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Corker Presses HHS for duals demo update as stakeholders await MOU    Share    Share on FacebookTwitterShare on LinkedinE-mail article
U.S. Sen. Bob Corker, R-Tenn., wants the Department of Health and Human Services to be more open and responsive as it tweaks individual states' proposals for the highly anticipated dual eligible demonstration that aligns Medicare and Medicaid financing. "In the absence of timely responses to inquiries from the states and clear guidance regarding key policy decisions, (e.g., supplemental hospital payments), I am concerned that CMS may not be able to negotiate agreements which will adequately support states' requirements to achieve better care at lower cost," the top Republican on the Senate Aging Committee wrote in an Aug. 13 letter to HHS Secretary Kathleen Sebelius. More

Budget cuts more risky to states than healthcare law
Reuters    Share    Share on FacebookTwitterShare on LinkedinE-mail article
When it comes to healthcare, Congressional attempts to reduce the federal budget deficit pose a greater risk to U.S. states' finances than an expansion of the insurance program for the poor known as Medicaid, Moody's Investors Service said. In June, the Supreme Court struck down part of the 2009 healthcare reform law compelling states to cover more people with Medicaid, and many conservative governors embraced the decision as a way to opt out of the expansion. "States that opt into the expansion of Medicaid under the new law will have greater exposure to the potential risks that will come with efforts to trim federal spending," said Moody's Senior Vice President Kenneth Kurtz in a statement. "The extent of any effects on ratings will depend on how states respond to underlying cost drivers, including any new federal actions." More

Arkansas, Oklahoma say expanding Medicaid would save them millions    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Arkansas and Oklahoma say expanding Medicaid would save their states hundreds of millions of dollars over 10 years, and proponents of the Affordable Care Act are presenting those state analyses as evidence that the Medicaid expansion isn't as expensive as some states claim. The Urban Institute recently estimated that 21 to 45 states would save money by expanding Medicaid. The states' analyses also offer details of how the price of Medicaid expansion varies among states. Neither of the states were among those that sued over the Affordable Care Act's Medicaid expansion or individual mandate. More

West Virginia Health Information Network launches statewide health information exchange with Truven Health Analytics
EMR Daily News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The West Virginia Health Information Network and Truven Health Analytics have announced the launch of a statewide health information exchange system within West Virginia. Working with early adopters across Medicaid, Public Health and provider networks, Wheeling Hospitals and West Virginia University Healthcare were selected to be the pilot sites. The WVHIN launches with the ability to access clinical information on more than 2.1 million patients including lab results (37 million distinct results), diagnosis history (96 million diagnoses), allergies (2.4 million), and patient visit history (88 million distinct patient visits over last 6 years). More

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Officials plan for transition to KanCare
Kansas Health Institute    Share    Share on FacebookTwitterShare on LinkedinE-mail article
State officials and health insurance providers promised a smooth transition into KanCare, the proposed overhaul of Kansas' $2.9 billion Medicaid program. "There is nothing simple about Medicaid," said Joe Ewert, commissioner of survey and certification with the Kansas Department for Aging and Disability Services. But he and officials from the three health insurance companies signed by the state to administer the Medicaid program said providers would receive timely payments and beneficiaries would continue to receive services for which they were eligible. More

Feds still reviewing NH Medicaid care management plan
Foster's Daily Democrat    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Federal healthcare regulators still are evaluating New Hampshire's proposal to implement a new care management system for Medicaid beneficiaries. Launching the new system will require a waiver from the Centers for Medicare & Medicaid Services. Under the new system, the state would pay three managed care organizations a monthly sum for each Medicaid client they enroll, and the companies would determine how to use the money to provide services within a budget. Most states have implemented some form of care management for Medicaid recipients, but New Hampshire's system would set a precedent by shifting long-term care for the elderly and people with disabilities under a care management system. More

Formal review sought for Pennsylvania's Medicaid proposal
Pharmacy Choice    Share    Share on FacebookTwitterShare on LinkedinE-mail article
A formal review of a proposal to change eligibility requirements for the poor and disabled receiving state Medicaid services is being sought by two ranking House lawmakers and several advocacy groups. Pennsylvania's Department of Public Welfare wants to implement the changes Sept. 1 to an existing assessment done by physicians or healthcare practitioners that determines whether individuals receiving or seeking medical assistance are employable or not. A determination that someone can hold a job would mean they are not eligible for medical assistance, observers said. More

