Tag: Tech

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CNSI’s Provider Services Module to Support Georgia Department of Community Health’s Medicaid Enterprise System Transformation Program

 
 

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[MM Curator Summary]: The tech giant will get $116M for its role in the GA provider management system over the next 10 years.

 
 

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.

 
 

 
 

CNSI’s CMS-certified, configurable, web-based system aims to enhance provider experience and support Medicaid modernization with an efficient, scalable platform

MCLEAN, Va., March 7, 2022 /PRNewswire/ — CNSI, a leading provider of innovative healthcare technology-driven products and solutions, announced today a new contract with the Georgia Department of Community Health (DCH) to implement a new provider services module (PSM) as part of the state’s Medicaid Enterprise System Transformation (MEST) program. Under the terms of the 10-year, $116 million agreement, CNSI will implement its provider management information system, evoBrix X PMIS™, delivering an enhanced user experience around enrollment and real-time claims status for the state’s Medicaid providers enrolled with DCH to administer essential health services.  

DCH selected CNSI as an approved Centers for Medicare and Medicaid (CMS) PSM vendor through the National Association of State Procurement Officials (NASPO) ValuePoint procurement platform. CNSI’s configurable, web-based provider module supports states’ Medicaid system infrastructure modernization efforts with a secure platform that increases self-service functionality for providers while delivering efficiency and scalability for state Medicaid programs.

“We are delighted to partner with the Georgia Department of Community Health in its efforts to optimize quality controls and provide the best experience for its valued healthcare providers,” said Todd Stottlemyer, CNSI CEO. “With this new contract, we are excited to support the state agency’s mission to create A Healthy Georgia.”

“Our Medicaid Enterprise System Transformation project will elevate how we interface with providers across Georgia,” said Caylee Noggle, DCH Commissioner. “We look forward to working with CNSI to develop and implement a modern user experience that helps providers reduce time spent on administrative tasks so they can focus on delivering high quality care.”

About CNSI:

CNSI delivers a broad range of health information technology enterprise solutions and customizable products to a diverse base of state and federal agencies in the United States. We align, build, and manage innovative, high-quality, cost-effective solutions that help clients achieve their mission, enhance business performance, reduce costs, and improve the health of individuals and communities.  Headquartered in the United States with global operations, CNSI employs a world-class team of technologists, program managers, and subject matter experts with large scale mission-critical information technology implementation experience. Learn more at cns-inc.com.

Clipped from: https://www.prnewswire.com/news-releases/cnsis-provider-services-module-to-support-georgia-department-of-community-healths-medicaid-enterprise-system-transformation-program-301496119.html

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CNMI- Governor vetoes Medicaid personnel bill

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[MM Curator Summary]: The Governor of CNMI has shot down a bill that would codify various authorities for the Medicaid agency.

 
 

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.

 
 

 
 

GOVERNOR Ralph DLG Torres on Friday vetoed House Bill 22-53, which proposes to “further enable recruitment, retention and appropriate classification and compensation” in the Commonwealth Medicaid Agency.

Introduced by Rep. Leila Fleming Staffler, the bill aims to:

1) Codify the authority of the Medicaid director to reprogram funding appropriated for Medicaid program among the established business units in a fiscal year budget;

2) Direct the Office of Personnel Management to undertake a repricing study for eligibility, enrollment, claims processing, and health information technology personnel and retention based on the classification and compensation of Commonwealth Healthcare Corp.; and

3) Authorize OPM to hire Medicaid Enterprise System, data analysis, program integrity, and auditing personnel under excepted service employment contracts until the market-based repricing classification and compensation study is completed.

According to the bill, the CNMI government’s fiscal year 2021 budget established a Compliance and Medicaid Enterprise System as a new business unit “to balance the program needs for administration and medical reimbursement with the legal requirements of Title XIX of the Social Security Act.”

In addition, the Legislature also provided the Medicaid director the authority to reallocate the funds appropriated in the budget law.

H.B. 22-53 clarifies the authority of the Medicaid director to reprogram funds among the Medicaid business units categories or any other business units the Legislature may establish in the appropriation measure.

