Category: Clay’s Weekly Medicaid Roundup

 

OK NOT OK – A 25% provider rate cut is on the table to address budget holes. Hospitals are wailing, with individual facilities beginning to report impact. (Hit to Duncan Regional – $2M). The cut comes right on the tails of a proposal (blocked this week) to remove 111,000 from the rolls via a waiver excluding non-pregnant, able-bodied adults under 65.

NM PASSES THE HAT TO PAY THE PIPER- NM is looking at the increasing expansion costs over the next few years (it ain’t free forever, people), and is starting to socialize the idea of getting counties to chip in more revenues to cover the bill.

OH ASKS BENNIES TO SPLIT THE TAB- Or at least pay for the appetizers. Kasich is pushing forward a plan to require Medicaid members to pay into an HSA to help cover the costs of their own medical care. Bennies would lose their card if they don’t pay 2% of their income (or $99- which is roughly what 1 carton of Marlboro Reds – what I used to smoke back when I did – now costs in Toledo, OH. Or 3 weeks of a daily Starbucks for those of us who grew up into fancy hipsters. Or 1 prescription for those of us with insurance we pay for under the “new normal” prices for everyone not on Medicaid).

ARE YOU WANTING TO CONTINUE YOUR MEDICAID HOSPITAL FEDERAL FUNDING, BUT DON’T WANT TO EXPAND? NOW YOU CAN (HERE’S HOW)- A little birdy brought a CMS letter to MS Mcd to my attention this week. In the letter (dated Mar 22), CMS tells MS Mcd that their plan to incorporate $533M of hospital UPL payments into its MCO rates as a pass through violates 42 CFR 438.60. But – since MS went ahead and did it, it would be hard to undo so CMS will look the other way for now. I uploaded the letter to the site here (http://bit.ly/1qm8oeG) for those who want to spend a little more time with it and tell me all about how I’m wrong to think this is questionable.

TN MCD DIRECTOR STEPPING DOWN- Darin Gordon has “sat in the chair” since 2006, and is now leaving TennCare. Gordon is widely respected on both sides of the political aisle, remaining in his spot for 10 years and through gubernatorial transitions. Congrats on a great tenure at TennCare, Darin! If you’re reading, I would love to interview you for the book I am working on about Medicaid directors. Working title – “A Day in the Life: The Medicaid Director’s Job Really is Rocket Science.”

ACA TURNS 6- Hard to believe that shining example of bipartisan politics, that grand-ole bill that passed with broad support from both parties elected to represent roughly 50% each of the American people, that policy that passed definitely not by procedural tricks and legislative bullying and good ole’ ram-it-through-no-matter-what-they-think elbow grease – [insert sound of vinyl record scratching to a halt here]. ACA turned 6 this month and a new round of analysis of impact is out. Punchline – for all its bluster about reducing the uninsured with exchanges and reforming commercial insurance, ACA is one big, fat Medicaid expansion. Which is great for us who live and breathe Medicaid. Not so great for the 50% of Americans (those evil Republicans) who are becoming more aware that Medicaid is another tax. Medicaid rolls have grown 25% since 2013 (when exchanges opened, and ACA really began in full force); Commercial coverage has dropped by 9M using CBO numbers (check the twitter feed for links to these #s).

FARRIS’S FANTASTIC FRAUD FOLLIES– I put lots of goodies in the twitter feed for all your fraudies that need your fix this week.

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 (its almost time to plant!) and keep running the race (you know who you are).

—-

FULL, FREE newsletter: http://eepurl.com/ep81Y

News that didn’t make it and sources for those that did: twitter @mostlymedicaid

Die Vader het die Seun aan die wêreld te red

MI COVERING HEP C DRUGS IN MCD- We covered the lawsuit in WA to cover these on the last monthly news show. Looks like MI is pre-empting a suit and has decided to cover the insanely pricey drugs in Mcd. State reps approved a budget for it (I don’t know how much yet) this week.

ITS A MANDATE! The Good Guvn’r Hutchison of AR is looking at pro-expansion Republicans winning in primaries this week as a mandate for his expansion plan. Not so fast so wonks in the state. Voters think about other things besides expansion (and usually they don’t care near as much about Medicaid as those of us who make our living off Medicaid wish they would).

DETAILS EMERGING ON TARHEEL STATE TRANSFORMATION PLAN- Based on presentations in the NC General Assembly this week, it looks like Mcd bennies will be able to choose from 1 of 4 MCOs – in about 3 years. CMS is expected to get the official proposal by June 1.

