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Medicaid directors urge CMS to revamp program integrity
efforts to reflect managed care focus
Inside Health Policy
As more Medicaid beneficiaries are enrolled in managed care plans, the National Association of Medicaid Directors is urging CMS to focus on four overarching program-integrity areas — provider enrollment, data reporting, compliance and benefits coordination. Streamlining processes and offering guidance to states in these areas requires the agency to work closely with state Medicaid programs and highlight some of the most innovative and efficient state practices, NAMD said in a letter to CMS.
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Sept. 24 Webinar Wednesday: 'Federal Government Oversight of Medicaid at the State Level and How Health Plans Can Prepare' by Cody Consulting
Cody Consulting
Medicare Advantage plans are very familiar with the stringent requirements placed upon them by CMS, including the immediate actions and sanctions that can occur when compliance violations are identified through their auditing process. Cody Consulting will provide background on CMS' oversight of Medicare Advantage plans. More importantly, we will discuss why the federal government is expected to have more oversight of Medicaid at the state level in the near future.
Medicaid, MCOs lag on beneficiary outreach
Healthcare Payer News
With enrollment at an all-time high and only increasing, state Medicaid programs and the health plans they contract with need to prioritize a few key areas of the beneficiary experience. A report conducted for the Medicaid and CHIP Payment and Access Commission found that while many Medicaid beneficiaries across the demographic spectrum are grateful to be covered, the experience still has a lot of friction that states, the federal government and private insurers with Medicaid plans can improve — especially if more people are going to be covered at lower per-capita costs.
mhpa2014 update: New sponsor; communications sessions
MHPA
MHPA is pleased to welcome Primrose Healthcare as mhpa2014's new Chairman's Sponsor. Primrose Healthcare combines clinical pathways developed by nationally recognized specialists in hepatitis C virus (HCV) and liver disease management with leading edge technology. To learn more, visit here.
In other mhpa2014 news, the conference will also feature two new sessions designed for health plan communications staff. "Using Social Media and Innovative Technology to Engage Beneficiaries" will show how to engage patients with healthcare social media via expert presenters sharing their experiences, best practices and policies at their respective organizations. In "Crisis Communications in Health Care," Zack Condry, vice president of digital crisis at Edelman, will instruct you on the basics of crisis communications through entertaining real-life case studies and interactive role-play scenarios. Click here for more information.
The new $84,000 hepatitis C treatment is losing momentum, for now
The Washington Post
After recording the best launch of any drug in history, it looks like the pace is starting to slow down for Gilead Sciences' Sovaldi — the new $84,000 hepatitis C cure that's sparking a new focus on specialty drug costs. Data released by CVS Health show that use of Sovaldi has slowed down since May after the drug's record-setting start last December. The slowdown can partly be explained by the healthcare industry's anticipation of more hepatitis C treatments soon hitting the market, including another one from Gilead that could gain FDA approval any day now.
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Complex Clinical Reviews. Dependent Audits. And More.
Contact HMS today!
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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.
Medicaid and CHIP: July 2014 monthly applications, eligibility determinations and enrollment report
Centers for Medicare & Medicaid Services
This monthly report on state Medicaid and Children's Health Insurance Program data represents state Medicaid and CHIP agencies' eligibility activity for the calendar month of July 2014. The data
included in this report was submitted to CMS from state Medicaid and CHIP agencies as part of the Medicaid and CHIP Performance Indicator process.
More states exploring alternative Medicaid expansion plans: What it means for health reform
California Healthline
Pennsylvania's now in. Indiana might be next. Is the tide turning on Medicaid expansion? Recent moves by previously entrenched states indicate that might be the case. However, what does it mean for Medicaid nationwide when more states are choosing alternative plans?
MACPAC questions how premium assistance plays into Medicaid's future
Inside Health Policy
Congressional Medicaid and CHIP advisers questioned the former Arkansas Medicaid director and others about whether more state Medicaid programs should consider a premium assistance model, and one commissioner said that while they were excited about the approach, there is concern that a recent Government Accountability Office report slamming the costs of Arkansas' program could dampen enthusiasm for the model.
Louisiana lawmakers call for more complete information on Medicaid privatization program going forward
The Times-Picayune
Louisiana lawmakers told officials with the Department of Health and Hospitals they needed to provide more complete information going forward about Bayou Health, Louisiana Gov. Bobby Jindal's Medicaid privatization program.
2nd suit seeks to derail California duals demo, this time alleging
actual harm
AIS (registration required)
Opponents this month filed a second lawsuit aimed at blocking and reversing implementation of California's CMS-backed demonstration program for Medicare-Medicaid dual eligibles. And this one could have a better chance than the first suit, which was filed in July and seeks an injunction that was denied by a state judge, because it focuses on actual harm allegedly suffered by specific duals beneficiaries.
Lawsuit accuses California of denying care to Medi-Cal applicants
Kaiser Health News
California's lingering backlog of Medi-Cal applications has left hundreds of thousands of people unable to access the healthcare they are entitled to receive, according to a lawsuit filed by a coalition of health advocates and legal services groups.
Dental benefits for Missouri's low-income adults still on hold
St. Louis Post-Dispatch
With the dust settled on Missouri's contentious veto session, about 300,000 low-income Missouri adults are still waiting to hear whether their government-funded health plan will cover the costs of dental care. When the Republican-controlled legislature voted in May to restore dental benefits for most adult Medicaid recipients, it seemed like a slam dunk.
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Virginia legislators approve budget deal, reject Medicaid expansion
The Washington Post
Virginia legislators united across party lines to plug a $2.4 billion hole in the state budget but quickly reverted to bitter partisanship as they debated Medicaid expansion, with House Republicans ultimately killing a bill to expand the healthcare program without giving it a formal vote.
Texas senator might use executive action to expand Medicaid
Houston Chronicle
Texas Sen. Wendy Davis says if she is elected governor, she will consider using "executive action" to expand the state's Medicaid under the federal Affordable Care Act despite almost certain opposition from the Republican-dominated legislature.
Missed our previous issues? See which articles your colleagues read most.
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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