The bill also stated that positions for Medicaid Enterprise System personnel approved and funded, at a minimum, with 50% to 90% federal funds, as approved by the Centers for Medicare and Medicaid Services, “have yet to be recruited, resulting in delays to important project activities and time lines.”

The measure states that “specialized health information technology and Medicaid data analytics personnel required by Medicaid are in short supply until OPM is able to undertake a market-based classification and compensation pricing study for health information technology and data analytics personnel that, in minimum, reflects the comparable classification compensation of like positions at CHCC.”

Ambiguous

In his veto message, the governor said due to ambiguities in the language of the bill as noted by the attorney general, and similar concerns of OPM, “I must respectfully exercise my constitutional authority to veto this bill.”

He said if approved, the measure would create a narrow exception to the reprogramming restrictions in the Planning and Budgeting Act, with regard to the Medicaid Agency.

He said funds appropriated to the Medicaid Agency may be reprogrammed by the director regardless of whether the funds are for personnel or non-personnel expenditures.

Right now, the governor said, the Planning and Budgeting Act permits the reprogramming of funds from personnel to non-personnel or operations, but not vice versa.

The governor also noticed that the bill would require OPM to establish personnel positions for the Medicaid Agency that fall under Medicaid Enterprise System. The MES positions, he added, are approved by the Centers for Medicare & Medicaid Services.

OPM is further tasked with performing a review and study of the classification of personnel required by the Medicaid program with classification and compensation rates comparable to CHCC and private insurers and providers.

In recruiting prospective employees, the governor said OPM would be directed to interview and employ individuals who have demonstrable and specific knowledge, skills, experience, training and abilities applicable in Medicaid administration and similar healthcare management and analytics program.

But the governor said H.B. 22-53 would exempt MES employees from the civil service system. Upon completion of OPM’s classification and compensation study to be approved by the Medicaid director, the MES employees may opt to convert to the civil service system and become civil service employees.

According to the governor, the attorney general makes it clear that Legislature’s lawmaking authority over the civil service system “is not plenary.” Only the Civil  Service Commission has the authority over civil service system and is the sole authority to exempt positions from civil service classification, the governor said.

 
 

Clipped from: https://mvariety.com/news/governor-vetoes-medicaid-personnel-bill/article_d9534576-8288-11ec-87c3-e3fe2accaba7.html

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Florida- Medicaid modernization will take hundreds of millions and require more staff

[ MM Curator Summary] Florida is beginning the process to rebid its MMIS and downstream modules.

 
 

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.

 
 

 
 

Florida’s health care regulation agency is setting the stage for an expensive rebuild of the computer systems that bind the state’s multibillion dollar Medicaid program even though state legislators have not agreed to pay for it.

The Agency for Health Care Administration has dropped three different invitations to negotiate with vendors that can update the state’s antiquated Medicaid management information systems and is expecting responses on the three requests by early- to mid-December.

In hopes of having contracts inked between the summer and fall of 2022, the agency is assembling for each Invitation to Negotiate (ITN) two multiagency teams — one to evaluate the vendors’ responses and the other to negotiate with vendors that received top evaluation scores.

Now all the agency needs is the Florida Legislature to approve its legislative budget request for $117.8 million so it can pay the vendors for the needed work. It’s a number that one top House Republican already suggested may be “excessive.” 

Currently, the Medicaid management information system is a single integrated system for claims processing and information retrieval. But AHCA wants to transform that into a modern modular system that connects with other data sources and programs.

 
 

Florida Health Care Connections, or FX, is the moniker AHCA assigned to the transformation of the system and the subsequent modular procurements necessary to make it happen. Florida lawmakers have already appropriated more than $158 million over the past five budgets for the replacement of the system responsible for billing and payment to the managed care companies, doctors and pharmacies providing health care to millions of Floridians enrolled in Medicaid.

FX Program Director Mike Magnuson told members of the FX Executive Steering Committee on Wednesday the latest budget request for the upcoming fiscal year 2022-2023 budget, “includes the funding to start the contracts that we now put out on the street. So the majority of it will be the fixed price deliverables for those functions.”

