Alabama Medicaid. APHCA Compliance Academy and Networking Forum. May 24, 2018
|
|
- Allen Long
- 5 years ago
- Views:
Transcription
1 Alabama Medicaid APHCA Compliance Academy and Networking Forum May 24, 2018 ROBERT MOON, MD CHIEF MEDICAL OFFICER ALABAMA MEDICAID AGENCY 1
2 AGENDA Medicaid Overview Political Environment Pivot Plan Questions 2
3 Medicaid Overview 3
4 Who Does Alabama Medicaid Serve? FY 2016 by Date of Service Disabled and Blind Children Aged Other Categories Any Age Age 0-18 Age 65 and Over Age Determined by the Social Security Office and have automatic Medicaid eligibility. Children in families below 146% of the Federal Poverty Rate. Adults who are in poverty. Almost all are also covered by Medicare Other adults including pregnant women, parent caretakers, and family planning services % of Expenditures % of Expenditures % of Expenditures % of Expenditures 45% 25% 18% 12% % of Members % of Members % of Members % of Members 22% 51% 9% 18% $10,644 Per Member Per Year $2,556 Per Member Per Year $10,440 Per Member Per Year $3,456 Per Member Per Year 4
5 FY 2017 Medicaid Expenditure Analysis Benefit Payments and Administrative Costs (in millions) Admin $279 4% Non Operating & Major Projects $110 Operating Costs $169 Other $912 14% Alternative Care $365 6% Hospitals $2,236 34% Mental Health $479 7% Total Expenditures $6.490 Billion Physicians $555 9% Pharmacy $718 11% Nursing Home $946 15% 5
6 FY 2017 Medicaid Funding Analysis State and Federal Funding (in millions) FY 17 Source of Funds: $6.490 Billion State Funds $1,946 30% General Fund $732 11% Other State Share Sources $1,214 19% Federal Funds $4,544 70% 6
7 Medicaid Funding Analysis General Fund Share: FY 15 FY 19 $800 $685 State General Fund Usage: FY 15 - FY 19 (in Millions) $722 $732 $806 $757 $600 $400 $200 $- FY 15 FY 16 FY 17 FY 18 FY 19 Appropriated General Fund Dollars 7
8 Average Monthly Enrollees Annual Expenditures Per Enrollee Enrollment and Annual Cost Per Enrollee ,200,000 $7,000 1,100,000 $6,027 $6,238 $5,741 $5,989 $5,895 $5,714 $5,783 $6,066 $6,352 $6,000 1,050,117 1,043,551 $5,000 1,000,000 1,012,125 1,021, , , , , ,594 Annual Compound Growth Rate of Enrollees 3.1% $4,000 $3, , ,187 $2, , $1,000 Number of Monthly Average Enrollees Annual Cost per Enrollee 8
9 Monthly Average Eligibles * 1,100,000 Alabama Medicaid Agency Monthly Average Eligibles 1,050,000 1,000, , , , , * Overall Total Total Without PlanFirst * Fiscal Year to date 9
10 FY 2016 Percent of Population Annually Eligible for Medicaid by County Highest Percentage Wilcox 55% Perry 53% Greene 52% Dallas 50% Lowndes 49% Lowest Percentage Shelby 13% Madison 18% Lee 19% Baldwin 19% Limestone 20% 10
11 Federally Qualified Health Centers (FQHCs) There are 126 FQHCs enrolled as Medicaid providers. Number of FQHC Recipients by County: FY 2017 FQHC Cost and Utlization Summary FY 2015 FY 2016 FY 2017 Amount Paid $45,744,259 $43,356,120 $43,888,819 Unique Recipients 104,158 99,665 99,085 Encounters 310, , ,472 Average Cost per Recipient $439 $435 $443 Average Cost per Encounter $147 $149 $153 11
12 Political Environment 12
13 Alabama Medicaid Workforce Initiative Section 1115 Waiver Demonstration Comment period ended April 2, 2018 Working to submit in the next few weeks 13
14 Pivot Plan 14
15 A Pivot Plan Organization Is NOT an RCO Does NOT take on full risk Does NOT pay providers Does NOT require TPA support (claims payment, risk management, prior authorization, etc.) like an RCO Does NOT require RCO scale upfront investments 15
16 A Pivot Plan Organization Includes the Patient 1 st population, maternity population, and possibly others Is responsible for an enhanced case management system Will have incentives, along with Primary Care Providers, for better outcomes Will have clinical and administrative incentive metrics focused on ambulatory care Will be solely responsible for a pre-defined region 16
17 A Pivot Plan Organization Will have funded quality improvement projects focusing on population priorities such as Substance Abuse Infant Mortality Obesity and Obesity Prevention 17