PLAN PROTESTS IN THE PEACH STATE POOH-POOHED- Its a rainy night in GA for AmeriChoice (UHC), Humana and AmeriHealth Caritas. GA Dpt of Administrative Services just threw out their protest over losing bids for the ginormous MCO business awarded recently. New contracts for Amerigroup, Peach State, WellCare and CareSource were set to start July 1, but the latest I have heard is that the implementation date is now Jan 1, 2017. Anyone who knows why, please write in and let me know.

AK JUDGE DISMISSES ANTI-EXPANSIONERS SUIT- The plaintiffs (legislators) sued, saying that the expansion population was optional, and any optional Mcd spending had to be approved by them. The Judge looked at the decision by the SCOTUS that said states could not be penalized for not exercising the option to expand – and then he concluded that Mcd expansion in AK somehow was mandatory and could be done with only the Good Guvn’rs approval. I think this quote from a local newspaper explains the Judge’s misunderstanding best: “Because the Social Security Act requires expansion, state law makes the expansion group eligible for Medicaid services. Because existing law required the governor to provide Medicaid to the expansion group, the governor did not violate the Alaska Constitution by doing so.” Judge Piffner – if you are Roundup reader please call / write in so we can discuss.

SD REPS REMOVE GUVN’RS ABILITY TO STOP EXPANSION- A move to require legislative approval for expansion was killed in committee this week. Make sure you read this slowly- a state legislature (that’s the “legislative branch” for those who have never had a “civics” class) just voluntarily decided to limit their own power and defer to the Guvn’r (the “executive branch”). Maybe I misunderstand my own education about checks and balances. Is it that the legislature is really good at writing checks, and the executive branch’s main job is to make sure the balance of power swings their way?

NE TRYING TO FIGURE OUT HOW TO PAY FOR EXPANSION. HAS ANYONE CALLED BERNIE? Looks like NE needs to come up with $112M in state dollars to pay for 5 years of expanded Mcd. Fun comparison – that’s about $22M/ yr. Average teacher salary in NE is $50k. So NE could hire 440 new teachers, or expand Mcd. Easy choice. Everybody knows Mcd beats out all other priorities, every single time.

MI GETS APPROVAL FOR MOST SPECIFIC MCD EXPANSION EVER- CMS approved expanding Mcd to kids in Flint, MI in households up to 400% FPL this week. An estimated 15,000 new members will be eligible. All this is to help address the water crisis and related health impact in the area, so the expansion is not only narrow in scope but also (likely) time limited.

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 (its almost time to plant!) and keep running the race (you know who you are).

—-

FULL, FREE newsletter: http://eepurl.com/ep81Y

News that didn’t make it and sources for those that did: twitter @mostlymedicaid
el Pare ha enviat el Fill per salvar el món

WEBINARS HAVE BEEN AWESOME- Thank you to the hundreds of folks who have signed up and attended. We had a great State Spotlight show on RI last week, and yesterday’s Medicaid News Roundtable was a blast. If you’re not signed up, it’s free @ mostlymedicaid.com/webinars .

MULTIPLE CHANGES TO AK MCD ON THE TABLE- Bring in managed care, focus on PCPs, privatize the state-run Pioneer Homes (nursing homes)- it’s all being discussed in subcommittees this week.

BUDGET SHORTFALL #S ROLLING IN- All #s are for the Mcd shortages only: DE- $29M, VA- $125M, MS – $52M. Don’t anyone worry, all the states will wind up spending more on Mcd, as they always do each and every single year. Its just a matter of how much time, how many special sessions and how much fiscal-conservative shaming will be required to get there.

EXPANSION IN MAINE TAKES A TWIST- Maine rep Saviello (D) is pushing a a private-option style expansion plan for Medicaid, but this week started tie-ing it to reducing heroin addiction. Maybe someone should tell the Good Rep that he doesn’t have to expand all of Medicaid but can just get a waiver to run a special heroin treatment program? Especially if you look at the gigantic cash the 2016 White House budget is putting at fighting opiod use alone?

EXPANSION IN WYOMING TAKES A FALL- Expansioners in The Cowboy State are now O for Four the last four years. A 20-10 Senate vote against shot it down on Friday.

EXPANSION IN ARKANSAS TAKES A BEAT- The Good Guvn’r Hutchinson returned down from the mountain after horsetrading concluding talks with CMS and put the ball in the legislature’s court. CMS was not too hot on his employment requirements for expansion cash, but the legislators have to approve any changes before CMS will look at it anyway.