In addition to requesting the $117.8 million to help initially pay the three ITNs, Magnuson told FX Steering Committee members the agency requested another $1.97 million to hire 12 full-time employees who can provide ongoing support to the office that will be created to help with the system.

Without the funding, Magnuson said, the agency would be reliant on paying contracted staff in order to operate the FX updates.

But Rep. Bryan Avila, the South Florida Republican charged with leading efforts to assemble a health care budget in the House of Representatives, recently questioned the size of the agency’s legislative budget request by asking if the project total was inflated.

 
 

Meanwhile, the three ITNs AHCA published have a combined value of nearly $350 million over a seven-year period.

The first ITN AHCA will award is for modular “unified operations centers” services. The contract would be in effect between Aug. 1, 2022, and July 31, 2029, and could be worth more than $161 million.

The second ITN AHCA will award is for modular provider management services.The system must allow for concurrent processing of enrollment and plan credentialing activities for both initial enrollment as well as renewals. According to the ITN, the contract would be in effect from Sept. 1, 2022, through Aug. 31, 2029, and would be worth more than $33 million.

The third ITN the agency will award is for so-called core systems and is expected to be worth $154.5 million. According to the ITN, the contract would be in effect between Nov, 1, 2022, and Sept. 30, 2029. 

“We are getting to the point where the rubber is starting to meet the road,” AHCA Secretary Simone Marstiller told members of the FX Executive Steering Committee. “It’s all starting to come together.”

Clipped from: https://floridapolitics.com/archives/472301-medicaid-modernization-will-take-hundreds-of-millions-and-require-more-staff/

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State: Technical ‘reporting errors’ caused data gap on kids’ Medicaid referrals

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A recent report showing GA failing to deliver EPSDT services at an alarming rate was based on bad data.

 
 

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.

 
 

State officials say “reporting errors” from the government led to recent data indicating that Georgia had a stunningly low rate of referring poor kids under Medicaid to specialty medical services.

 
 

“We’re certainly not below every single state” when it comes to referrals, Ryan Loke, deputy commissioner of the Department of Community Health, told the agency’s board earlier this month.

The agency investigated data under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program after Georgia Health News, citing a national analysis, reported that children covered by Medicaid weren’t getting their required “corrective treatments” at a rate comparable to those of other states.

The goal of EPSDT is to provide early detection and treatment of health conditions so that children and adolescents covered by Medicaid can get appropriate preventive, dental, mental health, developmental or other specialty services.

A report from the National Health Law Program compared states on their numbers of health screenings and referrals to specialized care. Georgia in 2019 had 1.4 million children eligible for EPSDT. The report’s figures showed the state was doing health screenings at recommended levels.

But just 30,000 Georgia kids that same year were referred to corrective treatment for a health condition, the report said.  That compared with Illinois, also with 1.4 million eligible kids, which referred more than 500,000 for services in 2019.

Community Health said in an email to GHN that the information technology system run by the state for Medicaid recorded tens of thousands fewer referrals than actually occurred.

Dan Young of the National Health Law Program (NHeLP), a nonprofit organization that generated the report, said the state’s explanation of the referral gap appears to make sense.

“I don’t know why the Georgia [Medicaid] information system isn’t capturing the correct data,” Young said.

He said the NHeLP report served to generate important questions about Georgia medical referrals, and he added that “hopefully it will encourage [state officials] to take notice of how they report data.”

The figures in the NHeLP report came from the federal Centers for Medicare and Medicaid Services, which gets its referral data directly as reported by state Medicaid programs.

A large majority of children in Georgia Medicaid are covered by managed care companies, known as care management organizations.

This story available through a news partnership with Georgia Health News.

 
 

Clipped from: https://thecurrentga.org/2021/10/27/state-technical-reporting-errors-caused-data-gap-on-kids-medicaid-referrals/

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OIG: Most states not doing enough to monitor Medicaid telehealth fraud for behavioral health services

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The report implies that states have very little idea about what is going on with their telehealth programs.