18 A Pivot Plan Organization Metrics and Benchmarks will focus on items under the control of the Pivot Organization and Primary Care Physicians such as: Well child visits Immunization rates BMI measurements Substance Abuse Care Coordination Prenatal and Post Partum Care Case Management 18
19 A Pivot Plan Organization Future additional functions can be added to this versatile platform Targeted population programs More standardized specialist support Provider supports Public Health Initiatives More 19
20 Pivot Plan Payment Principles Paying for activity Capped budget Earning incentive Using Case Management resources wisely
21 Primary Care Physician Payments Quality Metric Performance Cost Effectiveness PCMH Activities Above payments are achievable if the physician participates with the Pivot Plan Organization Pivot Participation Payment This will take the FFS payment to the current bump rate Base Fee For Service Current Medicaid FFS schedule for those physicians who choose not to participate with the Pivot Plan Organization 21
22 Pivot Plan Physician Incentive Payment Timelines Pivot Physician Incentive Payment Timelines Fall 2018 Winter 2019 Spring 2019 Summer 2019 Fall 2019 Winter 2020 Spring 2020 Summer 2020 Base Timeline Model For July 2020 Payment Patient Attribution Quality Cost Effectiveness PCMH July-18 August-18 September-18 October-18 November-18 December-18 January-19 Data Source Month February-19 March-19 April-19 May-19 June-19 July-19 August-19 September-19 October-19 November-19 December-19 Previous 24 Months Calendar Year w 6 Months Roll Out 12 Months Data w 3 Months Roll Out Quarterly Payment Date January-20 February-20 March-20 April-20 May-20 June-20 July-20 August-20 September-20 Calculated Payments Quality Data Range for First Caculated Payment (July 2020) Cost Effectiveness Data Range For First Calculated Payment (Jan 2020) PCMH Payments made quartly beginning Oct 18. Payments prior to caclulated payments above are distributed to all participating providers.
23 Current Health Homes Data Needs Are inconsistently supported by their organizations Require a high quality analytics staff which is both expensive and difficult to reproduce Function under limitations from the state A new data plan will be utilized to provide actionable data in a timely way. 23
24 Board Structure Boards can be as large as the Pivot Plan Organization desires but must include the following: 50% of the board (regardless of size) must be primary care physicians who practice in the region and participate with the Pivot Plan Organization Hospitals (2 positions) Community Mental Health Center Substance Abuse Treatment facility Federally Qualified Health Center Consumer Representative Included entities can employ no more than one board physician per entity 24
25 Proposed Pivot Plan Network Map (with number of delivering hospitals by county) CMS Rural Designation Region Populations No Yes Total Southwest 101,295 25, ,622 Jefferson/Shelby 120, ,073 East 65,629 45, ,855 Northeast 99,690 7, ,091 Southeast 38,223 68, ,327 Central 55,642 48, ,369 Northwest 39,753 62, ,979 Total 520, , ,315
26 Questions 26
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
More informationMedicaid Prescribed Drug Program Spending Control Initiatives. For the Quarter April 1, 2014 through June 30, 2014
Medicaid Prescribed Drug Program Spending Control Initiatives For the Quarter April 1, 2014 through June 30, 2014 Report to the Florida Legislature January 2015 Table of Contents Purpose of Report... 1
More information(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
More informationImplications of the Affordable Care Act for the Criminal Justice System
Implications of the Affordable Care Act for the Criminal Justice System August 14, 2013 Julie Belelieu Deputy Mental Health Director, Health Policy Center for Health Care Strategies, Inc. Allison Hamblin
More informationExpanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans. Senate Finance Committee May 14, 2009
Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans Senate Finance Committee May 14, 2009 1 Introduction Goals of proposed policy options To expand affordable health
More informationACA in Brief 2/18/2014. It Takes Three Branches... Overview of the Affordable Care Act. Health Insurance Coverage, USA, % 16% 55% 15% 10%
