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Monday Morning Medicaid Must Reads: July 23rd, 2018

Helping you consider differing viewpoints. Before it’s illegal. 

A few Medicare-ish ones this week, but keeping with our July them of technology.

Article 1:  

5 payers launch blockchain partnership, chronic disease tech released and more during Q2, Dave Muoio, MobiHealthNews, July 6, 2018

Clay’s summary: I still don’t really know what blockchain is. And I’d like to keep it that way I think. Seems like some big players are betting a lot on it, though.

Key Passage from the Article

 A handful of headlines from the past three months have made it clear that insurers are moving forward with novel technologies in mind.  Of note, a partnership of five healthcare organizations including insurers UnitedHealthcare and Humana, Optum, Quest Diagnostics, and MultiPlan announced plans to launch a blockchain pilot to help payers tackle mandated provider directories. The program will apply blockchain technology to improve the quality of data and reduce the administrative costs associated with insurers getting up-to-date healthcare provider demographic data, with results expected in the fall.

“I think the alliance is one of the first, if not the first, national blockchain alliances for healthcare,” Mike Jacobs, a senior distinguished engineer at Optum, who has been working on the test program for two years, said. Optum also seems to have been keeping an eye on other up-and-coming technologies, namely AI and neural networks. In a sold-out discussion hosted at Optum’s Boston office and organized by the Design Museum Foundation, Sanji Fernando, vice president and head of OptumLabs’ Center for Applied Data Science, explained at length how ongoing difficulties researchers face in explaining the decision-making process of these networks is limiting their role in healthcare. “There’s some amazing breakthroughs in AI that we expect will transform health and healthcare across the world,” Fernando said during his talk. “And while some of those breakthroughs may radically change the way you receive care, there’s a long road and journey before we accomplish that — along the way, though, there’s really valuable impact that AI can have in how we receive healthcare today.”

Earlier in the quarter Tom Beauregard, chief innovation officer at UnitedHealth Group, participated in a discussion with heads from Fitbit and Empatica on the future of health and fitness wearables in an industry becoming increasingly concerned about data privacy. Noting the increasing need to communicate with consumers about these topics, he said that the best way for insurers to keep patients on board with continuous monitoring strategies is to communicate the potential health benefits through a primary care physician.

Read it here 


Article 2:   

AHA ‘strongly opposes’ interoperability as a Medicare requirement, Evan Sweeney, FierceHealthcare, June 25, 2018

Clay’s summary: Hospitals don’t want any more things to slow down getting their cash, thank you very much.

Key Passage from the Article

 

The American Hospital Association (AHA) has come out against a policy floated by the Centers for Medicare & Medicaid Services (CMS) to make interoperability a requirement to bill Medicare and Medicaid.

In a proposed hospital payment rule issued in April, CMS included a request for information regarding a revision to hospital Conditions of Participation (CoP) and Medicaid Conditions for Coverage (CfC) that would require hospitals to share data electronically with other hospitals, community providers and patients “if possible.” In comments (PDF) submitted to CMS, the AHA said it “strongly opposes creating additional CoPs/CfCs to promote interoperability of health information.”

Read it here

 

 


 

Article 3:   

Medicare May Soon Pay Doctors For Diagnosis Via Text Message, Bruce Japsen, Forbes, July 12, 2018

Clay’s summary: You have about 6 weeks to tell CMS you want them to move forward with the policy.

Key Passage from the Article

By allowing doctors to bill Medicare for a text, it could cut down on a more expensive trip to a hospital emergency room or help a patient save time and money by making an unnecessary trip to the doctor’s office for something that can be treated or evaluated remotely. In a conference call with reporters Thursday, Verma cited the use of Skype as one example where a physician could be paid for evaluating and consulting with a patient. The following provisions are proposed in the 2019 physician fee schedule that would allow Medicare to:

  • Pay clinicians for “virtual check-ins – brief, non-face-to-face appointments via communications technology,” CMS said.
  • Pay clinicians for “evaluation of patient submitted photos,” CMS said
  • Expand covered telehealth services to include “prolonged preventive services,” CMS said.

Before the proposal can be implemented, it is open for public comment. But Verma believes it will go over well among physicians and their patients. “Physicians tell us they continue to struggle with excessive regulatory requirements and unnecessary paperwork that steal time from patient care,” Verma said. Public comments on the proposed rules are due by September 10, CMS said.

