Author: MM_ADMIN

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DeSantis urged to release plan for Florida’s looming Medicaid crisis

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Ronnie is being asked what his plan is.

 
 

Clipped from: https://www.tampabay.com/news/health/2022/12/08/desantis-medicaid-looming-crisis-florida-children-uninsured-covid-19-pandemic/

 
 

Hundreds of thousands of Florida’s poorest children could lose health insurance next year when the federal government is expected to end expanded Medicaid coverage put in place during the COVID-19 pandemic.

The looming crisis has prompted a coalition of 40 Florida nonprofits, health organizations and child advocacy groups to sign a letter sent Wednesday to Gov. Ron DeSantis, urging the state to release its plans for managing the transition.

The number of Floridians relying on the federal program that provides medical coverage for individuals with disabilities and very low-income families and children rose by 1.7 million during the public health emergency to 5.5 million, roughly one quarter of the state’s population.

Related: Medicaid expansion in Florida? South Dakota vote may show the way.

That was largely the result of the federal government paying states additional money to keep people covered through the federal program during the pandemic even though they were no longer eligible, according to a study by the Georgetown University Center for Children and Families.

But that money will dry up when the federal government ends the public health emergency declaration, possibly as soon as April.

Florida has yet to publish a plan on how it will deal with Medicaid recipients who are no longer eligible and at risk of losing health coverage. The state also faces the burden of having to recertify the eligibility of its 5.5 million recipients, a potential logjam that could force it to hire hundreds of additional workers.

“The public health emergency unwind will mean a tsunami of coverage loss,” said Alison Yeager, executive director of the Florida Health Justice Project. “We know who’s going to be hit the hardest by this loss — parents, children and young adults, postpartum women and the elderly and disabled.”

Florida Department of Children and Families officials said in a statement released Wednesday that they are working with the Agency for Health Care Administration, community partners and other state agencies to begin an effort to reach out to current Medicaid enrollees, emphasizing the importance of providing current contact information so they can be reached.

“To those groups creating unnecessary panic by insinuating that Florida is not prepared, we can assure you that the department is prepared,” the statement says. “There is a plan in place.”

But Florida has not published its plan as states like North Carolina, Utah and Oklahoma have already done.

The coalition’s letter calls for the state to ensure that qualified Floridians maintain their Medicaid coverage and those who are no longer eligible receive help finding other health insurance such as the marketplace options offered under the Affordable Care Act or KidCare, a subsidized insurance program for children.

It also states Florida should follow the recommendation from the Centers for Medicare & Medicaid Services that states stagger a return to pre-pandemic Medicaid operation over a 12-month period.

 
 

Related: Why millions on Medicaid are at risk of losing coverage

Nationwide, the Georgetown study warns that 6.7 million children are at risk of losing coverage, potentially more than doubling the nation’s uninsured rate for children if states do not take steps to keep eligible ones enrolled during the transition.

Florida residents currently covered by Medicaid may be more at risk from the end of the public health emergency than most.

Florida is among just 11 states to not take advantage of an Affordable Care Act provision that provides additional money to expand Medicaid eligibility. Doing so would would make an estimated 900,000 Floridians eligible, or more than 4% of the state’s population. That includes more than 400,000 who earn below the federal poverty level, according to the Florida Policy Institute, a Tallahassee nonprofit.

Staff writer Romy Ellenbogen contributed to this report.

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Up to 18 million people could lose Medicaid coverage after COVID-19 PHE

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: A new sky is falling number hides the punchline that 10M will go back to getting insurance from their employer, and more than 1M will get heavily-subsidized marketplace coverage. And that all of this is due to the fact that Medicaid will be returning to normal eligibility rules.

 
 

Clipped from: https://www.healthcarefinancenews.com/news/18-million-people-could-lose-medicaid-coverage-after-covid-19-phe

Findings suggest the result could see the largest changes in coverage since the ACA came into force more than a decade ago.

 
 

Photo: Image Source/Getty Images

Upwards of 18 million people could lose Medicaid coverage, and four million people could become uninsured entirely when the COVID-19 public health emergency expires next year, according to a recently published analysis from the Urban Institute.

