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OIG report on Medicaid MCOs and access to care:
The real takeaway

Morning Consult
MHPA's op-ed in the Morning Consult unspins the media's take on the recent Office of the Inspector General's report on access to care in managed Medicaid.
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Bicameral Committee Leaders Seek Medicaid Managed Care Best Practices from MHPA
Inside Health Policy
A bipartisan, bicameral group of lawmakers from the House Energy and Commerce Committee and the Senate Finance Committee are asking trade groups that represent Medicaid managed care plan providers to provide information on how plans provide cost savings and quality healthcare as a majority of Medicaid beneficiaries find themselves in some type of managed care program. MHPA President and CEO Jeff Myers said the timing of the request is perfect because his group plans to publish a compendium of best practices for Medicaid managed care plans on Oct 27. The compendium release will coincide with MHPA's Best Practices Awards Luncheon at mhpa2014, MHPA's annual conference in Washington, D.C.
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Medicaid managed care plans get federal help on state rates;
MHPA weighs in

Modern Healthcare (Subscription required)
The CMS recently took action to improve the way states pay private health plans to oversee the care of Medicaid beneficiaries. The agency issued a nine-page guidance that outlines new data requirements states must follow to show they are meeting the statutory requirement that payments to plans are actuarially sound—meaning they cover all medical costs, administrative costs, taxes and fees that the health plan will be responsible for. Of the more than 70 million people in Medicaid, 70 percent are in managed care plans for at least part of their care, according to the CMS.
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The mhpa2014 app is here! The mhpa2014 app is here!
Everyone loves to play on their gadgets. We've given you one more reason to do that with the release of our new conference mobile app. Check out the agenda, exhibitor and attendee lists, session room and exhibit hall maps, hotel and travel info, networking functionality, and more. Get it on Google Play or the Apple App Store here.

NB: the exclusive sponsorship of the app is still available. Get noticed with a dedicated branded splash page on the app. Contact Sarah Swango either via email or by phone at 202-857-5772.

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CVS's 1st glimpse of Sovaldi use shows drop in new starts
In what it's calling the first "real-world" look at Sovaldi utilization patterns since the costly oral hepatitis C treatment hit the market late last year, CVS Health on Sept. 17 released data showing "a plateau and actual downward trend" in the number of new Sovaldi users from May to August 2014. Moreover, therapy discontinuation rates were roughly four times higher than those observed in clinical trials, according to the data compiled by the company's PBM business, CVS/caremark. MPHA's take: Adherence via managed care is key.
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Gilead to price Harvoni close to cost of Sovaldi plus interferon and ribavirin
Inside Health Policy
Gilead Sciences will price its soon-to-be-approved hepatitis C combination drug Harvoni close to the near-$100,000 cost of the current 12-week regimen of Sovaldi plus pegylated interferon and ribavirin, Gilead President and CEO John Milligan said on Oct. 1.
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Drug Pricing News: A new service from
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 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, and get access to Drug Pricing News.

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Supreme Court takes up Idaho Medicaid challenge
The Associated Press via ABC News
The Supreme Court has said it will decide whether private sector healthcare providers can force a state to raise its Medicaid reimbursement rates to keep up with the rising cost of services. The justices agreed to hear an appeal from Idaho, which wants to overturn a lower court decision that ordered the state to increase payments.
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Michigan governor touts Medicaid expansion in re-election bid
Detroit Free Press
Michigan Gov. Rick Snyder touted the state's successful Medicaid expansion as part of his re-election bid, saying 63,000 more low-income adults have signed up than projected this year with less than four months left. The Republican governor said about 385,000 enrolled between April, when the Healthy Michigan program launched, and the end of September. His administration had expected 322,000 signups by year's end.
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Researchers: Sovaldi analysis could be used in lawsuits against Medicaid
Inside Health Policy
Researchers at Harvard and Brown universities are analyzing state Medicaid programs' coverage restrictions for the expensive hepatitis C drug Sovaldi, and the findings could lay the groundwork for beneficiaries to sue states, although a Harvard law instructor said legal action is a last resort.

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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.

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How states can fix their Medicaid programs; MHPA's Myers weighs in
All states will inevitably have to find ways to reform how they pay for Medicaid services. Right now, that way is looking like accountable care organizations. There's plenty of skepticism about ACOs and their ability to tame costs. To MHPA President Jeff Myers, the biggest question is how managed care organizations or the state will share risk for costs and quality.

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Centene 'No Bullying Zone' event | Oct. 6 in Washington, DC
Centene Corporation
One out of every 10 students drops out of school because of repeated bullying. Join Centene to recognize the completion of the first year of the national campaign "No Bullying Zone" and to continue the discussion of effective bullying-prevention initiatives on Blue Shirt Day® World Day of Bullying Prevention.

The event is scheduled for 10 a.m. until noon on Monday, Oct. 6, at the Newseum's Knight Conference Center (555 Pennsylvania Ave., NW) in Washington, D.C. RSVPto Wendy Donn either via email or by phone at 314-505-6734.

Please consider wearing blue to show your support for anti-bullying.

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Oct. 8 Webinar Wednesday: 'Using the Massachusetts Health Care Reform Experience to Understand Your New Medicaid Members' by HFI
This webinar will serve as a preview of Healthcare Financial Inc.'s (HFI) presentation at mhpa2014 on Oct. 28, which will include an interactive discussion of data, insights and recommendations.
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Missed our previous issues? See which articles your colleagues read most.

    Medicaid directors urge CMS to revamp program integrity efforts to reflect managed care focus (Inside Health Policy)
Medicaid and CHIP: July 2014 monthly applications, eligibility determinations and enrollment report (Centers for Medicare & Medicaid Services)
MACPAC questions how premium assistance plays into Medicaid's future (Inside Health Policy)
More states exploring alternative Medicaid expansion plans: What it means for health reform (California Healthline)
Senators: Widen Medicaid program for frail seniors (The Associated Press via ABC News)

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

Aetna job opportunities
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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