 
 

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.

 
 

 
 

A new survey of 37 states found that three didn’t know which Medicaid behavioral health services are offered via telehealth compared to in person, an Office of Inspector General report found.

Many states don’t monitor for telehealth fraud and fail to evaluate how telehealth has impacted patient access and care, a Department of Health and Human Services watchdog found.

The agency’s Office of Inspector General (OIG) released a report Tuesday that explored how states are evaluating the use of telehealth to treat behavioral health in Medicaid. While states have increasingly turned to telehealth during the COVID-19 pandemic, OIG found that a few don’t even know what services are offered virtually.

“As the nation confronts the psychological and emotional impact of COVID-19, the use of telehealth will be important in addressing behavioral health needs for Medicaid enrollees,” the report said.

Telehealth can be used to cover several behavioral health services such as mental health assessments and therapy. This reliance has increased since the pandemic that caused patients to stay home for fear of contracting the virus.

But the report finds states still have a way to go if telehealth flexibilities offered by the Centers for Medicare & Medicaid Services become permanent.

OIG spoke with Medicaid directors for 37 states that provide telehealth behavioral services.

RELATED: New House, Senate bills aim to make telehealth expansion permanent in Medicare, Medicaid

The agency found only two states have evaluated the effectiveness of telehealth on access to services for Medicaid enrollees.

One of the states found that 70% of enrollees who used telehealth for behavioral services resided in a rural area and would have to be transported a long distance to get care without it. Another found telehealth increased the types of providers beneficiaries could access such as psychiatrists, psychologists and nurse practitioners that specialize in mental health.

Only one of the 37 states evaluated the impact of telehealth on cost. It found that prior to the pandemic, telehealth generated $8,600 in savings for emergency room care avoidance in one managed care plan and $484,000 in reduced transportation costs for another plan.

OIG also found that three of the 37 states couldn’t say which services are provided to Medicaid beneficiaries via telehealth compared to in person.

“These states cannot do any analysis on the effects of telehealth, nor do they have the ability to perform basic monitoring and oversight specific to telehealth services, which are essential to ensuring the fiscal integrity of the Medicaid program and to protecting Medicaid enrollees,” the report said.

States are already providing a small amount of monitoring and oversight on telehealth. OIG found that 11 out of the 37 states perform monitoring and other actions to combat any fraud or waste in telehealth. But 23 out of the 37 states report fraud is a major concern surrounding telehealth use.

Even though Medicaid is a federal-state joint program, states are responsible for monitoring.

A few states told OIG it is difficult to verify that telehealth services are being provided appropriately.

States need to step up their efforts to evaluate and examine the impact of telehealth on their Medicaid programs, especially as flexibilities that emerged during the pandemic could be made permanent, OIG said.

“Evaluating the effects of telehealth on access, cost and quality of behavioral health services is particularly important in helping states make decisions about how best to use telehealth and about which populations benefit most from these services,” OIG said.

RELATED: Telehealth use drops for 3rd straight month as patients return to in-person appointments

An accompanying data brief from OIG (PDF) also found that states have had major challenges with implementing behavioral telehealth services. The brief looked at state challenges from January through February 2020 before the onset of the pandemic.

“Most states reported multiple challenges with using telehealth, including a lack of training for providers and enrollees, limited internet connectivity for providers and enrollees, difficulties with providers protecting the privacy and security of enrollees’ personal information, and the cost of telehealth infrastructure and interoperability issues for providers,” the brief said.

The findings act as a clarion call to states to prepare for potential permanent expansion of telehealth after the pandemic subsides. States can decide how to apply telehealth in their Medicaid programs.

 
 

Clipped from: https://www.fiercehealthcare.com/payer/oig-most-states-not-doing-enough-to-monitor-medicaid-telehealth-fraud-for-behavioral-health

 
 

 
 

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New Hampshire Extends Partnership with Conduent to Maintain, Operate and Enhance Medicaid

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Conduent (nee Xerox, nee ACS) continues its now 16-year contract for the huge MMS contract in NH.

