Managed Care Friday

Jan 25, 2018 | Managed Care Friday

1. 7.7 Million: The number of adults who have co-occurring mental health and substance use disorders according to the National Institute on Drug Abuse. New information on comorbidity from a study done across the globe in Australia. The Queensland Brain Institute released a study this month with Aarhus University showing the risk of developing a second mental health disorder. People within the study who were younger than 20 at the onset of their mental disorder were more at risk than others for developing a second disorder in the next 10-15 years. This study is now the largest and most...

Insufficient State Data Collection Impedes National Medicaid Oversight

Jan 24, 2018 | Medicaid

In an effort to improve CMS oversight of the Medicaid program and combat improper payments, federal administrators designed an updated data repository system, known as Transformed Medicaid Statistical Information System (T-MSIS). Though concerns originally arose over program participation, efforts have recently shifted to address inconsistencies between state and national data reporting, which have hindered CMS’s ability to properly oversee the Medicaid program. Click to read more.

MedPAC Assesses PAC & Hospice Payment Adequacy

Jan 22, 2018 | Hospice, MedPAC, Post-Acute Care

MedPAC annually reviews Medicare payment policies and makes recommendations to Congress. In this brief, we highlight MedPAC’s assessment of Medicare payments for hospice services and post-acute care settings, including skilled nursing facilities, home health, inpatient rehabilitation facilities, and long-term care hospitals. Click to read more.

CMS Issues Guidance On Medicaid Work Requirements, Approves 1st Waiver

Jan 16, 2018 | Medicaid

On January 11, CMS released long-awaited guidance on state opportunities to add work and other “community engagement” requirements to their Medicaid programs. The guidance indicates that such programs will need to be narrowly tailored to non-disabled, non-pregnant adults and must include “modifications” for people with opioid addiction and other substance use disorders. On January 12, the first of 10 requested waivers that include such features was approved for Kentucky.Click to read more.

Association Health Plan Rule

Jan 15, 2018 | Legislation/ Budgets/ Macro, Payers

The Department of Labor proposed new rules that would expand the definition of Association Health Plans, potentially making these a more viable option for employers to access health insurance. We believe this will have only modest implications for the composition of the insured, neither upending the current marketplace nor offering a significant solution to rising health care costs. Click to read more.

CMS Proposes Changes to the MA Risk Adjustment Model

Jan 11, 2018 | Medicare Advantage

On December 27, 2017, CMS released its Medicare Advantage (MA) Advance Notice plan for year 2019, which included proposed changes to the risk adjustment model. The changes are relatively modest and generally favorable to the industry. The proposed regulations would account for the number of beneficiary conditions, which would boost MA risk scores by an estimated 1.1%. It would also add behavioral health conditions to the risk model and would continue the slow transition toward the use of encounter data for risk scores. Click to read more.

MACPAC Recommendations Seek to Simplify Medicaid Managed Care Authorities

Jan 9, 2018 | Medicaid Managed Care

At its December meeting, the Medicaid and CHIP Payment and Access Commission approved two recommendations to simplify administration of Medicaid managed care authorities. One would allow longer approval periods for certain managed care waivers, and the other would allow state home and community based services programs to include managed care provisions without the need for multiple waivers.Click to read more.