This could result in the biggest changes in coverage since the Affordable Care Act was implemented more than a decade ago, findings suggested.

The most recent data shows that enrollment jumped by more than 18 million people from February 2020 to June 2022. This increased enrollment largely owes to the continuous coverage requirement of the Families First Coronavirus Response Act, which has prevented state Medicaid agencies from disenrolling people during the PHE unless they specifically request it.

Using the latest available administrative data on Medicaid enrollment, recent household survey data on health coverage, and the Urban Institute’s Health Insurance Policy Simulation Model, analysts estimated that about 3.2 million children are estimated to transition from Medicaid to separate Children’s Health Insurance Programs, so total Medicaid and CHIP enrollment will decline by 14.8 million people.

About 3.8 million people will become uninsured, data showed, while about 9.5 million people will either newly enroll in employer-sponsored insurance after losing Medicaid, or transition to employer-sponsored insurance as their only source of coverage after being enrolled in both employer-sponsored insurance and Medicaid sometime during the PHE.

On top of that, more than one million people will enroll in the nongroup market, most of whom will be eligible for premium tax credits in the marketplace.

Further extensions of the PHE are possible, according to the Urban Institute. If it’s extended for an additional 90 days, the number of people losing Medicaid will likely rise to nearly 19 million.

WHAT’S THE IMPACT?

The largest share of people losing Medicaid, 9.5 million, will end up with employer-sponsored insurance (ESI), the report found. Nationally, unemployment has nearly returned to pre-pandemic levels, and many people will lose Medicaid eligibility precisely because they gained new employment during the PHE. An unknown number of those transitioning from Medicaid to ESI only was enrolled in both types of coverage during the PHE; the number of people newly enrolling in ESI after the PHE will likely be considerably lower than 9.5 million.

The end of the PHE is still uncertain. If it is extended for 90 more days, about one million more people will lose Medicaid after its expiration. The Biden administration has promised to give 60 days’ notice before the end of the PHE but has resisted requests by many states for more notice.

While nearly four million people are likely to become uninsured, people transitioning from Medicaid to private coverage will pay more in premiums and out-of-pocket health costs. It is possible that more people losing Medicaid, particularly those without access to ESI, may experience a temporary interruption in health coverage before enrolling in alternative coverage.

State policy decisions during the transition following the PHE expiration will affect how many people lose coverage, how rapidly they lose coverage, and how many people will enroll in other coverage, according to the Urban Institute.

Medicaid enrollment during the PHE may have other lasting effects, such as raising awareness of churning in health insurance coverage, and possibly changing perceptions of Medicaid, authors said. The experience may also inform the debate around other issues related to churn and continuity of coverage, such as 12-month continuous eligibility in Medicaid and better coordination between Medicaid and the marketplaces.

THE LARGER TREND

The public health emergency will be extended past its current deadline of January 11. The new deadline will be in April if it’s extended for another 90 days.

The PHE keeps waivers and policies in place for Medicaid coverage, telehealth coverage, and add-on payments to hospitals and physicians. Telehealth waivers will expire 151 days after the end of PHE.
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com

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19 States Must Align Medicaid Vaccine Coverage Policies with IRA

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Most of the states that will need to cough up more for vaxxes are non-expansion states.

 
 

Clipped from: https://healthpayerintelligence.com/news/19-states-must-change-medicaid-vaccine-coverage-policies-to-comply-with-ira

Both fee-for-service programs and Medicaid managed care plans will have to review their Medicaid vaccine coverage policies.

 
 

Source: Getty Images

 
 

By Kelsey Waddill

December 06, 2022 – Almost two-fifths of US states—particularly those that have avoided Medicaid expansion—will need to change their Medicaid vaccine coverage policies in order to align with the Inflation Reduction Act, an Avalere white paper found.

The Inflation Reduction Act passed through Congress and received the presidential signature on August 16, 2022.

The law requires states to cover all recommended vaccines for adult Medicaid enrollees with zero cost-sharing by the beginning of October 2023. Coverage will be similar to commercial market requirements.

