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How the SCOTUS Medicaid ruling could save money
Kaiser Health News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The Supreme Court ruling on the healthcare law could have an unexpected effect — saving the federal government money, say some budget experts. The exact amount of savings is still unknown, because it depends on how many states decide not to expand their Medicaid programs, now that the court has said that they have a choice in the matter. Washington would save because it will provide the lion's share of funding for the jointly run program for the poor and disabled. The details won't become clear until the nonpartisan Congressional Budget Office weighs in the week of July 23 with estimates of how the court's ruling will affect federal spending. More

House Dem: Refusing Medicaid dollars a 'historic mistake'
The Hill    Share    Share on FacebookTwitterShare on LinkedinE-mail article
A House Democrat warned Virginia Gov. Bob McDonnell, a Republican, that refusing the healthcare reform law's Medicaid expansion will be a "costly and historic mistake." The Supreme Court's decision to uphold the law has touched off a fiercely partisan debate over whether to expand Medicaid. Many GOP governors have said they will refuse federal funds to expand the program because they worry that financial obligations to future beneficiaries will be too great. Among the governors threatening to do this is McDonnell, a possible vice presidential candidate for the GOP. More

MedPAC backs passive enrollment in duals demo despite reservations    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Congress' Medicare payment advisers wrote to CMS on Wednesday that they support letting states automatically enroll dual-eligible beneficiaries in duals demos as long as the "passive" enrollment meets certain conditions, a move coming just weeks after the advisers told lawmakers they had strong reservations with passive enrollment and as a key senator raised legal issues with the approach. The Medicare Payment Advisory Commission also told CMS that requirements for Medicare Advantage plans should set the minimum standard in the demos and that CMS should drop some states from the demos to keep the program at a more manageable size. More

Sebelius urges states to accept health law's Medicaid expansion
The Hill    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Health and Human Services Secretary Kathleen Sebelius urged governors Tuesday to participate in the Affordable Care Act's Medicaid expansion, which the Supreme Court said must be optional for states. Sebelius also announced a new round of meetings for state and federal officials to discuss implementation of President Barack Obama's healthcare law. Some conservative governors had been avoiding implementation until they knew how the Supreme Court would rule and eight, including most recently Republican Gov. Rick Perry of Texas, already have rejected the expansion. More

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Governors, state lawmakers may bump heads on Medicaid expansion    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Despite the focus on governors' positions on the reform law's now voluntary Medicaid expansion, state legislatures may have the chance to approve or deny the expansions and some believe that state Republican governors seeking attention on the national stage may run up against state lawmakers who are focused locally on the needs of those in their districts. Conversely, governors who have taken positions against the Medicaid expansion might seek cover from state legislatures to pass legislation expanding Medicaid if, as a result of the November elections, the law remains and the controversy over it recedes, sources say. More

Insights Webinar: Improving Member Retention/Reducing Churn | July 16
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Paul Frenkel and Lance Scott of Altegra Health present on most effective methods of outreaching to/communicating with Managed Medicaid members to ensure they remain enrolled in Medicaid and therefore stay enrolled in their plan. For more information and to register, click here.

House votes 244-185 to repeal healthcare
The Hill    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The House voted again Wednesday to repeal President Barack Obama's healthcare law, a largely symbolic gesture that gave Republicans some revenge against the Supreme Court ruling that declared the law constitutional. Republicans also see it as a way to motivate their base this fall as they fight to keep control of the lower chamber, win the Senate and take the White House. Members approved the repeal legislation on a 244-185 vote, after five hours of debate that stretched over two days. More

GOP governors put onus on administration to address coverage gap if states don't expand Medicaid    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Republican governors are telling President Barack Obama that it is incumbent upon the administration and drafters of the health reform law to specify how they will address the "significant gap in coverage" that likely will result for low-income individuals if a state opts out of the Medicaid expansion and therefore there are people who can't get Medicaid coverage and do not qualify for premium tax credits for private insurance, according to a July 10 letter from Republican Governors Association Chairman and Virginia Gov. Bob McDonnell. The RGA letter also asks if CMS will approve Medicaid block grants — which McDonnell refers to as "global waivers with an aggregate allotment, state flexibility and accountability" — if states are willing to do part of the expansion. More

Medicaid expansion likely to dominate National Governors Association meeting in Williamsburg
The Washington Post    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The National Governors Association kicks off its 104th annual meeting in Williamsburg, Va., on Friday — and already the state executives' reactions to the Supreme Court's healthcare ruling appear to be the main event. In the political hot seat this weekend likely will be those GOP governors who have yet to announce their positions on the issue — including Virginia Gov. Bob McDonnell, New Jersey Gov. Chris Christie and Georgia Gov. Nathan Deal. Some of those governors already are coming under pressure from Democrats in their home states to take part in the expansion. Rep. Gerry Connolly, D-Va., wrote a letter Wednesday to McDonnell arguing that opting out of the expansion would be "a costly and historic mistake." More

