CMS 2016 Final Managed Care Regulations
|
|
|
- Mercy Waters
- 5 years ago
- Views:
Transcription
1 CMS 2016 Final Managed Care Regulations Jami Snyder, Associate Commissioner Emily Zalkovsky, Deputy Associate Commissioner of Policy and Program Medicaid & CHIP Services Department November 2016
2 Agenda wanalysis Process and Implementation Timeframe wregulatory Guidance Currently In Process wregulatory Guidance Under Review wnext Steps wquestions and Contact
3 Analysis Process whhsc has split the regulation into 188 rules for analysis w Analysis includes: wreview of required contract changes wimpact to members, MCOs, providers, and the agency wplan to implement to maintain compliance wanticipate changes to MCO contracts by Spring 2017 onward whhsc will communicate changes via the contract amendment process, MCO Leadership Meetings, weekly MCO notices, and stakeholder meetings
4 Contract Changes wmcos are required to be compliant with all federal regulations wsee UMCC Attachment A. Article 7. Governing Law & Regulations; Section 7.02 MCO responsibility for compliance with laws and regulations wif a regulation requires a contract change, MCOs can expect to see the proposed language six months before the effective date whhsc is developing an implementation plan on how to operationalize the rules and will develop MCO guidance as appropriate
5 Implementation Timeframe CMS Effective Date Actual Date (if applicable) Proposed Contract Language Contract Effective Date Immediately May 6, days after publication (compliance date) No later than rating period for contracts starting on or after July 1, 2017 July 5, 2016 Spring 2017 September 1, 2017 No later than July 1, 2018 Fall 2017 March 1, 2018 No later than rating period for contracts starting on or after July 1, 2018 Spring 2018 September 1, 2018 No later than 3 years from the date of a final notice published in the Federal Register May 6, 2019 March 1, 2019 No later than rating period for contracts starting on or after July 1, 2019 Spring 2019 September 1, 2019
6 Regulatory Guidance In Process
7 Network Adequacy w42 CFR wcompliance date of September 1, 2018 wthe rule requires states to develop time and distance standards for a minimum set of provider types including PCPs, specialists, and LTSS
8 Network Adequacy w Medicaid and Managed Care Contracts w Adopting a modified version of the Medicare Advantage time and distance standards for select provider types (not including LTSS) w Aligns with work being done for SB 760, 84th Texas Legislature w Contract requirements will be effective in March 2017 for both Medicaid and CHIP MCOs w HHSC Data Analytics to conduct some of the reporting previously delegated to MCOs
9 Time and Distance Standards Effective March 1, 2017 Current Managed Care Proposed Contracts Distance in Miles Travel Time Distance in Miles Travel Time in Minutes Provider Type Metro Micro Rural Metro Micro Rural Behavioral Health-outpatient 30 urban none rural Hospital- Acute Care 30 none Prenatal none none Primary Care Provider 30 none Cardiovascular Disease 75 none ENT (otolaryngology) 75 none General Surgeon 75 none OB/GYN (non-pcp) 75 none Specialty Care Provider Ophthalmologist 75 none Orthopedist 75 none Pediatrician 75 none Psychiatrist 75 none Urologist 75 none Other Physician Specialties 75 none Occupational, Physical, or Speech Therapy 75 none Nursing Facility 75 none N/A N/A N/A Main Dentist (general or pediatric) Dental Specialists 30 urban none rural Pediatric Dental 75 none Endodontist, Periodontist, 75 none and Prosthodontist Orthodontist 75 none Oral Surgeons 75 none
10 Beneficiary Support System w42 CFR wcompliance date of September 1,2019 wstates must develop and implement a beneficiary support system that provides choice counseling and assistance understanding managed care, and process for resolving issues
11 Beneficiary Support System wtexas already has an independent consumer support system (ICSS) in place that operates independent of the MCOs wthe ICSS consists of HHSC s Medicaid/CHIP Division, Office of the Ombudsman (Ombudsman), the state s managed care Enrollment Broker (EB, "MAXIMUS"), and community support from the Aging and Disability Resource Centers (ADRCs)
12 Screening and Enrollment and Revalidation of Providers w 42 CFR (b) w Compliance date of September 1, 2018 w The state must screen, enroll, and periodically reevaluate all network providers in accordance with the requirements of part 455
13 Screening and Enrollment and Revalidation of Providers w Texas Medicaid provider enrollment compliance as of 11/10/2016: w Acute Care 89% w Pharmacies 98.5% w LTSS 84% w Next steps w w Additional streamlining of provider enrollment process Staggering of re-enrollment
