Topic: Medicaid

21st Century Cures Bill Slips in Some Changes to Medicare and Medicaid Programs

Olga Walther

What do medical research, Medicaid provider adequacy, and Star Ratings have in common? The 21st Century Cures Act. On January 7, 2016, Congress overwhelmingly passed this piece of legislation – a package of proposals which will provide $6.3 billion for medical research over the next decade.

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Trump Transition Team Picks Price, Verma to Head HHS, CMS; Providing Predictions for 2017 Agenda

Olga Walther

This week, Representative Tom Price was named the nominee for the new Department of Health & Human Services (HHS) Secretary. This widely expected pick provides us some foresight into what type of agenda to predict from the Trump Administration. Tom Price is one of the strongest opponents of Obamacare, from the very passage of the Affordable Care Act (ACA). Putting such a firm critic of the law as the head of HHS immediately sends the message we will see “below the waterline changes” and chips away at Obamacare before any repeal is even voted on. Price will soon have control of the constant flurry of subregulations and guidance put out by the Centers for Medicare & Medicaid Services (CMS) on a daily basis. Need an example? CMS released its early preview of CY2018 Medicare Advantage rate book growth rates this week. While the 2018 preliminary baseline rate increase is 2.31%, the actual rate will be finalized in April 2017 by the new Administration.

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What Do the 2016 Presidential Election Results Mean for Government Programs?

John Gorman

In a shocking victory, Donald Trump is our new President-elect, and Republicans held on to control of the House and Senate. The sweep gives Republicans wide control to pass significant legislation and reshape the federal government, including the entire federal civil service and the Supreme Court, in the next four years.

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2017 Readiness Checklist – Valuable Tool or an Exercise in Redundancy?

Julie Billman

Some people are list makers and wholeheartedly embrace the value of checklists. They utilize lists to manage tasks, stay focused, and ensure high-quality results. A publication by the Institute of Health’s Committee on Quality of Health Care in America, titled “To Err is Human: Building a Safer Health System,” lays out the value of checklists in improving patient safety. We should view the Centers for Medicare & Medicaid Services (CMS) Readiness Checklist in that same view: it is a tool to allow health plans to improve the quality and compliance of their health plan and safety of their members.

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Plan Now for Performance

Nancy Djordjevic

As 2016 comes to a close, planning for next year should be well underway.  Bids are in, and budgets for the current year are being evaluated against reality before next year’s strategies are finalized.  As the ACA continues to evolve, CMS has been busy with new programs and more oversight.  A plan or provider has to be vigilant about identifying any weaknesses that could mean high costs or low expectations relative to budget.  Parent companies have to be aware of line of business similarities and differences as Exchange and Medicaid business become more like Medicare Advantage in terms of programs and benchmarks.  A recent article from Kaiser on retention makes great points about the line of business impact on retention and how it is a simple metric that encompasses many operational issues.

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New Challenges in Network Development

Elena Martin

The sun is shining, kids are heading back to school, and fall will be here before we know it. Now is the perfect time to start planning for your network expansion needs. Plans need to be even more vigilant in managing their largest asset. Regardless of the size and scope of the organization, your plan’s network adequacy and accessibility is a cornerstone of any new initiative.

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Evolution or Extinction

Nancy Djordjevic

“The Theory of Evolution has two main points,” said Brian Richmond, curator of human origins at the American Museum of Natural History in New York City. “All life on Earth is connected and related to each other,” and this diversity of life is a product of “modifications of populations by natural selection, where some traits were favored in an environment over others,” he said.

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