Health law would cost Texas less than forecast
The Associated Press via KTVT-TV    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The health and human services commissioner has cut his estimate of what the federal healthcare law would cost Texas by 42 percent. Tom Suehs estimated Thursday that if Texas fully implemented the law, it would cost Texas $15 billion to $16 billion over 10 years. That is down from his original estimate of $26 billion to $27 billion to expand Medicaid. But Gov. Rick Perry has said he will reject any attempt to expand Medicaid in Texas to provide nearly 2 million people with health insurance. More

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Minnesota governor makes plans for state to implement healthcare law
Star-Tribune    Share    Share on FacebookTwitterShare on LinkedinE-mail article
While some states are opting out of President Barack Obama's healthcare programs, Minnesota Gov. Mark Dayton wanted it known Tuesday that he's all-in. "I write to reiterate the State of Minnesota's intention to continue the planning and development" of a state-based version of the federal healthcare act, Dayton wrote in a letter to the U.S. secretary of Health and Human Services. "We will seize the historic opportunities to improve the quality and affordability of healthcare afforded us by the new law, known as the Patient Protection and Affordable Care Act, whose constitutionality has now been upheld by the U.S. Supreme Court." More

Federal agency asking about sharp drop in Pennsylvania's Medicaid rolls
Philadelphia Inquirer    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Pennsylvania has dropped tens of thousands of people from its Medicaid rolls since last summer — and now the Obama administration wants to know if the state wrongly cut off those benefits. The federal agency that oversees how states administer Medicaid sent a letter last month to the Department of Public Welfare saying initial data showed 130,000 people, including 89,000 children, had been dropped from state Medicaid rolls between August and January. More

Nebraska governor says state cannot afford Medicaid expansion
Reuters    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Nebraska Gov. Dave Heineman has said that the state cannot afford the expansion of the Medicaid program under President Barack Obama's healthcare law, but stopped short of saying whether the Midwestern state would join six others rejecting the expansion. Heineman, a Republican, said in a letter to senators Wednesday that the expansion would force Nebraska to cut funding for education. More

Altegra Health, First 'Third-Party Submitter'

Altegra Health is the first ‘Third-Party Submitter’ to receive certification in Encounter Data Front End Testing from the Centers for Medicare and Medicaid Services (CMS). This certification reflects our expertise in encounter reporting, risk adjustment analytics, and data management. Altegra Health continues to be a health care services leader.

Program Integrity Initiative Webcast on Fraud, Waste and Abuse | 2-3 p.m. EDT July 17
Health Resources and Services Administration    Share    Share on FacebookTwitterShare on LinkedinE-mail article
  • All organizations are at risk for fraud.
  • Fraud schemes come in all forms — fraudulent billings, unnecessary services or prescriptions, kickbacks, duplicate claims, etc.
  • Schemes target large healthcare programs — both public and private — as well as healthcare beneficiaries.
  • Schemes are committed by healthcare providers, owners of medical facilities and laboratories, suppliers of medical equipment, organized crime groups, corporations, and even sometimes by the beneficiaries themselves.


Capitol Hill Briefing on Serious Mental Illness and Medicaid Managed Care | July 18 | Washington, DC
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The MHPA Center for Best Practices is holding a briefing titled "Challenges in SMI, Solutions in Medicaid Managed Care," from 2-3:15 p.m. July 18 in the Rayburn House Office Building, Room 2218, Washington, D.C. More

Free webinar: A Coventry Health Care Story — How One Plan Built the Ultimate Cost-Containment Solution | 1-2 p.m. EDT July 25
Verisk Health    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Free webinar on how Coventry Health Care unveiled the next-generation of claims editing and fraud prevention solutions and improved their claims payment accuracy. Topics to be discussed include Prepayment Fraud Prevention; Real-Time Editing; and Clinical Validation. For more information: Register here.

Agenda available for MHPA's 2012 Annual Meeting | Oct. 24-26
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The agenda for the MHPA 2012 Annual Meeting at the Hyatt Regency Washington on Capitol Hill in Washington, D.C., is now online at MHPA’s website. The meeting agenda for A Pivotal Time for Medicaid Health Plans includes keynote speeches from Tim Engelhardt, director of models and demonstrations at the CMS Medicare-Medicaid Coordination Office; 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. Also read about our new pre-conference, "Developments in the States" as well as other informative sessions and presentations at this three-day event. View the full agenda and register here.

2012-2013 Best Practices Compendium submissions due by July 31
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Click here for details.

Job Opportunity: Supervisor of Advertising and Production at Health Partners (Philadelphia)
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
For more details and to apply online, click here.

2nd Annual Leadership Summit on Medicaid | July 24-25, Arlington, Va.
The World Congress    Share    Share on FacebookTwitterShare on LinkedinE-mail article
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, Fla.
Healthcare Education Associates    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Thomas Johnson, president and CEO of MHPA, participates as a faculty member of the 2012 Dual Eligibles Best Practices Summit. 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 More

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