14 Regulatory Guidance Under Review
15 Medicaid Managed Care Quality Rating System w42 CFR wcompliance date in 2021 wcms will publish additional guidance specifying the measures and methodologies in 2018 wcms will develop the standards through a public input process wreviewing possibility of using current report card system wdependent on CMS approval
16 Grievance and Appeal System w42 CFR wcompliance date of September 1, 2017 waligns Medicaid managed care with Medicare Advantage wmcos may only have one level of appeal
17 Parity in Mental Health and Substance Use Disorder Benefits w42 CFR 438.3(e) and 438.3(n) wcompliance date of July 5, 2016 wregulation requires: wthe capitation rate must include services outlined in the State Plan, utilization and actual cost of in lieu of services, and services deemed by the state as necessary for compliance with federal mental health parity requirements wstates must provide services to enrollees in compliance with existing mental health parity requirements, as well as new requirements effective on October 2, 2017 wthis section applies to CHIP (see (l))
18 Managed Care Enrollment w42 CFR wcompliance date of July 5, 2016 wstates that select health plans for beneficiaries and enroll them passively must notify beneficiaries and provide them a 90-day period to change plans whhsc is exploring options related to this provision
19 Care Coordination of Services for Enrollees w42 CFR (b)(3)and (c) wcompliance date of September 1, 2017 wmcos are required to make best efforts to conduct an initial screening of new enrollees needs within 90 days of enrollment wmcos must implement processes to comprehensively assess Medicaid enrollees who need LTSS or have special health care needs
20 Next Steps
21 Next Steps whhsc will continue to evaluate impact and implementation plans to ensure compliance with the Medicaid managed care final regulation wregular updates will be provided via MCO Leadership meetings wcontract amendments will include updates to align with new requirements
22 Questions wplease submit any questions or comments related to the managed care regulations to:
Medicaid and CHIP Managed Care Final Rule (CMS-2390-F) Overview of the Final Rule. Center for Medicaid and CHIP Services
Medicaid and CHIP Managed Care Final Rule (CMS-2390-F) Overview of the Final Rule Center for Medicaid and CHIP Services Background This final rule is the first update to Medicaid and CHIP managed care
Center for Medicare & Medicaid Services (CMS) Medicaid and CHIP Managed Care Final Rule (CMS 2390-F) Fact Sheet: Subpart B State Responsibilities
Center for Medicare & Medicaid Services (CMS) Medicaid and CHIP Managed Care Final Rule (CMS 2390-F) Fact Sheet: Subpart B State Responsibilities Definition of Terms The final rule provides for a definition
Issue brief: Medicaid managed care final rule
Issue brief: Medicaid managed care final rule Overview In the past decade, the Medicaid managed care landscape has changed considerably in terms of the number of beneficiaries enrolled in managed care
Medicaid Managed Care: Ensuring Access to Quality Care
The Texas Association of Health Plans Representing health insurers, health maintenance organizations, and other related health care entities operating in Texas. Medicaid Managed Care: Ensuring Access to
2016 Medicaid Managed Care Final Rule 1 Summary
2016 Medicaid Managed Care Final Rule 1 Summary The final Medicaid Managed Care rule retains nearly all of the requirements of the proposed rule and does not make substantial changes to it. In particular,
Medicaid MCO Network Adequacy Overview June 2016 JAMIE DUDENSING, CEO Texas Association of Health Plans
The Texas Association of Health Plans Medicaid MCO Network Adequacy Overview June 2016 JAMIE DUDENSING, CEO Texas Association of Health Plans 1 Texas Medicaid MCO Enrollment Source: Texas Health and Human
Network Adequacy Standards Constance L. Akridge July 21, 2016
Network Adequacy Standards Constance L. Akridge July 21, 2016 Agenda Network Adequacy Developments Overview NAIC Network Adequacy Model Act 2 Network Adequacy Developments Overview --Growing concern over
MAXIMUS Webinar Series. CMS Rule for Medicaid and CHIP Managed Care. Version
MAXIMUS Webinar Series CMS Rule for Medicaid and CHIP Managed Care What It Means for States 1 Introductions Bruce Caswell President MAXIMUS Kathleen Nolan Managing Principal HMA Cathy Kaufmann Managing
Medicaid & CHIP Managed Care: Looking at the Rule through a Children s Lens June 17, Tricia Brooks Sarah Somers Kelly Whitener
