Complaint Management – Identifying the Riptides Drowning Your Health Plan

Julie Billman

Do you know the signs of a riptide? Often the general public isn’t aware of riptides when they go to the beach. The change in the way the water moves and breaks on the shore is something lifeguards keep an eye on to keep swimmers safe.

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2018 Medicare Marketing Guidelines

Regan Pennypacker

It was a hot summer night when the Centers for Medicare & Medicaid Services (CMS) released the final version of the calendar year 2018 Medicare Marketing Guidelines (MMG), and a few hot summer days have passed while the industry digests the changes. Don’t make the mistake and only share the MMG with sales and marketing; those handling enrollment, customer service, mailings, printing, Star Ratings and quality, compliance and oversight, legal affairs, provider relations, and finance (including delegates handling these functions) all have a stake in this chapter.

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2018 Medicare Marketing Guidelines – The Final word on Agency Compensation

Betsy Seals

If there is one thing we can always count on, it’s that the Centers for Medicare & Medicaid Services (CMS) will keep us on our toes!

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Are 1332 Waivers the Next Frontier of Obamacare Reform?

Olga Walther

Forty-nine Democrats and three Republicans delivered a blow to Affordable Care Act (ACA) repeal efforts last week by voting against what was then seen as the final effort to pass a bill through the Senate. Already this week, talks have ramped up of both a new repeal effort as well as bipartisan efforts to force through a “market stabilization bill.” Despite the focus on possible repeal legislation, the administration already holds one powerful card in their hand – the use of 1332 waivers – that could provide an avenue for healthcare reform through state action.

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Preparing for First Plan Preview of 2018 Star Ratings Data

Melissa Smith

While many of us have been enjoying the long days of summer and catching our breath after the Healthcare Effectiveness Data and Information Set (HEDIS®) season, the Centers for Medicare & Medicaid Services (CMS) has been hard at work preparing for the annual ritual of releasing the latest Star Ratings and program changes. Here’s an idea of what we can expect over the next few months:

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CHIP Reauthorization: Right Around the Corner

Thomas Johnson

Reauthorization for the Children’s Health Insurance Program (CHIP) lurks behind Washington’s focus on the Affordable Care Act (ACA) repeal and replace efforts. But the battle may be as contentious, and the added factor of a September 30th deadline makes stakeholders worry.

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New Challenges in Network Development

Elena Martin

The summer sun is shining and vacation season is in full swing! While our Health Plan Network and Product teams are taking a few deep breaths after application and bid filing deadlines, we cannot rest on our laurels for very long. Summer is the best time to start planning your next service area expansion (SAE) or even your first step into the Medicare Advantage (MA) world. Maybe you are an established MA plan evaluating where to expand your geographic footprint. Maybe you are a Medicaid plan looking to expand into the Managed Long Term Services and Supports (MLTSS) arena and are wondering what it would take to have a Dual Eligible Special Needs Plan (D-SNP) so many of the MLTSS Requests for Proposal (RFPs) are expecting; or maybe you are an Accountable Care Organization looking to leverage your infrastructure and enter the payer world. Now is the perfect time to start planning for your 2018 and 2019 network needs. Regardless of the size and scope of the organization, your plan’s network adequacy and accessibility is a cornerstone of any new initiative. And, Plans need to be even more vigilant in managing their largest asset

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