Archive for Medicaid managed care


Medicaid Directors Set Goals for First 100 Days

The National Association of Medicaid Directors has published a paper detailing its objectives for its interaction with the Trump administration during that administration’s first 100 days in office.

We call upon the new Administration to convene with NAMD’s Board of Medicaid Directors to solidify specific areas for ongoing collaboration to be carried out and reflected throughout our respective agencies.

The Administration should make two updates to the process for developing federal Medicaid regulations and guidance. First, build in a step for engaging states during the pre-conceptual phase of work. Second, establish a distinct process whereby state Medicaid leaders can review federal regulations and guidance prior to finalization to ensure policies are operationally sound.

NAMD also calls for the administration to foster state-federal collaboration in the following areas:

  1. Alternative Payment Methodologies
  2. Medicare and Medicaid Dual Eligible Population
  3. Prescription Drugs
  4. Managed Care/Risk-Based Delivery Models
  5. Behavioral Health Issues
  6. Access to Services
  7. Home and Community Based Services
  8. Department of Labor & the Fair Labor Standards Act
  9. Medicaid Management Information Systems
  10. Transformed Medicaid Statistical Information Services
  11. Other Existing Regulations

Learn more about NAMD’s goals for the first 100 days of the Trump administration in the association paper “The First 100 Days: Laying the Groundwork for

New Tools for Addressing Old Medicaid Problems

The new federal Medicaid managed care regulation gives state Medicaid programs new tools with which to address longstanding Medicaid challenges.

In an article titled “The Medicaid Managed Care Rule: The Major Challenges States Face,” the Commonwealth Fund describes the tools the rule does and does not offer for addressing five major Medicaid challenges:

  • reaching medically underserved communities
  • unstable eligibility and enrollment
  • organizing coverage an care and developing effective payment incentives
  • aligning managed care with health, education, nutrition, and social services
  • information technology

Find the article here, on the Commonwealth Fund’s web site.…

CMS Unveils New Medicaid Managed Care Regulation

For the first time in more than 20 years, the federal government is introducing major changes in how it regulates Medicaid managed care.

The Centers for Medicare & Medicaid Services describes the 1425-page rule as aligning Medicaid managed care with other health insurance programs, updating how states purchase managed care services, and improving beneficiaries’ experience with Medicaid managed care.

To learn more about what CMS has proposed, go here to see the rule itself.

Go here to see CMS’s news release accompanying the new regulation.

Go here to (under the link “final rule”) to find nine fact sheets summarizing key aspects of the new regulation.

And go here for a commentary on the new rule and the context in which it was released by CMS acting administrator Andy Slavitt.


OIG Reveals 2016 Plans

The U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) has published its work plan for the 2016 fiscal year.

In 2016, the OIG will continue to examine all aspects of HHS endeavor, including Medicare, Medicaid, hospital services, public health activities, and more. In the coming year it will continue a number of hospital-focused projects while also focusing more on health care delivery, health care reform, alternative payment methodologies, and value-based purchasing initiatives.

Among the OIG’s planned Medicare projects in 2016 – some of them continued from the past and some of them new, quoted directly from the work plan – are:

  • Hospitals’ use of outpatient and inpatient stays under Medicare’s two-midnight rule. We will determine how hospitals’ use of outpatient and inpatient stays changed under Medicare’s two-midnight rule, as well as how Medicare and beneficiary payments for these stays changed, by comparing claims for hospital stays in the year prior to the effective date of the two-midnight rule to stays in the year following the effective date of that rule. We will also determine the extent to which the use of outpatient and inpatient stays varied among hospitals.
  • Analysis of salaries included in hospital cost

PA Re-bids Medicaid Managed Care Contracts

The Pennsylvania Department of Human Services (DHS) has issued a request for proposals (RFP) for organizations interested in serving the state’s Medicaid population through its HealthChoices Medicaid managed care program.

The HealthChoices program, introduced in 1997, currently serves nearly 2.5 million Pennsylvanians. Among them, 200,000 have enrolled in the program since the state’s Medicaid expansion began in January.

The new contracts will put a greater emphasis on value-based purchasing and will require participating insurers to provide at least 30 percent of their services in a value-based or outcomes-based manner within three years.   Among the tools managed care organizations are expected to employ to achieve this goal are accountable care organizations, bundled payments, and patient-centered homes.

With a projected value of about $17 billion, the RFP is expected to attract interest from national organizations that have not necessarily served Pennsylvania’s Medicaid population in the past.

To learn more about the state’s HealthChoices plans, see this news release from the Department of Human Services and this Philadelphia Inquirer article. Find the RFP itself here.…