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Arizona's handling of 'dual eligible' healthcare patients gets high marks
Cronkite News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Arizona's system for providing medical care for "dual eligible" people — those who qualify for both Medicare and Medicaid services — was praised as a promising model for other states at a Senate hearing Wednesday. Tom Betlach, director of the Arizona Health Care Cost Containment System, told lawmakers that the state's system of Medicaid managed care for dual-eligibles has saved money and improved care for the "frailest members most in need of care coordination." More



Hill panel debates managing care for dual eligible seniors
Forbes    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Everybody wants to do a better job coordinating care for the frail elderly and younger adults with disabilities who have extensive medical and personal care needs. But just how to do it is becoming increasingly controversial — especially on Capitol Hill. The current flashpoint is an aggressive new Obama administration initiative aimed at improving care and cutting costs for those who are very poor and very sick. There are 9 million of these so-called dual eligibles receiving benefits through both Medicare and Medicaid. More

Integrated managed care model for dual eligibles reduces readmissions
Health Affairs Blog    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The June issue of Health Affairs raised important questions about the current effort by states and the federal government to enroll individuals eligible for both Medicare and Medicaid into managed care, citing states' and plans' lack of experience in delivering integrated care to this vulnerable, complex population. Despite growing enrollment in Medicare Advantage and Medicaid managed care across states, researchers remind us that, according to 2011 MedPAC estimates, less than 2 percent of dual eligibles are enrolled in some type of integrated care program that coordinates at least some services across Medicare and Medicaid. Policymakers stand to benefit from taking a closer look at the models of care and outcomes of plans that already offer this type of integration. More

States saying no to 'Obamacare' could see downside
The Associated Press via Yahoo News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
For Gov. Rick Perry, saying "no" to the federal healthcare law also could mean turning away up to 1.3 million Texans, nearly half the uninsured people who could be newly eligible for coverage in his state. Gov. Chris Christie not only would be saying "no" to President Barack Obama, but to as many as 245,000 uninsured New Jersey residents as well. States that reject the law's Medicaid expansion risk leaving behind many of their low-income uninsured residents in a coverage gap already being called the new "doughnut hole" — a reference to a Medicare gap faced by seniors. More

Once focus of health law, some in poverty may be left out
Kaiser Health News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Ashley Tagert didn't know her family might gain health coverage from the health law — or that the Supreme Court decision could wipe that away. Tagert, 28, and her husband live in Pearl, Miss., just east of Jackson, on the $2,224 a month that her husband earns as a mechanic. It's too little, she says, to buy health insurance. A lifelong migraine sufferer, Tagert has ended up in hospital emergency rooms several times because she couldn't afford $200 a month for medication that helps ward them off. Just one trip to the emergency room left Tagert $10,000 in debt, helping propel Tagert, her husband and three children into bankruptcy. Families like Tagert's were among those that Democrats targeted in the 2010 health overhaul. More

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GOP attacks on health law's subsidies could backfire on Medicaid
The Hill    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Conservatives' attacks on the central pillar of President Barack Obama's healthcare law could come with an unintended consequence: locking Republican governors into Medicaid requirements they strongly oppose. Many conservatives believe one of the best ways to weaken the Affordable Care Act is to challenge the subsidies it provides to help people buy insurance. If their view of the law starts to succeed, it could be a major threat to the law's effectiveness. But it also could be a major threat to Republican governors who want to escape Medicaid requirements they say are "unconscionable." More

Bill Frist calls for GOP to get over opposition to healthcare law
Los Angeles Times    Share    Share on FacebookTwitterShare on LinkedinE-mail article
As Republicans continue to fight implementation of President Barack Obama's healthcare law, one former party leader is urging them to get over it and embrace a central pillar of the new law. In an op-ed published Wednesday in "The Week," a weekly news magazine, former Senate Majority Leader Bill Frist, a surgeon from Tennessee, said state leaders in both parties should quickly move to establish state-based insurance exchanges where consumers who don't get insurance through an employer will be able to shop for health insurance plans. More

Gloomy forecast for states, even if economy rebounds
The New York Times    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The fiscal crisis for states will persist long after the economy rebounds as they confront rising healthcare costs, underfunded pensions, ignored infrastructure needs, eroding revenues and expected federal budget cuts, according to a report issued in Washington by a task force of respected budget experts. The problems facing states often are masked by lax budget laws and opaque accounting practices, according to the report, an independent analysis of six large states released by the State Budget Crisis Task Force. It said that the financial collapse of 2008, which caused the most serious fiscal crisis for states since the Great Depression, exposed deep-set financial challenges that will worsen if no action is taken. More

Arkansas: Medicaid expansion saves $372 million
The Washington Post    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Governors' gripes about the Medicaid expansion almost always have to do with the price tag. Texas Gov. Rick Perry, a Republican, says the program will "bankrupt" his state. Montana Gov. Gary Schweitzer, a Democrat, says his state can't "just print money" to make it work. That's not, however, what is coming out of Arkansas: Officials there estimate that the Medicaid expansion would save the state $372 million in the first six years. More



Arkansas governor: Lawmaker OK needed on expanding Medicaid
The Associated Press via KATV-TV    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Arkansas Gov. Mike Beebe says it'll ultimately be up to a super-majority of the state Legislature whether to go forward with an expansion of Medicaid under the federal healthcare law. Beebe told reporters that he's leaning toward proceeding with expanding Medicaid eligibility, especially after the Department of Human Services said that the expansion would save $372 million for the state over the next several years. More

