Posted on March 19, 2021 by MM_ADMIN

Senate confirms Xavier Becerra as HHS secretary

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Becerra has been confirmed to head HHS.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Key Points

The Senate confirmed Xavier Becerra as Health and Human Services secretary.
The California attorney general and former U.S. representative will have a major role in the Covid-19 vaccine rollout as the country tries to achieve a level of normalcy by the summer.
Becerra will also play a part in the Biden administration’s plans to create a Medicare-like public health-care option.
The confirmation vote was close, as Republicans have questioned Becerra’s health experience and previous support for “Medicare for All.”

Xavier Becerra, nominee for Secretary of Health and Human Services, answers questions during his Senate Finance Committee nomination hearing on Capitol Hill in Washington, DC, February 24, 2021.

Greg Nash | Pool | Reuters

The Senate confirmed Xavier Becerra as Health and Human Services secretary on Thursday as the U.S. aims to contain Covid-19 and achieve a semblance of normal life by summer.

Becerra, California’s attorney general, won approval by a narrow 50-49 margin in a Senate evenly split by party. Nearly all Republicans opposed the former U.S. representative’s nomination, questioning his health-care experience and past support for “Medicare for All.”

Becerra will be the first Latino to lead HHS. In a tweeted statement following his confirmation, Becerra said he is “honored and humbled by today’s vote” and “ready to get to work.”

The support of Sen. Susan Collins, a Maine Republican, removed the need for Vice President Kamala Harris to cast a tiebreaking vote.

Becerra will take a major role in one of the federal government’s most daunting undertakings ever. HHS will help to facilitate Covid-19 vaccinations and testing efforts as health officials hope widespread inoculation will beat back a mutating virus and allow businesses and schools to reopen.

While the virus’s spread has slowed in the U.S., the country is recording about 54,800 Covid-19 cases and at least 1,200 deaths every day, according to a seven-day average calculated by CNBC. About 15.5% of adults, and 37.6% of people over 65, are fully vaccinated, according to the Centers for Disease Control and Prevention.

Becerra will also have a prominent part to play if and when the Biden administration moves on to health-care reform. President Joe Biden has backed the creation of a Medicare-like public insurance option and changes to control the cost of drugs and care.

Ahead of the vote, Senate Majority Leader Chuck Schumer, D-N.Y., said Becerra “has decades of standing up for working-and middle-class Americans in Congress, fighting to protect and expand Medicare, Medicaid, and working to safeguard our health care system from attacks by the Trump administration.”

Becerra became the 20th member of the president’s Cabinet confirmed by the Senate. The chamber has turned its attention to filling out the executive branch since its passage of the $1.9 trillion coronavirus relief bill earlier this month.

Speaking at a Senate confirmation hearing last month, Becerra said he understands “the enormous challenges before us.” He said he would work not only to contain the virus but also to boost access to affordable health care.

Becerra touted his work as California’s attorney general to make Covid treatments more widely available and crack down on opioid manufacturers.

He succeeded Harris as the largest U.S. state’s top law enforcement official in 2017 after her election to the Senate the previous year. Becerra won a four-year term in 2018.

He represented California in the U.S. House from 1993 to 2017.

Clipped from: https://www.cnbc.com/2021/03/18/senate-to-confirm-xavier-becerra-as-hhs-secretary.html

Posted on March 19, 2021 by MM_ADMIN

Gov. Cox names Interim Medicaid Director

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Utah has a new interim Medicaid Director.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Utah Department of Health | Mar 17, 2021

The Utah Department of Health (UDOH) today announced Gov. Spencer Cox has appointed Emma Chacon as the Interim State Medicaid Director.

Chacon will be replacing Nathan Checketts who has served as Medicaid director for the past five years. In addition to overseeing the Medicaid program, Checketts also served as the deputy director of the UDOH. Checketts will be joining the Utah Department of Human Services (DHS) as a deputy director.

