Tagged with Medicaid Billing
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.
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.
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.
The Florida Legislature has passed a bill that will institute new restrictions on prescription drugs and increase funding for addiction treatment and prevention.
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.
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.
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.
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 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.
As of January 1st, Anthem expanded its BadgerCare Plus and Medicaid Supplemental Security Income (SSI) plans to seven counties in Wisconsin.
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.
On January 22nd, Humana will update its preauthorization and notification lists for all commercial fully insured, Medicare Advantage plans and dual Medicare-Medicaid plans.
CMS on January 8th introduced its new voluntary bundled payment model, Bundled Payments for Care Improvement Advanced (BPCI Advanced).
CMS, in a letter to state Medicaid directors on December 15th, said it will no longer accept state Medicaid waivers seeking new or renewed federal matching funds for designated state health programs (DSHP).
The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) recently announced that the repeal of the Affordable Care Act’s (ACA) individual mandate will significantly cut the cost to fund the Children’s Health Insurance Program (CHIP) for five more years.
Beginning January 2019, in hopes of improving health outcomes for its residents, Delaware’s Medicaid program will soon cover treatment visits for people struggling with obesity.
In an effort to curb reliance on opioid painkillers, an alternative pain management method was expanded under Ohio’s Medicaid program. Effective January 1st, the expansion will allow Medicaid patients to receive acupuncture treatment by licensed non-physician acupuncturists.
Anthem BCBS of Indiana has issued notice of medical policy revisions approved by the Medical Policy and Technology Assessment Committee (MPTAC).