States trim what they can to restrain Medicaid costs
Managed Care Share
In early April, state officials in Ohio unveiled a new regional structure for Medicaid. In place of the eight zones it has now, they carved the state into three big markets: North, Central and Southeast, and West. And they tapped five plans — Aetna Better Health of Ohio, CareSource, Meridian Health Plan, Paramount Advantage, and United Healthcare Community Plan of Ohio — to operate in all three zones starting Jan. 1, 2013. More
Advocates seek voice in duals MOU process, but CMS says pacts won't include surprises
Patient advocates are concerned about a lack of stakeholder input in the memorandum of understanding between CMS and the states that will cement details of demonstration programs to align the financing and care for beneficiaries dually eligible for Medicare and Medicaid, but a CMS official said the agreements should not contain any real surprises for advocates as they will follow the state plans and the stock MOU previously released by CMS. More
CMS defends 'passive enrollment' into dual eligible demonstration programs
McKnight's Long Term Care News Share
Government officials say safeguards are in place to prevent dually eligible Medicare and Medicaid beneficiaries from losing access to care when they enroll in demonstration projects. More
CMS posts all 26 duals proposals, breakdown shows 2.8 million likely participants
CMS has posted all 26 of the states' proposed dual beneficiary payment and care alignment demonstrations on its website and will be taking public comments for many of them over the next month. According to a Health Policy Source breakdown of the duals proposals, states proposed to include 2,862,803 beneficiaries in either the captitated or managed fee-for-service "Financial Alignment Incentive." More
McKesson and ValueOptions® Strategic Partnership to focus on integrated care for dual eligibles
ValueOptions and McKesson announced a strategic partnership to deliver holistic, coordinated care to dual eligible individuals across the nation. McKesson Corporation is a Fortune 500 health care services and information technology company and ValueOptions is a health improvement company that specializes in serving individuals suffering from mental illness and substance abuse disorders. More
Two upcoming MHPA webinars: Maximizing Your Capitation Revenue (Wednesday June 6 at 1:30 pm ET) and Reducing Provider Error Rates (Monday June 11 at 11am ET)
DataWing Software will give a free presentation on Wed. June 6 at 1:30 p.m. ET on reconciling capitation payments to identify ineligible members that will cover:
• Where the data come from and why there are discrepancies
• How you know that your MCO has an issue
• Ideas from other MCOs
• A technology solution to solve this challenge More
Reducing Provider Error Rates Using a Corrective Action Plan Process – June 11, 2012
- Prevention of inappropriate payments and affirmation of medically necessary, correctly coded, and accurately reimbursed claims begins with data analysis. The data analysis process yields results that point to both general and specific billing aberrancies and program vulnerabilities. The presentation will share two business processes; a Level of Concern (LOC) Calculator used to score providers against a set of criteria, and a Progressive Corrective Action Matrix (PCA) to create a consistent objective approach to reduce improper provider payments based on the gravity of errors. The results are a staff that is calibrated on identifying the severity of provider errors and the deployment of progressive actions. Click here for more information on this Webinar. More
Reshaping Georgia Medicaid care to affect many
The Atlanta Journal-Constitution Share
Georgia is reshaping its Medicaid program, a complex lifeline for 1.7 million vulnerable people that consumes $21 million in state and federal dollars every single day. More
Poll: Mixed views on health care, farm bill
National Journal Share
If the Supreme Court strikes down part or all of the Affordable Care Act, a strong plurality of the public wants Congress to try again to come up with a comprehensive health care law to guarantee insurance for all Americans. More
California Duals project goes to CMS for approval
California Healthline Share
It was a big moment for officials in the California Department of Health Care Services. "We are thrilled to be getting this in," said Jane Ogle, deputy director of DHCS. "It's a big project. So to get this in, we're all really excited. This is the result of a year's planning, a year of planning and work with advocates and stakeholders and within the department. And all of that comes together in this document." More
Federal officials want answers from New Hampshire about Medicaid
The Eagle Tribune Share