Read it here

 


 

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Clay’s Weekly Medicaid RoundUp: Week of July 16th 2018

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2LyE8IO

For optimist readers- http://bit.ly/2JCfUvg

GIVE A WARM WELCOME TO THE NEW IL MEDICAID DIRECTOR- Patti Bellock took the helm 7/11. Welcome!

LET’S TAKE ANOTHER LOOK AT THIS KY THING- Undeterred by the litigious slowdown from a few weeks ago, KY officials are revising and resubmitting their work requirements waiver to CMS. Keep in mind the judge did not rule work requirements to be the problem- but that CMS did not do a proper review of the impact. CMS has announced a 30-day comment period on the waiver. If you need boilerplate on how the sky will fall and the world will end if the waiver is approved, I can send you a few links to think tanks who are actively coordinating propaganda – er, I mean comments / responses “curated” to make sure the “public” opinion is heard correctly. I am sure it will be balanced.

 

LAST FRONTIER STATE ASKS FOR $15M BACK FOR OOPSIE PAYMENTS- Seems like the AK legislature passed a 10% cut to Medicaid (that’s called a law when its passed by the legislature), but the agency forgot to make it happen. This has been going on since October, so now the agency has paid out $15M illegally (that’s what its called when you do something in violation of a law) to providers. Now its sending out pretty-please-send-the-money-back letters to providers. More than a few providers are saying they’ve already spent it and can’t afford to pay it back. Somebody call Bernie. I know he’s been working on College-For-All and Healthcare-For-All. Surely he’s solved it by now.

DESPITE CLAIMS BY ADVOCATES THAT MOST MEDICAID BENNIES WHO COULD BE WORKING ALREADY ARE- A new report in Illinois shows that 70% of able-bodied Medicaid expansion bennies are not working.

EARLY NUMBERS IN ON BENNIES FAILING TO MEET WORK REQUIREMENTS IN THE NATURAL STATE- A little north of 7,000 members did not report enough hours in June to be compliant with the new rules in Arkansas (there are another 18,000 subject to work requirements but who don’t have to report hours due to other exemptions). About 450 members did meet the requirements. Those who missed the mark in June could lose coverage if they go 2 more months without working.

 

THE MOTHER OF PRESIDENTS STATE PAYS MOTHER OF ALL RX MARKUP FEES- An early look at the report looking into how much Medicaid money CVS Caremark (the pharmacy benefits manager, or PBM) kept in Ohio shows about $224M staying with the middleman (CVS) after pharmacies were paid. Not sure if that’s a big deal or not? According to the report the OH CVS markup is 3x what CVS normally gets in other markets. This kind of reminds me of 340B providers not passing on savings to poor patients, but that’s another kettle of fish…

ADD IDAHO TO THE LIST OF STATES WHERE VOTERS ARE ALL NOW MEDICAID DIRECTORS- Expansioners have certified the number of signature required to get expansion on the ballot in November.

ANOTHER TROUBLED NEMT MARKET IN THE NEWS- We covered challenges with Southeastrans service in Indiana on the show this week. Looks like Veyo continues to struggle in Connecticut. Recent reports include high profile meetings with healthcare providers and advocates who are voicing complaints over missed rides. In their defense, Veyo delivered 364,000 trips in May and only 478 complaints were filed (less than ½ of 1 percent of rides). Some of the complaints get into how long providers have to be on the phone to resolve issues, and whether drivers are showing up with appropriate vehicles (i.e. wheelchair accessible).

 

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Let’s start the ticker and see who wins this week’s award. There was a huge, national Medicare/Medicaid fraud dragnet in late June and most of the stories out now are from that. I will hit the highlights from that sweep: Health Quest Systems of NY will pay $14.7M to double-dog promise they are not guilty of upcoding E&M visits paid for Medicare/Medicaid. Brent Clarke of PA will pay $360k for his role in a medically unnecessary services scam. Mayura Kanekar of Queens and 12 of their (not sure if that’s a male or female name) closest criminal buddies were charged with stealing $163M from Medicare and Medicaid this week. Looks like this scam involved 5 physicians, 3 therapists and 2 pharmacy owners (there’s a high school algebra word problem in there somewhere). “Dr” Abraham Demoz of Oceanside, NY was nabbed (along with 4 of his buds) for his role in stealing $163M in an illegal kickback scheme using referrals to their clinics. Once they got the patients to their clinics, they then billed for lots of physical and occupational therapy. That’s it for the ones from the big national sweep. The biggest one that I think was Caid’ only this week was in MA. Michael Davini of Worchester, MA will go to court over fraud charges related to a $19M scam in which he is accused of money laundering and false bills to MA Medicaid for non-emergency transport. The case says Davini billed for wheelchair van rides for members not in wheelchairs. Mr. Davini – you win (we keep the award Medicaid-specific)! Taxpayers – you lost at least $350M this week by my count.

