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GAO slams Arkansas Medicaid expansion costs as HHS seeks to bring more states on board
Inside Health Policy
HHS officials said they don't have a limit on how many alternative Medicaid expansion proposals the department might approve to get more states on board, yet following their comments the Government Accountability Office criticized the department for not ensuring budget neutrality with Arkansas' expansion plan that served as a model for many states reluctant to pursue the traditional ACA option.
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Democrats borrow a GOP idea on healthcare costs
The Associated Press via The Washington Post
Borrowing a Republican idea, a group including former senior Obama and Clinton advisers, is unveiling a novel proposal to let states take the lead in controlling health costs. Individual states would set their own targets to curb the growth of healthcare spending. If they succeed, they'd pocket a share of federal Medicare and Medicaid savings, ranging from tens of millions to $1 billion or more, depending on the state.
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Burwell calls for end to Obamacare strife
The Hill
Health and Human Services Secretary Sylvia Burwell has called for an end to the strident partisan debates over Obamacare that have dominated U.S. politics for four years. In her first major public address, Burwell mounted a strong defense of the healthcare law, but described her mission as tamping down political controversy to focus on the rollout.
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Sept. 10 Webinar Wednesday: 'Under-capitated Plan Members in Medicaid Managed Care' by Human Arc
Human Arc
In many states, Medicaid managed care plans are capitated at higher rates for members with disabilities, due to typically higher medical costs. With several million people across the country potentially eligible for SSI or SSDI but not enrolled, plans often miss out on millions in revenue each year. Identifying members who are potentially disabled to address this revenue gap can be challenging.

Please join Human Arc to learn how to effectively identify and enroll (non-classified) disabled Medicaid health plan members in SSI/SSDI in an effort to secure capitation payments that more appropriately reflect actual health utilization.

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Virginia's Medicaid director joins mhpa2014 luncheon panel
MHPA
mhpa2014’s Day 2 luncheon session, "A Look at the Past, Present and Future of Medicaid Managed Care," will now feature state Medicaid directors from Kentucky, Louisiana, Tennessee and Virginia.

Join Sandi Hunt, a principal at PwC, as she moderates a lively discussion with Darin Gordon, director of TennCare, deputy commissioner, State of Tennessee, Department of Finance and Administration; Ruth Kennedy, Medicaid director, State of Louisiana Department of Health and Hospitals; Lawrence Kissner, commissioner, Department of Medicaid Services, Commonwealth of Kentucky, Cabinet for Health and Family Services; and Cindi B. Jones, director, Virginia Department of Medical Assistances Services.

For the full mhpa2014 agenda and registration info, please visit here.

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New lawsuit filed to block duals plan in California
California Healthline
Advocates for seniors filed a lawsuit in United States District Court in Los Angeles seeking an injunction to halt the Coordinated Care Initiative's duals demonstration project, known as Cal MediConnect. The project plans to move 456,000 seniors dually eligible for Medi-Cal and Medicare benefits into Medi-Cal managed care plans in eight California counties. That's roughly half of the state's population of 1.1 million dual-eligibles.
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CMS delays termination of MA, PDP plans with persistent low star ratings
Inside Health Policy
CMS is delaying for one year terminations of Medicare Advantage and prescription drug plans with persistent low performance ratings because it worries that the Star Ratings Program may disadvantage plans with unusually large numbers of poor enrollees, according to an agency memo. During the hiatus, CMS hopes to get help from insurers in determining whether the program does in fact unfairly penalize plans with a disproportionate share of enrollees who are dually eligible for Medicare and Medicaid or who qualify for the low-income subsidy.
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Drug Pricing News: A new service from InsideHealthPolicy.com
Inside Health Policy
Drug pricing policies have prompted a major fight among insurers, pharmacies, healthcare providers, drug makers, patient advocates and healthcare managers at the state and federal levels. The stakes are potentially huge, and you can't afford to miss a beat in the drug-pricing debate.

That's why InsideHealthPolicy.com has created Drug Pricing News — an email alert service on the latest news and developments in the fight over setting drug prices. Sign up for a free one-month trial to InsideHealthPolicy.com, and get access to Drug Pricing News.

