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HERE'S TO A NEW YEAR!

With 2014 coming to a close, MHPA's Industry NewsBrief would like to wish its subscribers, partners and other industry professionals a very safe and happy holiday season.


As we reflect on the past year, we would like to provide the subscribers with a look at the most-read news stories. Your regular news publication will resume on Tuesday, Jan. 6.



MHPA's best practices letter to the Hill
MHPA
From Nov. 18: On Nov. 14, MHPA sent a letter to the Senate Finance Committee and House Energy and Commerce Committee on best practices in nine areas of Medicaid managed care, including rate-setting, care coordination, encounter data accuracy, quality measurement and program integrity. The letter is a response to a bipartisan letter sent to MHPA and other associations asking for the best practices submission. Read the full letter.
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Michigan finalizes MOU for duals demonstration
The Centers for Medicare & Medicaid Services
From April 10: The following is a memorandum of understanding between The Centers for Medicare & Medicaid Services and the Michigan Department of Community Health regarding a federal-state partnership to test a capitated financial alignment model for Medicare-Medicaid enrollees.
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The 4 most important states to watch on Obamacare's Medicaid expansion
The Washington Post
From Jan. 30: With state legislatures kicking off their 2014 sessions, the Medicaid expansion is back in play. Twenty-six states had signed onto the Medicaid expansion at the start of this year — and that leaves nearly half the country deciding whether to make a go of it in the future. In some states, there's little discussion of the Medicaid expansion. There are states that rejected it in 2013 and will probably reject it in 2014. But in a handful of states, there's a debate slowly starting about the best way to move forward in this area.
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Actuarial study could affect Medicaid managed-care rates; MHPA talks managed care regs with Modern Healthcare
California Healthline
From May 29: The CMS has unveiled two initiatives that could significantly affect pay and operations for Medicaid managed-care plans and healthcare providers serving millions of low-income and disabled Americans. The agency has launched a study of the adequacy of how the states set payment rates to plans, which in turn affects the adequacy of reimbursements to providers, said Camille Dobson, a senior policy adviser at the CMS, at the Institute for International Research's Medicaid Managed Care Congress in Baltimore on May 21.
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MHPA's Jeff Myers talks access in story on OIG report
The New York Times
From Sept. 30: The recently released report by the Office of the Inspector General at the U.S. Department of Health and Human Services calls for the need for better oversight by the Centers for Medicare & Medicaid Services on state standards for access to care in Medicaid managed care. It discusses the variability in the state standards for network adequacy. Read the story on the report by famed health journalist Robert Pear of The New York Times, which includes comments from Jeff Myers, MHPA's president and CEO.
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MHPA/Milliman study: ACA insurer fee could backfire on states
Forbes
From Feb. 13: A provision of the Affordable Care Act that requires health insurance companies pay a fee to help fund the law and expand benefits to the poor and uninsured could actually lead to the federal government taxing states and itself, according to a new analysis.
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Coming Medicaid plan rules will set new access standards
Modern Healthcare (Subscription required)
From Oct. 31: 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.
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North Carolina lawmakers get glimpse of potential Medicaid budget shortfall
North Carolina Health News
From March 27: After months of waiting, North Carolina legislators got their first hint of how large the overrun on the healthcare program could be. They also received a warning that the numbers are subject to change.
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As pricey hepatitis pill Harvoni joins Sovaldi, states erect Medicaid hurdles; MHPA's Myers comments
Forbes
From Oct. 14: As Gilead Sciences launches its next generation Hepatitis C pill, Harvoni, Medicaid programs are bracing for another extraordinary wave of costs, with 70 percent of states implementing coverage restrictions. Already, the cost of Gilead's first generation hepatitis C drug Sovaldi, which costs $1,000 a pill and more than $84,000 for a course of treatment, has triggered 35 states to require prior authorization before Medicaid patients can get the drug, according to a report from Washington, D.C.-based consulting firm Viohl & Associates. Gilead has said Harvoni's price will be $94,500 for a 12-week course of treatment.
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Medicaid overhaul plan filed by Missouri senator
The Associated Press via Fort Worth Star-Telegram
From Jan. 21: With the help of a plan introduced by a key Republican senator, private insurers would gain a greater role in the Medicaid program in Missouri, and patients could get rewarded financially for holding down their medical costs.
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MHPA's Industry NewsBrief
Colby Horton, Vice President of Publishing, 469.420.2601
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Damon Sayles, Senior Editor, 469.420.2662   
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