 

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (have a water balloon fight, or run in the sprinkler) and keep running the race (you know who you are).

 

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: Faderen sendte Sønnen for å redde verden

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Criminal sanctions for HIPAA violations increasing

Based on new analysis by Matthew Fisher over at Health Data Management, the number of criminal penalties for HIPAA violations has been increasing.

A few highlights include:

  • About a third of breeches come from outside (hacking)
  • About 40% come from inside (unauthorized sharing/access/disclosure)

Fisher provides a good refresher on what the laws are regarding sanctions, and also walks through a few helpful recent examples of convictions.

Check out the full article here.

Shameless plug: Worried about your organization’s compliance? You could always take our online HIPAA awareness course.

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Let’s Do the Math: ACA Added At Least $1.3B in Annual Profit for Medicaid Health Plans

Disclaimer: I think its great when MCOs make money. From my study of economics and history (and life itself), only a profit motive will change healthcare outcomes. This quick analysis is meant to point out that ACA/ObamaCare has its own capitalist underbelly, too.

Disclaimer 2: This isn’t really news. I’ve had it on my list to do this calculation a while now. Just now getting around to it.

 

 

ACA added at least $1.3B annual profit for Medicaid managed care plans

Based on CBO estimates, ACA Medicaid expansion added $68B in spending 2015. Assuming a 2% profit, that means ACA added $1.36B to Medicaid health plan profits for each year moving forward. If we only used 2015 as the starting point, that means roughly $4B in profits have been added to Medicaid health plan bottom lines the past 3 years.

 

ACA added at least $8.8B annual administrative revenues for Medicaid managed care plans and vendors

Assuming 13% administrative expense (continuing with an assumed 85% MLR; 13% admin and 2% profit), then an additional $8.8B in annual administrative spending is happening due to Medicaid expansion. That’s $8.8B now going to pay for case managers, technology firm salaries, transportation company costs and myriad other services that are included in the administrative costs component allowed under Medicaid health plan spending.

 

 

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New Medicaid and telehealth market studies out; New Medicare payment for telehealth

Both Manatt and the Center for Connected Health Policy have released recent reports on the state of telehealth and Medicaid in the past few months. CMS also released a proposed change to Medicare reimbursement that would allow home health agencies to include remote patient monitoring in their cost calculations. Links below-

 

CMS Proposes Changes to Improve Access to Remote Patient Monitoring Technology

50 states summary infographic Spring 2018 FINAL

State Telehealth Laws and Medicaid Policies: 50-State Survey Findings (Manatt study)

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Monday Morning Medicaid Must Reads: July 16th, 2018

Helping you consider differing viewpoints. Before it’s illegal. 

 

Article 1:  

More Than 600 Charged In Historic Opioid Fraud Takedown, Beth Leipholtz, The Fix, 7/10/2018

Clay’s summary: The national fraud sweeps get cooler and cooler to watch each year. I think they should wear go pros next time so we can watch in real time as they kick in doors.

Key Passage from the Article

“This is the most fraud, the most defendants, and the most doctors ever charged in a single operation,” said Attorney General Jeff Sessions.Sessions says the DOJ’s investigation “has stopped or prevented billions of dollars’ worth of fraud.” More than 600 people within 58 federal districts have been charged by the U.S. government for their involvement in “multi-billion-dollar profit-making schemes involving opioid painkillers,” CBS News reported.

On Thursday, June 28, the U.S. Justice Department announced the charges, which have to do with billing government programs like Medicare and Medicaid, as well as private insurers, for prescription medications that have been deemed medically unnecessary. These actions resulted in more than $2 billion in losses, the Justice Department and the Department of Health and Human Services states.

Read it here 


Article 2:   

GAO Confirms It: 340B Hospitals and Contract Pharmacies Profit from Low-Income, Uninsured Patients, Adam J Fein, Drug Channels, July 10, 2018

Clay’s summary: 340B can be an amazing profit center for providers who choose to not pass the savings onto patients.