UnitedHealthcare donates 3,500 backpacks to help Washington students get ready for school
Business Wire via Seeking Alpha    Share    Share on FacebookTwitterShare on LinkedinE-mail article
UnitedHealthcare is donating 3,500 backpacks to community organizations in economically disadvantaged neighborhoods across Washington. Volunteers from Victory Outreach Church in Seattle handed out backpacks containing essential school supplies provided by UnitedHealthcare — part of a statewide effort that will put 3,500 backpacks in the hands of children as they prepare for the new school year. More

UNMC report details what Medicaid expansion would mean in Nebraska
UNMC via Pharmacy Choice    Share    Share on FacebookTwitterShare on LinkedinE-mail article
A report by the University of Nebraska Medical Center says expansion of Nebraska's Medicaid program under the Affordable Care Act would bring in at least $2.9 billion in revenue from the federal government by 2020. Expansion of Nebraska's Medicaid program under the ACA would bring in at least $2.9 billion in revenue from the federal government by 2020, potentially finance more than 10,000 ongoing jobs, and reduce charity care by $650 million from 2014-2019, the report indicates. More

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Medicaid expansion will cut North Carolina uninsured by 64 percent
North Carolina Justice Center via Insurance News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The Medicaid expansion under the Affordable Care Act will extend insurance coverage to more than half a million North Carolinians, while also saving the state and its taxpayers billions of dollars, according to a new report. With the implementation of health reform, the first year of the Medicaid expansion alone is expected to reduce the number of uninsured people in North Carolina by 64 percent, said a new report from the Budget and Tax Center, a project of the North Carolina Justice Center, with the number moving from 1.3 million uninsured individuals in 2013 to 475,185 in 2014. More

Commonwealth of Virginia awards Medicaid Recovery Audit Contractor contract to HMS
Business Wire via Yahoo Finance    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 serve as the Commonwealth's Medicaid Recovery Audit Contractor. Under the terms of this contract, HMS will audit in-state and out-of-state providers participating in the Virginia Medicaid program to identify underpayments and overpayments for all claims paid under the Medicaid and CHIP programs. More

Expand Medicaid, save money for Virginia
The Free Lance-Star    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Lost in the debate over the cost of extending health insurance to more than 400,000 Virginians through Medicaid is the reality that doing so would actually save money in other ways, improve overall public health, and save lives. Three recent studies, including one conducted by Virginia Commonwealth University-Richmond, provide strong evidence that the benefits of insuring more people far outweigh the costs. More

QualChoice Health Insurance chooses TriZetto's payment-bundling solution to help improve cost, quality of care for members
Business Wire via    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The TriZetto Group Inc. announced that QualChoice Health Insurance, Arkansas' second-largest managed care company, is using TriZetto software to administer episode-based payments to physicians who provide cardiac stents, perinatal care and hip and knee replacements for its group and individual health plan members. Under the new payment model, physicians and facilities will share cost savings or incur performance penalties, based on how well they complete episodes of care at appropriate cost and quality levels. More

Human Arc acquires L&S Associates, becomes nation's 2nd largest privately held eligibility firm
Marketwire via MarketWatch    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Human Arc, a leader in reimbursement and revenue enhancement services for hospitals and health plans across the U.S., has acquired L&S Associates of Lansing, Mich, a supplier of Medicaid eligibility enrollment services to Michigan hospitals, and its DCS division provides Supplemental Security Income and Social Security Disability Income enrollment services to qualified patients. The acquisition doubles Human Arc's capacity to provide Medicaid and other program screening and enrollment services, making the company the nation's second largest privately held eligibility services firm. More

Studies question medical rewards to doctors, hospitals
The Boston Globe    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Programs that reward doctors and hospitals for hitting certain quality targets are being rolled out in Massachusetts and across the country. A major focus of the healthcare law signed by Massachusetts Gov. Deval Patrick is that doctors should be paid for keeping patients healthy rather than for the volume of tests or treatments they order. Yet, several recent publications question whether pay-for-performance systems actually lead to better care for patients. A review of seven studies of primary care programs that paid doctors extra for meeting certain targets, published by the Cochrane Collaboration in September, was inconclusive about the effect on quality of care. More

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2012-2013 Best Practices Compendium submissions deadline is tomorrow, Aug. 24
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Click here for details.

