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Grassley: Focus entitlement reform on costliest patients, Obama's proposals misguided    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Republican Sen. Chuck Grassley of Iowa said on the Senate floor that to truly curb Medicare and Medicaid costs, lawmakers need to focus their attention on dual eligibles, high-cost Medicare beneficiaries with chronic conditions, and long-term supports and services under Medicaid. These areas need to be addressed as a part of entitlement reform rather than turning to proposals in the president's budget such as increasing income-relating for Medicare premiums, increasing home health copays or extending Medicaid rebates into Part D, Grassley said, just after the president outlined a two-step plan for averting the fiscal cliff and a broader deficit reduction deal that suggested gleaning $400 billion from entitlement programs based on his 2013 budget. More

Republicans make counteroffer in fiscal talks
The New York Times    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Republican Congressional leaders countered President Barack Obama's deficit reduction proposal with a plan of their own that is far heavier on spending cuts but embraces $800 billion in new taxes over the next 10 years. The counteroffer represented an acknowledgment by Republicans that they had to issue their own proposal to head off around $600 billion in automatic tax increases and spending cuts next year, a fiscal combination that could send the economy back into recession. They said that their approach was a move toward the center rather than sticking to a position established last year with the passage of the House Republican budget, which included contentious changes to Medicare and Medicaid and deep domestic spending reductions. More

State lawmakers gird for battle over Medicaid expansion
The Washington Post    Share    Share on FacebookTwitterShare on LinkedinE-mail article
As state legislatures prepare to meet in January, lawmakers across the country are girding for a battle over whether to sign on to the healthcare law's expansion of Medicaid. "This is the No. 1 issue," said Republican state Sen. Michael Lamoureux, incoming president of the Arkansas Senate. "And in 10 years this is by far the most difficult one we've ever dealt with." The national implications loom just as large. No provision is more central to achieving the healthcare law's aim of extending coverage to the uninsured than its expansion of Medicaid. More

States' Medicaid decisions scrutinized
The Associated Press via The Boston Globe    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Hundreds of billions of dollars and the well-being of millions of people will be at stake when more states consider in coming months whether to expand Medicaid under the federal healthcare overhaul. As legislatures look ahead to their 2013 sessions, the calculating and the lobbying already have begun. President Barack Obama's law expands Medicaid, the federal-state health program for low-income people, but cost-wary states must decide whether to take the deal. If they turn it down, governors risk coming off as callous toward their neediest residents. And they probably will be second-guessed for walking away from a pot of federal dollars estimated at nearly $1 trillion nationally over a decade. More

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State doctor groups hold back on ACA Medicaid changes
MedPage Today    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Most state physician groups have kept a low profile on their positions to expand Medicaid under the Affordable Care Act, even six months after the U.S. Supreme Court gave states an option to increase eligibility. "Right now if you looked at all the state medical associations, they have backed off for a moment just to see how this thing's going to flow," Dr. James Keeton, dean of the School of Medicine at the University of Mississippi Medical Center, told MedPage Today. "But most physicians want people insured." More

Texas Democrats expect deal on Medicaid despite Perry
The Texas Tribune via The New York Times    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Despite Gov. Rick Perry's firm opposition to a central tenet of federal health reform — expanding the state's Medicaid program for those with low incomes — Texas Democrats remain optimistic that the 2013 legislative session can yield a deal that brings in billions of additional federal dollars. It will be a tough sell: No Republican lawmaker has gone on record supporting the Medicaid expansion, which would add an estimated 1.8 million Texans to the joint state-federal health plan by 2022. But state Senator Rodney Ellis, D-Houston, said fiscal conservatives have an incentive to reach an agreement "because the alternative is going to cost us much more economically and dig a much deeper hole in our budget." More

Bachmann introduces bill to compel independent audits under Medicaid managed care programs
Targeted News Service via Pharmacy Choice    Share    Share on FacebookTwitterShare on LinkedinE-mail article
U.S. Rep. Michele Bachmann, R-Minn., has introduced legislation to "require independent audits and actuarial services under Medicaid managed care programs." The bill was introduced Sept. 21. The legislation was referred to the House Energy and Commerce Committee. More

Mismatched data hamper US accounting of Medicaid costs
Bloomberg    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The full extent of U.S. spending on Medicaid, the $459 billion state-federal health insurance program for the poor, is unclear because of mismatches between government databases, auditors reported. A $43 billion gap showed up in a comparison of 2009 spending data from the states, which run Medicaid, and the U.S. Centers for Medicare and Medicaid Services, which pays for more than half the program, according to a report released by the Government Accountability Office. More