Key Passage from the Article

The United States Government Accountability Office (GAO) has just issued a must-read report on the 340B Drug Pricing Program: Federal Oversight of Compliance at 340B Contract Pharmacies Needs Improvement.

Some of the report’s most startling revelations confirm our worst fears about how hospitals and pharmacies are abusing the 340B program.

Here are two especially dispiriting findings from the GAO’s analysis:

16 out of 28 hospitals (57%!) did not provide discounted drug prices to low-income, uninsured patients who filled prescriptions at the hospital’s 340B contract pharmacy. Seriously?!?
Many 340B contract pharmacies can earn excessive profit margins of 15% to 20% from brand-name 340B prescriptions. As I have long suspected, large, publicly-traded pharmacies are sharing in the 340B discounts generated for covered entities.
Bottom line: Hospitals and pharmacies are making money from poor people. Are you kidding me?!? For shame!

The 340B program’s apologists will have a hard time rebutting the uncomfortable facts from this GAO report. Calling something a “drug discount program” apparently doesn’t mean that the neediest patients get access to those discounts. Read on, and prepare to be outraged.

  

Read it here

 

 


 

Article 3:   

CMS suspends $10.4B in risk adjustment payments to insurers, Evan Sweeney, Fierce Healthcare, July 9, 2018

Clay’s summary: Health plans have a pretty big outstanding invoice. A smaller plan in NM is gumming up the works for the big guys with a lawsuit that says ACA calculations for the payments favor bigger plans.

Key Passage from the Article

Citing a March court ruling, the Centers for Medicare & Medicaid Services announced over the weekend that it is placing payments on hold while it resolves the litigation. Insurers on the Affordable Care Act marketplace are owed $10.4 billion in risk adjustment payments for the 2017 benefit year, which were slated to be paid in the fall. “We were disappointed by the court’s recent ruling,” CMS Administrator Seema Verma said in a statement. “As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold.”

Verma added that CMS has asked the U.S. District Court for the District of New Mexico to reconsider its ruling and that the agency “hopes for a prompt resolution.”

The case involves New Mexico Health Connections, a consumer operated and oriented plan (CO-OP), which sued the Department of Health and Human Services (HHS) over what the insurer said was a flaw in the calculation that favored larger insurers. Judge James Browning ruled that HHS’ formula was not illegal but should be re-examined.

A separate ruling in Massachusetts in January found HHS acted within its authority in calculating risk adjustment payments. The program was created under the ACA to prevent insurers from risk selection and avoiding sicker enrollees.

Read it here

 


 

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Clay’s Weekly Medicaid RoundUp: Week of July 9th 2018

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2NcLGkD

For optimist readers-  http://bit.ly/2NdUnLs 

Don’t forget Monday’s Monthly Medicaid News Roundtable show where will cover a lot of these in more depth with the panel. Sign up for free here –

http://www.mostlymedicaid.com/?page_id=3176

 

 Bigger than normal fraud section at end today. Enjoy!

BLUEGRASS STATE MEDICAID REFORM SLOWED DOWN AT THE BENCH- Most of you saw that the KY work requirements plan was stopped by a judge’s gavel last week (an image of king dropping his scepter to note a ruling flashes in my mind). Thank you to all the readers who sent in various analyses and insights. It appears to be a KY-only ruling, in that the judge found CMS did not consider whether this particular request facilitates the “purposes and goals of the Medicaid program.” I invite all readers to read Title XIX of the Social Security Act (which defines Medicaid) and weigh in on what the purposes of the program are. Here’s a link to the full act- https://www.ssa.gov/OP_Home/ssact/title19/1900.htm

My hot take is that SSA defines Medicaid’s “purpose” as a way to give states cash for health care (for the states that want to pay their part of it). Not the lofty insure the uninsured, etc stuff we have come to ensconce in Medicaid mantras some 50 years later. Do I think the judge actually read SSA to compare the request to the “purposes and goals” of Medicaid? Doubt it.

DID YOU KNOW UNIONS GET A CUT OF MEDICAID HOME HEALTH DOLLARS? I DIDN’T – Talk about graft. Seems Dear Leader O gave unions a tidy little bundle of cash under ACA. Here’s how the scheme works: ACA included a rule that allowed states to divert a portion of home health care workers to mandatory union dues. Usually federal regs don’t let Medicaid provider payments go to anyone but the provider, but O made an exception. How much did unions get from this tiny little vig off the ACA pie, you ask? About $200M each year. Plenty to send back in through campaign contributions, etc. Quick lefties – claim the moral high ground somehow. Tell me how this is anything but slimy politics with “healthcare for the poor” as cover.