Avalere examined the difference between vaccine coverage pre-implementation of the Inflation Reduction Act and post-implementation. The white paper received funding but no editorial input from Pfizer.

The researchers used publicly available data to observe changes for five recommended vaccines: influenza, tetanus/diptheria/acellular pertussis (Tdap), human papillomavirus (HPV), pneumococcal polysaccharide vaccine (PPSV23), and pneumococcal conjugate vaccine (PCV13). Avalere conducted this research from April through December 2021.

There were 11 fee-for-service programs and 6 Medicaid managed care plans that did not cover at least one of the recommended vaccines. The researchers noted that states that did not adopt Medicaid expansion were more likely not to cover one or more of the recommended vaccines.

States were most likely not to cover vaccines that involved risk-based or shared clinical decision-making. Across the states that had coverage gaps, eight fee-for-service and Medicaid managed care plans did not cover the HPV vaccine. Six plans—five fee-for-service programs and one Medicaid managed care plan—did not cover the PCV13 vaccine. Every plan covered the influenza vaccine.

Additionally, five fee-for-service programs and one Medicaid managed care plan covered a vaccine but required cost-sharing, which could range from $0.65 to $4.00.

These findings are critical for the 19 states that need to adjust their Medicaid coverage policies or review Medicaid managed care plans’ coverage to align with the Inflation Reduction Act.

“Although IRA requirements will not take effect until October 1, 2023, states that do not already cover all ACIP-recommended vaccines without cost sharing for their full adult Medicaid populations will need to act quickly and modify coverage policies in the coming months to meet the IRA timeline,” Avalere researchers noted.

Avalere anticipated that CMS would offer guidance to help Medicaid programs and stakeholders understand their obligations.

The researchers warned that the law could be pursued in a way that increases care disparities. The Inflation Reduction Act did not fix low provider reimbursement rates for vaccinations that disincentivize this form of preventive care, and the law may not reimburse pharmacists and set up billing barriers.

“These barriers may also extend to safety net providers which disproportionally serve vulnerable individuals and families, like Federally Qualified Health Centers. These barriers could lead to increased health disparities for patients. Some Medicaid-related vaccine topics are likely to be addressed in forthcoming implementation guidance; interested stakeholders should consider whether and how to engage CMS to shape that guidance,” Avalere recommended.

During the coronavirus pandemic, health equity in coronavirus vaccine distribution was a critical issue, but the challenges proved to have a presence beyond the coronavirus vaccine as well.

 
 

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MCOS- Centene to pay Oregon $17M in latest Medicaid overbilling settlement

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Rinse, repeat.

 
 

Clipped from: https://www.beckerspayer.com/payer/centene-to-pay-oregon-17m-in-latest-medicaid-overbilling-settlement.html

Centene will pay Oregon $17 million to settle allegations the payer overcharged the state’s Medicaid program for pharmaceutical services, the Oregon Justice Department said Dec. 6. 

The payer has settled with several other states over similar allegations, including Arkansas, Illinois, Kansas, Massachusetts, Mississippi, New Hampshire, New Mexico, Ohio, Texas and Washington. 

According to Kaiser Health News, Centene has paid settlements to other states not disclosed. 

According to a 2021 Securities and Exchange Commission report, Centene created a $1.25 billion reserve to pay for these settlements. 

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RX- Medicaid Spending on Antiretrovirals Increased Between 2007 and 2019

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Medicaid spent $25B on HIV drugs over a 12 year period, and the researchers try to figure out what drove increases.

 
 

Clipped from: https://www.infectiousdiseaseadvisor.com/home/topics/hiv-aids/medicaid-spending-antiretrovirals-increased-between-2007-2019/

Medicaid spending on antiretroviral therapies (ARTs) used to treat human immunodeficiency virus (HIV) increased by 178% between 2007 and 2019, according to study findings published in Clinical Infectious Diseases.

