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HHS: Partial Medicaid expansion not eligible for ACA's 100 percent federal match    Share    Share on FacebookTwitterShare on LinkedinE-mail article
CMS has decided that states cannot expand their Medicaid programs to less than the ACA's 133 percent of the federal poverty level and still receive 100 percent federal matching funds that states are eligible for from 2014 through 2016, the administration revealed in guidance, answering a crucial question that governors, Medicaid directors and other healthcare stakeholders have pressed the administration on ever since the expansion was made optional by the Supreme Court's June ruling. CMS adds, however, that if states declining to expand coverage to 133 percent of the federal poverty level would like to propose demonstrations that include a partial expansion, CMS would consider them but they would be subject to the regular Medicaid federal matching rate. More

White House drops support for major Medicaid cut
The Hill    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The Obama administration backed away from roughly $100 billion in Medicaid savings it had proposed during deficit-reduction talks earlier this year. The move comes as liberals have pressed the White House to take Medicaid off the table in negotiations surrounding the "fiscal cliff" — and it will make any agreement on entitlement spending about $100 billion harder to reach. More

Health plans demonstrate value in providing care for dual-eligible beneficiaries
AHIP Coverage    Share    Share on FacebookTwitterShare on LinkedinE-mail article
With recent attention on programs for "dually eligible" beneficiaries, individuals who quality for both Medicare and Medicaid, it's important to highlight health plans' crucial role in care delivery for these beneficiaries. Health plans serve as a crucial safety net for approximately 1.5 million of our nation's most vulnerable dual eligibles, many of whom have disabilities and chronic conditions. By tailoring their benefits and services to address the unique needs of the specific populations they serve, these health plans are providing a high level of value to both beneficiaries and taxpayers. More

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Free webinar at 3 p.m. EST today: 'Successful Patient-Centered Medical Home Strategies with Medicaid Practices'
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 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

Medicaid stakeholders lobby White House to reject provider tax cuts    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Nursing homes, public hospitals and various other Medicaid plans and stakeholders, including AARP and SEIU, are urging the White House and congressional leaders to refrain from reducing or ending states' ability to levy taxes on providers to help fund their Medicaid programs as part of fiscal cliff talks. Democrats and Republicans have charged that provider assessment simply is a way to "game" the system, but Medicaid stakeholders say that the process is crucial for the states still struggling to recover from the recession to continue providing services to vulnerable residents. More

Defeat on provider fee could gut Georgia hospitals' finances
Georgia Health News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Just weeks before the 2013 General Assembly convenes, the state's provider fee, called a "bed tax" by some, remains a high-profile wild card — one that could deal Georgia's hospital industry a crippling blow. If the fee is not renewed — and anti-tax forces will oppose it — the Medicaid system may lose $430 million-plus that the assessment now generates. That loss would swell the state's Medicaid financial shortfall, which already is about $400 million. Not renewing the fee could mean a 20 percent reimbursement cut to Georgia hospitals. More

KanCare approved to start Jan. 1
KHI News Service via Wyandotte Daily News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Gov. Sam Brownback said his administration has been given the green light by federal officials for the Jan. 1 start of KanCare, his plan to remake the state's Medicaid program. Kansas officials said they would continue to work with the Centers for Medicare and Medicaid Services to finalize the "special terms and conditions" of the waiver ahead of the program's launch. But they said they will move forward with their plan to move virtually all the state's 380,000 Medicaid beneficiaries into managed care plans run by three insurance companies: United Healthcare, Amerigroup and Sunflower State Health Plan, a subsidiary of Centene. More

HHS approves 6 state-run healthcare exchanges
The Hill    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The Obama administration approved six states' plans to run their own insurance exchanges. Officials from the Health and Human Services Department said 14 states and Washington, D.C., have submitted plans to run their own exchanges. HHS approved exchange plans in Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington. More

New Jersey governor nixes state-run insurance exchange
POLITICO    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Gov. Chris Christie rejected a state-run health insurance exchange, paving the way for the federal government to step in and run one. Christie — who was in Washington pushing for Hurricane Sandy aid — rejected a bill passed by New Jersey's Democratic state Legislature that would have built an exchange, a key part of the president's healthcare law that makes available subsidies to help low- and middle-income individuals purchase coverage in new health insurance markets starting in 2014. More