NEW TELEHEALTH REPORT OUT- Well 2 reports actually (check the site for links / copies in the next few days). Similar results as last year’s info, I think. Telehealth is now defined in most states, Medicaid has better payment than commercial, still struggling to get services that happen while patient is sitting in their living room covered (besides remote patient monitoring- have to go to a provider office that is part of a hub/spoke model for most consults).

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Let’s start the ticker and see who wins this week’s award. Rebecca Norris of Frostburg, MD (sounds chilly) plead guilty to nabbing $850k using her Appalachian Wellness Centers to do video-based therapy but billing it as face-to-face. Chin Kim of Bethel, AK has been charged with stealing Medicaid dollars by taking vouchers bennies are given by the state to cover travel costs (flying in to Bethel to get care, hotels, etc) and then submitting them to Medicaid for payment. That part seems ok per rules- it’s the $4k to $57k increase in one month that put Kim on the MFCU radar for fraudulent billings. Dana Trandahl of Butte, MT is charged with billing $74k in services not provided using her counseling service. Galit Levi of Queens plead guilty to stealing $67k in Medicaid benefits by hiding her annual income of $225k. In a very unusual twist, she paid it all back and got a $1,000 fine. Hope In-Home Care of Newport News, VA has agreed to settle Medicaid fraud allegations by coughing up $3.3M (to emphasize their innocence, of course). Charges included false claims for personal care services, falsifying statements of eligibility for members and for prior authorization and billing for services not provided. James Burkhart of Indianapolis was sentenced this week for his role in the American Senior Communities scheme which stole $10M from Indiana Medicaid using an elaborate vendor kickback model. The scheme facilitated multiple frauds by allowing vendors to send higher bills for their services to nursing homes, which would in turn be reimbursed by Medicaid (basically gaming the cost report if I understand correctly). Mom and daughter duo Julie Longton and Leanda Zupka of Norwich, CT will pay $300k back to Medicaid that they stole using unlicensed therapists in their counseling business. Galit – you win! You paid it all back, which never happens. Taxpayers, you lose. Which happens every week (but you better smile and take it, else you’re a big ole’ meanie!).

 

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (cut the grass-but bag it if you have weed problems. No need to put the seeds right back on your lawn) and keep running the race (you know who you are).

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: Bubālē chōrālā’ī sansāralā’ī bacā’unubhayō.

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Monday Morning Medicaid Must Reads: July 9th, 2018

Helping you consider differing viewpoints. Before it’s illegal. 

 

Article 1:  

N.J. bill would cap Medicaid ER visits at $140 for non-emergencies, Nicole Leonard, Press of Atlantic City, July 3, 2018

Clay’s summary: Great idea. Now spend 1,000 years arguing about all the exceptions to the rule. Forrest for the trees and all that.

Key Passage from the Article

  

If a Medicaid patient comes into an emergency room with what turns out to be a minor or nonemergency case, New Jersey hospitals will see a standard $140 reimbursement payment for that health care if a new bill becomes law.

Legislators who crafted the bill, which now awaits Gov. Phil Murphy’s signature, said the goal is to save the state and taxpayers money by capping payments to hospitals for these “low-acuity” cases, but some provider organizations and hospital experts fear it will do more harm than good.

“Our biggest concern is that hospitals will be penalized for treating patients who have nowhere else to go,” said Neil Eicher, vice president of government relations and policy at the New Jersey Hospital Association.

The bill, which passed the Assembly and Senate on June 21 with support and opposition within both political parties, applies specifically to Medicaid patients in the fee-for-service program.

About 1.8 million residents get coverage through Medicaid, according to state reports, and patients in the fee-for-service managed-care program account for about 5 percent of that population.

The state Office of Legislative Services estimated their collective outpatient health care services amounted to nearly $206 million in fiscal year 2017, but the amount that is related to emergency department visits is unknown.

 

 

Read it here 


Article 2:   

Finally, Some Answers on the Effects of Medicaid Expansion, Aaron Carrol, New York Times, July 2, 2018

Clay’s summary: If the goal was an insurance card in every pocket, we did awesome. According to lots of researchers.

