Topic: Brain Food

Medicaid Final Rule Aligns the Program with MA and Exchange Regulations

Olga Walther

The Centers for Medicare & Medicaid Services (CMS) issued the final Medicaid “mega-rule,” a huge regulation that makes changes to every part of the current managed care rules. Although the final rule makes some tweaks based on the comments received from the industry, it largely adopts the proposals released last May. The new changes will be phased in over the course of three years, with some provisions going into effect starting July 1, 2017.

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Where is Healthcare Now? The Long March to Value-Based Care.

David Sayen

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Takeaways from the Gorman Health Group 2016 Client Forum

John Gorman

The Gorman Health Group 2016 Forum concluded last week with over 200 of our closest clients and partners. There was great news and rough news, so here are a few takeaways: Read more

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Issues to Watch in Government Health Programs in the Next Few Months

Olga Walther

Last week was an exciting time for the policy world with the release of the Final Medicare Advantage (MA) Payment Rate and Call Letter. Here are some other notable stories we are watching develop in the next few weeks:

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What’s Good for Obamacare Is Good for Medicare Advantage, and Vice Versa

David Sayen

I’m really excited to join Gorman Health Group (GHG) after more than 30 years at the Centers for Medicare & Medicaid Services (CMS), and I’m especially excited about the GHG Forum next week in Fort Worth. If you are sitting on the fence, now is a great time to jump in.  Make no mistake ‒ we are at the tipping point where public finance at the federal level is quickly becoming the dominant driver of change in the whole system.  In 1966, Medicare was erected on the 30-year-old chassis that was the Blue Cross model.  Now the tables are turned: Obamacare is determining the shape of new market entrants, often in a push-pull with Medicare Advantage (MA), and nowhere is that more evident than in my adopted homeland of the People’s Republic of California.

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Reconciliation just got more complicated

Jessica Smith

The time has arrived when health plans will start receiving a monthly automated Health Insurance Exchange (HIX) 820. For most health plans, this will occur in April 2016; others, who aren’t fully ready yet, will transition in June 2016.

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2017 ACA Applicants and Network Transparency

Steve Balcerzak

The National Association of Insurance Commissioners (NAIC) completed their review of provider network rules and published a draft of a new Model Rule. This is the first update of network rules in over 20 years. NAIC convened a committee of regulators, health plans, and consumers to provide input to the development of the draft document. The drive to develop the new rules came from the realization narrow networks used in Marketplace plans were the basis of increases in consumer complaints. Throughout the draft, NAIC recognizes the differences that exist between regulations in various states and the proposed changes, so any state can choose to follow the draft or construct its own rules. It has a three-year timeline.

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