Topic: Medicaid

Medicare at 50: Past, Present & Future

Jean LeMasurier

Since its inception on July 30,1965, millions of elderly and disabled Americans have been able to obtain medical care through Medicare. Before Medicare, almost half of all Americans 65 and older had no health insurance. Today that number has dropped to a staggering 2 percent.

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MLTSS: Key to Caring for Duals

Mayling Naputi

We all want to do it: Provide the best healthcare services for our members. For our vulnerable population, this can be complicated, if not near impossible to achieve, given the current healthcare issues at hand.

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EHR Incentive Programs: Improving Access to Care

Mayling Naputi

The 2014 Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs were developed to provide financial incentives to eligible professionals, eligible hospitals, and Critical Access Hospitals (CAHs) to achieve meaningful use of certified EHR technology with the goal of improving patient care.  The programs worked to prompt healthcare providers to adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology.  In her May 18, 2015, article in RevCycleIntelligence, Jacqueline DiChiara reported by the end of 2014, EHR incentive payments reached over $28 billion with eligible hospitals receiving more than $17 billion, Medicare and Medicaid-eligible professionals collectively receiving nearly $10 billion.  However, there are some changes with the EHR Technology Incentive Program that may affect your revenue—and not in a good way.

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Quality Ratings: No National Standard for MCOs…Yet

Sunmi Janicek

A recent article noted five major changes in new Medicaid Managed Care rules, one pertaining to a quality ratings system. Many states have quality ratings for managed care plans, but currently there is no national standard.  Medicare has a five-star system evaluating private plans, and private plans offered through the Affordable Care Act’s (ACA’s) Health Insurance Marketplace will begin publishing quality ratings in 2016.  Ratings for Medicaid managed care plans would look similar to the Marketplace plan ratings.

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Game Changer: Key Reforms Proposed in CMS Medicaid Rule

Mayling Naputi

You’ve got your nose to the grind stone working to meet all the waves of operational changes and requirements related to Medicare, Medicaid, Obamacare, and Health Care Reform – you literally don’t even have time to glance upward to the skies. Understandable. But it can cost you.

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Takeaways from Accountable Physician Groups’ Annual Summit

John Gorman

Twice a year I get the honor of speaking to the California Association of Physician Groups’ (CAPG) annual summit and DC policy meeting.  CAPG represents accountable, capitated physician groups, and now has members in 39 states.  They’re always among my favorite speeches given how sophisticated the audiences are.  Here’s a few takeaways from my talk last week on “The Future of Government Programs”: Read more

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Medicaid Rule Imposes New Standards for Beneficiary Access

Elena Martin

Per the announcement by CMS on Tuesday, the proposed Medicaid rule would require plans to implement an 85% medical loss ratio (MLR). Implementing an MLR for Medicaid would bring the programs in line with the private health insurance market and Medicare Advantage.  However, as mentioned by GHG’s Sunmi Janicek, it would not be without challenges.  The compliance costs for Medicaid plans with the increase in diligence needed in identifying & documenting costs incurrent to improve quality could be high.  Additionally, the CMS proposed rule would impose new standards for beneficiary access and availability to the MCOs provider network.

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