Posted on December 8, 2017November 22, 2017 by MM_ADMIN — Leave a comment

Medicaid Acronym of the Day – QHP

Qualified Health Plan – Under the ACA, the designation of qualified health plan (QHP) is given to health insurance plans that are sold in the marketplace (exchange). The same basic rules apply to plans sold both in and out of the exchanges: they must be guaranteed issue, follow the ACA’s cost-sharing guidelines, and cover “essential health benefits” with no lifetime or annual maximums.

But in order to be sold in the exchanges, a health plan must also be certified by the exchange as a qualified health plan. In the spring of 2013, health insurance carriers in each state submitted plan designs and pricing to the exchanges – the ones that were approved are considered QHPs. The QHP label is basically an extra layer of consumer protection, one that makes shopping in the exchanges a good idea even for people who don’t qualify for subsidies.

Further reading –

https://obamacarefacts.com/insurance-exchange/qualified-health-plan/

Posted on December 7, 2017November 22, 2017 by MM_ADMIN — Leave a comment

Medicaid Acronym of the Day – ACAP

The Association for Community Affiliated Plans (ACAP) is a national trade association representing 57 Medicaid-focused health plans in 26 states. Headquartered in Washington, D.C., ACAP advocates on behalf of its community-affiliated member health plans operating throughout the United States. ACAP’s advocacy work focuses on representing publicly sponsored programs and health care providers who serve vulnerable populations. ACAP also promotes universal access to quality and cost-efficient care.

ACAP members are nonprofit plans that serve public insurance programs and the safety net. Collectively, ACAP plans serve more than 17 million enrollees, which is over 50 percent of individuals enrolled in Medicaid-focused health plans.[1]

Further reading –

https://www.communityplans.net/

Posted on December 6, 2017November 22, 2017 by MM_ADMIN — Leave a comment

Medicaid Acronym of the Day – ABP

Alternative Benefit Plan – States have the option to provide alternative benefits specifically tailored to meet the needs of certain Medicaid population groups, target residents in certain areas of the state, or provide services through specific delivery systems instead of following the traditional Medicaid benefit plan. Key Requirements of the Rule Include:

The term 1937 Medicaid Benchmark or Benchmark Equivalent Plan has been retitled to Alternative Benefit Plans.
ABPs must cover the 10 Essential Health Benefits (EHB) as described in section 1302(b) of the Affordable Care Act whether the state uses an ABP for Medicaid expansion or coverage of any other groups of individuals.
Individuals in the new adult VIII eligibility group will receive benefits through an ABP.

Further reading –

https://www.medicaid.gov/State-Resource-Center/Eligibility-Enrollment-Final-Rule/Alternative-Benefit-Plans-and-Essential-Health-Benefits.pdf

https://www.federalregister.gov/documents/2013/07/15/2013-16271/medicaid-and-childrens-health-insurance-programs-essential-health-benefits-in-alternative-benefit#h-14

Posted on December 5, 2017November 22, 2017 by MM_ADMIN — Leave a comment

Medicaid Acronym of the Day – ABA

Applied Behavioral Analysis – ABA is an empirically validated approach to improve behavior and skills related to core impairments associated with autism and a number of other developmental disabilities. ABA involves the systematic application of scientifically validated principles of human behavior to change inappropriate behaviors. ABA uses scientific methods to reliably demonstrate that behavioral improvements are caused by the prescribed interventions. ABA is presently considered the gold standard of autism interventions.

ABA’s focus on social significance promotes a family-centered and whole-life approach to intervention. Common methods used include: assessment of behavior, caregiver interviews, direct observation, and collection of data on targeted behaviors.

A single-case design is used to demonstrate the relationship between the environment and behavior as a means to implement client-specific ABA therapy treatment plans with specific goals and promote lasting change. ABA also includes the implementation of a functional behavior assessment to identify environmental variables that maintain challenging behaviors and allow for more effective interventions to be developed that reduce challenging behaviors and teach appropriate replacement behaviors.

Further reading –

https://www.hca.wa.gov/assets/billers-and-providers/ABA-services-20161001.pdf

Posted on December 4, 2017November 22, 2017 by MM_ADMIN — Leave a comment

Medicaid Acronym of the Day – AAC

Actual Acquisition Cost – In accordance with the Affordable Care Act and requirements of §447.512(b) of the final regulation, states’ reimbursement for ingredient costs for brand and certain multiple source drugs (that do not have a FUL calculated), will be established as an aggregate upper limit based on AAC, as opposed to an estimated acquisition cost. AAC is defined at §447.502 of the final regulation as the agency’s determination of the pharmacy providers’ actual prices paid to acquire drugs marketed or sold by specific manufacturers. CMS believes that changing this definition of
ingredient cost reimbursement to AAC will provide a reference price consistent with the dictates of section 1902(a)(30)(A) of the Act.

Further reading –

https://www.medicaid.gov/federal-policy-guidance/downloads/smd16001.pdf

Posted on December 1, 2017December 1, 2017 by MM_ADMIN

Conference Swag Ratings: MHPA 2017

As many of you know, I spend a LOT of my time at various industry conferences to speak, to see old friends, meet new ones and to stay abreast of what is going on. Part of Conference Life is swag.

It is important to know what vendors bring good swag, so you can plan room in your luggage. Below are my swag ratings for MHPA 2017. Only vendors with at least 3 out of 5 stars are shown, so as not to embarrass those that only brought pens or bought candy at the gift shop last minute to put in a bowl. (You know who you are).

Links are to company pages on LinkedIn. Helps you find actual humans you may know in these companies.

4 or More Stars Out of 5

Vendors in this category demonstrate mastery of the Art of Swag. Themes in this elite circle include brand-relevance, investment in the swag (cash spent), uniqueness, utility in the home setting, whether kiddos would like it and overall presentation. If you are a 3 out of 5 swag-rated vendor, you should pay close attention to these vendors when planning your next event. (Assuming you are running low on whatever you bought 10,000 of last year).

4 or More Stars Out of 5

National Vision Administrators (NVA)

Cipher Health

Cotiviti Healthcare

Relias Learning

Liberty Dental Plan

Human Arc

Healthcrowd

Mediware

3 to 4 Stars Out of 5

3M

Edifecs

CareStar

Sentinel Rx

TMG Health

i2i Population Health

Express Scripts

Veyo

Cribs for Kids

Cozeva