Category: Amazing Free Content

OH MY DEAR TARHEEL STATE, WHY CAN’T YOU GET IT TOGETHER? I love NC. Heck I lived there for 2 years. But its time for an intervention. News of $835M in misspent 2015 Mcd funds came out this week. Agency officials acknowledge the problem of improper payments, but challenge the number (but don’t provide an alternative number). Beth Wood (the state auditor) is sticking by her $835M number, which is based on a sample of 396 claims. For those of you with an NC connection (which is a lot of us in the Mcd world), you know this is just the latest bump in the road.

MO PUTS FOOT DOWN ON MCD BUDGET; IN OTHER NEWS HELL HATH FROZEN OVER- The Mcd agency was asking for an increase that would have consumed all new state revenues for the fiscal year. Instead, the Senate came back with a $55M cut for Mcd in the Show Me State. News of this unprecedented event (an actual cut to a Mcd budget, not a “we would have spent even more, so give us 10% more than last year and call it a cut”, cut) was immediately followed by swarms of locusts, great cracks in the ground swallowing cars and the Mississippi River turning to blood.

TEMPEST IN A TEAPOT: IOWA MCO TRANSITION GOING JUST FINE- The move to managed care can be painful. You’re taking what has been run by the government for decades, spawning hundreds of mini, protected, subsidized fiefdoms – and converting it into something that has to be run efficiently enough to turn a profit. There’s some growing pains. Iowa became the 39^th state to make the switch to managed care this week, but only after months of “the sky is falling” and ripping of sackloth from the legacy stakeholders. As long as the Good Guvn’r Brandstad is right, there wasn’t much to fuss about. The transition is going smoothly. We can all hope for a 6-month honeymoon, at least until the MCOs begin the obligatory “our rates are too low, so this is why the sky is falling now” wailing. See- the sky is always falling in Medicaid. It’s only a question of who’s playing Chicken Little.

MCD EXPANSION = BOON TIMES FOR LOBBYISTS- If KY is any indication, anyway. Looks like health related lobbying has ramped up 30% this year compared with last. I think they measure that based on reported payments to lobbyists, but not exactly sure. Would love to hear what you are seeing in your statehouse if your state is one of the expansion holdouts.

ANYBODY KNOW A GOOD CHARITY FOR VETS? For the last several years I have wanted to do a fundraising campaign for vets to be timed with Memorial Day / 4th of July. Both always sneak up on me … If you have a good one you recommend, please email it in.

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. Elva Santos and Manuel Gomez of TX got pinched for two very similar (but not related) scams this week. Santos pilfered $581K of Mcd dollars with her DME company; Gomez did the same with his, but added a patient data buying scheme to the charges. Gomez’s tab rings up at around $2M.  Christina Benson of Tallahassee plead guilty Mcd fraud- she got $170k by paying homeless men and women to pretend to be Mcd patients and then bill for home care solutions they did not need. Mr. Gomez – you win!

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).

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

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

ābi le‘alemi hone kewelidi bek’eri welidimi

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).

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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).

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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