Medicaid & CHIP Managed Care: Looking at the Rule through a Children s Lens June 17, 2016 Tricia Brooks Sarah Somers Kelly Whitener INTRODUCTION Tricia Brooks 2 Children in Managed Care o CMS finalized
July 23, Dear Mr. Slavitt:
Andy Slavitt Acting Administrator Centers for Medicare & Medicaid Services Hubert H. Humphrey Building 200 Independence Avenue, S.W., Room 445-G Washington, DC 20201 RE: Proposed Rule: RIN 0938-AS25 Medicaid
Medicaid Managed Care Final Rule: Analysis & Implications
Medicaid Managed Care Final Rule: Analysis & Implications Joe Greenman, Shareholder, LanePowell Mark Reagan, Managing Partner, Hooper, Lundy & Bookman P.C. Narda Ipakchi, Director of Managed Markets, AHCA
MAXIMUS Webinar Series
MAXIMUS Webinar Series The New Beneficiary Support System Requirements and Other Beneficiary Protections Continuing the Discussion on the CMS Rule for Medicaid & CHIP Managed Care June 8, 2016 1 Introductions
The Value of Health Plan Networks January 28 th, 2016
The Texas Association of Health Plans The Value of Health Plan Networks January 28 th, 2016 JAMIE DUDENSING, CEO The Texas Association of Health Plans The Texas Association of Health Plans (TAHP) is the
Proposed Rule on Medicaid Managed Care: A Summary of Major Provisions
Proposed Rule on Medicaid Managed Care: A Summary of Major Provisions Julia Paradise and MaryBeth Musumeci On June 1, 2015, the Centers for Medicare & Medicaid Services (CMS) published a Notice of Proposed
Proposed Medicaid Managed Care Rules: Possible Impact on Seniors and People with Disabilities. July 7, 2015
Proposed Medicaid Managed Care Rules: Possible Impact on Seniors and People with Disabilities July 7, 2015 1 Aging and Disability Partnership for Managed Long Term Services and Supports Elizabeth Priaulx,
Integrated Care Program and Dual Eligible Transition. Rebecca Thompson Benefits Advocacy Coordinator Progress Center for Independent Living
Integrated Care Program and Dual Eligible Transition Rebecca Thompson Benefits Advocacy Coordinator Progress Center for Independent Living Basics Managed Care Program through the Illinois Department of
Subpart D MCO, PIHP and PAHP Standards Availability of services.
Center for Medicare & Medicaid Services (CMS) Medicaid and CHIP Managed Care Final Rule (CMS 2390-F) Fact Sheet: Subpart D and E of 438 Quality of Care Each state must ensure that all services covered
Behavioral Health Parity and Medicaid
Behavioral Health Parity and Medicaid MaryBeth Musumeci Behavioral health parity refers to requirements for health insurers to cover mental health and substance use disorder services on terms that are
CMS s 2018 Proposed Medicaid Managed Care Rule: A Summary of Major Provisions
January 2019 Issue Brief CMS s 2018 Proposed Medicaid Managed Care Rule: A Summary of Major Provisions Elizabeth Hinton and MaryBeth Musumeci Executive Summary Managed care is the predominant Medicaid
Medicaid Managed Care in Texas
Medicaid Managed Care in Texas PRESENTED TO HOUSE COMMITTEES ON GENERAL INVESTIGATIONS AND ETHICS AND APPROPRIATIONS SUBCOMMITTEE ON ARTICLE II LEGISLATIVE BUDGET BOARD STAFF JUNE 2018 Statement of Interim
The Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans
The Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans Rachel Garfield, Elizabeth Hinton, Elizabeth Cornachione, and Cornelia Hall The Kaiser Family Foundation Survey of Medicaid managed
RULES OF TENNESSEE DEPARTMENT OF FINANCE AND ADMINISTRATION DIVISION OF TENNCARE CHAPTER COVERKIDS TABLE OF CONTENTS
RULES OF TENNESSEE DEPARTMENT OF FINANCE AND ADMINISTRATION DIVISION OF TENNCARE CHAPTER 1200-13-21 COVERKIDS TABLE OF CONTENTS 1200-13-21-.01 Scope and Authority 1200-13-21-.02 Definitions 1200-13-21-.03
Subpart D Quality Assessment and Performance Improvement. Subpart D Quality Assessment and Performance Improvement
438.206 Availability of services (b) Delivery network (1) (b) Delivery network. The State must ensure, through its contracts, that each MCO, and each PIHP consistent with the scope of the PIHP s contracted
Medicaid Alternative Benefit Plans and Essential Health Benefits 9/10/13
Medicaid Alternative Benefit Plans and Essential Health Benefits 9/10/13 Melissa Harris, Division Director Division of Benefits and Coverage Disabled and Elderly Health Programs Group Background Intended
REPORT OF THE COUNCIL ON MEDICAL SERVICE
REPORT OF THE COUNCIL ON MEDICAL SERVICE CMS Report -A- Subject: Presented by: Referred to: Essential Health Care Benefits (Resolution 0-A-0) William E. Kobler, MD, Chair Reference Committee A (Joseph
Medicaid: Auditing in the Managed Care Era. May 23, Darnell Dent
Medicaid: Auditing in the Managed Care Era May 23, 2016 Darnell Dent About FirstCare Health Plans At FirstCare, we believe that all Texans and our communities should be healthy and that health care should