Maine debate hints at rift on Medicaid after ruling
The New York Times    Share    Share on FacebookTwitterShare on LinkedinE-mail article
As some Republican governors declare that they will not expand Medicaid under the national healthcare law, Maine Gov. Paul R. LePage is going a step further. In what could lead to a direct confrontation with the Obama administration, he is planning to cut thousands of people from Maine's Medicaid rolls, arguing that the recent Supreme Court ruling on the law gives him license to do so. More

Florida insurance officials getting healthcare update in wake of court ruling
The Associated Press via The Republic    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Florida insurance officials are getting an update on healthcare coverage following the U.S. Supreme Court's landmark ruling that upheld the federal Affordable Care Act. The Florida Health Insurance Industry Advisory Board and the state Office of Insurance Regulation's joint meeting agenda includes presentations from a statewide association representing private health insurance companies, the state agency that oversees Florida's Medicaid program and the conservative Heritage Foundation. More

Virginia AG wants state to opt out of Medicaid expansion
The Washington Post    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Attorney General Ken Cuccinelli wants Virginia to opt of the new federal health law's Medicaid expansion. "I do not think we should get into the expansion," Cuccinelli said in an interview. "If I were the governor, I would not seek the expansion." Gov. Bob McDonnell told legislators that he was considering opting out, but he needed more information from the federal government. He said the same thing while hosting the National Governors Association during the weekend in Williamsburg, where other governors expressed similar reservations. 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.


HMS, OMIG collaboration with provider results in $3.1 million RAC recoveries
Pharmacy Choice    Share    Share on FacebookTwitterShare on LinkedinE-mail article
HMS, a wholly owned subsidiary of HMS Holdings Corp., announced that it has achieved $3.1 million in Medicaid recovery audit contractor recoveries through collaboration with New York State's Office of the Medicaid Inspector General and a corporate provider. Using a process that compares commercial carrier paid claim data to Medicaid paid claim records, HMS identified a potential systemic coordination of benefits issue with Medicaid billings within one of the provider's facilities. More

Briefing: Community Health Centers: Can They Plug the Gaps in the Safety Net?
Alliance for Health Reform    Share    Share on FacebookTwitterShare on LinkedinE-mail article
WHEN: 10:15 a.m. to noon EDT July 23 (Lunch available at 11:45)
WHERE: Caucus Room, Cannon House Office Building
RSVP: By noon July 20

Community health centers play a critical role in providing care to vulnerable populations, especially at a time when employer-sponsored coverage has declined and the demand for safety-net services has gone up. Currently, there are more than 1,100 community health centers providing care to approximately 20.2 million people in every state across the U.S.

Who do community health centers currently serve and how will this change as the health reform law plays out? How are CHCs faring in the current economic environment? Is there sufficient federal oversight of their operations? How are states and safety-net systems planning for 2014 and the challenges and opportunities presented under the ACA? What will be the impact of scheduled cuts to discretionary programs under the Budget Control Act of 2011 (the sequester)?

To address these questions and more, the Alliance for Health Reform and the Centene Corporation are sponsoring a luncheon briefing July 23. Speakers will be: Laurie Felland, Center for Studying Health System Change; David Stevens, NACHC Quality Center; Henry Taylor, Miles Square Health Center, Ill.; and Steven Shattls, Valley Health Systems, W.Va. Helen Bryson of Centene and Ed Howard of the Alliance will co-moderate. To register now, please click here.


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Insights webinar: State Oversight in the Medicare and Medicaid Arenas: The Different Impact of Federal Preemption in Each Program and Potential Changes in the Years Ahead | 11 a.m. EDT July 30
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
State regulators play crucial roles in oversight of plans operating in both the Medicaid managed care and Medicare managed care environments, but the scope of regulatory oversight is very different, based on the express federal preemption that applies to Medicare plans, but not to Medicaid plans.
  • The webinar first will review preemption under federal Medicare law and look at recent pushback against this preemption by state regulators and the implication for Medicare plans.
  • We'll next examine the role of conflict preemption in the Medicaid program. While there is no express preemption in Medicaid law, courts in recent years have invalidated some state statutes and regulations because they conflict with federal Medicaid laws.
  • The webinar will conclude with a discussion of the limits on federal power in Medicaid arising from the U.S. Supreme Court's opinion on the Affordable Care Act and a preliminary discussion of the opinion's implications.
Register here.


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: webinars@veriskhealth.com. Register here.

Insights webinar: 'How Can We Get Risk-Based Capital Relief' by Summit Reinsurance Services Inc. | 11 a.m. EDT Aug. 13
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Medicaid enrollment is expected to grow by an estimated 14 million to 16 million lives due to the expanded Medicaid eligibility provisions of the Patient Protection and Affordable Care Act. As a result, many Medicaid health plans have legitimate concerns about meeting risk-based capital requirements. Summit Reinsurance Services Inc. will be presenting information on quota-share reinsurance solutions for risk-based capital relief. Click here to register.

Free webinar from MHPA partner Verizon: Fraud Waste and Abuse — The Next Generation | 2 p.m. EDT Sept. 12
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Understanding the patterns of fraud, where to find it, how to detect, and when to act. The old pay-and-chase model of fraud management is inefficient and costly. Connie Schweyen, Debra Faulkner, MBA, MHA; and David Botsko, Ph.D., CFE, managing principals at Verizon Connected Healthcare, will show you how to catch crime before it happens and how a near real-time fraud management solution can ensure near-time results. More



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 tpowers@healthcare-conferences.com. More

MHPA on Twitter, LinkedIn and Facebook
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