 
 

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.

 
 

Company will continue to support Medicaid beneficiaries and providers with a range of services including online enrollment, eligibility verification and claims processing

Conduent will also upgrade technical capabilities of the Medicaid system to increase security and processing speed and provide cost efficiencies

FLORHAM PARK, N.J., Sept. 09, 2021 (GLOBE NEWSWIRE) — Conduent Incorporated (Nasdaq: CNDT), a business process services and solutions company, today announced it has extended its partnership with the New Hampshire Department of Health and Human Services (NH DHHS), serving as the exclusive provider of services to modernize the state’s Medicaid Management Information System (MMIS). Conduent will provide maintenance, operations and enhancements that support NH DHHS’s ability to serve approximately 220,000 beneficiaries and process more than 15 million claims annually.

In addition, the company will upgrade the state’s MMIS to a virtualized environment, while increasing system security, reliability, scalability, and performance. 

Since 2005, Conduent has provided solutions to the NH DHHS to enhance the effectiveness, coordination and delivery of numerous initiatives that embody the agency’s mission to facilitate whole-person care. The company will continue to serve as fiscal agent for the state’s Medicaid program, providing online enrollment, eligibility verification and claims processing to help 30,000 providers meet the medical, behavioral and social needs of people across New Hampshire.

“This award demonstrates our strong MMIS expertise, and the trust NH DHHS has placed in us to help the state move its Medicaid program forward for the future,” said Pat Costa, President, Government Healthcare Solutions at Conduent. “Our team is committed to the department’s effort to bring about new technologies and efficiencies that will ultimately benefit providers and beneficiaries across New Hampshire.”

The contract renewal for MMIS maintenance, operations and enhancements, which is valued at approximately $206 million, includes a five-year base term plus a five-year option to extend until 2031.

Earlier this year, Conduent announced a related contract to help the state comply with the federal Interoperability and Patient Access Final Rule. That project provides Medicaid beneficiaries with improved, secure access to their personal health information, enabling them to make more informed healthcare decisions.

With 50 years of experience in the government health and social services industry, Conduent supports more than 41 million customers annually with various government health programs and other eligibility services. For Medicaid, Conduent supports systems in 23 states, Puerto Rico and Washington, D.C., and it has facilitated federal MMIS certifications in 14 states.

About Conduent Conduent delivers mission-critical services and solutions on behalf of businesses and governments – creating exceptional outcomes for its clients and the millions of people who count on them. Through process, technology, and our diverse and dedicated associates, Conduent solutions and services automate workflows, improve efficiencies, reduce costs, and enable revenue growth. It’s why most Fortune 100 companies and over 500 government entities depend on Conduent every day to manage their essential interactions and move their operations forward.

Conduent’s differentiated services and solutions improve experiences for millions of people every day, including three out of every four U.S. insured patients, 10 million employees who use its HR Services, and nearly 18 million benefits recipients. Conduent’s solutions deliver exceptional outcomes for its clients, including $16 billion in savings from medical bill review of workers compensation claims, up to 40% efficiency increase in HR operations, up to 27% reduction in government benefits costs, up to 40% improvement in finance, accounting and procurement expense, and improved customer service interaction times by up to 20% with higher end-user satisfaction. Learn more at https://www.conduent.com.

Media Contacts: Sharon Lakes, Conduent, +1-214-592-7637, sharon.lakes2@conduent.com

Investor Relations Contact: Giles Goodburn, Conduent, +1-203-216-3546, ir@conduent.com

Note: To receive RSS news feeds, visit www.news.conduent.com. For open commentary, industry perspectives, and views, visit http://twitter.com/Conduent, http://www.linkedin.com/company/conduent or http://www.facebook.com/Conduent.

Trademarks Conduent is a trademark of Conduent Incorporated in the United States and/or other countries. Other names may be trademarks of their respective owners.