MCHO Informational Series
MCHO Informational Series Glossary of Health Insurance & Medical Terminology How to use this glossary This glossary has many commonly used terms, but isn t a full list. These glossary terms and definitions
Statewide Medicaid Managed Care
Statewide Medicaid Managed Care Justin M. Senior Deputy Secretary for Medicaid Agency for Health Care Administration Senate Health Policy Committee March 4, 2015 As requested by the Committee, this presentation
Enhancing the Beneficiary Experience
Medicaid/CHIP Managed Care Regulations: Enhancing the Beneficiary Experience by Tricia Brooks and Elizabeth Edwards Georgetown University Center for Children and Families (CCF) and the National Health
House Health Committee June 1, Department of Health and Human Services Medicaid Reform 1115 Waiver Submission
House Health Committee June 1, 2016 Department of Health and Human Services Medicaid Reform 1115 Waiver Submission Agenda Overview, milestones and vision Alignment with session law Public comments Waiver
Yes, written or oral approval is required, based upon medical policies.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.uhc.com/calpers or by calling 1-877-359-3714. Important
(C) MERCER MERCER
OVERVIEW OF MLTSS CAPITATION RATE DEVELOPMENT METHODOLOGY (C) MERCER 2015 0 MERCER 2015 0 C A P I T A T I O N R A T E S E T T I N G O B J E C T I V E S Develop a payment structure that will best match
Overview of New Reform Law. Federal Healthcare Reform: Impacts on Employer-Sponsored Plans. Agenda
: Impacts on Employer-Sponsored Plans June 3, 2010 Employee Benefits Planning Association Jack McRae SVP, Congressional and Legislative Affairs Premera Blue Cross Jim Grazko VP and General Manager, Underwriting
State Roles in Defining Essential Health Benefits (EHB)
State Roles in Defining Essential Health Benefits (EHB) Summary The Patient Protection and Affordable Care Act (ACA) requires the establishment of an essential health benefits (EHB) package to define benefits
Welcome to the Managed Care 101 Webinar
Welcome to the Managed Care 101 Webinar Communication Access Real-time Transcription (CART) is available by clicking here: https://archivereporting.1capapp.com The login: Username: OLL Password: OLL The
BENEFIT PLAN. What Your Plan Covers and How Benefits are Paid. Prepared Exclusively for Gwinnett County Board Of Commissioners
BENEFIT PLAN Prepared Exclusively for Gwinnett County Board Of Commissioners What Your Plan Covers and How Benefits are Paid Aetna Choice POSII and HSA Table of Contents Schedule of Benefits (SOB) Issued
Ensuring Accountability and Transparency
Medicaid/CHIP Managed Care Regulations: Ensuring Accountability and Transparency by Sarah Somers and Kelly Whitener Georgetown University Center for Children and Families (CCF) and the National Health
The New CMS Medicaid Managed Care Mega Reg Early Observations. May 31, 2016
The New CMS Medicaid Managed Care Mega Reg Early Observations May 31, 2016 1 Presenters Biographies Bill Barcellona serves as the Senior VP for Government Affairs for CAPG. He is a former Deputy Director
Texas Vendor Drug Program. Drug Addition Process. Effective Date. December 2017
Texas Vendor Drug Program Drug Addition Process Effective Date December 2017 This is a working document to provide a resource to interested internal and external stakeholders. Questions or comments regarding
States Focus on Quality and Outcomes Amid Waiver Changes
States Focus on Quality and Outcomes Amid Waiver Changes Findings from the Annual Kaiser 50-State Medicaid Budget Survey Robin Rudowitz Associate Director, Kaiser Program on Medicaid and the Uninsured
Iowa Medicaid Synopsis of Managed Medicaid Request for Proposal
Iowa Medicaid Synopsis of Managed Medicaid Request for Proposal The following information provides summary information of key aspects of the Iowa Medicaid Request For Proposal SOW for Capitated Managed
Implementing the Alternative Benefit Plan
Implementing the Alternative Benefit Plan Carolyn Ingram, Senior Vice President Shannon McMahon, Director of Coverage and Access State Network Medicaid Small Group Convening April 25, 2013 Agenda Alternative
Health Care Reform Laws and their Impact on Individuals with Disabilities (Part one)
Health Care Reform Laws and their Impact on Individuals with Disabilities (Part one) ONE STRONG VOICE Disabilities Leadership Coalition Of Alabama Montgomery, Alabama December 8, 2010 Allan I. Bergman
What is the overall deductible? Are there other deductibles for specific services?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com/cuhealthplan or by calling 1-800-735-6072.