PA REDUCES MEDS USE IN FOSTER CARE- Seems the Keystone State was able to cut psychotropic med use by 75% over 2 years for foster kids when it put in prior auth requirements. Put another way, when docs were slowed down by the hassle of proving it was needed for the vulnerable child (instead of just grabbing whatever samples in their lab coat pocket that the endless stream of pharma reps coming through their door put in there), they prescribed it 75% less. So all you have to do to get doctors treating foster kids to provide quality care is make something inconvenient for them?

SC PUTS UP REAL CONTROLS TO FIGHT OPIOD USE- Sort of like the PA story above, SC is now requiring docs to check a statewide database before prescribing any controlled substance. Not sure it will have the same 75% impact as the PA story, but surely it will slow docs (and doc shoppers) down a good bit. I guess if you don’t want to have your data stored on that new system, you should get an iphone. I hear those things can’t be hacked, even by Jack Bauer.

WELLCARE GOES SHOPPING- It’s been 2 years since WC dusted off the credit card. This week’s acquisition is Advicare, which runs an MCO in SC. WC announced its going on a shopping spree last week, and has nearly $1.3B to spend.

MEGARULE ARRIVES AT OMB- Elvis has left the building at Security Blvd and has trotted on over to OMB. The 653 page mega rule transforming Medicaid managed care (see our webinar on this last summer for a LOT more info) has been commented upon, and now goes to OMB for review. OMB review process rules are a bit tricky, and can take up to 90 days. Or forever if restarts happen. First reader to write in and tell me how many comments the rule received gets a $25 Amazon gift card.

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 (build a fire!) and keep running the race (you know who you are).

—-

FULL, FREE newsletter: http://eepurl.com/ep81Y

News that didn’t make it and sources for those that did: twitter @mostlymedicaid

hkamaeetawsai kambhar  kaalhphoet  sarrtawko hcay lwhaattaw muu

STILL SEATS FOR THE FREE WEBINAR SERIES FOR 2016! The response has been incredible. As of this morning, we had 330 people signed up. Room for about 100 more if you want to join us. If you haven’t signed up, please do- State Spotlight Series sign up- http://goo.gl/4LWxlA ; Clay’s Monthly Medicaid News Roundtable Signup- http://goo.gl/JkcPQL If you have signed up, please pass on to a friend or colleague. Don’t forget the chance to win the Amazon gift card!

FREESTONE STATE GUVN’R TRIES TO WRITE LEGISLATORS OUT OF THE LOOP- The Good Guvn’r Malloy wants to stop those mean ole’ legislators from doing that evil “checks and balances thing” in CT. In today’s CT law, the Mcd agency can’t just run out and get a bunch of federal waiver cash without getting legislative approval. Malloy wants to remove this authority specifically for Mcd waivers. The legislature has had this veto power since 2007, and over-rode then-guvn’r Rell’s veto to get it. Seems the people have spoken through their reps, Mr. Malloy. What part of 3 co-equal branches of government do you not understand? With this type of political worldview (that the Executive branch is supreme), perhaps you should accelerate your career path to DC?

DOVES IN HAWKEYE STATE FRET OVER MCO LAUNCH- Mcd officials have gone through various readiness tests, have doubled provider contracts with MCOs, and have done double-duty on the grueling legislative committee circuit to answer inane questions from legislators who know less-than-zero about healthcare, let alone Medicaid managed care. And Republican legislators are leading the push to delay the shift to Mcd privatization. Can someone please write in and tell me which end is up in Iowa?

HEART OF DIXIE HAS CHANGE OF HEART ON MEDICAID MANAGED CARE- My own beloved homeland is taking the plunge. She got approval from the federalis to bring Medicaid Managed Care starting October 1 this year. There was much celebration in Montgomery (and statewide, across all 5 RCO regions) last week, when the approval for the 1115 waiver was announced. The deal gets AL up to $748M from CMS. That’s a lot barbecue sandwiches (sorry TN and NC, you got nothing on Bama BBQ, which of course may be loosely related to our terrible health outcomes here).

BLUEGRASS STATE WARNS OF SKYROCKETING MEDICAID COSTS- KY Mcd will jump 20% to cost more than $3.7B in 2 short years. Maybe this explains why the Good Guvn’r Bevin wants to un-expand?

SOONER STATE HOUSE BILL 2665 SET TO KICK 111K OFF MEDICAID  ROLLS TO HELP PLUG $1.3B STATE BUDGET HOLE- The bill would kick off “any non-pregnant able bodied adult younger than age 65.” Savings estimates come in around $111M a year. Not sure how they are going to fill that hole, even with that annual savings. Maybe Bernie can write them a check to make it all free when he stumps in OK? Mr. Sanders, are you listening? We need some of your magic!