Researchers at Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts, sought to estimate Medicaid spending on ARTs to treat HIV between 2007 and 2019. They obtained publicly available data on Medicaid State Drug Utilization, and approximated Medicaid’s net spending based on average prices and Medicaid rebates for 48 available ARTs. The base Medicaid rebate ranged from 15% to 23% plus any added rebates if the medication’s price increased faster than inflation.

According to the researchers’ estimates, Medicaid spent around $25 billion for 17 million 30-day supplies of the 48 available ARTs between 2007 and 2019.

When comparing 2007 spending to 2019 spending, Medicaid’s annual net spending increased by 178% from $1.1 billion to $3.0 billion, while the average net price of ARTs increased 28% from $1432 to $1830 for every 30-day supply. Annual use of ARTs increased 118% from 700,000 to 1.6 million 30-day supplies during the same period. These increases suggest that newer ART formulations, combinations, and ingredients were more expensive, and that inflationary rebates did not effectively counteract rising costs.

Other factors may also explain the rising spending on ARTs. The population of Medicaid beneficiaries increased, particularly following the passage of the Affordable Care Act, which expanded Medicaid eligibility in 2012. Treatment advancements and improved efficacies also extended the lifespan of individuals living with HIV.

”

[T]he US government should be authorized to assure that launch prices for new drugs covered by Medicaid are aligned with the added benefit they offer over existing therapies.

In 2007, the most commonly used ARTs included TVD, EFV/FTC/TDF, and LPV/r. In 2019, the most commonly used ARTs consisted of single-tablet regimens, including BIC/F/TAF, E/C/F/TAF , and DOL/ABC/3TC.

Limitations of the study include possible underestimation of actual rebates, use of estimated ART prices and estimated medication usage based on 30-day supplies of medications.

“Medicaid spending on [ARTs] nearly tripled from 2007-2019, due to expanded use of [ARTs] and rising prices,” the study authors conclude. They add, “To prevent sustained high prices due to serial replacement of brand-name drugs with incrementally different products among [ARTs] and other classes of drugs, the US government should be authorized to assure that launch prices for new drugs covered by Medicaid are aligned with the added benefit they offer over existing therapies.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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Revecore Medicaid Analyst Job in Crescent Springs, Kenton, KY

Clipped from: https://www.recruit.net/job/medicaid-analyst-jobs/F4AD7B736B60707C?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Duties and Responsibilities
Skills and Experience
* Minimum 3-years Medicaid experience working with claims and/or billing
* Accounts receivable/follow-up experience
* Moderate computer proficiency including working knowledge of Microsoft Word and Excel
* High school diploma or equivalent
* Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division
* Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
* Ability to write routine correspondence (in English)
* Ability to define problems, collect data, establish facts and draw valid conclusions
* Strong customer service orientation
* Excellent interpersonal and communication skills
* Strong team player
* Commitment to company values
* Associate or Bachelors Degree preferred but not required
Disclaimer: BLS salaries are intentionally not posted and are based on level of experience. Some sites arbitrarily post salaries but are not an accurate representation.
Candidates must be currently and in the future authorized to work in the United States on a full-time basis. BLS does not sponsor candidates for permanent residency.

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Job Care Navigator – WellSense Health Plan

Clipped from: https://uk.talent.com/view?id=c6f1d25bc268&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The Care Navigator is a non-clinical member of the Care Team whose role is to engage members in care management, ensure member’s care is coordinated, issues are resolved and support the Care Management team.

The Care Navigator collaborates with their clinical team members, the Customer Care department and other internal departments to support member needs.

Our Investment in You :

  • Full-time remote work
  • Competitive salaries
  • Excellent benefits

Key Functions / Responsibilities :

  • Uses motivational interviewing skills to engage members into care management via telephonic outreach
  • Provides information to members with the goal of increasing Member knowledge and participation in their own healthcare management including but not limited to information on how to obtain resources;

basic health information; information packets containing health information relative to the Member’s identified condition