 
 

Clipped from: https://www.bakersfield.com/ap/news/new-hampshire-extends-partnership-with-conduent-to-maintain-operate-and-enhance-medicaid/article_9e52249b-50c0-586f-b2a2-95a32707b1f8.html

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Texans on Medicaid can now use Uber for non-emergency medical appointments

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Uber just added millions of new customers in TX Medicaid.

 
 

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.

 
 

Uber said it aims to eliminate barriers to care for Medicaid enrollees as well as provide a more cost-efficient form of transportation.

 
 

A sign in the lobby of Uber’s Deep Ellum office on Jan. 27, 2020 in Dallas.(Juan Figueroa / Staff photographer)

Uber is now offering millions of Texans on Medicaid rides to and from non-emergency medical appointments.

Uber Health, the company’s health care division, launched the service officially this week thanks to a law the company helped pass in the 2019 legislative session. Uber worked with now-Speaker of the Texas House of Representatives Dade Phelan to pass legislation allowing ride-sharing companies to utilize the Medicaid program.

Uber says that rides for Medicaid enrollees will be priced the same as the company’s UberX service, and the health systems providing care can schedule transportation on a dashboard. It can also streamline those providers’ payments by combining charges for Medicaid patients into a single monthly bill.

 
 

There are nearly 4.4 million people in the state enrolled in Medicaid who will be able to use Uber’s on-demand ride sharing platform for medical visits. The service touts a more cost-efficient way to get patients to appointments, and one that helps health systems overcome a thorny barrier to providing care.

Transportation issues are cited as the reason nearly 6 million Americans miss medical care appointments each year, according to a recent American Journal of Public Health
study cited by Uber.

“Texas is ahead of the curve and helping serve their communities, and especially the Medicaid community, in what they’ve done allowing Uber to be a piece of the transportation,” global head of Uber Health Caitlin Donovan said.

Donovan joined Uber from the home health industry about four months ago. She said the realization that case managers she worked with were spending more than half of their time sorting out logistics like transportation for patients drove her to join the ride-sharing company.

 
 

Health care providers can utilize Uber Health’s dashboard to manage and schedule rides.(Uber Health)

The company has been piloting the service since June 1 when it was finally approved by the Texas Health and Human Services Commission. Uber had hoped to launch the HIPAA-secure service sooner but COVID-19 created delays, Uber spokesman Chris Miller said.

 
 

“The truth is that spending our money on a ride with Uber Health can be a more cost-effective use of our Medicaid dollars and allows us to cut down on fraud, waste and abuse while creating more equitable patient outcomes,” Phelan said in a statement. “We’ve already begun to see health care organizations in the state report a serious decrease in their no-show rates.”

Uber has already worked with legislators to change laws in Arizona, Indiana and Florida allowing it to provide rides for Medicaid users.

In the last year, Uber has also partnered with NimbleRx to launch an on-demand prescription delivery service in Texas. Uber Health was launched in 2018 with the goal of providing transportation services to the health care industry.

 
 

Clipped from: https://www.dallasnews.com/business/technology/2021/08/26/texans-on-medicaid-can-now-use-uber-for-non-emergency-medical-appointments/

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New York Ends Telehealth Waivers; Issues New Medicaid Guidance

 
 

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NY Medicaid has made permanent telehealth services that were temporarily expanded during COVID.

 
 

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.

 
 

 
 

New York’s telehealth emergency waivers have expired, according to a June 25, 2021 announcement issued by Governor Andrew Cuomo’s Office declaring the waivers (contained in Executive Orders 202 through 202.11 and 205 through 205.3) are no longer necessary. Concurrent with the Governor’s announcement, the New York State Department of Health issued a guidance document on the New York Medicaid program’s continued coverage of telehealth services for the duration of the federal Public Health Emergency (PHE). The guidance is designed to maintain the ability of Medicaid providers to use telemedicine and digital health to deliver health services for the remainder of the federal PHE. The guidance will remain in effect until the federal PHE expires or the Department of Health issues permanent Medicaid telehealth rules, whichever comes first. The guidance also may be a preview of additional guidance to be issued in the near future regarding telehealth in New York State beyond the Medicaid Program.