Chacon brings years of public service experience, having served as Medicaid deputy director and operations director, as well as other positions within the agency since 2005. Prior to her service within Medicaid, Chacon was the director of the Office of Recovery Services for 12 years, in addition to nearly 25 years at DHS.

“As Medicaid director, Nate Checketts worked tirelessly to ensure Utah’s most vulnerable populations remained the focus of the Medicaid program, while still being a good steward of funds provided by the taxpayer,” said Rich Saunders, executive director of the UDOH. “We are fortunate to have Emma Chacon continue to lead such a complex program with her expertise and dedication. Medicaid will continue to be in good hands, especially under the current pandemic circumstances.”

Medicaid is one of the largest programs in state government and contributes significantly to the financing of Utah’s health care system. Medicaid has an operating budget of more than $4.5 billion, and through its many programs provides more than 410,000 Utahns access to health care every year.

This press release was provided by the Utah Department of Health.

Clipped from: https://stateofreform.com/featured/2021/03/gov-cox-names-interim-medicaid-director/

Posted on March 19, 2021April 8, 2021 by MM_ADMIN

Florida unlikely to expand Medicaid for 800,000 residents, despite offer of more federal money

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Florida is not being swayed by the new expansion funding being offered.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

TALLAHASSEE — Gov. Ron DeSantis and Florida legislative leaders still aren’t interested in expanding Medicaid under the Affordable Care Act, despite the federal government’s offer to defray the cost to the state for two years as part of the $1.9 trillion COVID-19 relief package signed by President Biden last week.

Democrats and advocates who’ve pushed for expansion say there’s no excuse not to offer coverage to 800,000 more Floridians now that the cost to the state would be less.

Sen. Annette Taddeo, D-Miami, for example, noted that DeSantis doesn’t plan on giving back to the federal government any of the $10 billion in direct aid Florida is getting, as U.S. Sen. Rick Scott requested, so traditional GOP arguments in favor of fiscal restraint seem to have evaporated in Tallahassee, she said.

“Even Gov. DeSantis said to former governor and senator Rick Scott, ‘that’s crazy to turn back money,'” Taddeo said Wednesday. “Well, I feel exactly the same way — that’s crazy to turn back money for Medicaid expansion in the middle of a global pandemic, to say to people, ‘you still can’t have insurance.'”

Medicaid expansion would provide coverage under the program, which is run jointly by the state and federal government and covers poor families, children and pregnant women, to people who earn up to 138% of the federal poverty line, which stands at $18,000 per year for a person and $37,000 for a family of four.

The federal government would cover the entire cost of expansion at first before their share reduces to 90%, with the state paying the remaining 10%. The usual cost share of the current Medicaid program varies by year but can reach as high as 60% paid by the federal government and 40% paid by Florida.

Under the relief package, for two years the federal government would pay an extra 5% of its share of the main Medicaid program, which is expected to serve nearly 4.6 million Floridians next fiscal year before enrollment drops in future years due to a rebounding economy.

Florida’s Medicaid program is projected to cost $31.6 billion this year, or about one-third of the state’s $92.2 billion budget. State economists estimate the state’s share this year to be $11 billion and it is expected to rise to $13 billion next year.

Florida Policy Institute, a liberal think tank based in Orlando, estimates expanding Medicaid now would save the state $3.5 billion.

That would free up money for other things, such as education and the environment, and advocates argue the savings would be even greater, because the cost of uncompensated care at hospitals would go down, eventually reducing health care premiums across the entire system.

“There is no excuse fiscally for any lawmaker to say it would be fiscally undoable,” said Holly Bullard, FPI chief strategy and development officer. “The fiscal argument isn’t there, it’s really reversed.”

But GOP leaders still have an eye on the 10% cost to the state in future years.

“The president has concerns about the long-term, recurring costs associated with Medicaid expansion,” Katie Betta, spokeswoman for Senate President Wilton Simpson, R-Trilby, stated in an email explaining his opposition.