BEEHIVE STATE HAS FOUR – COUNT EM’, 4! – MEDICAID EXPANSION PLANS ON THE TABLE – After 3 years of false starts, Utah may finally be ready to pass an expansion plan. 3 plans are from Republicans; 1 is from a Democrat. Check the twitter feed for details – some are pretty interesting, including one focused on expanding Medicaid to homeless or near-homeless families.

 

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 (build a fire!) and keep running the race (you know who you are).

—-

FULL, FREE newsletter: http://eepurl.com/ep81Y

News that didn’t make it and sources for those that did: twitter @mostlymedicaid

‘arsal al’ab w alaibn li’iinqadh alealam

ONLY 14 DAYS UNTIL OUR FIRST FREE WEBINAR FOR 2016! If you haven’t signed up, please do- State Spotlight Series sign up- http://goo.gl/4LWxlA ; Clay’s Monthly Medicaid News Roundtable Signup- http://goo.gl/JkcPQL If you have signed up, please pass on to a friend or colleague. Don’t forget the chance to win the Amazon gift card!

DÉJÀ VU?- Iowa Senate dems are promising to repeal the privatization of Mcd (fancy politico-speak for “hey we just got MCOs in our state”). House Republicans are promising the bill will be DOA. Isn’t this rich- we now have dems (albeit on a state level) making meaningless gestures about repealing a major change to the healthcare delivery system. Sound familiar (but reverse everything and make it national)?

ROLLING BACK EXPANSION, ONE LAWSUIT AT A TIME- AK anti-expansioners aren’t giving up. Reps appeared in court this week for the lawsuit to stop the unilateral expansion Guvn’r Walker did late last year. The Judge told them he will make his decision on whether the case can proceed by March. Both sides agree the case hinges on the interpretation of the word “requires” in one line of AK law (run over to the twitter feed for more detail).

CLOCK STARTS ON VA LTSS OPPORTUNITY- Our RFP Batphone has been ringing about this one for a few weeks now. The key info is that VA won’t be renewing its duals demo but will instead make most of it permanent with an 1115 waiver (submitted to CMS Jan 19). MCOs everywhere are sharpening their pencils for the RFP expected to drop in the next few weeks. For those interested, there was also an MLTSS databook released by the state mid-December.

2 DATA BREACHES- GA and LA both reported data breaches of Mcd benny PHI this week. In the Peach State, Centene lost hard drives of about 950k member’s data. In the Pelican State, someone who worked at a doctor’s office stole about 13,000 benny IDs and gave it to another provider.

HOME HEALTH UNDER INVESTIGATION IN MA– There has been an 82% surge (vs 2014) in home health spending in the Bay State. Per recent analysis, 62 companies are driving the surge (and they just so happened to have started doing business with the state during the last 2 years). Stay tuned.

IT HAD TO HAPPEN SOMETIME: A LARGE PLAN AND A “POPULATION HEALTH” COMPANY HAVE JOINED FORCES FOR MEGA MARKET SHARE PLAYS, ER – I MEAN FOR BETTER PATIENT STUFF– Passport and Evolent joined forces to take on the world this week. Expect lots of phrases like “industry-leading,” “patient-centered,” etc.

SHUMLIN’S BID FOR THE MCD MAGIC MONEY MACHINE GOES ON THE ROAD/TO THE PAPERS- Based on the pro-provider tax stories out this week, the Good Guvn’rs staff have been making calls and “suggesting” stories to their favorite journalists.

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Start the ticker and let’s see who wins this week’s award. 3 Florida fraudsters are on the run (Harrel, Durden and Daly. And their other brother, Darryl). They used a licensed MH provider’s billing number without the provider’s knowledge, and stole more than $500k. Rehan Zuberi of Boonton Township, NJ is facing a $7.4M Mcd fraud settlement (we reported on this May of 2014, but we now have a more precise $ amount to use for the award ceremony). It was a slow week for fraud news, but Dr Z – you win! (Note to newer readers: we only report on frauds $50k or higher. Otherwise we would be talking about hundreds of fraud items a week).

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 (build a fire!) and keep running the race (you know who you are).

—-

FULL, FREE newsletter: http://eepurl.com/ep81Y

News that didn’t make it and sources for those that did: twitter @mostlymedicaid

Taṇḍri kumāruni prapan̄ca sēv pampina