Tagged with Provider Contracting and Enrollment
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.
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.
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.
A Pennsylvania bill that outlines the states telemedicine guidelines around who can provide telemedicine services, and offers clarity around insurance company reimbursement for telehealth services has gained unanimous approval from the Senate Banking and Insurance Committee.
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, Ohio Senate Bill 129 (House Bill 505) now requires insurers to implement faster turn-around times for reviews of prior-authorizations (PA) that are submitted electronically.
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.
Aetna has made adjustments to five clinical payment, coding policies that will become effective on March 1st.
AmeriHealth posted a notice in early December, notifying providers and consumers that the insurer’s pathology provider network will be closing for new office-based pathology providers, effective January 1st, 2018.
CMS on January 8th introduced its new voluntary bundled payment model, Bundled Payments for Care Improvement Advanced (BPCI Advanced).
CMS has launched a new data submission system for clinicians participating in the Quality Payment Program (QPP), designed to reduce administrative burdens and streamline the data submission process.
CMS, on December 28th, issued a Survey and Certification Memorandum (S&C Memo) to state survey agencies to clarify and reinforce its position that it prohibits physicians and health care providers from texting orders.
CMS has posted the application fee amount for any enrollment application submitted on or after January 1, 2018 and on or before December 31, 2018.
CMS has finalized proposals to eliminate mandatory hip fracture and cardiac bundled payment models and decrease the scope of the existing Comprehensive Care for Joint Replacement (CJR) bundled payment initiative.
CMS has published the final rule updating Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) Payment System rates and policies for calendar year 2018 (CY 2018).