New Hampshire is in a dispute with federal Medicaid regulators and millions of dollars in state aid is at stake. An administrator with the federal Centers for Medicare and Medicaid Services warned state Health and Human Services Commissioner Nick Toumpas of potential "compliance action" if detailed information about Medicaid practices isn't forthcoming. More
Expert series from MHPA partner Thomson Reuters: How health plans can leverage data to better position themselves for reform changes
Bob Kelley, SVP, Thomson Reuters recently discussed the current market trends and issues affecting health plans. This six-video series continues with "How health plans can leverage data to better position themselves for reform changes."— click the link below to hear what he has to say. Coming up next week: Hear how health care reform is causing Health Plans to change their business model. More
Kingsdale: 'People are aware that there are huge problems'
Kaiser Health News Share
KHN's Mary Agnes Carey talks to Jon Kingsdale about the upcoming Supreme Court ruling on the health law and its implications for the future of health care. Kingsdale, who helped implement the Massachusetts health law, divides states into three camps when it comes to implementing the 2010 federal law: Some are preparing in earnest to be ready on time, some are taking steps but waiting on others until the Supreme Court rules and the fall elections occur, and other states have done nothing, with hopes the law will be struck down. Kingsdale now consults with states and others on implementation of the federal health law. More
Registration now open for MHPA's 2012 Annual Meeting | October 24-26
The MHPA 2012 Annual Meeting at the Hyatt Regency Washington on Capitol Hill in Washington, D.C., again will be the country's largest gathering of top-level executives in the Medicaid health plan industry. This year's meeting, "A Pivotal Time for Medicaid Health Plans," kicks-off just one week before Americans cast their ballots in a presidential election in which health care is one of the foremost issues. As you've come to expect, the MHPA Annual Meeting will provide the perfect opportunity to participate in thought-provoking sessions and hear from compelling speakers, including Charlie Cook, political analyst and publisher of The Cook Report; Donna Brazile, political strategist and commentator; and Robert Brownstein, political director for Atlantic Media Corp.
For more info and to register online, visit http://www.mhpa.org/Events/2012_Annual_Meeting/.
MHPA's New Keeping You Healthy video: Network Improvement Team by MDwise
Quality in health care is of paramount importance for Medicaid health plans. Learn how MHPA member plan MDwise improved their quality outcomes as Dr. Caroline Carney-Doebbeling, CMO at MDwise, and Laura Trainor, manager of this initiative, discuss their program. Watch the YouTube video here.
Partnership for reducing readmissions and length of stay — Thursday June 14 at 1:00 pm ET, A free webinar by VITAS Innovative Hospice Care
The Hospital Readmission Reduction Program is intended to reduce hospital readmissions by aligning them with payment incentives. Hospice and palliative care programs can help providers reduce hospital readmissions by providing comprehensive care to patients. They improve discharge planning and increase coordination of care while being cost effective. This results in improved quality patient care and increased patient/family satisfaction.
Register for this free webinar
2nd Annual Leadership Summit on Medicaid | July 24-25, Arlington, Va.
The WorlD Congress Share
With the Supreme Court Ruling to determine the future of Medicaid Expansion in June, the 2nd Annual Leadership Summit on Medicaid will be the first national platform for all stakeholders to come together to discuss the implications and next steps. Hear Thomas Johnson, president and CEO of MHPA, participate on a keynote panel with other industry leaders to address the Supreme Court Ruling on Medicaid expansion and health reform. MHPA members, receive a $200 discount when you register online or at 800.767.9499 with promo code MHPA200. More
Dual Eligibles Best Practices Summit | July 30-31 | Orlando, FL
Healthcare Education Associates Share
Learn how to execute a well-run dual eligibles plan, from outreach campaigns to managed long term care and everything in between. Members of MHPA are entitled to a 15 percent discount. Mention HMP122 during registration to enjoy this offer. For more information, click here or contact Theresa Powers at 704.341.2437 or email@example.com. More
Banner advertising available with MHPA NewsBriefs
Now you can ensure that your message gets out to the Medicaid managed care industry. For rate information, contact James Debois for opportunities 469.420.2618 or email at firstname.lastname@example.org.
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