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Coming Medicaid plan rules will set new access standards
Modern Healthcare (Subscription required)
CMS officials say they're on track for a January 2015 release of sweeping new Medicaid managed-care regulations intended to ensure that beneficiaries get timely access to care and better integration of services. HHS' inspector general's office, meanwhile, is preparing a follow-up to a September report that criticized the CMS and the states for not doing enough to make sure Medicaid plans offer adequate provider networks, according to CMS officials who addressed members of MHPA at an Oct. 28 conference.
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CMS vows new Medicaid managed care rules in 2015 at
The American Journal of Managed Care
A crackdown to ensure that Medicaid beneficiaries get accurate information about provider networks is coming in January, CMS officials vowed, according to published reports. New regulations for Medicaid managed care to be unveiled in early 2015 will ensure that consumers get timely access to care and better integration of services, following complaints and a September report from the HHS inspector general.
Proposed managed care rule could accelerate shift away from nursing home care, official suggests
Proposed regulations slated for release in early 2015 likely will affect how Medicaid managed care balances home- versus facility-based long-term care, news sources reported. The proposed rule should catch up to changes in how long-term care has come to be delivered, a government official said at the MHPA Conference.
OIG to report on errors in Medicaid managed care provider directories
Inside Health Policy (Subscription required)
The HHS Office of Inspector General is expected to publish within the next month a report on Medicaid managed care plans that likely will highlight inaccurate provider directories, CMS Director of the Division of Managed Care Plans James Golden said at MHPA's annual conference.
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Sales of Gilead's Sovaldi slowed as docs waited for Harvoni
The New York Times
Shares of Sanofi and Gilead Sciences fell after they reported lower-than-expected sales of their most important drugs. Sanofi, the French pharmaceutical giant, delivered the greatest surprise. It said that its biggest-selling drug, the Lantus insulin product, had been hit by sharp price competition in the United States, slowing its sales growth. Health insurers and pharmacy benefit managers are now trying harder to pit pharmaceutical companies against one another, threatening to not pay for certain drugs if manufacturers do not offer big enough discounts or rebates.
BlueCross BlueShield reverses its decision to exit Medicaid and
Child Health Plus
The Buffalo News
BlueCross BlueShield of Western New York no longer plans to exit the Medicaid and Child Health Plus managed care programs, the insurer announced. The reversal means the insurer's 53,000 Medicaid and Child Health Plus clients in the region — including about 29,000 in Erie County — don't have to worry about switching their coverage to another health insurance company this year.
Election may bring Medicaid expansion in 6 states
Medicaid coverage could be expanded to the poorest of the poor in six states depending on the outcome of the 2014 governors' races, says consulting firm Avalere Health. But as in Virginia, where the legislature is thwarting Democratic Gov. Terry McAuliffe's expansion efforts, control of the state Legislature makes a big difference, too. Republicans don't want to say much about the issue during campaigns, despite the fact 10 states with Republican governors have already expanded Medicaid and some new Republican governors could support expansion once in office, Avalere says.
North Carolina governor considering Medicaid expansion
North Carolina Gov. Pat McCrory said he's assessing whether to expand Medicaid, the health insurance plan for mostly poor children and the disabled. McCrory told a meeting of corporate CEOs in Raleigh that he's weighing having Washington pick up nearly the full cost versus expanding bureaucracy. McCrory has said for months he's willing to consider offering Medicaid to more of the working poor after containing costs and improving service delivery to the 1.8 million already covered.
Maine governor slammed over vetoes of expanded Medicaid program
An estimated 70,000 people in Maine and hundreds of thousands more around the country, would be eligible for expanded Medicaid under the Affordable Care Act. President Barack Obama's signature healthcare legislation allows those who make up to 138 percent of the federal poverty line, or about $15,800 a year for an individual, to receive state-run, federal-and-state funded insurance. But in response to a lawsuit challenging the constitutionality of the law, the Supreme Court ruled that states could opt out of the federal funds to expand the program, and 23 states, including Maine, have done so. Gov. Paul LePage, elected in 2010, is now facing not one, but two challengers who argue his five vetoes of bills that would have accepted the federal money to expand MaineCare have hurt Maine residents.
Medicaid expansion could be in play in Georgia after election day
Kaiser Health News
A growing number of states that strongly opposed Obamacare are rethinking their positions on Medicaid expansion as they watch billions in new federal dollars rain down on neighboring states. Arkansas is helping lead the shift by changing the rules. With Washington's permission, the state has enabled the poor to buy private insurance policies using the federal Medicaid expansion money. Other red states, finding this tack more politically palatable, are exploring Arkansas' approach. Tennessee Gov. Bill Haslam, for example, said he may submit a similar proposal to federal health officials.
Medicaid expansion: How it has worked in other Southern states
Georgia Health News
The University of Kentucky's Chandler Hospital has seen its inpatient numbers rise by 5 percent and its outpatient numbers rise by 10 percent since July. But its number of uninsured patients has dropped, from about 9 percent to 2.5 percent.
How Obamacare went south in Mississippi
Kaiser Health News
The first year of the Affordable Care Act in Mississippi was, by almost every measure, an unmitigated disaster. In a state stricken by diabetes, heart disease, obesity and the highest infant mortality rate in the nation, President Barack Obama's landmark healthcare law has barely registered, leaving the country's poorest and perhaps most segregated state trapped in a severe and intractable healthcare crisis.
Burwell meets with insurance execs ahead of Obamacare enrollment
Health and Human Services Secretary Sylvia Mathews Burwell met with leading health insurance executives on Wednesday to discuss Obamacare's second open enrollment period. Twelve executives met with Burwell, including two representatives of the industry's trade association, America's Health Insurance Plans, the department said.
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Nov. 5 Webinar Wednesday: 'From Preparation to Completion: Stress-Free Delegation Audit Tips'
Navitus Health Solutions
Does the word "audit" make you cringe? Put your fears to rest. Navitus Health Solutions will share its best practice approach to ensuring a successful delegation audit with your contractors. Topics include building your programs and processes with a focus on compliance, preparation, documentation, coordination and execution. Join Gayle Fisher, senior national account executive at Navitus Health Solutions, to gain invaluable takeaways that you can put into action in your organization.
Nov. 12 Webinar Wednesday: 'Value of Personalized Medicine in Delivering Quality Cancer Care'
Genomic Health, Inc.
Join Dr. Jack Spicer, director of medical affairs managed care for Genomic Health to learn about personalized medicine and how can it be used to improve care and lower costs with oncology patients.
- Genomic science has enabled an unprecedented understanding of cancer and tumor biology
- Personalized treatments may be more precisely delivered based on a patient's individual biology
- The right treatment for the right patients in the most appropriate setting improves quality of care and patient outcomes
- Reduces healthcare spending
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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