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Study: New Medicaid expansion could be a lifesaver
The Associated Press via The Wall Street Journal    Share    Share on FacebookTwitterShare on LinkedinE-mail article
States that expand their Medicaid programs under President Barack Obama's healthcare law may end up saving thousands of lives, a recently released medical journal report indicates. Until now, the Medicaid debate has been about budgets and states' rights. But a statistical study by Harvard researchers in the New England Journal of Medicine found a 6 percent drop in the adult death rate in Arizona, Maine and New York, three states that have recently expanded coverage for low-income residents along the general lines of the federal healthcare law. The study found that for every 176 adults covered under expanded Medicaid, one death per year would be prevented. More

13 states cut Medicaid to balance budgets
USA Today/Kaiser Health News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Thirteen states are moving to cut Medicaid by reducing benefits, paying health providers less or tightening eligibility, even as the federal government prepares to expand the insurance program for the poor to as many as 17 million more people. States routinely trim the program as tough times drive up enrollment and costs. But the latest reductions — which follow more extensive cuts last year — threaten to limit access to care for some of its 60 million recipients. More

MHPA submits comments on modified adjusted gross income conversion
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
MHPA offered comments July 23 on the CMS document, "Conversion of Net Income Standards to Equivalent Modified Adjusted Gross Income Standards and Solicitation of Public Input." Given that the chosen conversion methodology could affect Medicaid eligibility levels and beneficiary access to benefits and coordinated care of Medicaid health plans, MHPA's comments focus on state flexibility, eligibility levels, methodologies for different populations and clarification of a timeline. Click here to read the full letter.

Obama, insurers join to cut healthcare fraud
The New York Times    Share    Share on FacebookTwitterShare on LinkedinE-mail article
President Barack Obama and health insurance executives plan to announce a new joint effort to crack down on healthcare fraud by sharing and comparing claims data, administration officials say. The collaboration represents something of a turnabout for Obama, who in the last three years often has denounced "abuses by the insurance industry." The White House is now enlisting some of the same companies to help ferret out fraud. More

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Commonwealth of Virginia awards fraud and abuse detection contract to HMS
Business Wire via iStockAnalyst    Share    Share on FacebookTwitterShare on LinkedinE-mail article
HMS, a wholly owned subsidiary of HMS Holdings Corp., announced that it has been awarded a contract by the Commonwealth of Virginia, Department of Medical Assistance Services, to provide a customized Medicaid Fraud and Abuse Detection System to detect fraud, waste and abuse through data modeling algorithms that analyze claims and provider behavior. The contract runs for one year and includes two one-year renewal options. More

TriZetto enables BlueCross BlueShield of Tennessee to implement payment bundling with orthopedic groups
Business Wire via Enhanced Online News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The TriZetto Group Inc. announced that it has engaged with BlueCross BlueShield of Tennessee as a strategic advisor and technology partner to collaborate with four of the state's leading orthopedic practices to define and standardize best practices in medical care that health plan members should receive before, during and after total knee and hip replacements. The participating practices are Vanderbilt Medical Group and Tennessee Orthopaedic Alliance in Nashville; Campbell Clinic in Memphis; and the Knoxville Orthopaedic Clinic. More

CBO assumes Medicaid expansion flexibility in updated ACA analysis    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The Congressional Budget Office in its updated cost projections for the health reform law's coverage expansion appears to assume that HHS will let states expand Medicaid below 138 percent of the federal poverty level and still qualify for the law's higher match rate, Washington insiders tell Inside Health Policy, broaching a question that state Medicaid directors and many governors have posed to the administration but one which HHS officially has not answered. More

Blocking Medicaid expansion may burden Pennsylvania's hospitals
Pittsburgh Post-Gazette via Pharmacy Choice    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Philadelphia blog has suggested that if Pennsylvania decides not to expand Medicaid eligibility in 2014 under the federal health overhaul, it "could kill Pennsylvania's hospitals." Pennsylvania's hospitals don't necessarily agree with that grim assessment, but make no mistake, the stakes are high. "Would it be devastating financially? Yes," said Paula Bussard, senior vice president for policy and regulatory services at the Hospital and Healthsystem Association of Pennsylvania, the statewide hospital association. More

Timeline delineates California duals project tasks
California Healthline    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The California Department of Health Care Services has released a timeline of deadlines and target dates for its Coordinated Care Initiative, also known as the duals demonstration project. Eventually, the duals project hopes to move about 1 million Californians dually eligible for Medi-Cal and Medicare benefits into Medi-Cal managed care plans. The idea, state officials have said, is to provide better, more integrated care by pooling the funding sources from two disparate programs. The pilot program in eight counties, beginning in March 2013, will serve about 700,000 of the state's dual eligibles. More

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GOP governors press CMS for answers on Medicaid, exchanges    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Republican Governors Association Chairman and Virginia Gov. Bob McDonnell wrote a second letter to HHS seeking answers to questions about the health law's Medicaid expansion and the implementation of exchanges, saying a two-page response CMS Acting Administrator Marilyn Tavenner provided to the governors' first letter was "cordial but vague." During the National Governors Association Annual Meeting earlier this month, McDonnell said CMS' response was "very disappointing," and that he would be sending a follow-up letter. More

Missouri governor expects legislators to tackle Medicaid expansion, health insurance exchange in 2013
St. Louis Beacon    Share    Share on FacebookTwitterShare on LinkedinE-mail article
As he keeps his options open, Missouri Gov. Jay Nixon said that he expects it will be next winter — after the general election ends and the next legislative session begins — before the General Assembly is ready to address two key healthcare issues: whether to expand the state's Medicaid rolls or set up an exchange for the uninsured to buy insurance. Both actions are part of the federal Affordable Care Act, generally upheld last month by the U.S. Supreme Court. More

Two-thirds of Medicaid patients adherent to chronic meds
HealthDay News via Chemotherapy Advisor    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Based on a Medicaid claims model, among New York City Medicaid participants, adherence to chronic medications is inadequate, with considerable racial disparities noted. Dr. Kelly A. Kyanko of the New York University School of Medicine and colleagues retrospectively analyzed New York State Medicaid claims data from 2008–2009 to describe the rates and predictors of medication adherence. The medication possession ratio was used to measure adherence for Medicaid patients in New York City with dyslipidemia, diabetes, or hypertension. More

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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.

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
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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.

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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