Weekly Medicaid Update

Sep 30, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: –   CA: Gov. signs bill authorizing NPs to practice independently starting in 2023 –   CO: Medicaid to cover residential and inpatient SUD treatment and withdrawal management services –   NJ: Gov. signs $37.2B FY2021 budget with several healthcare provisions –   OH: State to release request for applications for new Medicaid managed care contracts on September 30, 2020 Click to read more.

Managed Care Friday

Sep 25, 2020 | Managed Care Friday

12: Percent of hospitals receiving incentive payments for reducing cesarean sections and meeting quality goals related to episiotomies, early elective deliveries, and maternity care under a pilot from Tricare set to conclude in March 2021. Tricare, which provides healthcare coverage to 9.6 million uniformed service members, retirees, and their families, has several value-based initiatives underway. 3,640 hospitals participated in the maternity pilot. Asthma Device: Anthem is pairing with UC-Irvine to study whether smart devices can help asthmatics predict an asthma attack. Anthem members...

Best Practices in Using MA Encounter Data for Healthcare Research

Sep 24, 2020 | BRG Publications, Medicare Advantage

BRG finds that 2015 MA encounter data is not an analytic-ready data set for researchers to evaluate utilization or quality of care among MA enrollees. This report highlights the importance of data cleaning and preparation before the data is used and offers areas of strength and weakness by MA contract and provider type, helping to guide researchers who have access to the 2015 and later MA encounter data and wish to evaluate care delivered by MA plans. Click to read more.

Weekly Medicaid Update

Sep 23, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: –  IN: State extends +4.2% Medicaid rate increase for NFs through September 30, 2020 –  NY: State identifies more than $700M in improper or questionable Medicaid payments –  PA: State updates guidance on retainer payments for IDD waiver providers Click to read more.

FY 2021 Final Rules for IPPS and LTCH

Sep 22, 2020 | Hospitals, Inpatient, LTCHs

CMS has finalized FY 2021 rules for the hospital inpatient prospective payment system (IPPS) and long-term care hospitals (LTCHs). This brief summarizes the proposed changes made to the IPPS, which applies to approximately 3,200 acute care hospitals, and LTCHs, which applies to approximately 360 LTCHs. Click to read more.

Managed Care Friday

Sep 18, 2020 | Managed Care Friday

74: Percent of medical directors from 103 plans we polled who say imaging studies for uncomplicated low back pain are a consistent problem, often ordered unnecessarily with the first month of diagnosis. Health plans like BCBS of Illinois say they have to collect and report this type of data to the National Committee for Quality Assurance. Like Pulling Teeth: A Midtown Manhattan dentist’s practice is thriving, despite being almost completely shut down for a few months during the peak of the pandemic. Why? Tooth fractures. The dentist, Dr. Tammy Chen, wrote in The New York Times that she’s...

Weekly Medicaid Update

Sep 16, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: –  National: CMS withdraws the proposed Medicaid Fiscal Accountability Rule (MFAR) –  AZ: State to implement new policy for coverage of behavior analysis services October 1, 2020 –  IL: State implements new training requirement for Medicaid Crisis Response providers –  PA: Bulletin addresses electronic visit verification for personal care Click to read more.