Health Insurance Coverage, USA, 2011 16% Uninsured Overview of the Affordable Care Act 55% 16% Medicaid Medicare Private Non-Group Philip R. Lee Institute for Health Policy Studies Janet Coffman, MPP,
More informationHealth Reform and NACo Policy
Health Reform and How do the two competing health care reform bills address important county health care concerns? Paul Beddoe, associate legislative director for health policy, details the provisions
More informationMedicaid Prescribed Drug Program. Spending Control Initiatives
Medicaid Prescribed Drug Program Spending Control Initiatives For Quarters Ended September 30, December 31, Table of Contents Purpose of Report... 1 Executive Summary... 2 Pharmacy Appropriations and Spending
More informationMedicaid State Report
Medicaid State Report NEW JERSEY, FY 1996 (October 1, 1995 - September 30, 1996) Produced by the Department of Research Division of Health Policy Research I. POPULATION AND CHILD HEALTH DATA Total Population,
More informationPRACTICE TRANSFORMATION. Moving Towards A Future of Team Based Care. Michael A. Kolber, PhD, MD
PRACTICE TRANSFORMATION Moving Towards A Future of Team Based Care Michael A. Kolber, PhD, MD 1 2 Financial Disclosures: None Thomas Cole, The Voyage of Life: Childhood 4 Medicare Passed into Law 1965
More informationImplications of the Affordable Care Act for the Criminal Justice System
Implications of the Affordable Care Act for the Criminal Justice System August 14, 2013 Julie Belelieu Deputy Mental Health Director, Health Policy Center for Health Care Strategies, Inc. Allison Hamblin
More informationRepublican Senators Unveil New ACA Repeal and Replace Legislation
September 14, 2017 Republican Senators Unveil New ACA Repeal and Replace Legislation Sens. Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV) and Ron Johnson (R-WI) Sept. 13 unveiled a health
More informationHealth Care Reform and Arkansas
Health Care Reform and Arkansas Joseph Thompson, M.D., MPH Surgeon General of Arkansas Director, AR Center for Health Improvement Director, Robert Wood Johnson Foundation Center to Prevent Childhood Obesity
More informationA State Child Health Walk Through Health Care Reform
A State Child Health Walk Through Health Care Reform The following is an outline of those provisions of the Patient Protection and Affordable Care Act of 2010 (ACA, Public Law 111-148) of particular interest
More informationInsurance (Coverage) Reform
Arkansas Health Law Check Up Insurance (Coverage) Reform Create Insurance Marketplaces For individuals & small businesses Expand Medicaid to 138% FPL Arkansas alternative = Private Option, not Arkansas
More informationHealth Care Reform Health Plans Overview
Health Care Reform Health Plans Overview Topics Status of health care reform Grandfathered plans Timeline for compliance Health Care Reform What is It? Patient Protection and Affordable Care Act (PPACA)
More informationState Cost (Savings) Biennium Biennium
Consolidated Fiscal Note SF3611-1A - "MA Work Engagement Requirement Waiver" Chief Author: Mark Johnson Commitee: Health and Human Services Finance and Policy Date Completed: 03/29/2018 Lead Agency: Human
More informationFlorida Medicaid Prescribed Drug Service Spending Control Initiatives
Florida Medicaid Prescribed Drug Service Spending Control Initiatives For the Quarters January 1, through March 31, and April 1, through June 30, Report to the Florida Legislature April 2018 [This page
More informationImplementing 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
More informationDepartment of Legislative Services Maryland General Assembly 2005 Session FISCAL AND POLICY NOTE
Department of Legislative Services Maryland General Assembly 2005 Session HB 1144 FISCAL AND POLICY NOTE House Bill 1144 (Delegate Hubbard, et al.) Health and Government Operations Public-Private Partnership
More informationHealth Care Reform, Substance Abuse Prevention and Treatment. DAS Professional Advisory Committee Meeting June 18, 2010
Health Care Reform, Substance Abuse Prevention and Treatment DAS Professional Advisory Committee Meeting June 18, 2010 The Patient Protection and Affordable Care Act The Patient Protection and Affordable
