Author: MM_ADMIN

WEBINARS HAVE BEEN AWESOME- Thank you to the hundreds of folks who have signed up and attended. We had a great State Spotlight show on RI last week, and yesterday’s Medicaid News Roundtable was a blast. If you’re not signed up, it’s free @ mostlymedicaid.com/webinars .

MULTIPLE CHANGES TO AK MCD ON THE TABLE- Bring in managed care, focus on PCPs, privatize the state-run Pioneer Homes (nursing homes)- it’s all being discussed in subcommittees this week.

BUDGET SHORTFALL #S ROLLING IN- All #s are for the Mcd shortages only: DE- $29M, VA- $125M, MS – $52M. Don’t anyone worry, all the states will wind up spending more on Mcd, as they always do each and every single year. Its just a matter of how much time, how many special sessions and how much fiscal-conservative shaming will be required to get there.

EXPANSION IN MAINE TAKES A TWIST- Maine rep Saviello (D) is pushing a a private-option style expansion plan for Medicaid, but this week started tie-ing it to reducing heroin addiction. Maybe someone should tell the Good Rep that he doesn’t have to expand all of Medicaid but can just get a waiver to run a special heroin treatment program? Especially if you look at the gigantic cash the 2016 White House budget is putting at fighting opiod use alone?

EXPANSION IN WYOMING TAKES A FALL- Expansioners in The Cowboy State are now O for Four the last four years. A 20-10 Senate vote against shot it down on Friday.

EXPANSION IN ARKANSAS TAKES A BEAT- The Good Guvn’r Hutchinson returned down from the mountain after horsetrading concluding talks with CMS and put the ball in the legislature’s court. CMS was not too hot on his employment requirements for expansion cash, but the legislators have to approve any changes before CMS will look at it anyway.

PA REDUCES MEDS USE IN FOSTER CARE- Seems the Keystone State was able to cut psychotropic med use by 75% over 2 years for foster kids when it put in prior auth requirements. Put another way, when docs were slowed down by the hassle of proving it was needed for the vulnerable child (instead of just grabbing whatever samples in their lab coat pocket that the endless stream of pharma reps coming through their door put in there), they prescribed it 75% less. So all you have to do to get doctors treating foster kids to provide quality care is make something inconvenient for them?

SC PUTS UP REAL CONTROLS TO FIGHT OPIOD USE- Sort of like the PA story above, SC is now requiring docs to check a statewide database before prescribing any controlled substance. Not sure it will have the same 75% impact as the PA story, but surely it will slow docs (and doc shoppers) down a good bit. I guess if you don’t want to have your data stored on that new system, you should get an iphone. I hear those things can’t be hacked, even by Jack Bauer.

WELLCARE GOES SHOPPING- It’s been 2 years since WC dusted off the credit card. This week’s acquisition is Advicare, which runs an MCO in SC. WC announced its going on a shopping spree last week, and has nearly $1.3B to spend.

MEGARULE ARRIVES AT OMB- Elvis has left the building at Security Blvd and has trotted on over to OMB. The 653 page mega rule transforming Medicaid managed care (see our webinar on this last summer for a LOT more info) has been commented upon, and now goes to OMB for review. OMB review process rules are a bit tricky, and can take up to 90 days. Or forever if restarts happen. First reader to write in and tell me how many comments the rule received gets a $25 Amazon gift card.

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (build a fire!) and keep running the race (you know who you are).

—-

FULL, FREE newsletter: http://eepurl.com/ep81Y

News that didn’t make it and sources for those that did: twitter @mostlymedicaid

hkamaeetawsai kambhar  kaalhphoet  sarrtawko hcay lwhaattaw muu

STILL SEATS FOR THE FREE WEBINAR SERIES FOR 2016! The response has been incredible. As of this morning, we had 330 people signed up. Room for about 100 more if you want to join us. If you haven’t signed up, please do- State Spotlight Series sign up- http://goo.gl/4LWxlA ; Clay’s Monthly Medicaid News Roundtable Signup- http://goo.gl/JkcPQL If you have signed up, please pass on to a friend or colleague. Don’t forget the chance to win the Amazon gift card!

FREESTONE STATE GUVN’R TRIES TO WRITE LEGISLATORS OUT OF THE LOOP- The Good Guvn’r Malloy wants to stop those mean ole’ legislators from doing that evil “checks and balances thing” in CT. In today’s CT law, the Mcd agency can’t just run out and get a bunch of federal waiver cash without getting legislative approval. Malloy wants to remove this authority specifically for Mcd waivers. The legislature has had this veto power since 2007, and over-rode then-guvn’r Rell’s veto to get it. Seems the people have spoken through their reps, Mr. Malloy. What part of 3 co-equal branches of government do you not understand? With this type of political worldview (that the Executive branch is supreme), perhaps you should accelerate your career path to DC?

DOVES IN HAWKEYE STATE FRET OVER MCO LAUNCH- Mcd officials have gone through various readiness tests, have doubled provider contracts with MCOs, and have done double-duty on the grueling legislative committee circuit to answer inane questions from legislators who know less-than-zero about healthcare, let alone Medicaid managed care. And Republican legislators are leading the push to delay the shift to Mcd privatization. Can someone please write in and tell me which end is up in Iowa?