H 7829 S T A T E O F R H O D E I S L A N D
LC00 0 -- H S T A T E O F R H O D E I S L A N D IN GENERAL ASSEMBLY JANUARY SESSION, A.D. 0 A N A C T RELATING TO INSURANCE - PRIMARY CARE TRUST ACT Introduced By: Representatives Ranglin-Vassell, and
Health Plan Benefits and Coverage Matrix
Health Plan Benefits and Coverage Matrix THIS MATRI IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE AND PLAN CONTRACT SHOULD BE CONSULTED FOR
What Your Plan Covers and How Benefits are Paid BENEFIT PLAN. Prepared Exclusively for Lee County Board of County Commissioners. Aetna Choice POS II
BENEFIT PLAN Prepared Exclusively for Lee County Board of County Commissioners What Your Plan Covers and How Benefits are Paid Aetna Choice POS II Table of Contents Schedule of Benefits... Issued with
ATTACHMENT I SCOPE OF SERVICES FEE-FOR-SERVICE PROVIDER SERVICE NETWORKS
ATTACHMENT I SCOPE OF SERVICES FEE-FOR-SERVICE PROVIDER SERVICE NETWORKS A. Plan Type The Vendor (Health Plan) is approved to provide contracted services as the following health plan type as denoted by
Health Plan Benefits and Coverage Matrix
Health Plan Benefits and Coverage Matrix THIS MATRI IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE AND PLAN CONTRACT SHOULD BE CONSULTED FOR
Coverage for: Single Enrollee Plan Type: TRAD/PPO. Important Questions Answers Why This Matters: $2,500/single Network $5,000/single Non-Network
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 STRS OHIO : Basic Plan with Medicare Part B Only Coverage for: Single
kaiser medicaid and the uninsured commission on
kaiser commission on medicaid and the uninsured State Demonstrations to Integrate Care and Align Financing for Dual Eligible Beneficiaries: A Review of the 26 Proposals Submitted to CMS October 2012 1330
OVERVIEW OF YOUR BENEFITS
OVERVIEW OF YOUR BENEFITS 9 IMPORTANT PHONE NUMBERS Rochester Benefit Fund Office (585) 244-0830 For questions about eligibility, Coordination of Benefits, your 1199SEIU Health Benefits ID card, prescription
Overview of the March 29, 2016 Final Rule on the Application of Mental Health Parity Requirements to Coverage Offered by Medicaid Managed Care
Overview of the March 29, 2016 Final Rule on the Application of Mental Health Parity Requirements to Coverage Offered by Medicaid Managed Care Organizations, the Children s Health Insurance Program, and
REMINDER: PROVIDERS MUST ADHERE TO NCCI GUIDELINES WHEN SUBMITTING CLAIMS
Volume I, 2015 COOK CHILDREN S HEALTH PLAN MEMBERSHIP: JANUARY 2015 CHIP: 20,240 STAR: 97,836 REMINDER: PROVIDERS MUST ADHERE TO NCCI GUIDELINES WHEN SUBMITTING CLAIMS The Patient Protection and Affordable
Retirees with Medicare (RETIREMENT DATE ON or AFTER March 1, 2015) Benefits Comparison Benefits effective January 1, December 31, 2019
Pelican HRA1000 Magnolia Local Plus Network Blue Cross and Blue Shield of Louisiana Preferred Care Providers & Blue Cross National Providers Blue Cross and Blue Shield of Louisiana Preferred Care Providers
Retirees with Medicare (RETIREMENT DATE BEFORE March 1, 2015) Benefits Comparison Benefits effective January 1, December 31, 2019
Network Eligible OGB Members Pelican HRA1000 Blue Cross and Blue Shield of Louisiana Preferred Care Providers & Blue Cross National Providers Magnolia Local Plus Blue Cross and Blue Shield of Louisiana
Retirees with Medicare (RETIREMENT DATE BEFORE March 1, 2015) Benefits Comparison Benefits effective January 1, December 31, 2017
Network Eligible OGB Members Pelican HRA1000 Blue Cross and Blue Shield of Louisiana Preferred Care Providers & Blue Cross National Providers (retirement date BEFORE 3/1/2015) Magnolia Local Plus Blue
[Ambetter Secure Care 1 (2018) with 3 Free PCP Visits-Standard Gold On Exchange Plan]
![[Ambetter Secure Care 1 (2018) with 3 Free PCP Visits-Standard Gold On Exchange Plan]](/thumbs/72/67333205.jpg "[Ambetter Secure Care 1 (2018) with 3 Free PCP Visits-Standard Gold On Exchange Plan]")
[Plan Information] [Health Plan:] [Primary Member:] [Ambetter Secure Care 1 (2018) with 3 Free PCP Visits-Standard Gold On Exchange Plan] [John Doe] [Member ID:] [01213456] [Date of Birth:] [08/12/62]
ACCESS PLAN COVER SHEET