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Tennessee rejects state-run exchange under Obama's health law
The Hill    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Tennessee is the latest state to reject a state-based insurance exchange under President Barack Obama's healthcare law. Republican Gov. Bill Haslam is one of the last governors to make a decision ahead of the deadline. "The Obama administration has set an aggressive timeline to implement exchanges, while there is still a lot of uncertainty about how the process will actually work," Haslam said in a statement. "What has concerned me more and more is that they seem to be making this up as they go." More

Drugs, fraud, mental health top legislative issues in Texas
The Associated Press via The Beaumont Enterprise    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Medicaid, the healthcare program for the disabled, the elderly poor and the impoverished raises hackles every two years in the Texas Legislature, mostly because the number in need keeps rising alongside healthcare costs. Texas lawmakers also regularly underfund the joint state-federal program to pass a so-called balanced budget, only to act surprised to find they created a budget deficit when they return to Austin. The 2013 legislative session, however, adds a new wrinkle: President Barack Obama's Affordable Care Act and its provision to dramatically expand Medicaid. Before lawmakers can even think about expanding the program, though, they must pass an emergency supplemental spending bill to cover the $4.7 billion hole they left in Medicaid in 2011. More

GAO hits Medicaid on waste
POLITICO    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The Medicaid program has government employees and contractors doing some of the exact same work, which is wasting government time and money, according to a new Government Accountability Office report. Medicare, meanwhile, could better use data programmed into claims processing systems to stop fraud, GAO said in a separate report. GAO made the recommendations in reports requested by U.S. Sens. Tom Carper, D-Del., Tom Coburn, R-Okla., and others. The reports come as lawmakers look to both programs for potential savings in the fiscal cliff negotiations and are part of the constant effort on Capitol Hill to reduce waste in both programs. More

Connected Care program from Community Care, UPMC for You, successfully integrates behavioral, physical healthcare
PR Newswire    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Connected Care, a program developed by Community Care Behavioral Health Organization and UPMC for You, has resulted in significant reductions in the use of behavioral and physical health services by their members and is influencing other community-based programs that provide Medicaid services for individuals with serious mental illness. Connected Care, which Pittsburgh-based Community Care and UPMC for You started in 2009 as a two-year pilot program for the Pennsylvania Department of Public Welfare, is designed to integrate behavioral and physical healthcare Medicaid services for individuals with serious mental illness. More

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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

Watch, listen to the Sept. 18 webinar, 'Importance of Coordinated Care in the Management of Members with Hemophilia,' free on MHPA's website
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The presentation on coordinating care in hemophilia and how to improve outcomes and reduce costs by Jeff Januska, PharmD, pharmacy director at CenCal Health and Dr. Steven Pipe, associate professor, Department of Pediatrics and the Department of Pathology, University of Michigan, now is available on MHPA's website.

Dec. 17 insights webinar rescheduled: 'Proper Capitation Rates for Hemophilia Patients' now at 11 a.m. EST Jan. 23
Baxter    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The webinar will cover the uniqueness of the hemophilia disease state and the difficulties to apply an appropriate capitation for this disease. Also on the agenda: considerations for managed health care plans to ensure that states understand this unique disease state and that adequate reimbursement is received for hemophilia patients to receive the needed care. For details, click here.

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Free webinar: 'Optimizing Pharmaceutical Care and Measuring Outcomes in a Collaborative Drug Therapy Management Program' | 2 p.m. EST Jan. 30
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Medication-related problems and medication mismanagement are massive public health problems in the U.S. Experts estimate that 1.5 million preventable adverse events occur each year that result in $177 billion in injury and death. In response to these problems, PerformRx, in collaboration with the AmeriHealth Mercy Family of Companies, successfully have developed a collaborative Drug Therapy Management program that has demonstrated significant reductions in emergency room visits and inpatient admissions, as well as significant costs savings. More

Free webinar: 'Getting to know the 30 million newly insured: New patients equals new challenges' | 2 p.m. EST Feb. 6
PwC    Share    Share on FacebookTwitterShare on LinkedinE-mail article
In the wake of the Supreme Court's ruling to uphold the Affordable Care Act, approximately 30 million uninsured Americans under age 65 stand to gain coverage under the law. States are making two crucial decisions: Whether to expand Medicaid coverage, and which type of health insurance marketplace to create — state-run, state-federal run, or federally facilitated. As decisions are made and plans put in place, one thing is certain: When the exchange population is combined with the new Medicaid beneficiaries, the result will be a distinctly different customer base for the health sector, bringing with it many new challenges and opportunities. More

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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