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Medicaid

Proposed MA State Budget Targets Medicaid Program Funding

April 12, 2017 - The Massachusetts House of Ways and Means Committee approved a state budget for fiscal year (FY) 2018 that funds MassHealth, the state’s Medicaid program, through new tax revenues. The committee budget follows the one proposed by Governor Charlie Baker earlier this year. The Baker proposal called for a new employer-based fee that assists in paying for MassHealth spending. While the House-proposed...


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Proposed MA State Budget Targets Medicaid Program Funding

by Thomas Beaton

The Massachusetts House of Ways and Means Committee approved a state budget for fiscal year (FY) 2018 that funds MassHealth, the state’s Medicaid program, through new tax revenues. The committee budget follows the one proposed by Governor...

MA Medicaid Wrongly Paid $193M in Fee-for-Service Claims

by Thomas Beaton

An audit of MassHealth, the Massachusetts state Medicaid program, found the agency improperly paid approximately $193 million in fee-for-service claims for behavioral healthcare between 2010 and 2015.   Questionable payments to the Massachusetts...

BCBS of Minn. Cites Risk Pools for $322.4M in 2016 Losses

by Thomas Beaton

Blue Cross Blue Shield (BCBS) of Minnesota reported a net operating loss of $322.4 million in their 2016 financial audit, citing unbalanced risk pools and rising premium pricing as a current and future detriment to profitability. At the end of...

Price, Verma Push for Better State Control of Medicaid Programs

by Jacqueline Belliveau

As one of her first actions as CMS Administrator, Seema Verma collaborated with the Department of Health and Human Services (HHS) Secretary Tom Price to detail how the federal government plans to improve its state partnerships to enhance state...

CMS Ruling Changes Medicare Advantage and Part D Programs

by Vera Gruessner

Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced in a press release new changes taking place for the Medicare Advantage and Part D Prescription Drug Program starting in 2017. Essentially, these deviations are meant...

Is the Affordable Care Act Sufficient for Mental Healthcare?

by Vera Gruessner

There are specific provisions that the Patient Protection and Affordable Care Act has brought to the American people. This includes eliminating healthcare coverage restrictions such as the clause surrounding pre-existing conditions. Additionally,...

How Medicaid Expansion Improves Behavioral Healthcare Access

by Vera Gruessner

When the Patient Protection and Affordable Care Act was passed into law, it established that Medicaid expansion across all 50 states would take place. However, a Supreme Court ruling created a clause that allowed Medicaid expansion to be optional...

Medicaid Challenges with Value-Based Care Payment Models

by Vera Gruessner

With the federal government and the healthcare industry as a whole focusing their efforts on adopting value-based care payment models that revolutionize medical care, it should come as no surprise that the National Association of Medicaid Directors...

Is the Affordable Care Act Leading Payers to Lose Profit?

by Vera Gruessner

The world of healthcare has often been a struggle between medical providers and the payers with one side looking to offset costs and make a profit while the other side concerns itself with the revenue of their patient care. With the federal government...

Aetna, Mount Sinai Invest in Accountable Care Organizations

by Vera Gruessner

Since the Affordable Care Act was passed and the Center for Medicare & Medicaid Service Innovation established the Medicare Shared Savings Program, the development of accountable care organizations began to blossom quickly. Along with CMS,...

4 Health Payer Industry News Items Revealed at HIMSS16

by Vera Gruessner

With the 2016 HIMSS Conference and Exhibition closing its doors, it grows important to address how the health payer industry remains vital to both the ongoing technology advancements in medicine and patient care in general. Below we outline some...

Medicaid Coverage Expansion Boosts Healthcare Access in Flint

by Vera Gruessner

In April 2014, contamination in drinking water began in Flint, Michigan when the region transitioned its water source to the Flint River from its previous source of Lake Huron and the Detroit River. The problem at hand is that corrosion control...

Open Enrollment Dates Announced for Health Insurance Exchange

by Vera Gruessner

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released its yearly Notice of Benefit and Payment Parameters related to the coverage options on the federal health insurance exchange in 2017. The rulings outline ways...

4 Elements Necessary for Switching to ICD-10 Diagnosis Coding

by Vera Gruessner

On October 1, 2015, the healthcare industry from payers and federal agencies to hospitals, physicians, and specialists transitioned to ICD-10 diagnosis coding. Many healthcare providers were concerned that their practices would not be prepared...

HHS Pursues Higher Enrollment on Health Insurance Exchanges

by Vera Gruessner

The Department of Health and Human Services (HHS) is pleased with the most recent enrollment numbers in the Affordable Care Act’s health insurance exchanges. Department of Health and Human Services Secretary Sylvia M. Burwell stated in...

More Part D Beneficiaries Gain Access to Cost-Sharing Pharmacies

by Vera Gruessner

Healthcare access among Medicare and Medicaid beneficiaries remains a top priority for the Centers for Medicare & Medicaid Services (CMS). In 2015, CMS listened to the concerns of many beneficiaries and discovered that many do not have efficient...

Merit-Based Incentive Payment System Transforms Meaningful Use

by Vera Gruessner

Last Spring, the Senate and the House of Representatives passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and repealed the former flawed SGR formula. Over the coming years, this law will require healthcare providers to...

70% of Uninsured Texans Find Medical Coverage Costs too High

by Vera Gruessner

The Rice University's Baker Institute for Public Policy and the Episcopal Health Foundation (EHF) found in a new report that nearly seven out of ten uninsured Texans cite the high costs of medical coverage as the reason for lacking insurance....

23% of Voters Find Affordable Care Act ‘Extremely Important’

by Vera Gruessner

The Henry J. Kaiser Family Foundation released the January Kaiser Health Tracking Poll last week showing that the Affordable Care Act did not make it past 23 percent of those surveyed stating that it’s ‘extremely important’...

Star Ratings System Created for Medicaid Home Health Services

by Vera Gruessner

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) established a final rule that alters the Medicaid home health services definition to include additional requirements for home care services which expands beyond medical...

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