Medicaid enrollee has primary commercial coverage at the point of sale — costing time and money, chasing reimbursements for claims that others should have paid. On average less than 17 percent of the dollars billed to primary insurers are paid back to Medicaid plans that paid claims in error. This webinar will focus on a very unique and powerful data source that has the potential to revolutionize the way Pharmacy & Medical OHI (Other Health Information) is discovered. Cost avoidance is more attainable than ever before. Capture savings by having the latest active insurance coverage information available to you, in real time.
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.
Philadelphia Asthma Summit set for June 26
U.S. Housing and Urban Development
The Philadelphia Asthma Summit will take place from 8 a.m. to 4 p.m. on Friday, Jun 26, at the Children's Hospital of Philadelphia. This is the fifth asthma summit that the U.S. Housing and Urban Development has hosted in collaboration with federal, state and local partners.
While each meeting is unique, the overall intent is to advance the conversation locally (state or region) around securing sustainable financing for in-home services targeting children disproportionately impacted by asthma. This Philadelphia Asthma Summit is designed to meet this intent with a specific focus on promoting the value of home-based interventions for children with poorly controlled asthma and reimbursement mechanisms for these services by healthcare insurers for children in low-income households.
Health plans participating in the meeting will hear perspectives and experiences from other health plans serving Medicaid populations. The meeting agenda includes a "Payers' Perspectives Panel" featuring Family Health Network (Barbara Hay, Retired COO), Keystone First (Dr. Lily Higgins, Medical Director) and Aetna Better Health (Dr. Guerra-Garcia, Chief Medical Officer).
Job opportunity: Senior Medicaid Strategist | Raleigh-Durham, NC
North Carolina Dept of Health and Human Services
The Senior Medicaid Strategist has responsibility for the execution of the day to day activities in all efforts related to implementing Medicaid Reform for DMA. This position acts a project manager by directing internal and external resources to successfully operationalize reform policy. This individual will report directly to the DHHS Deputy Secretary for DMA.
For more details and to apply: click here.
Job opportunity: RN, manager, Clinical Health Services,
pre-authorization | Detroit
Aetna seeks an experienced RN with managed care, leadership and prior authorization expertise. Reinforces clinical philosophy, programs, policies and procedures. Ensures implementation of tactics to meet strategic direction for cost and quality outcomes. Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results. Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
Visit here and search for requisition #24937BR to learn more and apply.
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