DeSantis office didn’t return a request for comment Wednesday, but his spokeswoman told the Washington Post this week he “remains opposed to the expansion of Medicaid in Florida.”

House Speaker Chris Sprowls, R-Palm Harbor, is more concerned about allowing more residents coverage, an echo of the criticism from past GOP House leaders that “able-bodied adults” would be eligible for Medicaid under expansion.

“The Speaker will not pursue a Medicaid expansion,” Sprowls spokeswoman Jenna Sarkissian stated in an email. “He believes Medicaid should be reserved for our most vulnerable residents, such as low-income senior citizens, people with disabilities, children and pregnant women.”

Sarkissian added that Sprowls “has expressed a strong desire to address disparities in maternal health care for low-income women and invest in areas like career and higher education help to generate better outcomes for Floridians and put them on a path to employment, financial resilience and prosperity.”

After years of intense debate over Medicaid expansion, the fight over the issue in the Legislature has cooled.

In 2013, Florida House Democrats demanded all bills be read in full, slowing down the chamber to protest the lack of action on the issue, but a Senate plan to allow newly eligible enrollees to receive private health plans paid by the federal government was rebuffed by House Republicans.

At the time, then-Gov. Rick Scott had come out in favor of expansion, as long as the federal government was covering the costs. After he was reelected in 2014, he reversed course and didn’t speak in favor of a plan pushed by Senate Republicans in 2015 to expand Medicaid while imposing work requirements and attaching other strings. House Republicans again rejected the plan, but only after a standoff between the chambers that delayed the budget.

Faced with the stalemate in the Legislature, those in favor of expansion have turned to a potential ballot measure that would put the issue before voters. Those efforts, however, have been stymied so far, too.

The Florida Decides Healthcare political committee halted its petition gathering push in 2019, saying it would be unable to gather enough petitions in time to be placed on the 2020 ballot. The group will try again for the 2022 ballot, but the Legislature last year passed a law placing greater requirements on petition gatherers and increased the amount of petitions needed for a Florida Supreme Court review.

Taddeo wants the Legislature to eliminate the need for that process by putting the measure on the ballot itself. She’s filed SJR 276 to put Medicaid expansion on the 2020 ballot, but that avenue is unlikely, too, because it requires 60% support in both chambers.

“After this icing on the cake is handed to us from the federal government … and we still don’t do it – it’s so sad because we’re playing with people’s lives,” Taddeo said.

grohrer@orlandosentinel.com

Clipped from: https://www.orlandosentinel.com/politics/os-ne-florida-medicaid-expansion-20210317-uxyqvh3trjgvthw4qxoba52syy-story.html

Posted on March 19, 2021 by MM_ADMIN

Georgia vows to continue fight if feds kill Medicaid waiver plan

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Georgia plans to fight CMS reneging on its approved waiver.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Georgia Commissioner of Community Health Frank Berry wrote in a letter that if the federal government revokes the state’s Medicaid waiver plan, “Georgia will challenge the decision.” The Trump administration approved the plan last year, but the CMS in February raised questions about its work requirements. Federal courts have blocked similar requirements in other states. (HYOSUB SHIN / HYOSUB.SHIN@AJC.COM)

Georgia officials, as expected, have appealed the new federal position on the state’s Medicaid waiver plan, saying its possible revocation by the Biden administration would be ”an arbitrary and unlawful bait-and-switch.”

The commissioner of the state’s Department of Community Health, in a letter dated March 12, noted that federal health officials last year approved Georgia’s approach to require low-income adults to meet work or other eligibility standards to get Medicaid coverage.

Those requirements were at the center of the Biden administration’s criticism last month of the Georgia plan, which is scheduled to begin July 1.