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Pennsylvania, health industry preps for Medicaid expansion
The Associated Press via WHTM-TV
Lots of work will be required before hundreds of thousands of Pennsylvanians can enroll in new Medicaid-funded health insurance plans under Gov. Tom Corbett's Healthy PA program. The Corbett administration's executive Medicaid director, Lisa Allen, says she's pretty confident that enrollment can start Dec. 1, a month before coverage begins.
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With Medicaid expansion blocked, Virginia governor unveils modest plan to insure more Virginians
The Washington Post
Virginia Democratic Gov. Terry McAuliffe, who vowed in June to defy the Republican-controlled legislature and expand healthcare to 400,000 uninsured Virginians, unveiled a much more modest plan after being thwarted by federal rules and a last-minute change to state budget language. McAuliffe outlined measures to provide health insurance to as many as 25,000 Virginians, just a fraction of those he had hoped to cover by expanding Medicaid under the Affordable Care Act.
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Study: Rise in ER visits after Medicaid expansion
The Associated Press via The Washington Post
Many people newly insured by Medicaid under the federal healthcare law are seeking treatment in hospital emergency rooms, one of the most expensive medical settings, a recently released study concludes. The analysis by the Colorado Hospital Association provides a real-time glimpse at how the nation's newest social program is working.
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The Medicaid pay raise: Georgia Doctors finally got it, but soon may lose it
Georgia Health News
Several Georgia physicians have received their first pay raise in more than a decade this year for treating Medicaid patients. That increase, though, will disappear in January if the budget recommendation from the Georgia Department of Community Health to the governor and legislature holds up during the state's budget process.
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Replacing an ambulance with a station wagon
NPR and Kaiser Health News
When they get a call for medical help, most fire departments scramble both an ambulance and a fully-staffed fire truck. But that's way more than many people really need, says Rick Lewis, chief of emergency medical services at South Metro Fire Rescue Authority in the Denver suburbs.
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Study: US eating habits improve, except among poor
The Wall Street Journal (subscription required)
Americans' eating habits have improved — except among the poor, evidence of a widening wealth gap when it comes to diet. Yet even among wealthier adults, food choices remain far from ideal, a 12-year study found. On an index of healthy eating where a perfect score is 110, U.S. adults averaged just 40 points in 1999-2000, climbing steadily to 47 points in 2009-10, the study found.
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Rural enrollment presents continuing health law challenges
Kaiser Health News
Americans living in rural areas will be a key target as states and nonprofit groups strategize how to enroll more people in health law insurance plans this fall. Though millions of people signed up for private insurance or Medicaid in the first year of the Affordable Care Act, millions of others did not. Many live in rural areas where people "face more barriers," said Laurie Martin, a RAND Corp. senior policy researcher. Brock Slabach, a senior vice president at the National Rural Health Association, said the "feds are particularly concerned about this."
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Who's paying the new Obamacare tax? You
Kaiser Health News via USA Today
When Congress passed the Affordable Care Act, it required health insurers, hospitals, device makers and pharmaceutical companies to share in the cost because they would get a windfall of new, paying customers. But with an $8 billion tax on insurers due Sept. 30 — the first time the new tax is being collected — the industry is getting help from an unlikely source — taxpayers.

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Is the Republican fight against Medicaid expansion over?
Washington Examiner
The Republican fight against Medicaid expansion is far from over, but there are fewer opponents than there used to be. The expansion of the government health insurance program was originally supposed to be mandatory under the Affordable Care Act, but the Supreme Court made it optional as part of a landmark decision on the law in June of 2012. In the wake of the decision, Republican governors flocked to announce they were declining to expand coverage.

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23 states still haven't expanded Medicaid: Which could be next?
The Washington Post
The recent announcement that Pennsylvania will expand its Medicaid program brings the country one state closer to the original expansion outlined under Obamacare. But because of the Supreme Court's 2012 decision making the expansion a voluntary program, there are still 23 states that haven't expanded public health insurance to all of their low-income residents.

