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As 2015 comes to a close, MHPA would like to wish its members, partners and other industry professionals a safe and happy holiday season. As we reflect on the past year for the industry, we would like to provide the readers of MHPA's Industry NewsBrief a look at the most accessed articles from the year. Our regular publication will resume Tuesday, Jan. 5.
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MHPA
From May 26: CMS has released the long-awaited Medicaid managed care regs. Read the full text of the rule here.
For pre-release comments from Jeff Myers on the rule and long-term care in Modern Healthcare, click here.
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National Journal
From May 19: Some time very soon, the Obama administration is going to propose federal regulations for Medicaid managed care for the first time since 2002. It is, in the immortal words of Vice President Joe Biden, a BFD within this world, where upwards of 40 million Americans receive health coverage through Medicaid that is administered by private insurers. The rules could touch almost every area of managed care, which pays plans on a per-member basis instead of the traditional fee-for-service that just pays for each procedure, test, office visit and so on.
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MHPA
From May 29: MHPA president and CEO Jeff Myers commented in a number of stories covering the release of the long-awaited Medicaid managed care proposed rule by CMS. Read them all here:
The Hill
From Dec. 17: Health insurers nabbed a victory in the $1 trillion spending bill unveiled late Tuesday night, earning a one-year freeze on the so-called premium tax. The tax has been opposed by groups representing Medicaid health plans, who have argued that the government is essentially "taxing itself" with the provision. It was expected to cost state Medicaid programs $14 billion over 10 years.
"Including a one-year delay of the annual excise tax on health insurers for calendar year 2017 in this bipartisan legislation shows the widespread opposition to this nonsensical policy," Jeff Myers, president and CEO of Medicaid Health Plans of America, wrote in a statement Wednesday.
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Bloomberg BNA
From Nov. 13: The Centers for Medicare & Medicaid Services recently sent letters to Medicaid directors of all 50 states, as well as to AbbVie, Gilead Sciences Inc., Johnson & Johnson and Merck & Co., which manufacture hepatitis C drugs like Sovaldi and Harvoni. The letters were all related to the cost of those drugs, which can run upwards of $90,000 for the course of treatment.
Jeff Myers, CEO of MHPA, said he doesn't think the letters will make much difference in the prior authorization policies, as health plans are acting in a perfectly legal way. Prior authorization policies are firmly rooted in medical efficacy, he said.
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The Associated Press via The Baltimore Sun
From Sept. 24: Far-reaching legislation designed to change how North Carolina government bills Medicaid patient treatment is going to Gov. Pat McCrory after the General Assembly approved Tuesday a final compromise measure that was years in the making. The legislation, voted for separately by the Senate and House, lays out the pathway by 2018 or 2019 to end the current fee-for-service system in which Medicaid in North Carolina reimburses doctors and hospitals for each service performed on a patient. Medicaid critics contend the practice has led to cost overruns and uncertainty.
The North Carolina Medical Society and N.C. Hospital Association opposed permitting managed-care companies to enter into contracts. Nearly 40 states already have some kind of coordinated care for Medicaid enrollees, according to Medicaid Health Plans of America. Jeff Myers, the group's CEO, praised the final legislation Tuesday night.
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Forbes
From Nov. 17: The expansion of Medicaid benefits for poor Americans under the Affordable Care Act and the general move away from fee-for-service medicine helped boost enrollment in private health plans by 7.8 million beneficiaries in the last year, according to a new report.
"Even if no other state expands Medicaid [under the ACA], managed care is going to increase its market share because states are moving away from fee-for-service medicine," said Jeff Myers, chief executive of MHPA. The report was released last week at MHPA's annual conference.
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Pharmalot
From Nov. 10: The Centers for Medicare and Medicaid Services wrote four drug makers asking for information about pricing arrangements with insurers and pharmacy benefits managers.
"The fact that CMS sent letters to each of the companies that make hep C drugs to remind them of their ethical responsibility to patients is a big deal," said Jeff Myers, chief executive officer and president of Medicaid Health Plans of America. "It highlights the unsustainability of their current pricing model."
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The Times-Picayune
From Oct. 27: Senate Finance Committee members met Monday to discuss the cost of the state's Medicaid program have more than the current costs of the program to worry about. The meeting was expected to address the state's options when it comes to controlling costs. But beyond costs, there's also a potentially threatened revenue source that has been hanging over the future of the Medicaid program that could require more urgency. It's known as the Disproportionate Share Hospital payment, which helps hospitals pay for the treatment of uninsured patients.
Hospitals "are right to be concerned that reducing DSH without expansion is the worst of both worlds," said Jeff Myers, the CEO of Medicaid Health Plans of America. "The absolute worst outcome ... is to have cuts in the DSH plan without Medicaid expansion because ultimately you would see your DSH payments drop, but you'd still have the same level or higher level of charity care because you'd still have people uninsured."
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Modern Healthcare
From Sept. 8: This summer, the Obama administration conceded it would need more time than expected to evaluate a large-scale test to better manage benefits and care for low-income and disabled Americans. The states participating in the initiative appear willing to stick with it, although two big ones expressed significant reservations.
Twelve states have rolled out three-year demonstrations under the Affordable Care Act to better coordinate health benefits provided to Americans who are eligible for both Medicare and Medicaid and, as a result, currently receive splintered care at extremely high costs to both programs.
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