If the feds revoke the Medicaid waiver plan, “Georgia will challenge the decision,” Commissioner of Community Health Frank Berry wrote in the conclusion of his letter to officials with the Centers for Medicare and Medicaid Services. He called the work and other eligibility requirements “core to the waiver.”

State Republican lawmakers have defended the waiver plan promoted by Gov. Brian Kemp.

The Berry letter comes as the federal government dangles new incentives for states to pursue a much larger enrollment increase in Medicaid through a regular expansion of the program under the Affordable Care Act, something most states have done already.

Medicaid provides health coverage to low-income and disabled residents, including about 2 million in Georgia.

Georgia’s waiver says that to get Medicaid coverage, a person is required to put 80 hours a month into a job, an education program, a volunteer organization or another qualifying activity.

A February letter from the CMS, though, criticized Georgia’s policies ”that condition health care coverage on meeting work or other community engagement requirements.”

The letter from the feds pointed to uncertainties related to the COVID-19 pandemic, including job training and other activities used to satisfy work and other requirements, along with access to transportation and affordable child care.

Twelve states received federal approval under the Trump administration to impose Medicaid work requirements. But federal courts have blocked work requirements in Arkansas, Kentucky and elsewhere, and the U.S. Supreme Court is expected to take up a related case this month.

Berry, in his letter, said state officials “worked with CMS in good faith to adopt an innovative program to deliver coverage to a new category of individuals while helping them build important skills and become more independent and self-reliant.”

The Berry letter said Georgia officials had agreed to allow virus-related exceptions to the requirements for coverage, and that the COVID-19 pandemic has now eased.

CMS officials could not be reached Wednesday for comment on the Georgia letter.

The Trump administration opposed the ACA, supporting lawsuits against it and congressional efforts to repeal it. CMS officials under Trump approved the Georgia waiver as an alternative to a standard Medicaid expansion.

President Joe Biden, however, is a staunch supporter of the ACA, which became law while he was vice president.

Sweetening the offer

Georgia is one of 12 states that so far have chosen not to expand their Medicaid programs as outlined by the ACA. But the newly approved COVID-19 relief legislation gives those states enhanced financial incentives to adopt expansion.

States that expand the program at this point would receive an additional 5-percentage-point increase in their regular federal Medicaid matching rate for two years. So over that time, even factoring in the costs of implementing expansion, Georgia would net $700 million under the new incentives, according to the Kaiser Family Foundation.

The Kemp waiver plan, as outlined now, is much less ambitious. It would cost $75 million for the first year and cover just 31,000 low-income adults, according to the consumer advocacy group Georgians for a Healthy Future. The federal match under the Kemp waiver plan would be the regular 67% of the cost.

A standard expansion would give Medicaid eligibility to 480,000 to 600,000 people in the state, said Laura Colbert, the group’s executive director.

“Medicaid expansion has always been the moral and cost-effective choice for Georgia,” she said recently. The new incentive package, she said, “just amplifies that choice.”

Democrats, including Georgia’s newly elected U.S. Sens. Jon Ossoff and Raphael Warnock, have pointed to the state’s potential gains under Medicaid expansion, including helping hospitals and other medical providers.

“If Georgia does not expand Medicaid,” Warnock recently told The Atlanta Journal-Constitution, “then we are literally leaving money on the table that could save the lives of Georgians.”

Andy Miller is editor and CEO of Georgia Health News.

Clipped from: https://www.ajc.com/politics/georgia-vows-to-continue-fight-if-feds-kill-medicaid-waiver-plan/A4CHZNBF6VETXND6UFQ72MRMPY/

Posted on March 19, 2021 by MM_ADMIN

Feds will cover 100 percent of Medicaid vaccinations

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Medicare will pay 2x for COVID vaccines under the new bill, and CMS will cover them through Medicaid at the same rate.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

This screen grab from the website shows the main web page for the HealthCare.gov. HealthCare.gov’s market for subsidized health plans reopens Monday, Feb. 15, 2021, for a special three-month sign-up window, as the Democratic-led Congress weighs legislation that could cut premiums by double digits for many. (Centers for Medicare and Medicaid Services via AP, File)

BOSTON (SHNS) – The federal government on Monday announced another part of its strategy to speed vaccinations — paying vaccinators more money and ensuring that vaccinations will continue to be free to those who receive them.

