The Medicare-Medicaid Data Match program (Medi-Medi program) enables program safeguard contractors (PSC) and participating State and Federal Government agencies to collaboratively analyze billing trends across the Medicare and Medicaid programs to identify potential fraud, waste, and abuse.
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Minimum Essential Coverage – Under the Affordable Care Act, the federal government, state governments, insurers, employers and individuals each are given roles in reforming and improving the availability, quality and affordability of health insurance coverage in the United States. Starting January 1, 2014, the individual shared responsibility provision calls for each individual to have minimum essential health coverage (known as “minimum essential coverage”) for each month, qualify for an exemption, or make a payment when filing his or her federal income tax return.
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Medicare Catastrophic Coverage Act – A government bill designed to improve acute care benefits for the elderly and disabled, which was to be phased in from 1989 to 1993. The Medicare Catastrophic Coverage Act of 1988 was meant to expand Medicare benefits to include outpatient drugs and limit enrollees’ copayments for covered services.
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The Medicaid and CHIP Payment and Access Commission (MACPAC) is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP). The U.S. Comptroller General appoints MACPAC’s 17 commissioners, who come from diverse regions across the United States and bring broad expertise and a wide range of perspectives on Medicaid and CHIP.
MACPAC serves as an independent source of information on Medicaid and CHIP, publishing issue briefs and data reports throughout the year to support policy analysis and program accountability. The Commission’s authorizing statute, 42 U.S.C. 1396, outlines a number of areas for analysis, including:
payment;
eligibility;
enrollment and retention;
coverage;
access to care;
quality of care; and
the programs’ interaction with Medicare and the health care system generally.
MACPAC’s authorizing statute also requires the Commission to submit reports to Congress by March 15 and June 15 of each year. In carrying out its work, the Commission holds public meetings and regularly consults with state officials, congressional and executive branch staff, beneficiaries, health care providers, researchers, and policy experts.
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Medicaid and CHIP Business Information Solutions – In 2010 CMS initiated the Medicaid and CHIP Business Information Solution (MACBIS) to meet mandates requiring reliable, comprehensive, and timely Medicaid and CHIP operational and programmatic data supported by leading edge technology and analytics solutions. MACBIS is an enterprise-wide initiative to ensure the Medicaid and CHIP data infrastructure and technology are commensurate to the programs’ role in evolving health care delivery reforms, access to coverage, and to enable proper monitoring and oversight. Aside from data needs to support the multi-billion dollar waiver negotiations, CMS will use MACBIS data for program integrity, evaluation of demonstrations, actuarial analysis, quality of care analysis, and to share this rich data set with states, stakeholders, and the research community.
MACBIS currently consists of four major projects: Medicaid and CHIP Program (MACPro), the Transformed Medicaid Statistical Information System (T-MSIS), the Medicaid Drug Rebate (MDR) program, the Medicaid and CHIP Financial program, the latter of which is the early planning in FY2017.
Further reading –
https://www.medicaid.gov/medicaid/data-and-systems/macbis/index.html
Medicare Advantage – You can get your Medicare benefits through Original Medicare, or a Medicare Advantage Plan (like an HMO or PPO). If you have Original Medicare, the government pays for Medicare benefits when you get them. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits. If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage.
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Low-income Subsidy – Eligible beneficiaries who have limited income may qualify for a government program that helps pay for Medicare Part D prescription drug costs.
Medicare beneficiaries receiving the low-income subsidy (LIS) get assistance in paying for their Part D monthly premium, annual deductible, coinsurance, and copayments. Also, individuals enrolled in the Extra Help program do not have a gap in prescription drug coverage, also known as the coverage gap, or the Medicare “donut hole.” The amount of subsidy depends on the individual’s income compared to the Federal Poverty Level and resource limitations set by the Social Security Act.
Further reading –
https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8094.pdf
A lot happens in Medicaid in 30 days. We covered it all in 60 minutes with Rob Demler with Milliman, Virgil Dickson with Modern Healthcare and Joe Moser with Straight Arrow Consulting.
Kaiser Commission on Medicaid and the Uninsured – The Program on Medicaid and the Uninsured is the largest operating program of the Kaiser Family Foundation and serves as a key resource for policymakers, the media, and organizations seeking information on health care for the low-income population and the Medicaid program. Its work focuses on key health policy issues at the national and state level, including Medicaid and health reform, access to care, and health care financing for the low-income population. The Program provides timely, relevant and trusted information and analysis on health care coverage and access to care, the role of Medicaid and the Children’s Health Insurance Program, and coverage of the uninsured to inform policy discussions. The Program collects and analyzes policy and data at the state and federal level on eligibility and enrollment; spending, coverage, and care delivery; long term services and supports; and Medicaid’s role for high-need populations and dual eligible beneficiaries. The Program was formerly the Kaiser Commission on Medicaid and the Uninsured, chaired by James R. Tallon, Jr., with a bipartisan advisory group of national leaders and experts in health care and public policy from 1991-2016.
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We talked all things Arizona Medicaid with Jami Snyder, Deputy Director at the Arizona Health Care Cost Containment System (AHCCCS).
