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CMS seeks input on innovative payment, delivery models to test in Medicaid managed care; MHPA's Amy Ingham comments
Inside Health Policy
CMS is seeking stakeholders' advice on whether the agency should test Medicaid managed care reforms in the areas of pharmacy and medication management, value-based insurance design, telehealth, hospice care, long term services and supports, network design, behavioral health and provider incentive arrangements like accountable care organizations in order to potentially reduce costs while improving quality of care. Additionally, Amy Ingham, MHPA director of federal policy, said the RFI is a positive opportunity for managed care plans to highlight work they are doing to improve quality of care while controlling costs and innovative programs they have developed.
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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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Appy Anniversary: MHPA celebrates conference mobile app's 2nd year
Features include:
  • The agenda by date, track, topic or speaker
  • Sponsor and exhibitor info and booth locations
  • Session location maps of the Washington Convention Center/Marriott Marquis Washington, D.C.
  • Attendee info (published at conference time)
  • Networking with fellow attendees, exhibitors and speakers (optional)
  • hotel, airfare reservations
Preview an online version here. From your mobile device, tap here, or search for "mhpa" on Google Play or the App Store to find the MHPA app icon — a blue M on a yellow and white field. Click to download the MHPA app, and you'll see the mhpa2014 event listed in the app.

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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Indiana governor, feds unable to reach deal on Medicaid expansion
The Indianapolis Star
Indiana Gov. Mike Pence has not been able able to reach an agreement with the federal government on his alternative approach to expanding Medicaid under the Affordable Care Act. Pence said after meeting with Health and Human Services Secretary Sylvia Burwell that "differences remain."
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Why is Indiana's GOP governor talking healthcare with Obama?
As soon as Air Force One touched down in Indiana on Oct. 3, Gov. Mike Pence met President Barack Obama on the tarmac with a plea: Expand the state's access to government-sponsored health insurance. The catch: Pence wants to do it with a conservative twist.
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Pennsylvania Medicaid managed-care expansion plans struggle to
sign providers

Modern Healthcare (Registration required)
Medicaid managed-care plans providing coverage under Pennsylvania's Medicaid expansion are struggling to find enough hospitals and physicians for their networks. Insurers say the problem is false expectations created by the administration of Republican Gov. Tom Corbett and the state Department of Public Welfare that the plans would pay providers more than traditionally low Medicaid rates.
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Report: Maryland adds 22,000 Medicaid consumers
The Baltimore Sun
The Maryland state health insurance exchange continued enrolling consumers in Medicaid, adding almost 22,000 new people to the rolls in the last month, according to a report. The report said 376,850 people in the state have gained coverage under the federal-state program for the low-income since the exchange launched a year ago under the federal Affordable Care Act.
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Providers point to 'crisis' in dental care for some Medi-Cal patients
California Healthline
Some special-needs patients are so scared of being at the dentist's office, it's almost impossible to diagnose them. That's just the dental exam, according to Terry Jones, a dentist in Sacramento. Doing actual dental work can be impossible.
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Michigan governor to mark dental care boost for Macomb County children
Detroit Free Press
Michigan Gov. Rick Snyder is helping to mark the expansion of dental coverage for Medicaid-eligible children in Macomb County. The state budget that recently went into effect includes the addition of Macomb and Kalamazoo counties to Michigan's Healthy Kids Dental program. It's now available to more than 555,000 children in 80 of 83 counties.
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Maine governor's race serves as referendum on welfare
The Wall Street Journal
A sustained push to trim Maine's welfare rolls — arguably the most divisive effort of its kind in the country — has emerged as a prominent test for both parties' positions on spending for the poor. Republican Gov. Paul LePage describes the cuts he has made to food stamps, Medicaid and cash-assistance programs as both a budget-cutting exercise and a kick-in-the-pants to many of Maine's low-income workers.
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Ohio under fire for blocking Medicaid for seniors whose spouses
bought annuities

The Columbus Dispatch
A war is being waged in Ohio over whether elderly couples with one person in a nursing home can buy an annuity to keep the other from going broke — and still apply for public assistance. Elder-law attorneys say the state isn't following federal laws regarding Medicaid-compliant annuities, and that's hurting middle-class seniors who worked hard and saved for a rainy day.
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Abstract: The Impact of Recent CHIP Eligibility Expansions on Children's Insurance Coverage, 2008-12
Health Affairs
Following the reauthorization of the Children's Health Insurance Program in 2009, 15 states raised their CHIP income eligibility thresholds to further reduce uninsurance among children. The impact of these expansions was examined on uninsurance, public insurance and private insurance among children who became newly eligible for CHIP after the expansions.
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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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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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House, Senate seeks Medicaid managed care info from MHPA
House Energy and Commerce and Senate Finance Committee leaders have asked organizations representing Medicaid plans for information on managed care plans. "We believe it is important for Congress to better understand the growing and evolving role managed care plays in the Medicaid program. ... Given the emerging diversity and growth within the program, we are particularly interested in providing private sector partners the opportunity to benefit from the consideration of an array of successful models for patient care," the bipartisan group wrote to MHPA.

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Oct. 15 Webinar Wednesday: 'Strategies for Developing a Successful Member Conversion Strategy' 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. Identifying plan members who are potentially disabled, conducting outreach and providing SSI/SSDI enrollment assistance can be challenging.

Please join Linda Roman, associate vice president of business development at Human Arc, to learn how to design a successful member conversion strategy and secure capitation payments that more appropriately reflect actual health utilization.

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IIR's FDA/CMS Summit for Payers featuring MHPA's Jeff Myers | Dec. 11-12, Washington, D.C.
Institute for International Research USA
Hear from the FDA and CMS under one roof, along with C-level executives from top health plans, at the FDA/CMS Summit for Payers. The entire healthcare continuum is coming together to understand how to better interact with the government to remain compliant, adaptive, and successful as our landscape evolves to become more patient-centric. Collaborate with the most influential people in health care, including speakers MHPA's president and CEO Jeff Myers and Janet Woodcock, M.D., director of the Center for Drug Evaluation and Research, FDA. Click here for more information.
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Missed our previous issues? See which articles your colleagues read most.

    MHPA's Jeff Myers talks access in Robert Pear NYT story on OIG report (The New York Times)
CMS considers letting ACOs merge with part D plans, Medicaid; accept capitated pay (Inside Health Policy)
North Carolina lawmakers contemplate overhaul of state Medicaid department (North Carolina Health News)
Confusion remains over Pennsylvania governor's Obamacare alternative (The Philadelphia Inquirer)
Gilead to price Harvoni close to cost of Sovaldi plus interferon and ribavirin (Inside Health Policy)

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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