Tagged with Medicaid Billing

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.”

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.

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Rhode Island, New Jersey, and Vermont, are amongst the states considering the state mandates to replace the recently repealed federal individual mandate.

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.

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.

New CBO Estimate shows ACA Mandate Repeal Cuts CHIP Funding Costs

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.

Ohio Medicaid Expands Acupuncture to Combat Opioid Epidemic

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.

Indiana Medicaid Medical Policy Updates

Anthem BCBS of Indiana has issued notice of medical policy revisions approved by the Medical Policy and Technology Assessment Committee (MPTAC).