Topic: Medicaid

Senate passes bill repealing major provisions of Affordable Care Act

Olga Walther

Last week, the Senate passed an Affordable Care Act (ACA) repeal bill, with a vote of 52-47. Although largely symbolic, this marks the first time the Senate has been able to pass such a bill.

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Proposed Changes to the CMS-HCC Risk Adjustment Model

Daniel Weinrieb

Policy changes governing risk adjustment in plans for Medicare-Medicaid dual eligibles may soon be coming.

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Recommendations Made by the National Quality Forum on Medicaid Measures

Sunmi Janicek

The National Quality Forum (NQF) is a non-profit organization working to evaluate and endorse standardization of healthcare performance measures. Recently, NQF submitted a series of reports to the U.S. Department of Health and Human Services (HHS) outlining recommendations on new measures aimed at improving Medicaid beneficiary quality of care.  For the last four years, NQF started providing strategies to HHS on improving care for dual eligibles, adults, and children in the Medicaid program.  These new quality measures were created to improve healthcare quality for more than 70 million adults and children.  The key area of concentration was the beneficiaries’ behavioral health and how it affects diabetic and cardiovascular care delivery.

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How to Partner with Key Health Systems in your Service Area to Optimize Benefit Plan Offerings

Elena Martin

As we anticipate additional information this week on the Centers for Medicare & Medicaid Services (CMS) network adequacy (pilot) audit, we can’t help but consider how CMS’ rigorous access and availability standards hamper Medicare Advantage (MA) plans’ ability to be on the cutting edge of innovative network design. The Affordable Care Act, in comparison, has allowed for Marketplace plans to offer narrow networks as long as the networks have sufficient numbers and types of providers to deliver services without “unreasonable delay,” leaving states to define the meaning of “unreasonable.” This difference in network adequacy standards has widened the gap in plan offerings.

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Government Sends Stark Reminders that Insurers’ Biggest Customer is Still the Regulator

John Gorman

Since we opened our doors 19 years ago, we’ve preached to health insurers to think of the government as your business partner.  This week, we got several reminders that insurers’ biggest customers — Medicare, Medicaid, and ObamaCare — are still the regulator.  As business conditions improve for health plans across these business lines, government expectations are rising, and scores are about to get settled, as they always are in the second term of a Democratic administration.

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The Affordability Review – “Reading the Tea Leaves”

Nancy Djordjevic

The fall season is a good reality check – back to school, cooler weather, end of summer, and …. Budgeting/financial forecasting. Forecasting is like predicting the future – you have to know how to read the tea leaves and see the efficiencies and interdependencies of your current performance to have a better idea of future performance and challenges.

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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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