Medicaid Managed Care

CMS plan would completely overhaul Medicaid managed care

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Over the next few weeks, the Centers for Medicare & Medicaid Services is expected to unveil an ambitious and comprehensive policy-making effort that promises to completely transform and radically overhaul the Medicaid managed care marketplace.

Managing managed care

Managing managed care

The common loopholes offered by the Fee for Service model made it harder for governments to maintain balanced budgeting.

Mental health would have coverage parity with medical care under federal proposal

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The Centers for Medicare & Medicaid Services has announced a proposed rule that would require Medicaid managed care patients to receive the same level of coverage for mental health and addiction treatment as they do for medical and surgical care.

Also in the news for Sept. 30, 2014 . . .

CMS clarifies appropriate use of power strips in long-term care resident rooms ...GAO: Integrating Medicare and Medicaid may not reduce costs on dual-eligible care ... Brookdale discriminated against worker with fibromyalgia, EEOC claims ... State standards for physician access under Medicaid managed care vary widely, OIG finds

Medicaid fraud units recovered $10 million from nursing homes in 2013, annual report shows

Medicaid fraud units recovered $10 million from nursing homes in 2013, annual report shows

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Medicaid Fraud Control Units recovered about $10.3 million from nursing facilities in fiscal year 2013, according to an annual report issued Friday. Civil fraud settlements and judgments accounted for the majority of nursing home recoveries last fiscal year, the report showed.

Many post-acute providers anticipate being acquired by more tech-savvy competitors, survey shows

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Nearly half of post-acute providers anticipate they will be acquired by an organization with better technological capabilities in 2015, according to survey results released today.

Managed care plans will account for 75% of Medicaid beneficiaries by 2015, analysts estimate

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Three-quarters of Medicaid enrollees will receive their benefits through a managed care organization (MCO) as of 2015, according to a new report from healthcare advisory company Avalere Health. Because Medicaid is the primary payer for long-term care in the United States, LTC providers are carefully monitoring the shift to a managed care environment.

Gap between long-term care costs and Medicaid payments was widest ever last year, report finds

Gap between long-term care costs and Medicaid payments was widest ever last year, report finds

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Medicaid underfunded long-term care by the greatest margin on record in 2013, according to a new report from the American Health Care Association/National Center for Assisted Living, the nation's largest long-term care provider association.

Managed care is here to stay, Minnix says

Managed care is here to stay, Minnix says

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Medicaid managed care systems have the potential to improve care outcomes, and providers' bottom lines, so operators should embrace them, said LeadingAge President and CEO Larry Minnix.

Better Medicaid managed care oversight needed to protect providers serving high-risk populations: OIG

Better Medicaid managed care oversight needed to protect providers serving high-risk populations: OIG

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States are not doing a good job of monitoring how Medicaid managed care enterprises handle providers serving high-risk populations, according to a new government report. Five of six states evaluated in a recent study were not monitoring MCEs' compliance with a federal nondiscrimination provision, the Department of Health and Human Services Office of the Inspector General found.

Minnix: Medicaid managed care is inevitable, can benefit every community

Minnix: Medicaid managed care is inevitable, can benefit every community

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Providers and long-term care advocates need to embrace Medicaid managed care systems, which have the potential to drive improved health outcomes and bottom lines while helping providers serve those most in need, according to LeadingAge President and CEO Larry Minnix.

CMS clarifies long-term care quality review in managed care models

CMS clarifies long-term care quality review in managed care models

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Noting that long-term care increasingly is being provided through Medicaid managed care plans, the government has released guidance on how to monitor the quality of care in these systems.

Report: Providers should prepare for managed care partnerships for dual-eligibles services

Report: Providers should prepare for managed care partnerships for dual-eligibles services

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Managed care organizations are set to play a bigger role in how long-term care is provided for people currently eligible for both Medicare and Medicaid, and providers should focus on having the right capabilities in place for them, according to a new report. Released by merchant bank TripleTree, it also identifies technology vendors enabling these capabilities in the long-term and post-acute care settings.

Providers: Get detailed contracts when entering Medicaid managed care systems, AHCA guidance urges

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Long-term care providers should be cautious adopters as Medicaid managed care programs grow in scope and number, according to a new report and toolkit from the American Health Care Association. Advisory documents for providers are attached as Appendix B and Appendix D to the toolkit.

States ready for Medicaid managed care expansion, but long-term care remains a worry, report says

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Stakeholders in Medicaid managed care programs feel prepared for the enrollment surge that will follow the full implementation of the Affordable Care Act, but there are ongoing concerns related to long-term care and provider capacity, according to a new report.