  • Advocates for the Member by sharing information with community-based providers to include follow-up on closed loop referrals
  • Answers and triages calls from the department’s toll-free line
  • Triages cases to clinical staff, other departments, contracted vendors and providers as appropriate
  • Manages referrals, performs telephonic screening assessments, arranges wellness visits and provides appointment and preventative care reminders, as needed
  • Coordinates and facilitates access to services, resolves issues or benefit questions, and transfers to the appropriate Care Manager as needed
  • Performs Care Management Case Closure Satisfaction Assessments with Members
  • Acts as the primary point of contact for Coordinated Transportation Solutions (CTS), responsible for managing the internal CTS mailbox, provides initial triage for issues, and escalates as appropriate
  • Partners with department leadership and team members to organize staff assignments, prioritize and triage activities and calls
  • Provide administrative support to Well Sense high risk / high needs and Transitional care management programs
  • Programs member cell phones as needed to support care management team
  • Responsible for preparing department data / reports assigned by Management
  • Provides administrative support for meetings
  • Identifies opportunities for improvement in administrative workflows and processes
  • Performs other associated tasks as assigned by Manager
  • Maintains accurate and timely documentation in the medical management information system CCMS / JIVA in keeping with contractual requirements, internal policy and accreditation standards.

Qualifications : Education :

Education :

Associate’s degree required in health care or a related area or equivalent relevant work experience

Experience :

  • Two years of office experience, specifically in either a high-volume customer service call center, data entry office, or health care office administration department
  • Prior customer service / call center experience preferred
  • Prior work with Medicaid population preferred
  • Bilingual preferred

Competencies, Skills, and Attributes :

  • Strong motivational interviewing skills
  • Ability to engage members
  • Strong oral and written communication skills
  • Detail oriented
  • Ability to work independently but also in a team setting
  • Demonstrated strong organizational and time management skills
  • Demonstrated ability to successfully prioritize, plan, organize and manage multiple tasks in a face-paced environment
  • Intermediate skill level with Microsoft Office products Outlook, Word, Excel
  • Ability to effectively collaborate with health care providers and all members of the interdisciplinary team
  • Knowledge of medical terminology strongly preferred

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 440,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans.

Founded 25 years ago, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

WellSense will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.

Required Experience

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Health Insurance Specialist- CMS

Clipped from: https://www.usajobs.gov/job/689981300?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Department of Health And Human Services
Office of Legislation (OL)

COVID-19 Vaccination Requirement

The COVID-19 vaccination requirement for federal employees pursuant to Executive Order 14043 does not currently apply. Some jobs, however, may be subject to agency- or job-specific vaccination requirements, so please review the job announcement for details. Click here for more information.

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Legislation (OL), Medicare Parts A and B Analysis Group.

As a Health Insurance Specialist, GS-0107-13, you will review, analyze, and evaluate proposed legislation, regulations and other administrative actions for CMS programs.

Learn more about this agency

Help

Overview

  • Accepting applications

 
 

  • Open & closing dates

11/30/2022 to 12/04/2022

  • Salary

$81,216 – $105,579 per year

This is the BASE salary for this position. Please see “Additional Information” for locality pay rates.

  • Pay scale & grade

GS 13

Location

No

  • Telework eligible

Yes—as determined by the agency policy.

  • Travel Required

Not required

  • Relocation expenses reimbursed

No

  • Appointment type

Permanent –

  • Work schedule

Full-time –

  • Service

Competitive

  • Promotion potential

13

  • Job family (Series)

0107 Health Insurance Administration

  • Supervisory status

No

  • Security clearance

Not Required

  • Drug test

No

  • Position sensitivity and risk

Moderate Risk (MR)

  • Trust determination process

Credentialing

Suitability/Fitness

  • Announcement number

CMS-OL-23-11735368-DE

  • Control number

689981300

Videos


Help

Duties

  • Develop, recommend, and prepare legislative policies and proposals for consideration by senior policy officials.
  • Conduct legislative, economic, and policy analyses related issues under Parts A and B of the Medicare Program.
  • Anticipate and address congressional inquiries on complex policies and issues.
  • Review and prepare responses to press articles, external reports and studies, congressional statements, and proposed legislation to identify potential policy and technical issues and other concerns.