More informationFlorida Medicaid Prescribed Drug Service Spending Control Initiatives. For the Quarter April 1, 2016 through June 30, 2016
Florida Medicaid Prescribed Drug Service Spending Control Initiatives For the Quarter April 1, through June 30, Report to the Florida Legislature December 2017 [This page intentionally left blank.] Table
More informationCRS Report for Congress
Order Code RS21054 Updated March 5, 2004 CRS Report for Congress Received through the CRS Web Summary Medicaid and SCHIP Section 1115 Research and Demonstration Waivers Evelyne P. Baumrucker Analyst in
More informationBehavioral Health Services Revenue Maximization Plan
Behavioral Health Services Revenue Maximization Plan Beth Kidder Interim Deputy Secretary for Medicaid Agency for Health Care Administration Senate Health and Human Services Appropriations January 11,
More informationThe Affordable Care Act: Opportunities to Influence Implementation
The Affordable Care Act: Opportunities to Influence Implementation Dylan H. Roby, PhD Assistant Professor of Health Policy and Management UCLA Fielding School of Public Health Director of Health Economics
More informationPresentation to the Actuaries Club of the Southwest
Presentation to the Actuaries Club of the Southwest Texas Medicaid Overview and Reform David Palmer, Chief Actuary June 8, 2007 1 HHS Organization Governor Health & Human Services Council Health and Human
More informationT H E P O L I C Y P A G E
T H E P O L I C Y P A G E An Update on State and Federal Action 900 Lydia Street, Austin,, 78702 PH: 512.320.0222 www.cppp.org September 22, 2005 For more information: Anne Dunkelberg, dunkelberg@cppp.org
More informationThe Medicaid Landscape
The Medicaid Landscape Robin Rudowitz Associate Director, Kaiser Commission on Medicaid and the Uninsured Kaiser Family Foundation Council of State Governments Washington, DC June 18, 2014 Figure 1 Medicaid
More informationFlorida Medicaid Prescribed Drug Service Spending Control Initiatives. For the Quarter July 1, 2016 through September 30, 2016
Florida Medicaid Prescribed Drug Service Spending Control Initiatives For the Quarter July 1, through September 30, Report to the Florida Legislature March 2018 [This page intentionally left blank.] Table
More informationHealth Care Reform: Chapter Three. The U.S. Senate and America s Healthy Future Act
Health Care Reform: Chapter Three The U.S. Senate and America s Healthy Future Act SECA Policy Brief Initial Publication September 2009 Updated October 2009 2 The Senate Finance Committee Chairman Introduces
More informationMaryland Medicaid Program & HIV Service Delivery. Alyssa L. Brown, J.D. Medicaid Department of Health and Mental Hygiene April 11, 2016
Maryland Medicaid Program & HIV Service Delivery Alyssa L. Brown, J.D. Medicaid Department of Health and Mental Hygiene April 11, 2016 1 3 MEDICAID ENROLLMENT Maryland Medicaid Basics In Maryland, Medicaid
More informationC H A P T E R 1 4 : Medicare and Other Insurance Liability
C H A P T E R 1 4 : Medicare and Other Insurance Liability Reviewed/Revised: 10/1/2018 14.0 FIRST AND THIRD PARTY/OTHER COVERAGE Steward Health Choice Arizona, as an AHCCCS contractor is the payor of last
More informationHealthy Indiana Plan (HIP) Provider Orientation
Serving Hoosier Healthwise, Healthy Indiana Plan Healthy Indiana Plan (HIP) Provider Orientation Agenda Program overview Benefit coverage Eligibility HIP offerings Medically frail and various member categories
More informationIowa 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
More informationWho is eligible for the Insure Oklahoma/O-EPIC Individual Plan? What are the income guidelines for the Insure Oklahoma/O-EPIC Individual Plan?
Individual FAQ Who is eligible for the Insure Oklahoma/O-EPIC Individual Plan? The Insure Oklahoma/O-EPIC program provides a health coverage option to uninsured adults between 19-64 years of age whose
More informationMEDICAID 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
More informationSTATEWIDE MEDICAID MANAGED CARE PROGRAM FREQUENTLY ASKED QUESTIONS
STATEWIDE MEDICAID MANAGED CARE PROGRAM FREQUENTLY ASKED QUESTIONS Table of Contents DOCUMENT PURPOSE... 1 GENERAL QUESTIONS... 1 COVERAGE... 1 PLAN TYPES... 2 CONTINUITY OF CARE... 3 CHOICE COUNSELING/ENROLLMENT...