Register online today for MHPA's 2012 Annual Meeting
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Register online for the MHPA 2012 Annual Meeting in October at the Hyatt Regency Washington on Capitol Hill in Washington, D.C. The pre-conference "Developments in the States" will run from noon to 6 p.m. Oct. 24 and will feature state Medicaid directors and leadership from Michigan and Florida health plan associations who will discuss current trends and what's in store for Medicaid health plans at the state level. The main event, "A Pivotal Time for Medicaid Health Plans," kicks off Oct. 25, just two weeks before Americans vote in a presidential election that, with the addition of Wisconsin Congressman Paul Ryan to the Republican ticket, will decide the future of Medicaid. For meeting details, including travel/lodging info and agendas, click here. Remember: Sign up before Aug. 31 to take advantage of the early-bird discounts on both conference and pre-conference fees. Register online from your PC or PDA here.

Insights webinar: Reduce Outsourcing Risk scheduled for Aug. 27 has been postponed. New date TBD.

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Free webinar: Making the Business Case — Fundamentals, Opportunities and Risks for Health Plans Considering the Dual Eligible Market | 1 p.m. EDT Aug. 29
Sellers Dorsey    Share    Share on FacebookTwitterShare on LinkedinE-mail article
This webinar by MHPA partner Sellers Dorsey will examine the opportunities and potential risks for Medicaid health plans to manage the duals population. Health plan execs will learn the crucial external and internal points that influence their decisions such as market size, provider capacity, ROI, provider contracting constructs, compliance risk and capacity for clinical integration. Presenters: Mike Fox, senior consultant, is a leading expert in major Medicaid managed-care expansion, oversight, contract and rate development. Having both state Medicaid agency and health plan experience, he offers a deep understanding of managed care policy, operations and business development. Also, Kip Piper, senior consultant, is a top expert in Medicaid, Medicare and health reform. Kip advises health plans, hospitals and health systems, state Medicaid agencies, drug and device manufacturers, and investment firms. His experience includes senior adviser to the CMS administrator, head of Wisconsin Medicaid, state health commissioner and health plan executive. Click here to register.

Insights webinar: Evolving Toward a New Model of Care | 11 a.m. EDT Sept. 10
Daiichi Sankyo Inc.    Share    Share on FacebookTwitterShare on LinkedinE-mail article
This presentation reviews the challenges that PCPs face, case studies where PCMH has been undertaken, and barriers/challenges associated with its implementation. More

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

Free webinar by MHPA partner Baxter: Importance of Coordinated Care in the Management of Members with Hemophilia | 11 a.m. EDT | Sept. 18
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
This webinar is focused on coordinating care in hemophilia, improve outcomes and reduce costs. Best practice coordination of care includes the plan's relationship with the patient, specialty pharmacy, and hemophilia treatment centers. A managed Medicaid plan will discuss management of hemophilia patients through working with the state as well as outcomes associated with care through a specialty pharmacy. A hemophilia physician will discuss the uniqueness of coordinated care through the hemophilia treatment center and demonstrated outcomes. More

Reaching, Retaining, and Serving Dual Eligible Beneficiaries | Sept. 19-20
Healthcare Education Associates    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Explore effective marketing, outreach and engagement for Medicare/Medicaid dual eligibles. Healthcare Education Associates and the Risk Adjustment Initiative & Society for Education are pleased to present the Reaching, Retaining, and Serving Dual Eligible Beneficiaries Summit, slated for Sept. 19-20 in Scottsdale, Ariz. This groundbreaking two-day intensive event designed to tackle the unique challenges of marketing and outreach to the dual eligible population, will feature MHPA President and CEO Thomas Johnson as a guest speaker. MHPA members get 15 percent off registration by using Priority Code: HMP122. Call Theresa Powers at 704-341-2437 or register online here.

Free webinar by MHPA partner LexisNexis: Why Identity Management Matters to Medicaid | 1 p.m. EST Nov. 8
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
As a Medicaid Plan you should not just be addressing the "what" of identity management — the technical side — but, more important, the question of "who?" How do we know who the person on the other end is who they say they are and what risks they may pose for the environments and systems they are attempting to enter. More

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