Insights & Articles

Medicaid

CMS finalizes interoperability and prior authorization rule

The Centers for Medicare & Medicaid Services (CMS) on Friday finalized the “CMS Interoperability and Prior Authorization” to improve the electronic exchange of health care data and streamline processes related to prior authorization.

Medicaid

Regulatory update: CMS approves first Medicaid block grant; HHS extends COVID-19 public health emergency

RISE reviews the latest from the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS).

Medicaid

Regulatory roundup: Medicare spending grew 6.3% in 2019; CMS offers new Medicaid MCO model for dual eligibles

RISE reviews the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.

Medicaid

In Becerra, an HHS nominee with political skill but no front-line health experience

Xavier Becerra, President-elect Joe Biden’s choice to head the Department of Health and Human Services, is set to be a pandemic-era secretary with no public health experience. Whether that matters depends on whom you ask.

Medicaid

Red states’ case against ACA hinges on whether they were actually harmed by the law

The Republican-led states are trying to prove they were harmed by the 2010 health law—and thus have “legal standing”—because their Medicaid costs increased, even though Congress eliminated the penalty for not having health coverage in 2019. At least one justice was skeptical.

Medicaid

CMS offers new flexibilities in final Medicaid, CHIP final rule

The rule puts an end to overly prescriptive regulations that stakeholders have complained about since 2016, according to CMS Administrator Seema Verma.

Medicaid

Justices bound to see ACA as ‘indispensable,’ says Californian leading defense

The U.S. Supreme Court will hear arguments today in a case that could overturn the Affordable Care Act. California Attorney General Xavier Becerra, who is defending the law with the backing of more than 20 other states, told California Healthline that he predicts the justices will uphold it.

Medicaid

No winner for president yet and health care hangs in the balance

As the votes continue to be counted in the tight battle between President Donald Trump and former Vice President Joe Biden, the federal role in health care is at stake.

Medicaid

Regulatory roundup: CMS OKs Nebraska Medicaid expansion program; MA plans offer more supplemental benefits in 2021

RISE reviews the latest headlines that impact Medicare, Medicare Advantage, Medicaid, and the Affordable Care Act marketplace.

Medicaid

Regulatory roundup: CMS expands list of telehealth services for Medicare FFS; Health care policy implications under a newly configured Supreme Court

RISE looks at recent headlines in the news that impact the health care industry.

Medicaid

Regulatory roundup: Trump signs exec order on preexisting conditions; OIG officials weighs in on MA investigations; and more

RISE summarizes the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.

Medicaid

Regulatory roundup: MA health risk assessments under fire; ACOs saved Medicare $1.2B in 2019; CMS withdraws MFAR rule

RISE looks at the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.

Medicaid

The 2020 election’s impact on health care: Part 1 of a video interview with John McDonough of the Harvard T.H. Chan School of Public Health

John E. McDonough, DrPH, MPA, professor of public health practice, Harvard T.H. Chan School of Public Health, will be a featured speaker at RISE’s upcoming virtual event, RISE West 2020, Sept. 9-11.

Medicaid

Regulatory roundup: Cigna accused of MA fraud; Trump emergency order expands access to telehealth;

RISE reviews the latest headlines involving Medicare, Medicaid, and the ACA marketplace.

Medicaid

The COVID-19 downturn triggers jump in Medicaid enrollment

For the first time since 2017, Medicaid enrollment has begun to increase, but not by as much as many analysts expected.

Medicaid

Update: Medicaid providers to finally receive $15B from COVID-19 relief fund

U.S. Department of Health and Human Services (HHS) announced Tuesday it would distribute relief funds to Medicaid providers following complaints from Congressional leaders about the payment delay.

Medicaid

Medicaid providers at the end of the line for federal COVID funding

Casa de Salud, a nonprofit clinic in Albuquerque, New Mexico, provides primary medical care, opioid addiction services and non-Western therapies, including acupuncture and reiki, to a largely low-income population. And, like so many other health care providers that serve as a safety net, its revenue—and its future—are threatened by the COVID-19 epidemic.

Medicaid

Medicaid Managed Care Leadership Summit: Case studies show real power behind community partnerships

Community collaboration was a common theme throughout RISE’s two-day virtual event. Here are highlights from two case study sessions that offered an inside look at pilot programs that have proven partnership is key to addressing social determinants of health and improving population health outcomes.

Medicaid

RISE’s Medicaid Managed Care Leadership Summit goes virtual

The annual, two-day event will still feature the high-quality content that attendees are accustomed to but will now take place from the comfort of your home offices.

Medicaid

Medicaid nearing ‘eye of the storm’ as newly unemployed look for coverage

The coronavirus outbreak has forced millions out of work and the federal-state health program for low-income people could face unprecedented strains as many states don’t necessarily have the resources or systems in place to meet the demand.

Medicaid

Medicaid news roundup: 11 more states receive Section 1134 waivers for COVID-19; CMS releases checklists to help states respond to outbreak

RISE looks at the latest actions from the Centers for Medicare & Medicaid Services to help state Medicaid agencies respond to the coronavirus outbreak.

Medicaid

Coronavirus copay conundrum: State Medicaid programs can waive copayments but CMS doesn’t make it easy

New Medicaid guidance reveals what states must do in response to the coronavirus outbreak.

Medicaid

A first look at topics and speakers to take the stage at the 5th Annual Medicaid Managed Care Leadership Summit

The two-day conference will be a one-stop shop for Medicaid stakeholders to hear from leading experts as they share clinical best practices, first-hand experiences and insights, and how to prepare for the push toward value-based care.

Medicaid

The latest on Medicaid Work requirements: Federal judge issues a major blow to Trump administration; KFF finds 18K lost coverage in Arkansas for failure to meet rules

Despite the Trump administration’s desire to force some Medicaid beneficiaries to work to maintain their benefits, a federal judge has thrown a monkey wrench into the plan by ruling against work requirements in Kentucky and Arkansas. The ruling comes in the wake of a Kaiser Family Foundation issue brief that found thousands of recipients in Arkansas have lost coverage because they failed to comply with the work requirements.

Medicaid

3 health plan executives to join CEO roundtable on Medicaid at the 4th Annual Medicaid Managed Care Leadership Summit in Chicago

Thomas Duncan of Trusted Health Plan, John Lovelace of UPMC Health Plan, and Jim Milanowski of Genesee Health Plan will discuss the evolving landscape of Medicaid and ROI of social determinants of health as part of a panel to kick off the Medicaid Managed Care Leadership Summit in Chicago.