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CMS clears the air about Medicaid tax; MHPA's Myers comments
Government Health IT
The Centers for Medicare & Medicaid Services has issued answers to some frequently asked questions regarding payment of the Affordable Care Act's health insurance fee in Medicaid, with the main clarification being that it should be reimbursed by the states, in accordance with the Balanced Budget Act of 1997. "By issuing this guidance, CMS is saying to states that they should pay the fee in accordance with actuarial soundness requirements," MHPA President and CEO Jeff Myers said.
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Medicaid managed-care rates must factor in insurance tax; MHPA weighs in
Modern Healthcare (Registration required)
After months of ambiguity, the CMS has clarified that states must factor in the Obamacare health insurance tax in setting the rates they pay Medicaid managed-care plans. The tax is expected to raise nearly $100 billion over 10 years from all insurers to help fund the coverage expansion under the Patient Protection and Affordable Care Act. Insurers have argued that states should cover the cost of the tax, while some state officials have complained about the financial burden. But other observers say the amount of new federal dollars flowing to states that accept the ACA's Medicaid expansion more than offsets the cost of the tax. Jeff Myers, president and CEO of MHPA, commented on CMS' guidance.
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mhpa2014: Will you be there?
Have you registered for mhpa2014 yet? From Oct. 26-28 in Washington, D.C., we will be launching THE conference for Medicaid MCOs in 2014.
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Advocates to MCOs: Closely watch how states implement Medicaid HCBS
Inside Health Policy
HHS officials and advocates for people with disabilities are advising Medicaid managed care organizations to pay close attention to how states implement a new home and community-based services rule issued by CMS earlier this year. One advocate warned insurers that states' failure to fully live up to the new HCBS rules could make MCOs the target of lawsuits.
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How the 2014 governors races could impact Medicaid expansion
In the largest batch of gubernatorial contests since Republicans won big in 2010, this November has major implications for the future of Medicaid expansion in several states. The potential changes are mostly isolated to races where there are good chances that the governor’s office could change parties. In some of those cases, state legislatures — some of which bear the imprint of the 2010 GOP wave — present obstacles to gubernatorial candidates pledging to expand Medicaid to more poor adults.
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Democrat promises to undo Kansas Medicaid change
The Sacramento Bee
Democratic challenger Paul Davis has proposed reversing part of Republican Gov. Sam Brownback's overhaul of the Kansas Medicaid program, appealing to vocal advocates for the disabled in a political race that remains a toss-up.
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Docs group joins push to expand Medicaid in Mississippi
AudioBriefA Mississippi physicians group is joining the push to expand Medicaid in the state. The Mississippi Primary Care Association believes Medicaid expansion is an important step to improve access to healthcare statewide. The Mississippi Primary Care Association represents 21 community health centers around the state which largely offers care to the poor and uninsured. During a press conference at the Jackson Medical Mall, executive director Robert Pugh says they are joining a new campaign called Mississippi Left Me Out to lobby state lawmakers to expand Medicaid to hundreds of thousands of uninsured Mississippians.
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Medicaid, often criticized, is quite popular with its customers
The New York Times
Low-income people in three southern states were recently asked whether they preferred Medicaid or private insurance. Guess which one they picked? A study published in the journal Health Affairs found that poor residents of Arkansas, Kentucky and Texas, when asked to compare Medicaid with private coverage, said that Medicaid offered better "quality of healthcare" and made them better able to "afford the healthcare" they needed.
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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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Did you miss our Webinar Wednesday, 'Pharmacogenetic Testing in the Clinical Setting'?
View and download the Oct. 1 Webinar Wednesday "Pharmacogenetic Testing in the Clinical Setting" by Millennium Health here. Other webinars are available to download, as well.
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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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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.

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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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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