The Medicare reimbursement rate for administering vaccines will nearly double from $23 to $40 per shot. In addition, under the $1.9 trillion spending bill signed by President Biden last week, the federal government will now cover 100 percent of the cost for Medicaid and children’s health insurance beneficiaries to get vaccinated.

“This protects states from bearing any costs associated with the increased Medicare reimbursement rates,” Acting Centers for Medicare and Medicaid Services Administrator Andy Slavitt said. “And the Biden administration stands ready to work with states who are interested in increasing their Medicaid reimbursement rates for vaccinations so that we can make sure that we have most effectively reached vulnerable communities. This is an important health equity step, as working and lower-income Americans have faced the brunt of this crisis and must receive the resources needed to protect them.”

MassHealth, the state’s Medicaid program, already reimburses providers $45 a shot for COVID-19 vaccinate, or $90 for two doses of the Moderna and Pfizer vaccines.

The two moves show the federal government is “doing more than saying thank you to all the people we call heroes,” Slavitt said.

Clipped from: https://www.wwlp.com/news/state-politics/feds-will-cover-100-percent-of-medicaid-vaccinations/

Posted on March 19, 2021 by MM_ADMIN

U.S. Supreme Court scraps arguments in Medicaid work case

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SCOTUS takes its orders from the Executive branch on state-approved Medicaid reforms.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

By Lawrence Hurley

WASHINGTON (Reuters) – At the request of President Joe Biden’s administration, the U.S. Supreme Court on Thursday canceled an upcoming oral argument on a policy introduced under his predecessor Donald Trump backing work requirements for people who receive healthcare under the Medicaid program for the poor.

The court granted a request made by Acting Solicitor General Elizabeth Prelogar on Feb. 22, who said the new administration has started the process of reversing the previous policy. The oral argument concerning pilot programs adopted by the states of Arkansas and New Hampshire had been scheduled for March 29.

Under Trump, the Department of Health and Human Services (HHS) in 2018 approved the pilot projects in those two states as part of a push to put a conservative stamp on Medicaid, a program that was expanded under the Affordable Care Act, also known as Obamacare, to provide medical coverage to millions more Americans.

Biden, a Democrat, succeeded Trump, a Republican, on Jan. 20. Under Biden, HHS made a preliminary finding that work requirements would be inconsistent with the objectives of Medicaid, which provides medical insurance for the poor, Prelogar told the court.

Biden’s Justice Department has reversed course in several cases originally filed by the Trump administration. In response to one such shift, the court on Tuesday dismissed an upcoming case on Trump’s policy barring immigrants deemed likely to need government benefits from legal permanent residency.

The Supreme Court on Feb. 3 canceled oral arguments in two other cases after Biden’s administration changed course from Trump policies. Both were appeals by Trump’s administration – one defending his funding of the U.S.-Mexico border wall and the other defending his so-called “remain in Mexico” asylum policy.

Clipped from: https://whbl.com/2021/03/11/u-s-supreme-court-scraps-arguments-in-medicaid-work-case/

Posted on March 19, 2021 by MM_ADMIN

Centene’s “corporate greed” led it to allegedly overcharge Ohio’s Medicaid department

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The Ohio AG has initiated a lawsuit years after the story of Centene using multiple PBMs broke.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

The Ohio attorney general has filed a lawsuit alleging that a Centene subsidiary, which provides Medicaid services in the state, hired multiple companies to administer pharmacy benefits in order to inflate costs. As a result, the state’s Medicaid department paid millions in overcharges.

Ohio has had it with Centene’s alleged “corporate greed.”

