Author: MM_ADMIN

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Medicaid Acronym of the Day – CPCI

Comprehensive Primacy Care Initiative – CPCI was a four-year multi-payer initiative designed to strengthen primary care.  The initiative was a multi-payer collaboration that paid population-based care management fees and had shared savings opportunities to participating primary care practices to support the provision of a core set of five “Comprehensive” primary care functions. These five functions are: (1) Risk-stratified Care Management; (2) Access and Continuity; (3) Planned Care for Chronic Conditions and Preventive Care; (4) Patient and Caregiver Engagement; (5) Coordination of Care across the Medical Neighborhood.  Ob-gyns were not permitted to participate unless they were in a multispecialty practice.

Further reading –

https://innovation.cms.gov/initiatives/Comprehensive-Primary-Care-Initiative/

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Medicaid Acronym of the Day – CEHRT

Certified Electronic Health Record Technology – CEHRT meets the data standards established by the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health Information Technology to qualify for the EHR Incentive Program.

Further reading –

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Certification.html

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Weekly Medicaid RoundUp: Week of September 18th, 2017

Clay’s Weekly Medicaid RoundUp: Week of September 18th, 2017

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2xjCC9z

 

For optimist readers-  http://bit.ly/2xkfN5j

 

OCEANIA INSPECTOR #1731- As service to my country (Oceania) I have enlisted as a social media inspector. My current duties are limited to tagging suspect articles with “thoughtcrime” but may expand pending further instruction from BB. If you see me comment on social media with this label please do not be alarmed. This entry was written with special digital ink only visible to good citizens who comply with the Party, so if you can read this you are OK. </doublespeak>.

 

FLIGHT OF THE NAVIGATORS- As ACA money dries up, Ohio is nixing its navigator program (navigators are sort of like guides to help applicants understand options for exchanges and Medicaid). We will likely see similar stories in other states over the coming weeks. In Ohio, the Navigators contract went to the OH Association of Foodbanks, which just watched its annual budget go from $1.7M to $485k.

 

ADD COLORADO TO LIST OF DEADBEAT MEDICAID STATES- Its taking a little while to work out the kinks of the new claims payment systems. Hospitals are owed a little north of $200M for services dating back to March (when the new system launched). There are currently 98,000 pending claims.

 

BRIGHT SPOT FOR NC BABIES AND MOMS- New results from North Carolina’s Pregnancy Medical Home are uplifting. The program is credited with reducing maternal mortality by 40% in the last 15 years. NC pairs a pregnancy care manager with high risk moms to help ensure the right dots are connected. There are about 400 of these pregnancy care managers across the state, helping about 25,000 moms each year.

 

FHN SELLING ENROLLMENT TO COOK COUNTY HEALTH SYSTEM- If you have been watching the Illinois market you know there are myriad challenges. All the stress and strain was too much for Family Health Network (one of the largest existing MCOs), and they are starting the exit process. Cook County Health System (a big winner in the recent contract awards) will start transitioning 160k legacy FHN members November 1.

 

COPAYS AND PREMIUMS MOVE FORWARD IN NEW MEXICO- State officials are moving forward with the plan to charge $10-$50 premiums for some members (with exemptions for the most poor and for Native Americans). Copays would be $2 for scripts, $5 for pcp visits and $50 for hospital admissions. NM is also considering eliminating retro-active coverage (for a discussion on how this work, and other states considering this same change – check out the recording of last week’s news show).

 

CHICKEN LITTLE FATIGUE- Another bill to dramatically alter Obamacare has been introduced, and the Resistance has been re-activated by Generals Slavitt, Schumer and Moore. In an amazing coincidence, the Graham-Schumer bill has the same purported outcomes as all previous 4 attempts this year – it will kill all babies, all the elderly and make the solar system implode. We haven’t done a deep dive on this one yet, but who needs it really? We know the truth from the media talking heads so why bother questioning what they say will happen if the bill would pass. (thoughtcrime)

 

PELICAN STATE RE-UPS MMIS WITH MOLINA- Molina got another extension (the 4th 1-year extension), this time with a $46M price tag. MMIS-bid watchers collectively moved onto other states for another year…

I WILL BE AT MHPA 2017 IN OCT., WILL YOU? You can check it out here – http://bit.ly/2twCi5L Every 100th registrant will get a free Medicaid Foundations Course registration (our online training course).

 

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph… Not so fast my little fraud junkies. Not enough room in this week’s roundup, but I put plenty of fraud stories in the twitter feed for you. Check out the “food stamp millionaire” story for sure.

