Weekly Medicaid Update

Oct 13, 2021 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: AZ:   AHCCCS proposes rate increases for HCBS providers MN: Legislature enacts bills enhancing dental service coverage and provider rates OR: OHA has finalized the 2022 capitation rates for coordinated care organizations WI: Study finds Medicaid smoking cessation incentives for pregnant women successful Click to read more.

BRG Quarterly Compliance and Program Integrity Developments

Oct 12, 2021 | Legislation/ Budgets/ Macro

The BRG Healthcare Transactions and Strategy quarterly compliance bulletin compiles noteworthy developments in the healthcare sector related to compliance, program integrity, and enforcement activities. In the third quarter of 2021, we have taken particular note of: DOJ/HHS activity OIG Medicare Advantage Company Review Three Comparative Billing Reports Two GAO reports OCR activity Approved and proposed additions to the RAC audit list Click to read more.

Managed Care Friday

Oct 8, 2021 | Managed Care Friday

112M: The cost savings BCBS of NC experienced through its partnership with laboratory benefit manager, Avalon Healthcare Solutions. Since initiating the partnership in 2017, Avalon helped move more lab services in-network and implemented pre-approval to ensure tests were medically necessary.  There’s a growing focus on the “clinical utility” of lab tests.  In 2020, 99% of all lab services were provided within BCBS NC’s network, compared to 86% in 2017. Good Genes: Beginning January 2022, BCBS Michigan will begin allowing genetic counselors to join their network and receive direct...

MA Enrollment Grew, Premiums Steadied & Benefits Increased Since ’10

Oct 7, 2021 | Medicare, Medicare Advantage

The 2010 Affordable Care Act (ACA) reshaped payments to MA plans, including reducing government spend relative to pre-ACA levels. Despite these cuts, MA plan enrollment has grown, monthly premiums have declined, more plans offer $0 premium options, and supplemental benefits continue to expand. Current Congressional discussions of MA payment changes are much more modest relative to ACA changes. Click to read more.

Weekly Medicaid Update

Oct 6, 2021 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: AL: CMS awards state grant to implement mobile crisis intervention services AZ: CMS grants state one-year extension of 1115 waiver CA: San Mateo pilot program integrates dental benefit into comprehensive managed care IL:   State expands coverage of services for ASD OH: Proposal to add Medicaid coverage of TMS for treatment of depression Click to read more.