The state filed a lawsuit last week claiming that the St. Louis-based Centene company engaged in an elaborate plot to maximize profits at the expense of its Medicaid department. But Centene denies any wrongdoing, stating that the claims are “unfounded.”

The lawsuit alleges that Centene subsidiary Buckeye Health Plan, a managed care organization, used three subcontractors to provide pharmacy benefits in order to inflate costs. This resulted in millions of dollars in overpayments made by the Ohio Department of Medicaid, the state’s Attorney General Dave Yost said in a statement issued last Thursday.

“Corporate greed has led Centene and its wholly-owned subsidiaries to fleece taxpayers out of millions,” Yost said. “This conspiracy to obtain Medicaid payments through deceptive means stops now.”

The lawsuit comes several years after a Columbus Dispatch investigation that described how Centene’s Buckeye Health Plan contracted with two companies, Envolve Health Solutions and Health Net Pharmacy Solutions, to administer pharmacy benefits though it had already hired CVS Caremark to manage these same benefits. In other words, Buckeye was double-billing the state by using two different sets of pharmacy benefit managers.

Pharmacy benefit managers administer prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers and other payers. They essentially act as middlemen and their role in the drug distribution chain has faced increased scrutiny in recent years, according to a 2019 explainer by The Commonwealth Fund. This is largely because pharmacy benefit managers often receive rebates that are calculated as a percentage of the manufacturer’s list price, meaning they get a higher rebate for more expensive drugs.

In this case, suspicions were raised due to the fact that Buckeye charged nearly double for prescription drugs compared with other managed care organizations hired by the state to coordinate Medicaid services.

The attorney general’s office, through outside counsel, investigated Centene and Buckeye and found evidence of several contract violations. These include filing reimbursement requests for amounts already paid by third parties, failing to accurately disclose the true cost of pharmacy services and artificially inflating dispensing fees.

The lawsuit was filed in the Franklin County Court of Common Plea under seal due to a confidentiality and nondisclosure agreement.

In a statement issued last week, Centene said that its pharmacy contracts are reviewed and pre-approved by state agencies before they go into effect. The insurer also claimed that these pharmacy benefit services saved millions of taxpayer dollars for Ohioans.

“We look forward to answering any of the attorney general’s questions,” the insurer said. “Our company is committed to the highest levels of quality and transparency.”

This is not the first time AG Yost has gone after pharmacy benefit managers. Just last year, Yost filed a lawsuit against Express Scripts, accusing the company of multiple contract breaches that allowed it to pocket millions in overcharges to the state.

Photo: Hailshadow, Getty Images

Clipped from: https://medcitynews.com/2021/03/centenes-corporate-greed-led-it-to-allegedly-overcharge-ohios-medicaid-department/?rf=1

Posted on March 19, 2021 by MM_ADMIN

Texas Judge Sides Against Planned Parenthood, Finalizing Cut From Medicaid Program | The Texan

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A judge has ruled that TX Medicaid has the right to determine whether a provider is qualified to provide services to its members.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Planned Parenthood lost a last-minute bid yesterday to remain on the Medicaid program in Texas.

A Travis County district court judge ruled against the organization’s claim that Texas failed to provide proper notice before cutting it from the program, the latest loss for the company in a legal back-and-forth that began in 2015 and may leap up to a federal appeal.

Motivated by a series of undercover videos showing Planned Parenthood higher-ups discussing the sale of fetal remains, Texas decided to cut Planned Parenthood from the Medicaid program in October 2015. The Office of Inspector General sent a final notice of termination to Planned Parenthood in December 2016.

Planned Parenthood sued the Texas agency and found favor in court with a 2017 ruling that kept it on the Medicaid program. However, the company lost in late 2020 when an appeals court ruled that the state reserved the right to determine Medicaid providers.