This article discusses the top five highlights in the New York Medicaid telehealth guidance.

1. Scope of Telehealth Services

  • Telehealth Definition: The term telehealth is broadly defined as “the use of electronic information and communication technologies to deliver health care to patients at a distance.” Medicaid-covered telehealth services include assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a Medicaid patient. During the PHE, “telehealth” includes telephonic, telemedicine, store and forward, and remote patient monitoring. The guidance uses the term “telemedicine” to denote two-way audiovisual communication.
  • Originating Site Restrictions: An originating site is where the Medicaid patient is located at the time health care services are delivered to him/her by means of telehealth. Originating sites during the PHE can be anywhere the member is located including the member’s home.
  • Distant Site Restrictions: A distant site is the site where the telehealth provider is located while delivering health care services by means of telehealth. During the PHE, any site within the fifty United States or United States’ territories, is eligible to be a distant site for delivery and payment purposes. This includes Federally Qualified Health Centers and providers’ homes.

2. Expansion of Eligible Providers

During the PHE, any provider authorized to deliver Medicaid billable services is eligible to provide services via telehealth, so long as the services are appropriate for telehealth and within the provider’s scope of practice. Providers must still comply with HIPAA and all other relevant privacy and security laws when delivering care remotely.

3. Consent and Recording

Providers must confirm the patient’s identity and provide the patient with basic information about the services the patient will receive via telehealth. The patient need not give written consent to telehealth services, but if verbal consent is given the provider should document this in the medical record. Providers cannot record telehealth sessions without the patient’s consent.

4. Billing Rules for Telephonic (Audio-Only), Asynchronous, and Remote Patient Monitoring Services

The Medicaid program will cover telephonic services during the federal PHE. Telephonic service is “two-way electronic audio-only communications to deliver services to a patient at an originating site by a telehealth provider located at a distant site.” The guidance provides detailed billing instructions and a 2-page table setting forth in detail the billing and coding rules, along with modifiers, for telephonic services. The guidance also expands and elaborates previous rules for billing and coverage of two-way audiovisual communication, store and forward, and remote patient monitoring.

5. Specialty Program Requirements Still Apply

The Medicaid guidance document applies to all Medicaid providers under the Medicaid FFS program and Medicaid managed care plan contracts. However, other State agencies have also issued their own separate guidance on telehealth standards and practice. If a provider’s specialty area renders them subject to licensure or registration with one of these agencies, those rules will apply in addition to the Medicaid reimbursement rules. The Office of Mental Health, the Office for People with Developmental Disabilities, the Office of Addiction Services and Supports, and the Office of Children and Family Services have issued their own guidance materials and regulations. Providers should review these carefully.

 
 

Clipped from: https://www.jdsupra.com/legalnews/new-york-ends-telehealth-waivers-issues-1855071/

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OHIO- Medicaid Contractor Data Breach Affected 334,000 Providers

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Maximus alerted Ohio, Maine and other states about the breach of its systems that occurred in mid-May.

 
 

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.

 
 

 
 

Maximus Corp. Says Personal Information Exposed in Unauthorized Access to App Doug Olenick (DougOlenick) • June 23, 2021    

 
 

Maximus Corp., a global provider of government health data services, says a data breach exposed the personal information of more than 334,000 Medicaid healthcare providers nationwide.

See Also:
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The company says in a statement provided to Information Security Media Group that on May 19, it discovered an unauthorized party had accessed one of its applications related to Medicaid provider credentialing and licensing with the Ohio Department of Medicaid between May 17 and May 19.

“This incident did not affect patient or Medicaid beneficiary information. Some personal information about healthcare providers may have been impacted, including names, dates of birth and Social Security numbers,” the company states.

A breach notification provided to the Montana attorney general’s office says Medicaid providers’ Drug Enforcement Agency numbers also may have been exposed in the breach.

System Breached

In a filing with Maine’s attorney general, Maximus says 334,690 individuals were affected when one of the company’s external systems was breached. The notice states those affected will receive two years of free identity protection services through Experian.

