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Public Payers News

Medicaid Service Equals or Surpasses Private Health Payers

April 27, 2017 - A new report by the Commonwealth Fund found that Medicaid provides equal or better quality health coverage to private health insurance plans.  The Commonwealth Fund’s 2016 Biennial Health Insurance Survey measured statistics related to access to care, quality of care, and problems related to medical bills.   The study found Medicaid recipients rated ahead of private payers...


Articles

Population Health Approach to Prenatal Care Cuts Payer Costs

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Health insurance payers can improve patient outcomes and reduce spending by expanding the use of population health management models for expectant mothers.  Early intervention and preventive care can lower costs in high-risk birth situations,...

OR May Cut ACA Medicaid Expansion Funds to Favor State Budget

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The Oregon state legislature is considering a retraction of Medicaid expansion and benefits to address an anticipated $1.8 billion budget shortfall between 2017 and 2019.  The move to cut back Medicaid could potentially leave more than 355,000...

Medicare Fee-for-Service Program Improperly Paid $41.1B

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Due to problems with oversight and contract issues, the Medicare Fee-for-Service Program wrongly made payments of $41.1 billion in 2016, according to a GAO report. Following an HHS report that initially found the inappropriate payments in the...

Texas Wrongly Claimed $3.8M in Medicaid Reimbursements

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Texas’s Department of Health and Human Services failed to adhere to federal guidelines and inappropriately claimed $3.8 million in Medicaid managed care reimbursement.    The Office of Inspector General (OIG) recently published...

Minn. Healthcare Payers Reported $687M in Financial Losses

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Local healthcare payers in Minnesota reported financial losses of $687 million due to the rising gaps in premiums and healthcare spending. The Minnesota Council of Health Plans gathered statewide data from insurance companies and HMOs, and found...

CMS: Payers May See 2.95% Rise in Medicare Advantage Revenue

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CMS announced updates to the Medicare Advantage (MA) program and Part D Prescription Drug Program, including an expected 0.45 percent increase in revenues for payers and the potential for up to 2.95 percent in revenue growth. “Medicare...

CHIP Funding Cuts Would Leave 8M Low-Income Kids Uninsured

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More than 8 million low income children living with chronic diseases would lose healthcare coverage and incur higher costs if CHIP funding is not extended beyond 2017, says new research from the Yale School of Medicine. In a study published in...

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

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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...

WI Improperly Claimed $3M in Medicaid Drug Reimbursement

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Wisconsin’s Department of Health Services failed to correctly invoice providers for over $3 million in Medicaid drug reimbursement, says the Office of the Inspector General (OIG) in a new report, leading to improper reimbursement from federal...

CMS Extends Pediatric Alternative Payment Model Comment Period

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CMS will continue to take public comment on its pediatric alternative payment model (APM) initiatives until April 7, 2017.   In March, CMS issued a request for information (RFI) related to establishing an APM specifically focused on the...

Medicare Limitations on Diabetes Supplies Endanger Patients

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Medicare’s Competitive Bidding Program (CBP) may increase the risk of negative patient safety events or medication nonadherence for diabetics by limiting the variety of available diabetes testing supplies, finds a survey by the American...

Price, Verma Push for Better State Control of Medicaid Programs

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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...

Medicaid Fraud Control Units Recovered $1.8 Billion in 2016

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Data released from the Office of Inspector General (OIG) showcases the investigations, convictions, settlements, and billion-dollar recoveries of Medicaid fraud by Medicaid Fraud Control Units (MFCUs) across the county. MFCUs coordinated over...

Org Offers 25-Point Plan for NJ Medicaid Program Improvement

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The New Jersey Health Care Quality Institute (NJHCQUI) recently partnered with the Nicholson Foundation to release a 25-point plan for modernizing and improving New Jersey’s Medicaid program. “The current program has too often failed...

CMS Seeking Feedback on Pediatric Alternative Payment Model

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The Centers for Medicare & Medicaid Services (CMS) recently issued a request for information seeking input on designing an alternative payment model focused on improving care quality and cost (APM) that specializes in pediatric care. The...

CMS Solicits Payer Participation to Next Phase of CPC+

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In support of second round of payer solicitation for Comprehensive Primary Care Plus (CPC+), The Centers for Medicare & Medicaid Services (CMS) has issued a list of frequently asked questions aimed at increasing payer support for the alternative...

GAO: Erroneous Medicaid Claims Data Pose Fraud Risk at CMS

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Millions of people rely on long-term personal care services under Medicaid coverage, but significant gaps and errors in two major CMS data systems are creating significant opportunities for fraud and abuse.   A new report from the Government...

Bundled Payment Model Attracts More Oncologists than Expected

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The new bundled payment model from the Centers for Medicare & Medicaid Services (CMS) called the Oncology Care Model has shown strong participation numbers among healthcare providers with twice as many medical organizations participating...

Key Best Practices for Success on the Health Insurance Exchanges

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Which healthcare insurers are succeeding in the health insurance exchanges? What best practices can be taken from these payers? The weekly newsletter Washington Health Policy Week in Review published an editorial answering these questions by...

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