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OIG: Not all states reporting required Medicaid data
A number of states still do not report required quarterly data about services provided to Medicaid beneficiaries enrolled in managed care — information that's crucial to running Medicaid and protecting it from fraudsters, according to a study HHS' Office of Inspector General released. States have gotten better in recent years at reporting encounter data — information detailing services provided to beneficiaries in capitated managed-care programs. But work remains, and the CMS should do more to improve reporting, according to the report.
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North Carolina legislators want Medicaid reform before expansion
The Associated Press via The Baltimore Sun
Despite a key win in the Supreme Court and pressure from liberal activists, North Carolina's legislative leaders recently said that they have no plans to expand the state's Medicaid rolls through President Barack Obama's 2010 health care law. Legislative leaders argue that the state's Medicaid structure is inefficient and say reforms are needed before more people can be added to system. Competing proposals in the House and Senate budgets set aside up to $800 million over the next two years to pay for increased enrollment and higher healthcare costs but offer very different ideas for how to overhaul the system.
Few details available to explain NC Medicaid surplus
For the second consecutive fiscal year, state health officials have declared the state's Medicaid program ended the year on a positive financial note, this time with an unknown amount of "cash on hand."
However, the lack of firm data in the three-paragraph release from the North Carolina Department of Health and Human Services has advocates, analysts and legislators again questioning how the accomplishment occurred.
Indiana's Medicaid experiment offers a conservative take on health reform
Indiana, which has a conservative Republican governor and Legislature, is pioneering an experiment that requires low-income patients to contribute monthly to a special health account. Charging poor people small premiums or fees for care — long favored by conservatives who contend that "skin in the game" engages patients in their health — has historically produced mixed results.
Ohio Medicaid plan would require enrollees to share in cost
About 1 million low-income Ohio residents could be required to pay a new monthly cost for Medicaid health coverage or potentially lose it under a Republican provision in the state budget, officials estimate.
The idea, which will require federal approval, was part of the $71.2 billion, two-year spending blueprint that Republican Gov. John Kasich signed recently.
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Covering poor immigrant children is first step, say California advocates
Kaiser Health News
The coverage under Medi-Cal, the state’s version of Medicaid, is expected to result in more preventive care and better long-term health for an estimated 170,000 children who have long relied on safety-net clinics and emergency rooms. But while many policymakers, advocates and researchers celebrated the budget deal announced by Gov. Jerry Brown, they also said the new coverage is limited because it doesn’t guarantee access to doctors and doesn’t include adults.
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Aetna to acquire Humana for $37 billion, combined entity to drive consumer-focused, high-value healthcare
Aetna and Humana Inc. announced that they have entered into a definitive agreement under which Aetna will acquire all outstanding shares of Humana for a combination of cash and stock valued at $37 billion or approximately $230 per Humana share based on the closing price of Aetna common shares on July 2, 2015.
The complementary combination brings together Humana’s growing Medicare Advantage business with Aetna’s diversified portfolio and commercial capabilities to create a company serving the most seniors in the Medicare Advantage program and the second-largest managed care company in the United States.
Centene to combine with Health Net in transaction valued at approximately $6.8 billion
Centene Corporation and Health Net, Inc. announced that the Boards of Directors of both companies have unanimously approved a definitive agreement under which Centene will acquire all of the shares of Health Net in a cash and stock transaction valued at approximately $6.8 billion, including the assumption of approximately $500 million of debt.
Centene is expected to continue to deliver attractive growth by offering a more comprehensive and scalable portfolio of innovative solutions focusing on uninsured and under-insured individuals, including participation in Medicare Advantage, TRICARE, and Veterans Affairs programs.
mhpa2015 registration now open!
MHPA via YouTube
Thanks to all of you who made our 2014 annual conference a smashing success. For a recap of the event, please watch this short video.
This year, we will examine Medicaid's 50-year evolution through thought-provoking sessions on the latest in managed healthcare operations, policies and populations, as well health plan best practices. Please visit our mhpa2015 home page for info on registration, lodging and sponsorships.
For more information, please contact Erin Liberatore via email or by phone at 202-857-5773.
July 15 Webinar Wednesday: 'Delivering Healthy NICU Outcomes through a Coordinated Model'
Many times, it's the most fragile members that use the most resources. ProgenyHealth addresses this by managing the care coordination delivered to infants admitted to the NICU. Join Jerry Lee, M.D., and Letitia Lieb, MHA, medical director and strategic business executive, respectively, for ProgenyHealth to discuss specialized population management in managed care that's expected to improve outcomes and save costs.
The webinar will preview some of the successes achieved through collaborative partnerships with providers, families and managed care plans. Specific findings will be discussed that address current NICU trends and variations in care.
July 29 Webinar Wednesday: 'Transforming Medicaid
Member Communications' (rescheduled from July 8)
Join Neng Bing Doh, CEO of HealthCrowd, for a presentation on how macro healthcare trends are requiring a transformation in Medicaid member communications. This webinar will cover current hot topics including how to scale text messaging programs to affect HEDIS scores, using multiple modalities "in concert" to improve member experience while optimizing outreach budget, the need to move away from transactional communications, and how to make each outreach campaign better than the last. Accompanied by case studies and even comics, this webinar will be one every health plan employee can derive value from.
Did you miss Webinar Wednesday: 'The New Frontier: Measuring Patient Engagement and Experience' by Avalere?
View and listen to the webinar recording.
For additional information, please contact Madeline Abram, visit www.avalere.com or follow Avalere on Twitter.
For copies of other past webinars, visit here.
Job opportunity: Vice president of marketing and sales | Chalfont, PA
Project Transition enables people with serious mental illness, co-occurring substance use disorder and/or a dual diagnoses of SMI and IDD live meaningful lives in the community on terms they define. This position is responsible for the planning, development, and implementation of marketing and sales strategies. View the complete job description.
To apply, please email your resume to Adorable Harper.
Job opportunity: Senior Medicaid Strategist | Raleigh-Durham, NC
North Carolina Department 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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