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Inside Health Policy (Subscription required or sign up for free trial)
CMS's new plan to reduce Medicaid overpayments does not go nearly far enough, the top congressional watchdog told the Senate Homeland Security & Governmental Affairs Committee Wednesday as Democrats denounced CMS Administrator Seema Verma for declining the committee's invitation to testify. "There are huge gaps in knowledge about the extent of the program integrity issues in the Medicaid program, and much more needs to be done," Comptroller General Gene Dodaro told the committee.
But Medicaid Health Plans of America said most Medicaid fraud is in fee-for-service, not managed care. "CMS has a responsibility to address concerns around fraud and mismanagement in Medicaid, and MHPA supports those efforts," MHPA's President Jeff Myers said in a written statement. "CMS and others should know that Medicaid managed care organizations address this issue with their management approaches, including employing robust financial integrity units."
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Modern Healthcare
The CMS has denied Massachusetts' request to become the first state in the nation to determine which drugs it will cover in its Medicaid program. The state filed a federal waiver request last fall to establish its own drug formulary similar to private insurance companies.
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STAT
Medicaid must cover drugs that the Food and Drug Administration has approved with a lower standard of evidence through its "accelerated approval" program, the Centers for Medicare and Medicaid Services said Wednesday in a letter to states. This announcement comes at a time when state Medicaid agencies and private insurers are trying to figure out what to do about high-priced drugs with unclear benefits.
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Project Transition
Learn how one provider is challenging the status-quo in behavioral healthcare and advocating for society’s most vulnerable members to discover their life worth living by providing a recovery experience like no other. Individuals with serious mental illness (including dual diagnosis) are empowered and able to realize a life in the community, on terms they define with the right treatment and services. In Philadelphia, PA and Nashville, TN, a unique extended behavioral support program has been proven to reduce cost and increase positive outcomes, by combining apartment-style community living with intensive, daily, evidence-based programming. This setting helps minimize stigma and create normalized social expectations and consequences.
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Henry J. Kaiser Family Foundation
On Jan. 11, the Centers for Medicare and Medicaid Services (CMS) issued a State Medicaid Director Letter providing new guidance for Section 1115 waiver proposals that would impose work requirements (referred to as community engagement) in Medicaid as a condition of eligibility. As of June 2018, CMS has approved such work requirements in four states: Kentucky, Indiana, Arkansas and New Hampshire. A number of other states have waivers pending at CMS to impose work requirements or are considering such proposals. Not all states are interested in Medicaid work requirements, but Senate proposals and the House Budget Resolution passed by the House Budget Committee are calling for a federal requirement that all states implement work requirements in Medicaid.
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Veyo is a full-service transportation brokerage designed specifically for healthcare. By integrating consumer technology with rideshare fleets, we have decreased costs and increased efficiencies. Operating in eight states with over 6 million completed trips and a 97.1% on-time rate, we're changing NEMT - one trip at a time. Learn More
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CNN
Republicans say that Medicaid recipients will become healthier and more financially independent if they work. Kentucky is about to find out if that's true. The Bluegrass State is about to launch a sweeping overhaul of its Medicaid program, taking advantage of new powers granted by the Trump administration that allows states to require many recipients to work or lose their benefits.
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The Associated Press via The Washington Post
Gov. Jerry Brown took a victory lap Wednesday after he signed a $139 billion California budget that marks a stark turnaround from the financial crisis he inherited almost eight years ago. Nearing the end of his second two-term stint as governor, Brown has celebrated the state's financial strength and thriving economy, even as President Donald Trump and his allies paint the nation’s most populous state as in decline.
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The Sacramento Bee
Thanks to FDA-approved breakthrough medicines, modern treatments for hepatitis C are able to virtually cure the infection in nearly 100 percent of cases. Over the past decade, the effectiveness of treatment has drastically increased and, at the same time, there has been a significant decrease in related side effects, according to Dr. Robert Malmstrom, a pharmacoeconomics pharmacist at Northern California Veterans Affairs. In 2011, treatments on the market were 50 to 60 percent effective, Malmstrom said. Three years later, in 2014, with the FDA approval of the drug Harvoni, effectiveness reached 90 percent.
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HFI’s mission is to partner with healthcare clients to improve their fiscal health by advocating for their most vulnerable members. HFI helps members get necessary benefits and income affording them access to important social determinants of health.
We effectively identify and reclassify eligible super-utilizers from TANF/ACA to ABD.
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The Hill
Amazon announced Thursday that it is acquiring the online pharmacy PillPack, a sign of its long-rumored push into the pharmacy business. Shares of CVS and Walgreens declined on the news of Amazon's purchase.
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Leading Medicaid plans depend on Medecision's cloud-based Aerial™ platform to deliver personalized, predictive, and prescriptive decision support for their clinicians, physicians, members, and their caregivers. Find out how your organization can expand beyond traditional care management with stronger data integration, insights, and flexibility.
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Institute for Medicaid Innovation
You can do your share to help reverse childhood obesity trends by accessing the IMI toolkit for program implementation at your health plan. Not only is childhood obesity a serious health issue, but it’s a financial one, too, with the annual costs of obesity for children and adolescents alone peaking at $2.9 billion. The ROI argument for starting a childhood obesity prevention program at your plan is compelling to say the least. Find the toolkit on the IMI website at http://bit.ly/CHOPTtoolkit.
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