Managed Care Friday

Jan 15, 2021 | Managed Care Friday

3: The amount of free PCP visits Blue Cross NC members will have through a new feature designed to encourage their members to go to the doctor’s office. Effective January 1, 2021, select Blue Cross NC members have no copay for their first 3 visits when visiting their PCP on file. Benefit available to ASO, fully insured, and fully insured individuals under-65 with a copay for office visits. Kidney Care: Beginning this month kidney care management company Somatus launched a pilot to better integrate care for CareFirst BCBS patients with chronic kidney and end-stage renal disease. 250 members...

Medicaid Weekly Update

Jan 13, 2021 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: CA: Gov. Newsom releases FY 2021-22 budget proposal MD: Rate increases for behavioral health and long-term care providers OH: State solicits public comments for HCBS waiver amendments; announces single PBM TN: CMS approves state’s Medicaid block grant waiver; Biden may exercise withdrawal authority TX: State publishes managed care procurement schedule WA: Gov. Inslee releases FY 2021-23 budget proposal Click to read...

Non-Emergent Ambulance Transport Demo Expanded

Jan 12, 2021 | Ambulance, Ground, Medicare

CMS is delaying the nationwide expansion for the Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT). CMS will expand the demonstration in the states that have currently implemented the program to review payment efficiency, reduce expenditures, and ensure the right population is covered to receive reasonable services of care. Click to read more.

Managed Care Friday

Jan 8, 2021 | Managed Care Friday

2.2B: The amount Centene is spending to acquire Magellan Health in an effort to strengthen its mental health business. The deal will add 2 million pharmacy benefit members and 16 million medical pharmacy members to Centene's portfolio, the company said. The deal will also bring Centene 18 million third-party customers of specialty health services, which includes physical medicine and rehabilitation to people with disabilities. Acne: “I’m not sure if we’re missing an opportunity to reduce depression, alcoholism, violence and suicide by adding payment incentives to encourage dermatologists to...