Help

Requirements

Conditions of Employment

  • You must be a U.S. Citizen or National to apply for this position.
  • You will be subject to a background and suitability investigation.
  • This is a remote position; however, the position reports to a CMS Office on a periodic basis. Requirements to report to the office will vary and can be discussed at the time of interview.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT.


Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.


In order to qualify for the GS-13 you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-12 grade level in the Federal government, obtained in either the private or public sector, to include:
(1) Working with Members of Congress or their staff on legislative interests or concerns; (2) Producing written documents, such as briefing documents, reports, issue papers, or decision memoranda regarding the Medicare program AND (3) Conducting analysis of Medicare legislation.


Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.


Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11735368

Education

This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: Yes–American Federation of Government Employees, Local 1923

Tour of Duty: Flexible

Recruitment/Relocation Incentive: Not Authorized

Financial Disclosure: Not Required


To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce Executive Order 14043 Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a federal job announcement includes the requirement to be fully vaccinated against COVID-19 pursuant to Executive Order 14043, that requirement does not currently apply. Positions with vaccination requirements under authority(ies) separate and distinct from Executive Order 14043 will be clearly identified. HHS may continue to require documentation of proof of vaccination to ensure compliance with those policies. Health and safety protocols remain in effect, in accordance with CDC guidance and the Safer Federal Workforce Task force. Consistent with current guidance, workplace safety protocols will no longer vary based on vaccination status or otherwise depend on the availability of vaccination information. Therefore, to the extent a job announcement states that HHS may request information regarding the vaccination status of selected applicants for the purposes of implementing workplace safety protocols, this statement does not currently apply.


Remote-In Positions at CMS: This is a remote position; however, the position reports to a CMS Office on a periodic basis (e.g. 8-12 times per year). Requirements to report to the office will vary and can be discussed at the time of interview. As such, your pay will be based on your home address. For more information on locality and pay scales, please visit here. Your worksite must be within the United States and you must adhere to all regulations and policies regarding remote work at CMS and in the federal government, including the signing of a remote work agreement.


Full-Time Telework Program for CMS Employees: CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program. If an employee in this program is selected, the pay will be set in accordance with the locality pay for the applicable duty station. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page.


The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM’s Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.

Read more

A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

Review our benefits

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

You will be evaluated based on how well you meet the qualifications listed in this vacancy announcement. Your qualifications will be evaluated based on your application materials (e.g., resume, supporting documents), the responses you provide on the application questionnaire, and the result of the online assessments required for this position. Please follow all instructions carefully. Errors or omissions may affect your rating.


You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics):


  • Analysis
  • Attention to Detail
  • Customer Service
  • Decision Making
  • Flexibility
  • Health Insurance
  • Integrity/Honesty
  • Interpersonal Skills
  • Learning
  • Oral Communication
  • Reading Comprehension
  • Self-Management
  • Stress Tolerance
  • Teamwork
  • Written Communication

In order to be considered for this position, you must complete all required steps in the process. In addition to the application and application questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job.


Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration. Cheating on the online assessment may also result in your removal from consideration.


You will be placed in one of the following categories based on category rating and selection procedures if you meet all of the requirements outlined in this job opportunity announcement:

  • Best Qualified – for those who are superior in the evaluation criteria
  • Well Qualified – for those who excel in the evaluation criteria
  • Qualified – for those who only meet the minimum qualification requirements

If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration.


This is a competitive vacancy announcement advertised under Delegated Examining Authority. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would therefore be given new appointments to the civil service; however, benefits, time served and all other Federal entitlements would remain the same.


The category rating process does not add veterans’ preference points or apply the “rule of three” but protects the rights of veterans by placing them ahead of non-preference eligibles within each category. Veterans’ preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent will be listed in the highest quality category (except in the case of professional or scientific positions at the GS-09 level or higher).


Additional selections may be made from this announcement for similar positions within CMS with the same remote/telework designation and same geographical location, if applicable. For example, for Woodlawn, MD vacancies the “same geographical location” includes Baltimore, Maryland; Bethesda, Maryland; and Washington, D.C.

A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

Review our benefits

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

  • As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have – whether you’re a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you’re eligible under their policies.