Key Passage from the Article

 Since the start of Medicaid expansion, 77 studies, most of them quasi-experimental in design, have been published. They include 440 distinct analyses. More than 60 percent of them found a significant effect of the Medicaid expansion that was consistent with the goals of the Affordable Care Act.

Only 4 percent reported findings that showed the Medicaid expansion had a negative effect, and 35 percent reported no significant findings. Negative effects could include more uninsurance and increased wait times, but none showed decreased quality. It should be noted, moreover, that the few studies with negative outcomes were more likely to employ methodologies that were less likely to be able to show that Medicaid was causing these outcomes.

The majority of analyses looked at access to care, and they showed that after the Medicaid expansion, insurance coverage improved and the use of health services increased. It’s harder to study quality than access, but 40 analyses in 16 studies did so. About half of these reported improvements in quality measures like diabetes monitoring or preventive care screenings.

Read it here

 

 


 

Article 3:   

Kentucky cuts dental, vision coverage for nearly 500,000 Medicaid recipients, Tami Luhby, CNN, July 3, 2018

Clay’s summary: I’ve been telling you guys he’s not bluffing.

Key Passage from the Article

 Kentucky Republican Gov. Matt Bevin has suspended dental and vision benefits for nearly 500,000 Medicaid recipients after a federal judge blocked his plan to overhaul the safety net program.

Bevin’s administration was set to launch a massive reorganization of Medicaid benefits on July 1. The changes, which were approved by the Trump administration in January, included requiring certain beneficiaries to work and to pay premiums. The reorganization also would have changed dental and vision coverage for many low-income adults.
The effort was halted — at least temporarily — on Friday after US District Judge James Boasberg voided the federal approval and kicked the matter back to the Department of Health and Human Services for further review. Calling the agency’s approval “arbitrary and capricious,” Boasberg said HHS Secretary Alex Azar had neglected to analyze whether Kentucky’s plan would cause recipients to lose their health insurance coverage.
Bevin administration officials quickly warned that the state would have “no choice but to make significant benefit reductions” to offset the increasing cost of Medicaid expansion. On Sunday, they announced that dental and vision coverage would end for about 460,000 recipients until the overhaul moves forward.

Read it here

 


 

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Tech focus: New Electronic Visit Verification (EVV) Association Formed

For those of you following EVV (we’ve covered it a bit over the years as it relates to home health, program integrity, etc) – you may be interested in the forming of the National Electronic Visit Verification Association (NEVVA).

Press release info below

 


Repost of Press Release

 

Gaining Momentum: National Electronic Visit Verification Association (NEVVA) Formed and Executive Director Announced

New organization appoints industry expert, Mark Dillon, to leadership role

 

Deerfield Beach, FL — (ReleaseWire) — 06/21/2018 — The National EVV Association (NEVVA) announced today that the organization has officially completed its formation and incorporation in the state of Florida and has filed for non-exempt status with the IRS. NEVVA, spurred as a result of the recent national EVV Summit, sponsored by Tellus, LLC, a leading provider of mobile health and EVV technology, is intended to expand the EVV conversation, creating a leadership forum that bridges the key constituencies across states, managed care organizations and provider agencies. NEVVA will focus solely on EVV and will serve as the industry voice and resource for all news, information, expertise and advocacy related to EVV.

As part of the initial formation of the association, Mark Dillon, founder and CEO of Pulsewrx, Inc., has been appointed to the role of Executive Director for NEVVA.

Mark Dillon is a pioneer in the EVV industry and has a deep understanding of GPS, Wireless Networks and the applicability in Home and Community-Based Care. Dillon completed the first GPS EVV-based implementation for a State Medicaid Department and its respective MCO contractors. Dillon has served as a GPS industry expert to Government payers and State Medicaid Departments in the structuring of their EVV solution for a range of mobile delivery services.

A speaker at this year’s EVV Summit, Dillon said, “Everyone who knows me knows that I’m extremely passionate about EVV. I feel very strongly that it’s good for everyone involved and the right thing to do. I’m honored to lead this new organization.”

Dillon’s first area of responsibility is to establish the organization’s bylaws and membership categories. A logo identity and temporary web presence at www.nevva.org has been established to collect contact information for anyone interested in joining the organization.

EVV enables health care providers to confirm that care services were actually delivered by using a variety of electronic methods like GPS geofencing, biometric information capture, telephony and other methods.

EVV became a national requirement for Medicaid-reimbursed personal care services and home health care through the 21st Century Cures Act, enacted on December 13, 2016, intended to accelerate health care innovation. The Cures Act relies, in part, on savings generated through reductions in fraud, waste and abuse from EVV.

