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- INOC | NOC for Data Center on Network Adequacy Test Submissions for Medicare-Medicaid Plans
- Raji on Obamacare Reinsurance and Risk Adjustment, Year One.
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- Gorman Health Group on Is This Condition For Real? CMS Compliance Program Audit Findings Tied to FDR Oversight
- Liz Robinson on Is This Condition For Real? CMS Compliance Program Audit Findings Tied to FDR Oversight
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.
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
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.
The much anticipated Medicaid regulation from the Centers for Medicare & Medicaid Services (CMS) has been released, which aims at helping align regulations for managed care plans, creating a dynamic shift in how the Medicaid business will be handled moving forward.
Health plans diligently strive to be the best and first choice for delivering excellent healthcare services. Many seek accreditation with various organizations such as the National Committee for Quality Assurance (NCQA), the Utilization Review Accreditation Commission (URAC), and, most recently, the Malcolm Baldrige National Quality Award (MBNQA) as confirmation they provide their members with the utmost quality healthcare services.
For the last several weeks health policy nerds have been anxiously awaiting the release of the long-awaited Medicaid managed care proposed rule, the first from the Centers for Medicare and Medicaid Services (CMS) in 13 years. We’re coming to call it the “mega-reg” here. Friday at the Congressional advisory MACPAC meeting, Commissioners were widely quoting the term “epic” used by Jeff Myers, CEO of Medicaid Health Plans of America, in a recent National Journal article.