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MHPA's Suchi Madan presents at AIS virtual conference: 'Dual-Eligibles Programs: Initial Results, Successes and Remaining Challenges' | Sept. 17
AIS
Preliminary results are already available on some CMS-backed and state initiatives for Medicare-Medicaid dual eligibles. What is working? Where must participating plans and states now focus to solve remaining problems?

Get the details of bottom-line solutions during AIS' Sept. 17 virtual conference, "Dual-Eligibles Programs: Initial Results, Successes and Remaining Challenges." Register now to find out the initial results and lessons learned from CMS-backed and state duals demos. SAVE $125 — use coupon code "VIRTUAL125" at checkout.

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Sept. 17 Webinar Wednesday: 'Managed Medicaid Highlights: Approaches to Integrated Payment and Delivery Reform and Dual Eligibles' by Lilly
Lilly
Please join us for this Eli Lilly and Company webinar led by Ryan Urgo, director, federal government strategy at Lilly USA, as he provides context and current progress on CMS' financial alignment demonstration efforts that are in place to help coordinate care for dual eligible beneficiaries. He's also provide a snapshot of opportunities for Medicaid managed care and a better understanding of the effect on long-term care as well as highlight trends towards the use of managed care to treat this population.
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National Hemophilia Foundation Annual Meeting Pre-Conference Symposium on Hemophilia Pharmacy Management: Sept. 18 in Washington, DC
National Hemophilia Foundation
The National Hemophilia Foundation Annual Meeting Pre-Conference Symposium on Hemophilia Pharmacy Management: "Steps for Success With Managed Care and Specialty Pharmacy" will take place Sept. 18 in Washington, D.C.

Specifically designed for specialty pharmacists, home health pharmacists, health plan pharmacists, managed Medicaid pharmacists, medical directors and other health care professionals with an interest in the management of patients with hemophilia, this free event is also a CME/CPE-certified activity. For more details including program overview, educational objectives, the full agenda, and free registration, click here.

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TRENDING ARTICLES
Missed our previous issues? See which articles your colleagues read most.

    Tennessee governor: Medicaid expansion proposal going to feds soon (Chattanooga Times Free Press)
Texas hospitals say they've lost insured patients to urgent care (The Texas Tribune via The New York Times)
Adherence programs have yet to fully embrace predictive analytics (AIS)
California bill would protect estates of many who received Medicaid (Capital Pubilc Radio via Kaiser Health News)
MHPA sends letter to CMS on Medicaid managed care regulations update (MHPA)

Don't be left behind. Click here to see what else you missed.


National Forum on Hospitals, Health Systems and Population Health: Partnerships to Build a Culture of Health | Oct. 22-24 | Hyatt Regency, Washington, DC
Robert Wood Johnson Foundation
Building partnerships to create a culture of health is the driving theme behind the National Forum on Hospitals, Health Systems and Population Health. Sponsored by the Robert Wood Johnson Foundation, the forum will bring together the people and organizations with the capacity and creativity to change health for the better, including hospitals, health systems, health plans, public health professionals, federal and state health officials and others.

Register for onsite attendance at the rate of $895 prior to Sept. 12, $995 after Sept. 12. To register at the co-sponsor registration rate, click here, and register using the discount code "pophealth."

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Aetna job opportunities
Aetna
The following are job opportunities from Aetna. Visit here, and enter Req # for full description and details.
    MD/Psychiatrist; Newark, Delaware; Req# 19223BR
    This successful candidate will become the Delaware Physicians Care (DPCI) Medical Director for Behavioral Health and will serve as our expert physician resource in the areas of utilization management, quality management, case management and overall medical management. This critical role sits at the intersection of behavioral and physical health services in helping DPCI to develop holistic programs to improve the quality and outcomes of our constituent members.

    MD/Physical Health; Newark, Delaware Req# 19166BR
    The position entails duties and responsibilities of Medical Director for Delaware Physicians Care (DPCI). The successful candidate will serve as a critical contributor to the DPCI medical management team in the role of clinical expert to the various functional areas including utilization management, case management and quality management. A key component of this position is to use the clinical credentials, experience and judgment in rendering benefit determinations based on medical necessity.

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