“A state agency may determine that a Medicaid provider is unqualified and terminate its Medicaid provider agreement even if the provider is lawfully permitted to provide health services to the general public,” the ruling reads.

In response to Planned Parenthood’s request for a grace period to refer patients to new providers, the Texas Health and Human Services Commission (HHSC) gave the organization 30 days, beginning January 4 of this year. The decision that came yesterday ended a new tangent of litigation that began as that grace period came to a close, when Planned Parenthood successfully argued that the state didn’t send proper notice of termination.

The court kept the state on the Medicaid program with a temporary restraining order against the state before the fourteen-day renewal ended yesterday, when Judge Lora Livingston sided with Texas against Planned Parenthood.

The Austin American-Statesman
reports that Livingston treated the decision with gravity.

“This decision is not made lightly. In the light of the ongoing public health crisis, the risks of the individual losing health care and medical attention requires increased attention and scrutiny,” Livingston wrote.

Though Livingston sided against the company yesterday, a similar concern for harm to Planned Parenthood patients motivated the 2017 ruling at least in part.

“The Individual Plaintiffs have proven a substantial likelihood of success on their claim terminating the Provider Plaintiffs from Medicaid violates their right to their chosen provider and would cause irreparable harm,” Judge Sam Sparks wrote.

“If the termination were allowed to proceed, the Individual Plaintiffs would, at minimum, see their health care disrupted.”

The videos that prompted the state to cut Planned Parenthood from Medicaid show a range of personnel including abortion physicians discussing how best to harvest the organs from fetal remains for sale to researchers.

While federal money cannot fund abortions, Democrat lawmakers have proposed a bill that would let the state pay for them with taxpayer money in a program parallel to Medicaid, dispensed by the Texas Health and Human Services Commission.

Clipped from: https://thetexan.news/texas-judge-sides-against-planned-parenthood-finalizing-cut-from-medicaid-program/

Posted on March 19, 2021 by MM_ADMIN

Centers for Medicare and Medicaid Services guidance expands nursing home visits

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FL nursing home providers are determining whether the CMS or state Medicaid guidance applies.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

TAMPA, Fla. — The past year was one filled with isolation for Elyce Turba and her mother, a resident of a long-term care facility.

A few months ago, Turba said she got to see her mother in person again, though they still couldn’t touch. But this week, she was finally able to give her now vaccinated mother a hug after a year.

“It was just a joyous feeling at that point and also a very hopeful feeling. I thought maybe we’re coming to the end of this pandemic,” she said.

Last week, the Centers for Medicare and Medicaid Services released guidance, that though it has similarities to the state’s last order for long-term care facilities, it also expands indoor visits and touching.

The CMS guidelines still recommend physical distancing and outdoor visits when possible.

In the event of a new COVID-19 case, it recommends allowing visits to resume as long as facility-wide testing is complete and transmission is contained to a single area. If a resident is fully vaccinated, it says they can choose to have close contact with their visitor while wearing a mask.

The Florida Health Care Association, an advocacy organization, says it’s asked the state for future clarification. Nursing homes are regulated by both CMS and the Agency for Health Care Administration, though assisted living facilities are not regulated by CMS.

“We’ve informed our members and we’re guiding them that they should follow the stricter of the two regulations or the stricter of the two guidelines in this situation so that’s what they’ll be doing,” said the group’s director of communications, Kristen Knapp, noting facilities have been having families.

AHCA stated, “The recently released CMS guidelines support the approach Florida has taken to ensure that long-term care facilities encourage and enable families and compassionate care providers to visit residents, which we know is important to residents’ wellbeing. The Agency for Health Care Administration will continue to work with facilities to safely give residents and visitors greater freedom to spend more time with their loved ones.”

AHCA said there has been a 74% decrease in COVID positive residents of nursing homes and a 78% decrease in COVID positive residents of assisted living facilities in about the last month.