HEART OF DIXIE HAS CHANGE OF HEART ON MEDICAID MANAGED CARE- My own beloved homeland is taking the plunge. She got approval from the federalis to bring Medicaid Managed Care starting October 1 this year. There was much celebration in Montgomery (and statewide, across all 5 RCO regions) last week, when the approval for the 1115 waiver was announced. The deal gets AL up to $748M from CMS. That’s a lot barbecue sandwiches (sorry TN and NC, you got nothing on Bama BBQ, which of course may be loosely related to our terrible health outcomes here).

BLUEGRASS STATE WARNS OF SKYROCKETING MEDICAID COSTS- KY Mcd will jump 20% to cost more than $3.7B in 2 short years. Maybe this explains why the Good Guvn’r Bevin wants to un-expand?

SOONER STATE HOUSE BILL 2665 SET TO KICK 111K OFF MEDICAID  ROLLS TO HELP PLUG $1.3B STATE BUDGET HOLE- The bill would kick off “any non-pregnant able bodied adult younger than age 65.” Savings estimates come in around $111M a year. Not sure how they are going to fill that hole, even with that annual savings. Maybe Bernie can write them a check to make it all free when he stumps in OK? Mr. Sanders, are you listening? We need some of your magic!

BEEHIVE STATE HAS FOUR – COUNT EM’, 4! – MEDICAID EXPANSION PLANS ON THE TABLE – After 3 years of false starts, Utah may finally be ready to pass an expansion plan. 3 plans are from Republicans; 1 is from a Democrat. Check the twitter feed for details – some are pretty interesting, including one focused on expanding Medicaid to homeless or near-homeless families.

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (build a fire!) and keep running the race (you know who you are).

—-

FULL, FREE newsletter: http://eepurl.com/ep81Y

News that didn’t make it and sources for those that did: twitter @mostlymedicaid

‘arsal al’ab w alaibn li’iinqadh alealam

ONLY 14 DAYS UNTIL OUR FIRST FREE WEBINAR FOR 2016! If you haven’t signed up, please do- State Spotlight Series sign up- http://goo.gl/4LWxlA ; Clay’s Monthly Medicaid News Roundtable Signup- http://goo.gl/JkcPQL If you have signed up, please pass on to a friend or colleague. Don’t forget the chance to win the Amazon gift card!

DÉJÀ VU?- Iowa Senate dems are promising to repeal the privatization of Mcd (fancy politico-speak for “hey we just got MCOs in our state”). House Republicans are promising the bill will be DOA. Isn’t this rich- we now have dems (albeit on a state level) making meaningless gestures about repealing a major change to the healthcare delivery system. Sound familiar (but reverse everything and make it national)?

ROLLING BACK EXPANSION, ONE LAWSUIT AT A TIME- AK anti-expansioners aren’t giving up. Reps appeared in court this week for the lawsuit to stop the unilateral expansion Guvn’r Walker did late last year. The Judge told them he will make his decision on whether the case can proceed by March. Both sides agree the case hinges on the interpretation of the word “requires” in one line of AK law (run over to the twitter feed for more detail).

CLOCK STARTS ON VA LTSS OPPORTUNITY- Our RFP Batphone has been ringing about this one for a few weeks now. The key info is that VA won’t be renewing its duals demo but will instead make most of it permanent with an 1115 waiver (submitted to CMS Jan 19). MCOs everywhere are sharpening their pencils for the RFP expected to drop in the next few weeks. For those interested, there was also an MLTSS databook released by the state mid-December.

2 DATA BREACHES- GA and LA both reported data breaches of Mcd benny PHI this week. In the Peach State, Centene lost hard drives of about 950k member’s data. In the Pelican State, someone who worked at a doctor’s office stole about 13,000 benny IDs and gave it to another provider.

HOME HEALTH UNDER INVESTIGATION IN MA– There has been an 82% surge (vs 2014) in home health spending in the Bay State. Per recent analysis, 62 companies are driving the surge (and they just so happened to have started doing business with the state during the last 2 years). Stay tuned.

IT HAD TO HAPPEN SOMETIME: A LARGE PLAN AND A “POPULATION HEALTH” COMPANY HAVE JOINED FORCES FOR MEGA MARKET SHARE PLAYS, ER – I MEAN FOR BETTER PATIENT STUFF– Passport and Evolent joined forces to take on the world this week. Expect lots of phrases like “industry-leading,” “patient-centered,” etc.

SHUMLIN’S BID FOR THE MCD MAGIC MONEY MACHINE GOES ON THE ROAD/TO THE PAPERS- Based on the pro-provider tax stories out this week, the Good Guvn’rs staff have been making calls and “suggesting” stories to their favorite journalists.

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Start the ticker and let’s see who wins this week’s award. 3 Florida fraudsters are on the run (Harrel, Durden and Daly. And their other brother, Darryl). They used a licensed MH provider’s billing number without the provider’s knowledge, and stole more than $500k. Rehan Zuberi of Boonton Township, NJ is facing a $7.4M Mcd fraud settlement (we reported on this May of 2014, but we now have a more precise $ amount to use for the award ceremony). It was a slow week for fraud news, but Dr Z – you win! (Note to newer readers: we only report on frauds $50k or higher. Otherwise we would be talking about hundreds of fraud items a week).

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (build a fire!) and keep running the race (you know who you are).

—-

FULL, FREE newsletter: http://eepurl.com/ep81Y

News that didn’t make it and sources for those that did: twitter @mostlymedicaid

Taṇḍri kumāruni prapan̄ca sēv pampina