A notice of proposed rulemaking (NPRM) is a public notice issued by law when one of the independent agencies of the United States government wishes to add, remove, or change a rule or regulation as part of the rulemaking process.
Further reading
https://www.federalregister.gov/uploads/2011/01/the_rulemaking_process.pdf
AMIA (the American Medical Informatics Association) is a professional scientific association that was formed by the merger of three organizations in 1988: the American Association for Medical Systems and Informatics (AAMSI); the American College of Medical Informatics (ACMI); and the Symposium on Computer Applications in Medical Care (SCAMC).
For more than 35 years, members of AMIA and its honorific college, ACMI, have sponsored meetings, education, policy, and research programs. AMIA continues to gain influence as the authoritative voice in the growing field of informatics through the individual and collective efforts of its members, who continue to drive thought leadership, and research and practice in their respective disciplines.
AMIA aims to lead the way in transforming health care through trusted science, education, and the practice of informatics. AMIA connects a broad community of professionals and students interested in informatics. AMIA is the bridge for knowledge and collaboration across a continuum, from basic and applied research to the consumer and public health arenas. AMIA actively supports five domains:
Translational Bioinformatics
Clinical Research Informatics
Clinical Informatics
Consumer Health Informatics
Public Health Informatics
AMIA’s program and services are centered around core purposes to:
advance the science of informatics
promote the education of informatics
assure that health information technology is used most effectively to promote health and health care
advance the profession of informatics
provide services for our members such as networking and opportunities for professional development.
Further reading
Utilization Review Accreditation Commission – URAC was originally incorporated under the name Utilization Review Accreditation Commission. That name was shortened to the acronym URAC in 1996 when it began accrediting other types of organizations such as health plans, pharmacies, and provider organizations.
Further reading
https://www.urac.org/about-urac/frequently-asked-questions/#acronym
State Children’s Health Insurance Program – The Children’s Health Insurance Program (CHIP) is a partnership between the federal and state governments that provides health coverage to uninsured children whose families earn too much to qualify for Medicaid, but too little to afford private health coverage.
Further reading
Qualified Medicare Beneficiaries – There are several programs to help people pay their Medicare expenses: The Qualified Medicare Beneficiary or QMB program; the Specified Low-income Medicare Beneficiary or SLMB program; and the Qualifying Individual or QI program.
Further reading
The Office of Management and Budget (OMB) is the largest office within the Executive Office of the President of the United States (EOP). OMB’s most prominent function is to produce the President’s Budget,[2] but OMB also measures the quality of agency programs, policies, and procedures to see if they comply with the president’s policies and coordinates inter-agency policy initiatives.
The current OMB Director is Mick Mulvaney. The OMB Director reports to the President, Vice President and the White House Chief of Staff.
Further reading
The Office of the Actuary conducts and directs the actuarial program for CMS and directs the development of and methodologies for macroeconomic analysis of health care financing issues.
Performs actuarial, economic and demographic studies to estimate CMS program expenditures under current law and under proposed modifications to current law.
Provides program estimates for use in the President’s budget and for reports required by Congress.
Studies questions concerned with financing present and future health programs, evaluates operations of the Federal Hospital Insurance Trust Fund and Supplementary Medical Insurance Trust Fund and performs microanalyses for the purpose of assessing the impact of various health care financing factors upon the costs of Federal programs.
Estimates the financial effects of proposals to create national health insurance systems or other national or incremental health insurance reform.
Develops and conducts studies to estimate and project national and area health expenditures.
Develops, maintains, and updates provider market basket input price indexes and the Medicare Economic Index.
Analyzes data on physicians’ costs and charges to develop payment indices and monitors expansion of service and inflation of costs in the health care sector.
Performs actuarial reviews and audits of employee benefit expenses charged to Medicare by fiscal intermediaries and carriers.
Publishes cost projections and economic analyses, and provides actuarial, technical advice and consultation to CMS components, governmental components, Congress, and outside organizations.
Further reading
https://www.cms.gov/About-CMS/Agency-Information/CMSLeadership/Office_OACT.html
Medicaid Statistical Information System – The 25 MSIS statistical tables contain national state-by-state data. These tables contain high-level aggregated statistics relating to Medicaid eligibility and claims data.
Further reading
Jim Milanowski is the conference chairperson for the upcoming Health Plan Innovations for Care Coordination Conference in Scottsdale, AZ on September 13th – 14th. Use code MM300 for $300 off your registration HERE!
Medicaid Who’s Who: Jim Milanowski – President and Chief Executive Officer of the Genesee Health Plan
1. What segment of the industry are you currently involved?
A: I run the Genesee Health Plan. We provide an outpatient health care coverage to those who do not qualify for the Medicaid Expansion or the ACA, or are waiting to enroll/become eligible for these coverages. Our staff are all trained to enroll people in the Medicaid Expansion or the ACA exchange. Finally, we do member onboarding and health risk assessments for Medicaid Expansion enrollees for two Medicaid Health Plans.
2. How many years have you been in the Medicaid industry?
A: I have been in the Medicaid industry for over 25 years, starting off as a Case Manager for mental health clients.
3. What is your focus/passion? (Industry related or not)
A: With understanding of health care coverage being so overwhelming to most people, making sure that the people we assist are educated on what coverage they qualify for and how to use their health benefit to becoming healthier.
4. What is the top item on your “bucket list?”
A: I am a big sports fan, so attending a Super Bowl would be right at the top, especially if the Detroit Lions would ever make it.
5. What do you enjoy doing most with your personal time?
A: Spending time with my two sons, who are 22 and 18. They still like hanging out with their father!
6. Who is your favorite historical figure and why?
A: Abraham Lincoln. During a stressful and chaotic time in our history, he stayed focus on the task at hand and found time to spend with his family.
7. What is your favorite junk food?
A: Pizza
8. Of what accomplishment are you most proud?
A: Our organization, Genesee Health Plan has provided hands on assistance to over 75,000 county residents in the last ten years.
9. For what one thing do you wish you could get a mulligan?
A: When the ACA came out in 2014, we spent that original open enrollment period getting as many people enrolled into coverage as quickly as possible, without spending an adequate time one on one educating them on options and benefits. We have slowed down our approach since that first year.
10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?
A: 1. Deciding what happens with Medicaid funding at the national level.
2. To start developing a health care safety net if Medicaid Expansion goes away.
Jim Milanowski is the conference chairperson for the upcoming Health Plan Innovations for Care Coordination Conference in Scottsdale, AZ on September 13th – 14th. Use code MM300 for $300 off your registration HERE!
The Medicaid Analytic eXtract (MAX) data is a set of person-level data files on Medicaid eligibility, service utilization, and payments. The MAX data are created to support research and policy analysis. The MAX data are extracted from the Medicaid Statistical Information System (MSIS). The MAX development process combines MSIS initial claims, interim claims, voids, and adjustments for a given service into final action events.
Further reading