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 (even though the weather tricked us and its still not sweater weather) 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: preahbeta ban chat preah botra aoy yeang mk sangkroh mnoussa lok

 

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Medicaid Acronym of the Day – DSRIP

Delivery System Reform Incentive Payment – DSRIP initiatives, which are part of broader Section 1115 demonstration waiver programs, provide states with significant funding to support hospitals and other providers in changing how they provide care to Medicaid beneficiaries. DSRIP waivers are not grant programs – they are performance-based incentive programs. The concept is that states undertake initiatives expected to save Medicaid funds and then use the available savings for new investments in delivery system reform. To obtain DSRIP funds, eligible entities, including hospitals and other providers and/or provider coalitions, must meet certain milestones or performance metrics. While the exact structure and requirements of DSRIP initiatives vary, there is often a focus on meeting process-oriented metrics in the early years of the waiver, such as metrics related to infrastructure development or system redesign, and a focus on more outcome-oriented metrics in later years.22 For example, infrastructure related metrics might pertain to implementation of chronic care management registries or enhanced interpretation services. System redesign metrics might relate to expansion of medical homes or physical and behavioral health care integration. Outcome measures might address clinical care improvements or population health.

Further reading –

http://www.kff.org/medicaid/issue-brief/an-overview-of-delivery-system-reform-incentive-payment-waivers/

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Medicaid Industry Who’s Who Series: Jeff Myers

Jeff Myers is the President and CEO for the upcoming Medicaid Health Plans of America (MHPA) Conference in Washington, DC on October 29th -31st. Use code MHPA17-MM200 for $200 off your registration HERE!

 

Medicaid Who’s Who: Jeff Myers – President and CEO, Medicaid Health Plans of America (MHPA)

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

A: Four (dog) years

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

A: Leaving the world a better place than I found it – if that includes motorcycles, sailing, or Medicaid reform, then all the better

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

A: Hearing one of my children say “you know, Dad, you’re right.”

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

A: With three kids, there is no such thing.

5. Who is your favorite historical figure and why? 

A: And this is risky (it is what I said to the Board): Joan of Arc – she did what she thought she was called to do, and was willing to burn at the stake for her beliefs.

6.  What is your favorite junk food?

A:  whiskey

 7.  Of what accomplishment are you most proud?

A: Hiking the Andes over an old Jesuit trail with my now-wife and not scaring her off.

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

A: Every mistake is a learning opportunity and chance for growth, and every mulligan I have ever taken on the golf course has ended the exact same way as the first shot.

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

A:

      • CMS decision(s) on all of the pending waivers;
      • Congressional decisions on  the future of the funding structure for Medicaid;
      • CHIP extension of current and future reauthorization
      • (since this is only 6 months)

 

Jeff Myers is the President and CEO for the upcoming Medicaid Health Plans of America (MHPA) Conference in Washington, DC on October 29th -31st. Use code MHPA17-MM200 for $200 off your registration HERE!

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Medicaid Acronym of the Day – MLTSS

Managed Long-Term Services and Supports – MLTSS refers to risk-based arrangements for the delivery of Medicaid long-term services and supports, which often include institutional and home and community-based services (e.g., adult day care), enabling Medicaid beneficiaries to live independently in their homes and communities rather than receive care in an institution.7 Some MLTSS programs provide only long-term services and supports (e.g., operate as PHPs), but, in other arrangements, MLTSS are provided through comprehensive MCOs.

Further reading –

https://www.medicaid.gov/medicaid/managed-care/ltss/index.html

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Medicaid Acronym of the Day – PHP

Prepaid Health Plan – As distinct from an MCO, a PHP is a non-comprehensive health plan that provides only certain services, such as dental services or non-emergency medical transportation.4 Most PHPs are paid on a risk, or capitated, basis. There are several types of PHPs:

Prepaid Ambulatory Health Plan (PAHP): A PAHP is a non-comprehensive prepaid health plan that provides only certain outpatient services, such as dental services or outpatient behavioral health care, and does not cover any inpatient services.5
Prepaid Inpatient Health Plan (PIHP): A PIHP is a non-comprehensive prepaid health plan that provides only inpatient hospital or institutional services, such as inpatient behavioral health care, and does not have a comprehensive risk contract.6

Further reading –

https://www.michigan.gov/documents/RevisedPlanforProcurementFinalVersionSenttoHCFA_7983_7.pdf