ACCESS PLAN COVER SHEET Required Elements 1. Standards for network composition: Describe how the issuer establishes standards for the composition of its network to ensure that networks are sufficient in
1 HB By Representative Patterson. 4 RFD: Insurance. 5 First Read: 21-FEB-17. Page 0
1 HB284 2 186943-4 3 By Representative Patterson 4 RFD: Insurance 5 First Read: 21-FEB-17 Page 0 1 2 ENROLLED, An Act, 3 Relating to health benefit plans; to amend Sections 4 10A-20-6.16, 27-21A-23, and
UTILIZATION MANAGEMENT (UM) POLICY AND PROCEDURE MANUAL
University of Florida, Pediatric Integrated Care System UTILIZATION MANAGEMENT (UM) POLICY AND PROCEDURE MANUAL Policy: Delegated Entity: Program(s): Utilization Management Ped-I-Care Title XIX and Title
North Carolina Medicaid Reform Status Briefing
North Carolina Medicaid Reform Status Briefing Overview Medicaid reform was signed into law by Gov. McCrory in September 2015, after extensive engagement with the General Assembly, providers, beneficiaries
Florida Medicaid Fee Schedule Overview
Florida Medicaid Fee Schedule Overview Bureau of Medicaid Policy Agency for Health Care Administration Fall 2017 Disclaimer The information provided in this presentation is only intended to be general
2015 Benefits Overview
2015 Benefits Overview ASPIRE HEALTH ADVANTAGE VALUE (HMO) BENEFIT Monthly Plan Premium Out-of-Pocket Limit (In-Network Medicare-covered benefits) Annual Part C Deductible (all services except for Prescription
Frequently Asked Questions. PBP Data Entry/Cost Sharing
Frequently Asked Questions PBP Data Entry/Cost Sharing 1. Q. How should we answer the following new question in the 2016 PBP Sections B-1 and 2: What is your inpatient hospital benefit period? The answer
Retirees with Medicare (RETIREMENT DATE ON or AFTER March 1, 2015) Benefits Comparison Benefits effective January 1, December 31, 2017
Pelican HRA1000 Magnolia Local Plus Network Blue Cross and Blue Shield of Louisiana Preferred Care Providers & Blue Cross National Providers Blue Cross and Blue Shield of Louisiana Preferred Care Providers
West Suburban Health Group High Deductible Health Plan with HSA
West Suburban Health Group High Deductible Health Plan with HSA November 30, 2017 Today s Agenda 1. Consumer Driven Health A new way to Receive Your Health Benefits 2. HMO/PPO Plan Design Features 3. Health
Non-Medicare Retirees (RETIREMENT DATE BEFORE March 1, 2015) Benefits Comparison Benefits effective January 1, December 31, 2019
Network Pelican HRA1000 Blue Cross and Blue Shield of Louisiana Preferred Care Providers & Blue Cross National Providers Magnolia Local Plus Blue Cross and Blue Shield of Louisiana Preferred Care Providers
A. High-Level Description of the Recommended Patient-Centered Service Delivery Model
A. Recommended Patient-Centered Service Delivery Model A. High-Level Description of the Recommended Patient-Centered Service Delivery Model 1. Name and describe Respondents chosen model including reason
Summary of Benefits Prominence HealthFirst Small Group Health Plan
HealthFirst/ Calendar Year Deductible (CYD) 2 $1,000 Single / $3,000 Family Summary of Benefits $3,000 Single / $9,000 Family Coinsurance - Member responsibility 30% coinsurance 50% coinsurance Out-of-Pocket
Managed Care Quality Strategy
Managed Care Quality Strategy 2 nd Edition 2011-2015 Publication date: June 2011 Virginia Department of Medical Assistance Services 600 East Broad Street Richmond, Virginia 23219 Table of Contents Page(s)
Summary of Benefits Prominence HealthFirst Small Group Health Plan
Prominence Nevada Gold A Plus In-Network Calendar Year Deductible (CYD) 2 $1,000 Single / $3,000 Family Summary of Benefits $2,000 Single / $6,000 Family Coinsurance - Member responsibility 20% coinsurance
Adventist Health System Schedule of Benefits for Adventist Health System Effective January 1, 2018
Adventist Health System Schedule of Benefits for Adventist Health System Effective January 1, 2018 High Health Plan with Health Savings Account (Health Savings Plan) TIER 1 TIER 2 TIER 3 CALENDAR YEAR
Benefits. Guide to. Small Business Health Plan Hawaii Choice - A