More informationVermont Legislative Joint Fiscal Office
Vermont Legislative Joint Fiscal Office One Baldwin Street Montpelier, VT 05633-5701 (802) 828-2295 Fax: (802) 828-2483 ISSUE BRIEF Date: October 21, 2016 Prepared by: JFO Staff* DRAFT FOR DISCUSSION This
More informationMICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES NOTICE OF PROPOSED POLICY
MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES NOTICE OF PROPOSED POLICY Public Act 280 of 1939, as amended, and consultation guidelines for Medicaid policy provide an opportunity to review proposed
More informationMASSHEALTH: THE BASICS
MASSHEALTH: THE BASICS PREPARED BY CENTER FOR HEALTH LAW AND ECOMICS UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL Webinar: May 29, 2014 INTRODUCTION ELIGIBILITY AND ENROLLMENT SPENDING WEBINAR OVERVIEW MassHealth:
More informationATTACHMENT 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
More informationDEFICIT REDUCTION ACT OF 2005: IMPLICATIONS FOR MEDICAID PREMIUMS AND COST SHARING CHANGES
February 2006 DEFICIT REDUCTION ACT OF 2005: IMPLICATIONS FOR MEDICAID On February 8, 2006 the President signed the Deficit Reduction Act of 2005 (DRA). The Act is expected to generate $39 billion in federal
More informationMedicaid Benchmark Benefits under the Affordable Care Act: Options for New York
Medicaid Benchmark Benefits under the Affordable Care Act: Options for New York PRESENTED TO: NEW YORK STATE DEPARTMENT OF HEALTH JANUARY 2013 PREPARED BY: DENISE SOFFEL, PH.D. ROBERT BUCHANAN TOM DEHNER
More informationAffordable Care Act Repeal and Replacement Legislation
Affordable Care Act Repeal and Replacement Legislation Timeline/ Actions to Date In February 2017, draft legislation aimed at repealing and replacing the Affordable Care Act (ACA), or Obamacare, was informally
More informationFederal Policy & Budget Update Mercedes González
Federal Policy & Budget Update Mercedes González March 28, 2017 Agenda Child Care & Development Block Grant (CCDBG) Trump Budget Proposal for FY2018 Trump Administration s Child Care Tax Plan Supplemental
More informationATTACHMENT I SCOPE OF SERVICES CAPITATED HEALTH PLANS
ATTACHMENT I SCOPE OF SERVICES CAPITATED HEALTH PLANS A. Plan Type The Vendor (Health Plan) is approved to provide contracted services as the following health plan type as denoted by X : TABLE 1 Health
More informationArizona Health Care Cost Containment System (AHCCCS) Summary
AHCCCS Update 1 Arizona Health Care Cost Containment System (AHCCCS) Summary AHCCCS model has been documented to provide higher quality coverage at lower cost AHCCCS has had to administer significant reductions
More informationJackie Prokop, RN, MHA Director Program Policy Division Medical Services Administration Michigan Department of Health and Human Services
Jackie Prokop, RN, MHA Director Program Policy Division Medical Services Administration Michigan Department of Health and Human Services March 23, 2016 Overview of the Healthy Michigan Plan (HMP) Federal
More informationYou may be asking yourself, I don t work on Medicaid, why
Medicaid Innovation: The Need for Actuaries in the Medicaid Program By Chris Bach You may be asking yourself, I don t work on Medicaid, why should I care what s going on with it? For me, it s personal.
More informationThe Affordable Care Act: Implementation in Illinois
The Affordable Care Act: Implementation in Illinois Stephanie F. Altman, J.D. Assistant Director of Health Care Justice Sue Augustus. J.D. Director, Program and Operations Housing Opportunities for Women
More informationJBC staffer, Eric Kurtz, provided an overview of the HCPF budget, noting a few key points and tables/charts:
Joint Budget Committee Briefing for Department of Health Care Policy and Financing December 8, 2015 Prepared by Jennifer Miles, Miles Consulting: jennifer@milesgovtrelations.com The JBC staff for HCPF
More informationPresumptive Eligibility. Last Updated: February 20, 2018
Presumptive Eligibility Last Updated: February 20, 2018 Agenda Presumptive Eligibility Overview Covered Benefits Qualified Providers (QPs) How to Become a QP Completing the PE Application Other Resources
More informationRULES OF TENNESSEE DEPARTMENT OF HUMAN SERVICES DIVISION OF MEDICAL SERVICES CHAPTER COVERAGE GROUPS UNDER MEDICAID TABLE OF CONTENTS
RULES OF TENNESSEE DEPARTMENT OF HUMAN SERVICES DIVISION OF MEDICAL SERVICES CHAPTER 1240-03-02 COVERAGE GROUPS UNDER MEDICAID TABLE OF CONTENTS 1240-03-02-.01 Necessity and Function 1240-03-02-.04 Enrollment
More informationSeventh Floor 1501 M Street, NW Washington, DC Phone: (202) Fax: (202) MEMORANDUM
Seventh Floor 1501 M Street, NW Washington, DC 20005 Phone: (202) 466-6550 Fax: (202) 785-1756 MEMORANDUM To: ACCSES Members cc: John D. Kemp, CEO From: Peter W. Thomas and Theresa T. Morgan Date: Re:
More informationReport from the JMOC Actuary. Presentation to the JMOC Committee November 15, 2018
Report from the JMOC Actuary Presentation to the JMOC Committee November 15, 2018 Setting a Growth Target for Medicaid: JMOC Responsibilities Under ORC Section 103.414, JMOC must Contract with actuary
More informationMedicaid Payment and Delivery System Innovation: Minnesota s Experience
Medicaid Payment and Delivery System Innovation: Minnesota s Experience MARIE ZIMMERMAN, MEDICAID DIRECTOR MINNESOTA DEPARTMENT OF HUMAN SERVICES MILBANK RSG 2015 Health Reforms in Minnesota MNSure (state
More informationSOONERCARE MANAGED CARE HISTORY AND PERFORMANCE 1115 Waiver Evaluation
SOONERCARE MANAGED CARE HISTORY AND PERFORMANCE 1115 Waiver Evaluation James Verdier Margaret Colby Mathematica Policy Research, Inc. Presentation to Oklahoma Health Care Authority Board Oklahoma City,
More informationREVIEW OF KANCARE: COST AND UTILIZATION
REVIEW OF KANCARE: COST AND UTILIZATION November 2017 INTRODUCTION KanCare, the state of Kansas managed Medicaid program, will reach the end of its five-year demonstration period under a 1115 CMS waiver
More informationHCR FAQ. Covered California Individual and Family Coverage. What is Covered California? What is Obamacare? Are they the same?
