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Reuters
Hundreds of medical providers banned from a Medicaid program in one state are able to take part in another state's program despite regulations designed to stop them, according to a report by an independent federal auditor released on Wednesday. The study also found that half of the states were unable to terminate providers enrolled in Medicaid managed care programs. CMS said it supports a requirement for states to screen providers in Medicaid managed care programs and a recommendation that CMS tell states to terminate providers banned by other states even if the provider still has a medical license.
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National Journal
Given Donald Trump's inflammatory rhetoric about undocumented immigrants, the outrage over Planned Parenthood, and President Barack Obama's freshly inked nuclear deal with Iran, the Republican presidential contenders won't lack for material at their first debate Thursday in Cleveland.
The decidedly less sexy yet potentially explosive topic of entitlement reform could also be on the agenda. It presents candidates with the opportunity to distinguish themselves from the fracas with a serious-minded policy discussion, but it also could make them vulnerable to attacks, from their GOP peers or Democrats, if they're seen as advocating a drastic overhaul of America's most beloved government programs.
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Inside Health Policy (Subscription required)
CMS is making it easier for states to renew traditional Medicaid demonstrations, according to a recent letter to Medicaid directors, but the types of demonstrations that are more important to many states are not covered by the so-called fast-track policy.
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AmeriHealth Caritas
AmeriHealth Caritas, a national leader in Medicaid managed care and other integrated health care solutions, announced that it is hosting a full-day forum at the Newseum in Washington, D.C., to commemorate the 50th anniversary of the signing of Medicaid into law and to discuss the creation of a new healthcare paradigm for the next generation. The forum provides a unique opportunity for open, engaging and diverse discussion from noted experts with the participation of more than 160 thought leaders from the healthcare industry, government, business and academia.
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The Associated Press via The Charlotte Observer
There's some small movement in the state Senate over two key policy differences with the House, a development that could help the North Carolina General Assembly wrap up this year's work session. Senate Rules Committee Chairman Tom Apodaca of Hendersonville, North Carolina, on Tuesday shifted House bills on economic recruitment incentives and overhauling Medicaid from committees where they seemingly were sent to die to new committees.
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Complex Clinical Reviews. Dependent Audits. And More.
Contact HMS today!
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Montgomery Advertiser
The House will have a General Fund budget to consider. But members may have to think through their votes. In the climax of an exceptionally tense day, the House Ways and Means General Fund committee Tuesday approved a General Fund budget that chairman Steve Clouse said would strip $156 million from the state's Medicaid program, a program that even the sponsor of the budget calls the "foundation" of healthcare in Alabama.
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The Dallas Morning News
Even as they left nearly $18 billion unspent, Texas lawmakers ordered a $350 million cut this year to Medicaid pay for therapists who perform one of health care’s most exacting jobs. In a two-year budget that was flush enough to trim taxes and triple state spending on border security, the legislature told Medicaid officials to slash nearly a quarter of the $1.4 billion they shell out for acute care — or outpatient — therapy.
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The Associated Press via KTHV-TV
Gov. Asa Hutchinson says Arkansas is suspending a push to terminate coverage for thousands on Medicaid as the state addresses a backlog of responses from recipients trying to verify their incomes. The Republican governor on Tuesday said the state won't send any more termination notices over the next two weeks. Notices have already gone out to thousands who haven't responded to efforts to verify their incomes. The state has already terminated coverage for more than 35,000 people, most of who were on Arkansas' compromise Medicaid expansion.
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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.
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MHPA
We are pleased to announce that we are now accepting submissions from member plans that highlight best practices for Medicaid and CHIP beneficiaries. The Center for Best Practices Advisory Committee will review submissions for potential inclusion in the 2015-2016 MHPA Best Practices Compendium that will be published in November 2015. Additionally, the selected best practices will be honored during the MHPA annual conference luncheon.
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MHPA
Download the presentation (PDF).
To request a copy of the presentation or for additional information please contact Nicholas Rebholz, or visit www.janssenhealthcareinnovation.com.
For copies of other past webinars, visit here.
MTM
Home and community-based services (HCBS) can help waiver populations and other special needs members with costly chronic health conditions avoid expensive long-term care and reduce readmissions — but coordinating these services can be a daunting task for case managers. As a service coordinator, MTM partners with health plan case managers to relieve the burden of coordinating disparate provider networks. MTM created a comprehensive solution that offers high-quality network building, credentialing and monitoring; continuous performance tracking and trending; and consolidated claims adjudication and payment, including 100 percent claims verification.
In this webinar, MTM Vice President of Client Services Aaron Crowell will demonstrate how the organization's HCBS coordination model can help solve health plans’ biggest challenges in connecting members to nonclinical care. Additionally, Vice President of Field Health Services Cindi Scollins with WellCare — one of MTM's HCBS clients — will discuss how this model has benefited members using innovative services like equine therapy in the Florida market.
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LexisNexis Health Care
Member information, demographic or other is at the heart of every health plan's operations. Unfortunately, this information is often siloed, incomplete or completely unavailable. This is particularly true for minor populations and the "underbanked" or those with little to no credit fingerprint against which information can be verified or gathered.
Please join Albert Gimbel, senior director of product management for LexisNexis Health Care, and explore the challenges with member demographic data and, more important, what payers can employ to solve the data challenge and ensure they have the information they need to locate, contact, engage and manage their member populations.
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MHPA
Market Access World and Evidence Congress held an interview with keynote speaker MHPA CEO Jeff Myers, the keynote speaker of Market Access World USA 2015, which is scheduled for Sept. 30 and Oct. 1 in Philadelphia. Listen to Myers discuss the future of patient access, current challenges the sector is facing and why he will be attending this year's congress.
Join the congress to examine:
- Innovative pricing strategies for high-value drugs
- How to overcome barriers to patient access
- How to adapt to the changing models of the payers globally
- How you can meet payers' expectations
- Securing reimbursement for personalized medicines
Book now using code BR01.
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Project Transition
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.
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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.
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Aetna
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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