Tagged with Medicaid Billing
Ohio Study Says Proposed Medicaid Eligibility Requirements to Cost $378M
A recent analysis by the Center for Community Solutions finds that Ohio’s proposed Medicaid eligibility requirements would cost the state $378 million over five years in added administrative costs for county governments.
New Hampshire Senate Passes Medicaid Expansion Bill with Work Requirements
The New Hampshire Senate recently passed a bill reauthorizing the state’s Medicaid expansion program to continue for another five years, transition to managed care in 2019, and imposes member work requirements.
Illinois Governor Approves New Medicaid Hospital Assessment Plan
The Governor of Illinois has signed a new Medicaid funding plan that makes changes to the hospital assessment formula and is intended to ensure that hospitals whose patients overwhelmingly rely on Medicaid coverage receive additional funding.
Connecticut Considers Work Requirement Bill for Certain Medicaid Enrollees
Connecticut lawmakers have introduced a bill that would implement work or volunteer requirements for adult Medicaid recipients and prohibit the Department of Social Services (DSS) from removing work requirements for Supplemental Nutrition Assistance Program (SNAP) recipients.
Anthem Blue Cross and Blue Shield Withdrawal of Modifier 25 Policy
Anthem Blue Cross and Blue Shield (BCBS) has published a notice informing health care professionals and policyholders that the insurer will no longer proceed with the reimbursement policy impacting physician use of payment Modifier 25.
Aetna Balance Billing Notice for Medicare Beneficiaries
Aetna has issued a notice reminding providers and billing professionals that Medicare beneficiaries under the Qualified Medicare Beneficiary (QMB) program should not be billed for cost sharing (balanced billing).
CMS Releases Proposed Regulation Intended to Alleviate State Burden
CMS has issued a notice of proposed rulemaking (NPRM) aimed at providing state flexibility from certain regulatory access to care requirements within the Medicaid program.
Massachusetts Introduces New Medicaid Rules
Massachusetts’ Medicaid program, MassHealth, has implemented major changes to the structure of the program, including shifting to accountable care organizations, allowing health care providers to address social determinants of health, and reimbursements will be tied to provider performance.
CMS Hospital Medicaid Reimbursement Rule Annulled
A U.S. District Judge has annulled a new rule from CMS which allowed the Agency to count private insurance payments against hospitals’ Medicaid reimbursement amounts, known by hospitals as “double dipping.”
Pennsylvania Updates Medication-Assisted Treatment (MAT) Prior-Authorization Requirements for Substance Use Disorder
Pennsylvania has announced plans to remove a pre-authorization requirement for Medicaid recipients to access Medication-assisted treatments (MAT) for opioid/substance abuse addiction.
New York Finalizes Draft Waiver Transition Plan for Individuals with Intellectual and Developmental Disabilities
The New York Office for People with Developmental Disabilities (OPWDD) has finalized its Draft Waiver Transition Plan which lays out their vision for reform of the system serving people with intellectual and developmental disabilities (IDD), “People First Care Coordination.” The Transition Plan describes the development of Care Coordination Organizations, which will provide Health Home Care Management services.
New Jersey Seeks Inpatient Capacity Expansion for Mental Health and Substance Use
The New Jersey Department of Health is seeking to further expand inpatient treatment capacity for individuals battling mental health issues and drug addiction and has invited providers across the state to submit plans to add up to 53 more inpatient beds in the underserved regions of the state.
Florida Legislature Passes Bill Limiting Opioid Rx to Three Days
The Florida Legislature has passed a bill that will institute new restrictions on prescription drugs and increase funding for addiction treatment and prevention.
CMS Introduces New Interoperability Initiative
CMS has announced its new initiative for interoperability, MyHealthEData. The program has been designed to empower patients by giving them control of their healthcare data, and allowing it to follow them through their healthcare journey.
Department of Health and Human Services Announces Future Changes to Provider Reimbursements
The Department of Health and Human Services (HHS) has announced its plans to overhaul the way the federal government reimburses providers. The Department states, in an effort to improve technology and transparency, it will make changes to interoperability, price transparency, and care delivery through Medicare and Medicaid, and remove regulations that hinder private innovation.
States Consider Individual Mandates in Place of Federal Individual Mandate
Nine states and the District of Columbia have announced they are considering laws that would require residents to purchase health insurance. Connecticut, Rhode Island, New Jersey, and Vermont, are amongst the states considering the state mandates to replace the recently repealed federal individual mandate.
Delaware Shifts Managed Medicaid Contracts to Value-Based Agreements
In an effort to improve outcomes, increase quality, and lower healthcare costs within Medicaid populations, Delaware says it will move its managed Medicaid contracts to value-based agreements.
CMS to Reinstate QMB Indicator in Medicare FFS Claims Processing System
CMS has issued a notice announcing the agency will reinstate the Qualified Medicare Beneficiary (QMB) Indicator in the Medicare Fee-For-Service (FFS) Claims Processing System in an effort to prevent providers from illegally billing some Medicare beneficiaries for cost-sharing.
Wisconsin – Anthem Expands BadgerCare Plus, SSI Plans to Seven Additional Counties
As of January 1st, Anthem expanded its BadgerCare Plus and Medicaid Supplemental Security Income (SSI) plans to seven counties in Wisconsin.
Massachusetts – HPC Certifies 17 Health Care Organizations through New ACO Program
In an effort to bring transparency and to identify best practices and areas for improvement, the Massachusetts Health Policy Commission (HPC) has announced a first-of-its-kind, state-wide, all-payer initiative. Seventeen organizations have already been certified though the state’s new Accountable Care Organization (ACO) certification program.