To be compliant with the Cures Act, personal care services are required to be verified using EVV technology beginning January 1, 2019, and home health services beginning January 1, 2023. The Centers for Medicare and Medicaid Services recently released much-anticipated guidance that clarified certain points of the provision but did not lift any requirement to deploy EVV by those deadlines.

Following the announcement of NEVVA, Tellus CEO Brad Levine said, “I felt strongly that this conversation needed to occur, which is why Tellus took the lead in sponsoring the first EVV Summit. We want to continue to push the organization forward, and I look forward to participating as a charter member and working closely with those who lead it.”

With the help of Mark Dillon and other participating members, the conversation surrounding EVV will continue well beyond the initial implementation deadlines and continue to drive innovation.

About NEVVA
The National Electronic Visit Verification Association (NEVVA) is a not-for-profit organization dedicated to serving as the single source for Electronic Visit Verification industry-related information for states, managed care organizations and providers. NEVVA provides expertise, news and information, advocacy and support to all of these constituents, enabling them to continuously deliver the highest quality of care possible to those who depend on it.

About Tellus
Tellus is a leading provider of mobile care delivery, Electronic Visit Verification (eVV) and claims processing technology designed especially for the Home Health and Long-Term Care markets. Tellus is proud to be the provider of choice among a variety of states, managed care organizations and provider agencies. The company’s comprehensive, cloud-based solutions work to simplify, streamline and quickly and easily verify care delivery tasks and process claim data right at the point of care. That means agencies, caregivers and patients can focus their time and attention on what matters most — improved patient care with better outcomes, greater efficiency and cost reduction.

Tellus is a privately owned company headquartered in Deerfield Beach, Florida. For more information about Tellus, visit http://4tellus.com/, or call 954-719-0004, ext. 2014.

About Pulsewrx
Pulsewrx, Inc. is an advisory and software-as-a-service company that has developed innovative workflow automation tools for Payers and Providers of Electronic Visit Verification services. Pulsewrx has developed and licensed an innovative Request for Services and Provider toolkit allowing Payers and Providers workflow automation tools that have largely been manual in the EVV industry. As the EVV industry adopts an Open Model, the Pulsewrx Request for Services Product, when coupled with the Pulsewrx Provider Toolkit will be essential to Payers, Care Management Organizations and Providers. Also, Pulsewrx has designed an innovative IoT GPS and Cellular EVV device, bringing a truly cost-effective solution that removes the barrier to mass deployments. This unique product offering significantly lowers the cost in deploying GPS EVV dedicated devices.

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Medicaid Who’s Who Interview: Mary Doherty

Mary has decades of experience in the Medicaid space. Check out her LinkedIn profile here. 

You can also get her help on consulting projects- look for the “schedule a time to chat” info on our website.

1. Which segment of the industry are you currently involved?

A:  Throughout my career as an Dr. of Nursing Practice (DNP) and consultant in healthcare, I have been fluid shifting my skills and knowledge between the bedside to payer and providers to develop policies for better patient outcomes.

2. How many years have you been in the Medicaid industry?

A: 15 years.

3. What is your focus/passion? (Industry related or not)

A: My focus is working with the low socioeconomic population to find strategies and solutions for healthcare equality. My passion is working in a free clinic that serves uninsured population providing care.

4. What is the top item on your “bucket list?”

A:  South Africa

5. What do you enjoy doing most with your personal time?

A: My family and friends whether it is a sit-down dinner or traveling. I cannot get enough of them.

6. Who is your favorite historical figure and why?

A: Albert Einstein is one of my favorite people because he is probably one of the most influential figures in science in the twentieth century. His theory of Relativity is part of health care’s technology. He defied his learning disability of dyslexic and shared his brilliance with the world.

7. What is your favorite junk food?

A: Chocolate

8. Of what accomplishment are you most proud?

A: Educating nurse ’s of all degrees and levels on their abilities to advocate for safety, lead significant change initiatives, coach patients and communities, and coordinate delivery of services, that very often determine health outcomes and the procurement of ethical care.

9. For what one thing do you wish you could get a mulligan?

A: Career- I should have gone to Medical School when provided the opportunity.

10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

A:

  1. Coverage: Who will be eligible?
  2. Opioid epidemic crisis how fast will there be a response?
  3. Medicaid cuts to Mental Health.