HCR FAQ Covered California Individual and Family Coverage What is Covered California? What is Obamacare? Are they the same? Covered California is a new, easy-to-use marketplace established for California
More informationOverview of the ACA and Wisconsin Medicaid Reforms. Covering Kids & Families Wisconsin Wisconsin Primary Health Care Association
Overview of the ACA and Wisconsin Medicaid Reforms Covering Kids & Families Wisconsin Wisconsin Primary Health Care Association Updated September 9, 2013 Topics to be Covered What is the ACA? Wisconsin
More informationRandall Chun, Legislative Analyst Updated: December MinnesotaCare
INFORMATION BRIEF Research Department Minnesota House of Representatives 600 State Office Building St. Paul, MN 55155 Randall Chun, Legislative Analyst Updated: December 2017 MinnesotaCare MinnesotaCare
More informationHIP 2.0: The Basics Coverage Elements, Financing, Our Agreement and What s Next
HIP 2.0: The Basics Coverage Elements, Financing, Our Agreement and What s Next Brian Tabor, VP June 9, 2014 Highlights of HIP 2.0 Full expansion as envisioned under the ACA to all earning up to 138% of
More informationSDMGMA Third Party Payer Day. Anja Aplan, Payment Control Officer
SDMGMA Third Party Payer Day Anja Aplan, Payment Control Officer Agenda Medicaid Overview Third Party Liability Common TPL Errors NPI and Taxonomy Billing Transportation Billing Diagnosis codes Aid Category
More informationCoverage 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
More informationEvaluation of Florida s Managed Medical Assistance (MMA) Program Demonstration: Project 2 Final Interim Report
Evaluation of Florida s Managed Medical Assistance (MMA) Demonstration: Project 2 Final Interim Report Contract Deliverable No. 12, Managed Medical Assistance Final Interim Report Project 2 DY1: Component
More informationHealth Care in Maine: An Overview
Legislative Policy Forum on Health Care February 4 th, 2011 Health Care in Maine: An Overview Wendy J. Wolf, MD, MPH President & CEO Maine Health Access Foundation www.mehaf.org Health Forum Sponsor: The
More informationOklahoma SoonerCare (Medicaid) and the Affordable Care Act (ACA)
Oklahoma SoonerCare (Medicaid) and the Affordable Care Act (ACA) Cindy Roberts, CPA OHCA Deputy CEO Buffy Heater, MPH Director of Planning & Development SoonerCare Today SoonerCare Landscape -Today Insured
More informationATTACHMENT I SCOPE OF SERVICES CAPITATED HEALTH PLANS
ATTACHMENT I SCOPE OF SERVICES CAPITATED HEALTH PLANS A. Plan Type The Vendor (Health Plan) is approved to provide contracted services as the following health plan type as denoted by X. When the statewide
More informationFlorida Medicaid Prescribed Drug Service Spending Control Initiatives. For the Quarter October 1, 2017 through December 31, 2017
Florida Medicaid Prescribed Drug Service Spending Control Initiatives For the Quarter October 1, through December 31, Report to the Florida Legislature September 2018 [This page intentionally left blank.]