“The one thing that we’re seeing is that the vaccines are working. We’re seeing our positive cases decline so we’re all very hopeful. So I think you’re seeing that because you’re having those widespread vaccinations in our facilities as our numbers go down you know it gives us more opportunities to get back to normal,” said Knapp.

Knapp said they’re still working to educate staff, and looking at long-term strategies for vaccinations.

AHCA data shows 67.55 percent of nursing home residents and 92.65 percent of assisted living facility residents have received the vaccine.

Meanwhile, the agency says 35.15 percent of current nursing home staff and 39.67 percent of current assisted living facility staff have received the vaccine.

That number is concerning for Turba.

“I just really feel like as long as we can keep more people getting vaccinated and getting a vaccine that’s going to allow us all to go in and see people that we love to be around groups again so it’s not just those in the long term care but it’s for the benefit of all of us,” she said.

She’s hopeful in the future, people like hairstylists can also enter the facility. But for now, she’s smiling that they were able to hug.

“Well I’m hopeful it will help her to be able to feel that connection again and know that I haven’t abandoned her,” she said.

Clipped from: https://www.abcactionnews.com/news/coronavirus/centers-for-medicare-and-medicaid-services-guidance-expands-nursing-home-visits

Posted on March 19, 2021 by MM_ADMIN

NCDHHS launches statewide open enrollment for Medicaid Managed Care

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Open enrollment for NC Medicaid managed care has finally begun after years of delays.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

From NCDHHS

RALEIGH — The North Carolina Department of Health and Human Services on Monday announced the launch of statewide open enrollment for NC Medicaid Managed Care. Beneficiaries can enroll online, by calling the NC Medicaid Managed Care Call Center at 833-870-5500 (TTY: 833-870-5588) or through the free NC Medicaid Managed Care mobile app available on Google Play or the App Store. They can also use the mail-in forms sent to them in the enrollment packet.

“With the start of NC Medicaid Managed Care open enrollment, families now have the chance to make important decisions about their health care to prepare for managed care launch in July,” said NCDHHS Secretary Mandy Cohen, “There are many resources available to help families select the health plans and providers that best meet their specific needs.”

The NC Medicaid Managed Care website offers a wide variety of tools and information to assist beneficiaries in choosing a primary care provider (PCP) and a health plan for their families’ care. Tools include frequently asked questions, a chat function, the Medicaid and NC Health Choice Provider and Health Plan Lookup Tool with four categories of search capabilities, advanced search based on specialty and the ability to view all providers within an organization/location and by practice name.

Most people who receive Medicaid can choose from five health plans as part of the state’s transition to managed care. Some people will not need to choose a health plan because of the type of health services they need. All health plans are required to have the same Medicaid services, such as office visits, blood tests and X-rays. Health plans each have their own network of qualified doctors and health care professionals. Health plans also have added services such as educational assistance and programs to have a healthy pregnancy. People can choose a PCP from their health plan’s network to deliver their families’ Medicaid services.

The Eastern Band of Cherokee Indians (EBCI) Tribal Option is an additional managed care option, and the first Indian Managed Care Entity in the nation that is available for federally recognized Tribal members and individuals eligible to receive services through the Indian Health Service.

Open enrollment ends May 14, 2021. Beneficiaries who enroll with a health plan during open enrollment will have the opportunity to select a PCP from a list of contracted providers. If they do not choose a health plan before May 14, NC Medicaid will assign one to them. In the first 90 days after their coverage effective date, beneficiaries can change health plans for any reason. After that, unless there is a special reason, beneficiaries cannot change health plans until the next NCDHHS Medicaid recertification date.

For more information, beneficiaries can reference the enrollment packets that were mailed to them, visit the NC Medicaid Managed Care website or call the NC Medicaid Managed Care Call Center at 833-870-5500 (TTY: 833-870-5588).

Clipped from: https://www.thewashingtondailynews.com/2021/03/15/ncdhhs-launches-statewide-open-enrollment-for-medicaid-managed-care/