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Monday Morning Medicaid Must Reads: Feb 18, 2019

Helping you consider differing viewpoints. Before it’s illegal.

In this issue…
Article 1:     Maryland Mulls Medicaid Reimbursement for Telemental Health Services
Clay’s summary:     I have said for years there’s lots of good reasons to move MH/BH into telehealth.
Key Excerpts from the Article:
“Tele-behavioral health can help improve the efficiency and effectiveness of our provider workforce and remove unnecessary obstacles to provide treatment for MassHealth members who have difficulty leaving their home environment, who live in rural areas, and or have other unique needs,” Dan Tsai, MassHealth’s Assistant Secretary, said in a press release. “In addition, behavioral health providers are also incentivized to promote and utilize telehealth services and are reimbursed at the same rates as in-person visits.”
Read full article in packet or at links provided

Article 2:     Texas announces record $236M Medicaid fraud settlement
Clay’s summary:     State settles for pennies on the dollar (compared to original damages sought); re-named tech behemoth ready to put legacy brand behind it so it can win some new MITA bucks.
Key Excerpts from the Article:
Texas hired Xerox in 2004 to evaluate applications for Medicaid-funded dental procedures. The company was supposed to have dental professionals carefully review each application to make sure the tooth repairs were medically necessary, the standard for Medicaid to cover them.
According to the lawsuit, however, the company did little more than rubberstamp the paperwork. Under pressure to keep pace with the exploding number of applications from dentists and orthodontists, Xerox hired untrained workers who often barely glanced at the medical records, molds and x-rays, spending only minutes on each application in some cases, court records show. Those who didn’t keep pace were reprimanded. The company employed a single dentist to review and sign off on several hundred preapproval applications per day.
Read full article in packet or at links provided

Article 3:     Passport sues Kentucky over Medicaid cuts – Louisville Business First
Clay’s summary:     In which Passport says mean things.
Key Excerpts from the Article:
Passport alleges that the cuts to its payments and the increase to its competitors’ payments “are the result of either an improper motive to harm or eliminate Passport; a motive to assist one or more of Passport’s competitors in expansion of market share at the expense of Passport; or gross and deliberate indifference to the harm inflicted on Passport, its 315,000-plus members, its employees and the communities it serves generally.”
Read full article in packet or at links provided