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Gilead sued over 'exorbitant' hepatitis C drug prices
Reuters
Philadelphia's transportation authority has filed a class action lawsuit accusing Gilead Sciences Inc of charging "exorbitant" prices for its blockbuster hepatitis C drug Sovaldi. The lawsuit, filed in federal court in Philadelphia by the Southeastern Pennsylvania Transportation Authority, seeks an unspecified amount of money damages.
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MHPA/NAMD fault HHS report on Medicaid managed care providers
MedPage Today
A government report finding that more than half of Medicaid managed care providers weren't seeing Medicaid patients touches on an important issue but doesn't tell the full story, according to Medicaid trade groups. The report, issued by the Office of Inspector General at the Department of Health and Human Services, found that 51 percent of Medicaid managed care providers contacted couldn't offer appointments to enrollees. MHPA's Jeff Myers said he found several problems with the report. "The report [incorrectly] implies that because of deficiencies in directories ... Medicaid beneficiaries would not be able to get to the care they need."
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Half of listed Medicaid doctors are unavailable; MHPA: That doesn't mean patients don't get access
Governing
About half of Medicaid doctors in managed-care networks can't offer appointments to patients because they don't have availability, or their status with the health plan isn't accurate, according to a report released by the Department of Health and Human Services Office of Inspector General. MHPA's Jeff Myers pushed back, saying provider directories should be up to date, but most patients don't get their information from the directories they receive when they sign up for a plan.
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Obamacare paradox: Medicaid is expanding, but doctors are facing a
huge pay cut

The Washington Post
Obamacare's Medicaid expansion is facing a new threat from an unlikely source — the law itself. An additional 9.1 million Americans have been added to the Medicaid rolls in the year since the program expanded under Obamacare. But a scheduled cut in Medicaid payments — built into the law — could steer doctors away from taking new patients covered the program. That's because a temporary payment bump to Medicaid primary care doctors, included in the Affordable Care Act, is likely to expire at the end of the year. That will mean an average payment cut of 42.8 percent to Medicaid primary care doctors next year, according to a new Urban Institute analysis.
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Capitol Hill briefing on reducing preterm birth on Dec. 11
MHPA
MHPA's report, "Preterm Birth Prevention: Evidence-Based Use of Progesterone Treatment — Issue Brief and Action Steps for Medicaid Health Plans," was featured at a Capitol Hill event with the March of Dimes, the Society of Maternal-Fetal Medicine, the American Congress of Obstetricians and Gynecologists, the American College of Nurse-Midwives, Rep. Ami Bera, Rep. Lois Capps and CerviLenz to educate legislators and their staff on the problem of preterm birth, the leading cause of infant morbidity and mortality in the U.S.

Read the MPHA preterm issue brief at http://bit.ly/pretermbirth.

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Legislative differences on future of North Carolina Medicaid program persist
Charlotte Observer
After months of talk, legislators continue to disagree over the structure of the state Medicaid program and whether insurance companies should be allowed to manage patient care. The differences reached a pivot point when a legislative committee on health and human services voted to strip language from a proposal that envisioned insurance companies and provider-led care networks in regional competition for Medicaid patients.
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Using Medicaid dollars to expand long-term care choices in Michigan
PBS NewsHour
AudioBrief Most Medicaid funds for long-term care go to nursing homes, but waiver programs give low-income seniors and younger adults with disabilities alternative options to get care in more home-like settings. The NewsHour's Cat Wise reports on a program in Michigan called "MI Choice," which aims to empower participants and their families to make decisions about the services they want.
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Kansas governor unveils plan to close budget gap; Medicaid untouched
The Washington Post
With Kansas facing a projected $279 million budget shortfall after enacting aggressive tax cuts, Republican Gov. Sam Brownback proposed to trim spending and divert funds for highway projects and public pensions to general government programs. The plan, which applies only to the current budget year, avoids reducing aid to the state’s public schools, its Medicaid healthcare program for the needy, prison operations or state universities.
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IIR's FDA/CMS Summit for Payers featuring MHPA's Jeff Myers | Dec. 11-12, Washington, DC
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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Dec. 17 Webinar Wednesday (rescheduled): 'Why All Medicaid Managed Care Organizations Need an ACO Strategy' | 3 p.m. ET
Epstein Becker Green and Health Policy Source, Inc.
The growth and persistence of the state accountable care organizations (ACO) movement is being fueled by CMS' State Innovation Model grants and by state implementation of Medicaid ACOs — 17 states have already implemented some form of Medicaid accountable care. Join Clifford Barnes, partner at Epstein Becker Green, PC, and Jenny Gladieux, senior health policy analyst for Health Policy Source, Inc., as they provide the tools to develop an understanding of how Medicaid ACOs affect Medicaid managed care and provide the rationale on why Medicaid managed care needs to develop state-specific ACO strategies.
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MHPA's Myers to speak at 6th Annual Medicaid Innovations 2015 Forum | Feb. 3-5, 2015 | Orlando
Medicaid Innovations Forum
Join MHPA President and CEO Jeff Myers at the Sixth Annual Medicaid Innovations 2015 Forum in February 2015. This meeting offers a unique combination of forward-thinking perspectives including first-hand case studies and examples of true innovation from both Medicaid managed care plans and state government agencies. The forum, which gathers hundreds of representatives from states, health plans and solution providers in one room, goes beyond policy to explore the specific strategies these organizations are leveraging to improve quality of care, reduce costs and position themselves for success in serving the rapidly expanding Medicaid population. Use Discount Code MHPA200 to receive $200 off the current rate.
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MHPA's Myers to chair WHCC 4th Annual Medicaid and Medicare Reform Summit | March 2015 | Washington, DC
World Congress
MHPA President and CEO Jeff Myers will chair the WHCC 4th Annual Medicaid and Medicare Reform Summit, a meeting that convenes executives from health plans, hospital systems and policy organizations to share, learn and discuss approaches to improve the quality of government programs and achieve payment and delivery reform. For conference details, agenda and registration, please visit here.
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TRENDING ARTICLES
Missed our previous issues? See which articles your colleagues read most.

    Healthy Pennsylvania enrollment begins but program could be scrapped next year (Pittsburgh Post-Gazette via InsuranceNewsNet.com)
Texas panel backs Medicaid waiver but not expansion (The Hill)
GOP may thwart Obamacare's huge pay raise for doctors (Forbes)
Wyoming devises plan to expand Medicaid (The New York Times)
Georgia Medicaid chief to step down (Athens Banner-Herald)
Unequal treatment in Arizona: Swings in Medicaid access show program's impact (Los Angeles Times)
3 insurers to split $151 million in Medicaid contracts (Indianapolis Business Journal)

Don't be left behind. Click here to see what else you missed.


Job opportunity: Clinical director, Homecare & Managed Care
First Quality
First Quality, a leading manufacturer of disposable home health care products, is seeking a clinical director for our Homecare & Managed Care Business. This candidate will provide leadership and have a focus on clinical education, utilization management protocols and programs and operational program development within home care and managed care markets.
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