More informationU.S. Senate Finance Committee Coverage Policy Options Detailed Section by Section Summary May 18, 2009
U.S. Senate Finance Committee Coverage Policy Options Detailed Section by Section Summary May 18, 2009 This document outlines the 61-page report, Expanding Health Care Coverage: Proposals to Provide Affordable
More informationVACCINES FOR CHILDREN PROGRAM PROVIDER AGREEMENT
VACCINES FOR CHILDREN PROGRAM PROVIDER AGREEMENT FACILITY INFORMATION Facility Name: Facility Address: VFC Pin: City: County: State: Zip: Telephone: Fax: Shipping Address (if different than facility address):
More informationCOVERED CALIFORNIA: THE GOOD, THE BAD & THE UNDEFINED FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS
1 COVERED CALIFORNIA: THE GOOD, THE BAD & THE UNDEFINED FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS Ann-Louise Kuhns President & CEO California Children s Hospital Association Health Care Reform: The Basics
More informationBringing Accountable Care To Medicaid Susan E. Birch, MBA, BSN, RN Executive Director, Colorado Department of Health Care Policy & Financing
Bringing Accountable Care To Medicaid Susan E. Birch, MBA, BSN, RN Executive Director, Colorado Department of Health Care Policy & Financing 1 Agenda Colorado Overview Accountable Care Collaborative Program
More informationOverview of Medicaid Dashboards November 2016
Joint Legislative Oversight Committee on Medicaid and NC Health Choice Overview of Medicaid Dashboards November 2016 Steve Owen, Fiscal Research Division November 29, 2016 Discussion Guide Purpose of Dashboards
More informationIMPLEMENTATION OF THE AFFORDABLE CARE ACT. August 29, 2012
IMPLEMENTATION OF THE AFFORDABLE CARE ACT August 29, 2012 2 THE MOVING PARTS: Caseload growth without the impact of ACA; Impact on the state s uninsured population; FMAP vs. state share (Regular FMAP,
More informationHealth Spending Explorer
03.05.2015 DEFINITIONS Health Spending Explorer The following list is a quick reference to definitions of type-of-expenditure and source-of-fund categories used in the Health Spending Explorer. These and
More informationImpact on the State Health Insurance Program of the Patient Protection and Affordable Care Act
Impact on the State Health Insurance Program of the Patient Protection and Affordable Care Act Adopted August 20, 2012 by the Self-Insurance Estimating Conference Prepared by: Florida Department of Management
More informationMedicaid 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
More informationPharmacy Service Requirements Under Medicaid Reform. Duval County June 27, 2006
Pharmacy Service Requirements Under Medicaid Reform Duval County June 27, 2006 Florida Medicaid Reform Overview Sybil Richard Assistant Deputy Secretary for Medicaid Operations 1 Key Elements of Reform
More informationAgenda Key Budget Drivers Revenue & Expenditure Summary Cook County Health Fund Allocation Budget Summary FY15 Initiatives
1 Agenda Key Budget Drivers Revenue & Expenditure Summary Cook County Health Fund Allocation Budget Summary FY15 Initiatives Revenue Assumptions & Detail CountyCare C Expenditure Detail 2 2 Key Budget
More informationMedicaid Expansion in Louisiana
1 Medicaid Expansion in Louisiana United Way of Southeast Louisiana Policy Forum New Orleans, LA February 16, 2016 Governor s Executive Order - JBE 16-01 2 Signed by Governor John Bel Edwards on January
More informationVermont Medicaid Next Generation Pilot Program 2017 Performance
State of Vermont Department of Vermont Health Access NOB 1 South, 1 st Floor 280 State Drive Waterbury, Vermont 05671 REPORT TO THE GENERAL ASSEMBLY Vermont Medicaid Next Generation Pilot Program 2017
More informationWashington, DC Washington, DC 20510
September 13, 2017 The Honorable Lindsey Graham The Honorable Bill Cassidy United States Senate United States Senate Washington, DC 20510 Washington, DC 20510 Dear Senators Graham and Cassidy: On behalf
More informationUpdate on Implementation of the Affordable Care Act
Update on Implementation of the Affordable Care Act Yvonne Knight, J.D. ADEA Senior Vice President Advocacy and Governmental Relations ADEA Policy Center The Affordable Care Act On March 23, 2010, President
More informationCENTERS FOR MEDICARE & MEDICAID SERVICES SPECIAL TERMS AND CONDITIONS
CENTERS FOR MEDICARE & MEDICAID SERVICES SPECIAL TERMS AND CONDITIONS NUMBER: TITLE: AWARDEE: 11-W-00048/6 SoonerCare Oklahoma Health Care Authority XI. GENERAL FINANCIAL REQUIREMENTS UNDER TITLE XIX 56.