Guide to Benefits Small Business Health Plan Hawaii Choice - A (Includes Drug and Children's Vision) Health Maintenance Organization (HMO) January 2016 An Independent Licensee of the Blue Cross and Blue
Oklahoma Health Care Authority
Oklahoma Health Care Authority SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration 11-W-00048/6 Application for Extension of the Demonstration, 2016 2018 Submitted to the Centers for Medicare and
ACCESS PLAN COVER SHEET
ACCESS PLAN COVER SHEET Required Elements 1. Standards for network composition: Describe how the issuer establishes standards for the composition of its network to ensure that networks are sufficient in
Each MCO, PIHP, and PAHP must have a grievance and appeal system in place for their enrollees.
Center for Medicare & Medicaid Services (CMS) Medicaid and CHIP Managed Care Final Rule (CMS 2390-F) Fact Sheet: Subpart F Grievance and Appeal System This rule finalizes several modifications made to
Checklist: How Consumer Focused Are Your State s Medicaid Managed Long Term Services and Supports?
Checklist: How Consumer Focused Are Your State s Medicaid Managed Long Term Services and Supports? Many states are overhauling the delivery of long-term supports and services (LTSS) for consumers in Medicaid
Medicaid Benefits for Children and Adults: Issues Raised by the National Governors Association s Preliminary Recommendations
Medicaid Benefits for Children and Adults: Issues Raised by the National Governors Association s Preliminary Recommendations July 12, 2005 Cindy Mann Overview The Medicaid benefit package determines which
BENEFIT PLAN. What Your Plan Covers and How Benefits are Paid. Prepared Exclusively for Sarasota County Government
BENEFIT PLAN Prepared Exclusively for Sarasota County Government What Your Plan Covers and How Benefits are Paid Aetna Choice POS II with Aetna HeathFund Non -Union Table of Contents Schedule of Benefits...
This is an ERISA plan, and you have certain rights under this plan. Please contact your Employer for additional information.
Schedule of Benefits Employer: Rider University ASA: 884014 Issue Date: January 2, 2013 Effective Date: January 1, 2013 Schedule: 1E Booklet Base: 1 For: Choice POS II (Aetna Choice POS II) Safety Net
Cost Estimates for Universal Primary Care In accordance with Act 54 of 2015, Sections 16-19
State of Vermont Agency of Administration Health Care Reform 109 State Street Montpelier, Vermont 05609 REPORT TO THE VERMONT LEGISLATURE Cost Estimates for Universal Primary Care In accordance with Act
The TennCare Transition in Middle Tennessee Fact Sheet for Providers
The TennCare Transition in Middle Tennessee Fact Sheet for Providers TennCare is beginning an exciting new phase Starting April 1, 2007, approximately 95% of the TennCare enrollees in Middle Tennessee
Medicare Payment Advisory Commission (MedPAC) January Meeting Summary
Medicare Payment Advisory Commission (MedPAC) January Meeting Summary The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional agency established by the Balanced Budget Act of
kaiser medicaid and the uninsured commission on A Profile of Medicaid Managed Care Programs in 2010: Findings from a 50-State Survey EXECUTIVE SUMMARY
kaiser commission on medicaid and the uninsured A Profile of Medicaid Managed Care Programs in 2010: Findings from a 50-State Survey EXECUTIVE SUMMARY Prepared by Kathleen Gifford, Vernon K. Smith, and
1 HB By Representative Patterson. 4 RFD: Insurance. 5 First Read: 21-FEB-17. Page 0
1 HB284 2 182346-2 3 By Representative Patterson 4 RFD: Insurance 5 First Read: 21-FEB-17 Page 0 1 182346-2:n:02/21/2017:PMG/cj LRS2017-691R1 2 3 4 5 6 7 8 SYNOPSIS: Under existing law, a health benefit
Texas Health Care Network
Why was the Health Care Network (HCN) created? Texas had the second highest workers compensation costs in the country. The cost to employers was making it difficult for employers to operate in Texas and
CMS Final Rule: Mental Health/Substance Use Disorder Parity
CMS Final Rule: Mental Health/Substance Use Disorder Parity Understanding the Impact of the Mental Health Parity and Addiction Equity Act Final Regulations Speakers: Barbara Leadholm, Principal, Don Novo,
What is the overall deductible?