HHS announces FMAP, eFMAP rates to determine federal matching for Medicaid, CHIP effective Oct. 1, 2013-Sept. 30, 2014
Federal Register    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The Federal Medical Assistance Percentages, Enhanced Federal Medical Assistance Percentages, and disaster-recovery FMAP adjustments for Fiscal Year 2014 have been calculated pursuant to the Social Security Act. These percentages will be effective from Oct. 1, 2013, through Sept. 30, 2014. More

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Insurance surcharges will fund most online exchanges created under health law
Kaiser Health News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Republican governors in Florida, Virginia, Texas and several other states say they're reluctant to build the online insurance markets required by the federal health law because they're worried about getting stuck with the bills. "That's not a good value proposition for the people of Virginia or any other state," Virginia Gov. Bob McDonnell told Fox News last month. But Democrat-controlled California, which will run the country's largest insurance market, will do so without taking a cent from the state treasury. Instead, operations of the market, also called an exchange, will be financed by a surcharge on the billions of dollars in insurance premiums sold in the exchange. More

Rx adherence seen as matter of incentives
MedPage Today    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Physicians and health plans need more financial incentives to spur greater medication adherence, experts said at a recent panel discussion in Washington. Without such a push, the healthcare community will continue to struggle with the issue of getting patients to take their medication as prescribed, they agreed. An estimated three-fourths of patients either stop their medication, don't use it, don't refill it, or don't take their medication often enough. Non-adherence costs the healthcare system between $100 billion and $289 billion a year in direct costs, according to the Agency for Healthcare Research and Quality. More

Centene Corporation appoints executive vice president, insurance group officer
PR Newswire via The Seattle Times    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Centene Corporation has named K. Rone Baldwin head of the company's newly formed insurance group. Mr. Baldwin will oversee commercial and hybrid insurance, products associated with future exchanges and implementation of exchange products. Baldwin comes to Centene with more than 25 years of experience as a business executive leading a range of domestic and global financial service businesses focused primarily in the life and health insurance sector. More

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Free webinar: ' Successful Patient-Centered Medical Home Strategies with Medicaid Practices' | 3 p.m. EST Dec. 11
Qualis Health    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Qualis Health is providing targeted technical assistance to practices in support of Medicaid providers through the practice transformation process as they become high-functioning patient-centered medical homes. Qualis Health has worked with Medicaid health plans and other organizations to design and implement PCMH programs, including recruiting participating sites, helping to select practices, assessing practice transformation readiness, and preparing gap analysis and individual technical assistance plans for each practice. Qualis health also is supporting participating practices attain NCQA PCMH recognition. Please join us Dec. 11 when Qualis Health will highlight its technical assistance consultation work with Medicaid managed care in a free 60-minutes Webinar featuring Bonni Brownlee, MHA, CPHQ, CPEHR, consulting director at Outlook Associates, a division of Qualis Health. Click here to register. More

Insights webinar: 'Proper Capitation Rates for Hemophilia Patients' | 11 a.m. EST Dec. 17
Baxter    Share    Share on FacebookTwitterShare on LinkedinE-mail article
For details, click here.

Insights webinar: 'Reduce Outsourcing Risk by CGS' | 11 a.m. EST Dec. 20
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Refine your outsourcing process and reduce ongoing operational risk by implementing a vendor qualification and review tool. The CGS presentation, "Reduce Outsourcing Risk with a Vendor Qualification and Review Process," demonstrates how to qualify a supplier during the selection process using a defined set of scoring criteria and how to use the same criteria to manage the supplier during ongoing operations. More detail and registration here.

Free webinar by LexisNexis 'Why Identity Management Matters to Medicaid' | 1 p.m. EST Jan. 9
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The challenges of identity risk management can be boiled down to these two words: "Who's there?" At its core, this is the essence of security. Government efforts are driving much of the focus on identity management — a primary concern for the healthcare industry. Medical identity theft or improper access to sensitive records, as well as liability issues, are of paramount concern. Patients want to know what steps are being taken to ensure their privacy. As a Medicaid plan, you should not just be addressing the "what" of identity management — the technical side — but also the question of "who?" How do you know people are who they claim to be and what risks do they pose for the environments and systems they are attempting to enter? Clint Fuhrman, director of Government Health Care Programs for LexisNexis Risk Solutions, addresses these issues in a FREE 60-minute webinar. More

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MHPA CEO Thomas Johnson to speak at Strategic Solutions Network's 4th Annual 'Medicaid Innovations Forum' | Feb. 5-7 | Orlando, Fla.
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Medicaid Innovations is designed to be the meeting place for all participants in the Medicaid universe who want to participate, share and learn about innovations that promote quality improvement, cost reduction and transformation in the face of reform. Use discount code MHPA when registering to receive a $200 discount off the current rate. For complete agenda and to register, click here.

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