More informationState of Hawaii QUEST Integration Section 1115 Demonstration. Section 1115(a) Renewal Application December 28, 2012
State of Hawaii QUEST Integration Section 1115 Demonstration Section 1115(a) Renewal Application December 28, 2012 Hawaii is pleased to submit this five-year, Section 1115(a) renewal application to align
More informationChanges under ACA for consumers
Changes under ACA for consumers Individual mandate Covers pre-existing conditions No annual or lifetime coverage limits Coverage for children to age 26 Requires coverage of certain preventive care services
More informationLEGAL CONCERNS FOR POLIO SURVIVORS:
LEGAL CONCERNS FOR POLIO SURVIVORS: A Benefits Primer with an emphasis on Medicare and the Affordable Care Act Martha C. Brown Martha C. Brown & Associates, LLC 220 W. Lockwood, Suite 203 ST. Louis, MO
More informationOverview. Procure.shtml
Statewide Medicaid Managed Care (SMMC) Cost Proposal Magellan Complete Care (Florida MHS Inc., dba Magellan Complete Care) Actuarial Memorandum and Certification Overview The purpose of this memorandum
More informationSoonerCare. Insured (2.2M) and. Uninsured (500K) $54, % FPL 250% FPL $45, % FPL $36, % FPL $33,874 $24, % FPL 100% FPL $18,310
Oklahoma SoonerCare (Medicaid) and the Affordable Care Act (ACA) Cindy Roberts, CPA OHCA Deputy CEO Buffy Heater, MPH Director of Planning & Development SoonerCare Today SoonerCare Landscape Today Annual
More informationNational Health Expenditure Accounts
National Health Expenditure Accounts Joe Benson, Devin Stone and The NHEA Team American Academy of Actuaries Webinar February 4, 2016 Overview National health spending reached $3.0 trillion, or $9,523
More informationCRC Memorandum MEDICAID ELIGIBILITY
Governmental Research Since 1916 No. 1074 A A publication of the of the Citizens Research Council of of Michigan July 2003 This CRC Memorandum was made possible by grants from the W.K. Kellogg Foundation
More informationNEW JERSEY. PROGRAM NAME Plan: NJ FamilyCare S-CHIP 1115 Waiver: NJ FamilyCare
PROGRAM NAME Plan: NJ FamilyCare S-CHIP 1115 Waiver: NJ FamilyCare CONTACT INFORMATION Heidi J. Smith, RN, MSN Executive Director NJ FamilyCare Department of Human Services P.O. Box 712, 5 Quakerbridge
More informationPatient-Centered Medical Homes and the Health of Ohio s Adults and Children
Patient-Centered Medical Homes and the Health of Ohio s Adults and Children Thomas Wickizer, Kenneth Steinman, Abigail Shoben, Deena Chisolm, Jeff Biehl, Lauren Phelps #OMAS2015 1 Please note: This study
More informationHere are some highlights of the revised Senate language released July 13:
The Better Care Reconciliation Act of 2017, Version 2.0 July 17, 2017 On July 13, Senate Republican leaders released a second working draft of the Senate version of H.R. 1628, the American Health Care
More informationMedicaid Managed Care Cost Savings A Synthesis of 24 Studies
Medicaid Managed Care Cost Savings A Synthesis of 24 Studies Prepared for: America s Health Insurance Plans July 2004 Updated March 2009 Table of Contents EXECUTIVE SUMMARY... 1 I. INTRODUCTION AND CONCEPTUAL
More informationMarch MEDICAID & CHIP Enrollment Service Use & Payments
AMERICAN INDIAN AND ALASKA NATIVE MEDICAID PROGRAM AND POLICY DATA March 2010 MEDICAID & CHIP Enrollment Service Use & Payments For the Centers for Medicare & Medicaid Services & Tribal Technical Advisory
More informationClass 8 - Medicaid. Ellen Andrews, PhD PCH 358 SCSU Spring 2018
Class 8 - Medicaid Ellen Andrews, PhD PCH 358 SCSU Spring 2018 If you only get one thing... Medicare Run by federal government Funded only by federal government Covers seniors, people with disabilities
More informationDepartment of Legislative Services Maryland General Assembly 2004 Session FISCAL AND POLICY NOTE
Department of Legislative Services Maryland General Assembly 2004 Session SB 737 FISCAL AND POLICY NOTE Senate Bill 737 Finance (Senator McFadden, et al.) Public-Private Partnership for Health Coverage
More informationFlorida Health Care Expenditures Report
Florida Health Care Expenditures Report 2015 Table of Contents Table of Contents... i Florida Health Care Expenditures in 2015... 1 Introduction... 1 Data and Methodology... 1 Findings... 2 Overall Trend...
More information