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 7/1/2018 6/30/2019 WEA Trust Essential Health Plan: Kenosha School District Coverage for: Individual/Family
Aetna Choice POS II Medical Plan PLAN FEATURES NETWORK OUT-OF-NETWORK. Individual Deductible* $1,000 $2,000. Family Deductible* $2,000 $4,000
Schedule of Benefits Employer: Adobe Systems Incorporated ASC: 660819 Effective Date: January 1, 2012 Schedule: 2B Booklet Base: 1 For: Aetna Choice POS II 80/60 Plan This is an ERISA plan, and you have
PLAN MANAGEMENT ADVISORY GROUP. May 14th, 2015
PLAN MANAGEMENT ADVISORY GROUP May 14th, 2015 AGENDA AGENDA Plan Management and Delivery System Reform Advisory Group Meeting and Webinar Thursday, May 14th, 2015, 10:00 a.m. to 12:00 p.m. May Agenda Items
ACA Regulations: Insurance Exchanges and EHBs
ACA Regulations: Insurance Exchanges and EHBs 1 Insurance Exchanges Insurance Exchanges: Exchanges are online marketplaces More than 20 million individuals and employees of small businesses may purchase
MEDICAID IMPACT CONFERENCE Fiscal Year (Post January 13, 2012)
1 2 3 4 5 6 7 8 9 10 11 Eliminate Adult Dental Provide savings associated with eliminating this Services service based on FY 2012-13 estimate. 08/01/2012 ($13,913,359) ($19,287,371) ($33,200,730) No State
2016 Benefits Overview
2016 Benefits Overview ASPIRE HEALTH ADVANTAGE VALUE (HMO) BENEFIT Monthly Plan Premium Out-of-Pocket Limit (In-Network Medicare-covered benefits) Annual Part C Deductible (all services except for Prescription
H.R. 4302, Protecting Access to Medicare Act of 2014 AMA Summary March 28, 2014
TITLE I MEDICARE EXTENDERS H.R. 4302, Protecting Access to Medicare Act of 2014 AMA Summary March 28, 2014 Section 101: Physician Payment Update. Extends the current 0.5 percent update through the end
Parity Compliance Toolkit Applying Mental Health and Substance Use Disorder Parity Requirements to Medicaid and Children s Health Insurance Programs
Parity Compliance Toolkit Applying Mental Health and Substance Use Disorder Parity Requirements to Medicaid and Children s Health Insurance Programs January 17, 2017 Acknowledgements This report was prepared
Changes to Small Business HMO Off Exchange plans Blue Shield of California
Changes to Small Business HMO Off Exchange plans Blue Shield of California As of January 1, 2019 This notice describes the changes to your Blue Shield health coverage upon your group s renewal. This is
2019 Summary of Benefits
2019 Summary of Benefits Bexar, Dallas, El Paso, Harris, Tarrant, Travis Traditional (HMO) PBP 003 Dual (HMO SNP) PBP 004 Value (HMO SNP) PBP 005 Section 1 (HMO) (HMO SNP) Who can join? To join any of
KAISER PERMANENTE INSURANCE COMPANY (KPIC) 2018 COLORADO NETWORK ACCESS PLAN
KAISER PERMANENTE INSURANCE COMPANY (KPIC) 2018 COLORADO NETWORK ACCESS PLAN Rev. 6/21/2017 TABLE OF CONTENTS I. INTRODUCTION... 1 II. NETWORK ADEQUACY AND CORRECTIVE ACTION PROCESS... 2 A. Summary of
Coverage for: Individual/Family Plan Type: PPO
This is only a summary: If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.medica.com or by calling 952-945-8000 (Minneapolis/St.