In its statement provided to ISMG, Maximus did not supply a complete list of the states that were informed of the breach nor did the company offer details on the type of attack. The company says it began informing the individuals affected on June 18, along with filing formal data breach notifications with state officials where the victims are located.

As of Wednesday, the incident was not yet listed on the Department of Health and Human Services’ website that offers a tally of major health data breaches.

“Because the unauthorized activity was detected at a very early stage, Maximus believes our quick response limited potentially adverse impacts. This incident did not affect any other Maximus servers, applications or customers,” the company says in its statement. It says it has no evidence the attackers have misused any of the information.

Maximus, which is based in Reston, Virginia, is an administrator of Medicaid enrollment broker services. The company says it answers more than 7 million Medicaid-related calls per month. It handles similar services in Australia, Canada, Italy, Saudi Arabia, Singapore, South Korea, Sweden and the U.K.

Other Recent Healthcare Incidents

Healthcare providers and their third-party suppliers have been targeted by cybercriminals in increasing numbers.

In a recent data breach notice, Attleboro, Massachusetts-based Sturdy Memorial Hospital said that on Feb. 9, it identified a security incident that disrupted the operations of some of its IT systems affecting about 57,400 people. The hospital reported paying a ransom in exchange for promises by the attackers to destroy stolen data.

On Monday, Reproductive Biology Associates , an Atlanta-based clinic operator, and its affiliate, MyEggBank North America, reported their systems were hit by a ransomware attack in April. The clinic operator says it regained control of its network and data after contacting the attackers.

 
 

Clipped from: https://www.govinfosecurity.com/medicaid-contractor-data-breach-affected-334000-providers-a-16929

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Illinois Selects CNSI to Support Ongoing Medicaid Modernization Efforts

MM Curator summary

 
 

CNSI has won the IL MMIS contract.

 
 

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.

 
 

CNSI to Assist with Claims and Encounter Data Processing, Managed Care Coordination, and AWS Cloud Migration

MCLEAN, Va., June 8, 2021 /PRNewswire/ — CNSI, a leading provider of innovative, healthcare technology-driven products and solutions that improve health outcomes and reduce healthcare costs, announced today that Illinois has selected CNSI’s Medicaid Management Information System (MMIS) for core claims processing, encounter data processing, and MC-Track® managed care coordination platform. CNSI will also support Illinois’ MMIS migration to the Amazon Web Services (AWS) secure public cloud to power their infrastructure, become more agile, and lower costs. The Centers for Medicare & Medicaid Services (CMS) approved the four-year contract, which includes CNSI’s Fast Healthcare Interoperability Resources® (FHIR) based interoperability solution.

The Illinois Department of Healthcare and Family Services (HFS) is responsible for providing healthcare coverage for adults and children who qualify for Medicaid. Illinois’ medical assistance programs, consisting of Medicaid and numerous other associated health and human services programs, provide comprehensive health-care coverage to about 3.2 million Illinoisans.

“The state of Illinois is dedicated to creating a more efficient, accountable and integrated healthcare system, and providing better quality care and positive outcomes for our customers,” Illinois Department of Healthcare and Family Services Director Theresa Eagleson said. “CNSI’s partnership helps us avoid significant loss of time and inefficiencies as we work to modernize our 35-year old payment system and allows us to better focus our resources on connecting the Illinoisans we serve with quality care and services.”

Todd Stottlemyer, CEO of CNSI, added, “We have expanded the CNSI modular product suite to encompass claims and encounter data processing for care provided in a multitude of settings – each with their own data interoperability nuances. Illinois’ adoption of FHIR-based standardization will reduce the work required to implement, track, and report on health quality measures – all part of their long-term vision for growth and scalability.”

Central to the Illinois MMIS contract, CNSI received the top overall score in the 2020 NASPO ValuePoint™ multi-state evaluation of MMIS Claims Processing and Management Services.

 
 

Clipped from: https://www.prnewswire.com/news-releases/illinois-selects-cnsi-to-support-ongoing-medicaid-modernization-efforts-301307542.html