Insights & Articles

Medicaid

Centene to pay $71M in Illinois, Arkansas Medicaid overpayment dispute

The attorneys general in Illinois and Arkansas on Thursday separately announced settlements with Centene Corporation, the largest Medicaid managed care organization in the United States, over inaccurate billing practices.

Medicaid

As Democrats bicker over massive spending plan, here’s what’s at stake for Medicaid

More than 2 million low-income adults are uninsured because their states have not accepted Medicaid expansion under the Affordable Care Act. Congressional Democrats want to offer them coverage in the massive spending bill being debated, but competition to get into that package is fierce.

Revenue & Quality

Census: Insured population holds steady, with a slight shift from private to public coverage

The Census Bureau on Tuesday released its 2020 findings regarding Americans’ income, poverty, and health insurance coverage.

Medicaid

Colorado Clinic’s prescription for healthier patients? Lawyers

Although Medicaid traditionally doesn’t fund clinics to supply legal assistance, Colorado is one of several states that have been given permission to use some of their Medicaid money to help pay for such programs.

Population Health & SDoH

Kaiser Family Foundation report: Medicaid authorities and options for states to address social determinants of health

While federal Medicaid rules prohibit costs related to non-medical services, such as social determinants of health (SDoH), there are opportunities for state Medicaid programs to address enrollees’ social needs both within and outside of managed care, according to a new report by the Kaiser Family Foundation (KFF). In the brief, KFF discusses the options and federal Medicaid authorities that states can leverage to address enrollees’ SDoH, as well as examples of initiatives launched in response to the COVID-19 pandemic.

Population Health & SDoH

Decline in health coverage under ACA for 3 consecutive years amplifies health disparities among racial/ethnic populations

A recent brief from Kaiser Family Foundation (KFF) found that after years of progression in coverage across all racial/ethnic groups, uninsured rates have increased through 2019.

Revenue & Quality

Regulatory roundup: Most ACA insurers don’t expect COVID-19 to impact 2022 costs; CMS issues OPPS proposed rule; and more

RISE summarizes recent regulatory news, including announcements and proposals from the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services.

Population Health & SDoH

BCBS, Humana, Centene, and more sign letter of support for Social Determinants of Health Accelerator Act

A coalition of more than 100 organizations have expressed their support for the reintroduction of the bipartisan bill.

Population Health & SDoH

5 ways SNPs can support special needs populations with SDoH programs to drive health equity

Learn about the innovative strategies special needs plans (SNPs) can leverage to support individuals with significant, complex social needs while advancing health equity.

Medicaid

Biden quietly transforms Medicaid safety net

In a sharp shift from Trump-era policies, President Joe Biden looks at expanding Medicaid eligibility to new mothers, inmates, and undocumented immigrants and adding services such as food and housing.

Revenue & Quality

COVID-19: OIG on impact of pandemic in nursing homes; spike in Medicaid enrollment during PHE; threat of variant grows

RISE rounds up the latest news concerning COVID-19.

Revenue & Quality

Supreme Court dismisses GOP-led challenge to Affordable Care Act, leaves law intact

The Supreme Court on Thursday dismissed a challenge to kill the Affordable Care Act (ACA) and saved health care coverage for millions.

Revenue & Quality

New HHS report shows record number of Americans have health coverage through the ACA

The latest data reveals 31 million Americans are enrolled in health coverage through the Health Insurance Marketplaces and Medicaid expansion under the Affordable Care Act (ACA).

Medicare Market

Senate confirms Chiquita Brooks-LaSure as CMS administrator

The Senate voted 55-44 on Tuesday to confirm President Joe Biden’s nominee to oversee the Centers for Medicare & Medicaid Services (CMS).

Population Health & SDoH

6 reasons to register for RISE’s virtual Medicaid Managed Care Leadership Summit

The live-streaming virtual event will be a one-stop shop for state and federal legislators, health plans, providers, and community-based organizations (CBOs) to gain tactics to navigate a changing environment, move forward amid the pandemic, and further the drive for value-based care.

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.

Revenue & Quality

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).

Revenue & Quality

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.

Revenue & Quality

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.

Revenue & Quality

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.

Revenue & Quality

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.

Revenue & Quality

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.

Revenue & Quality

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.

Revenue & Quality

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.

Revenue & Quality

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.

Revenue & Quality

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.

RISE West

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.

Revenue & Quality

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.