To apply for this position, you must submit a complete Application Package which includes:


1. Resume showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates. For work in the Federal service, you must include the series and grade level for the position(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/.


Your resume will be used to validate your responses to the assessment tool(s). We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Determining length of general or specialized experience is dependent on the information provided in the resume. Failure to include ALL of the information listed below on your resume WILL result in a finding of ineligible.

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates in the month and year format (e.g. June 2007 to April 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.


3. Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments, if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments here: https://help.usastaffing.gov/Apply/index.php?title=Reasonable_Accommodations_for_USA_Hire

  • Please read the entire announcement and all the instructions before you begin an application. To apply for this position, you must complete the initial online application, to include the initial online assessment and submission of the required documentation specified in the Required Documents section. The complete application package must be submitted by 11:59 PM (ET) on 12/04/2022 of the announcement to receive consideration. The application process is as follows:

 
 

  1. To begin the application process, click the Apply button. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
  2. Follow the system prompts in USAJOBS to select your resume and supporting documents; review your application package; include personal information; and continue the application process in the USA Staffing agency site.
  3. Answer the questions presented in the online application and attach all necessary supporting documentation in USA Staffing.
  4. Click the Submit Application button prior to 11:59PM (ET) on 12/04/2022.
  5. After submitting an online application, you will be notified whether or not you are required to take additional online assessments through the USA Hire Competency Based Assessment system. This message will be delivered to you via email notification. The email may be routed to your “Spam” or “Junk” folder.
  6. If you are asked to take the USA Hire Competency Based Assessments, you will be presented with a unique URL to access the USA Hire system. Access to USA Hire is granted through your USAJOBS login credentials. Be sure to review all instructions prior to beginning your USA Hire Assessments. Click here for Computer System Requirements.
  7. Note, set aside at least 3 hours to take these assessments; however, most applicants complete the assessments in less time. If you need to stop the assessments and continue at a later time, you can re-use the URL sent to you via email and also found by clicking the Track This Application link located in the application record in your USAJOBS account.

To update your application, including supporting documentation, at any time during the announcement open period, return to your USAJOBS account (https://my.usajobs.gov/Account/Login). There you will find a record of your application, the application status, and an option to Edit My Application. This option will no longer be available once the announcement has closed.


To verify the status of your application both during and after the announcement open period, log into your USAJOBS account: https://my.usajobs.gov/Account/Login. All of your applications will appear on the Welcome page. The application record in your USAJOBS account contains a Track This Application link that provides information regarding the documentation you submitted and any correspondence we have sent related to this application, including the invitation to take the USA Hire assessment. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.


Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.
 

Agency contact information

CMS TABG DCO A2

Email

TABG_DCOATeam2@cms.hhs.gov

Address

Office of Legislation
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

Based on your application and your responses to the application questionnaire, you may be presented with instructions on how to access the USA Hire system to complete the online assessments. The online assessments must be completed within 48 hours following the close of this announcement. You will have the opportunity to request a testing accommodation for the assessment should you have a disability covered under the Americans with Disabilities Act (ADA).


Your assessment results will be kept on record for one year and used toward future positions for which you might apply that require the same assessments.


  • The Federal hiring process is set up to be fair and transparent. Please read the following guidance.

 
 

Help

Required Documents

To apply for this position, you must submit a complete Application Package which includes:


1. Resume showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates. For work in the Federal service, you must include the series and grade level for the position(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/.


Your resume will be used to validate your responses to the assessment tool(s). We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Determining length of general or specialized experience is dependent on the information provided in the resume. Failure to include ALL of the information listed below on your resume WILL result in a finding of ineligible.

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates in the month and year format (e.g. June 2007 to April 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.


3. Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments, if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments here: https://help.usastaffing.gov/Apply/index.php?title=Reasonable_Accommodations_for_USA_Hire

Help

How to Apply

Please read the entire announcement and all the instructions before you begin an application. To apply for this position, you must complete the initial online application, to include the initial online assessment and submission of the required documentation specified in the Required Documents section. The complete application package must be submitted by 11:59 PM (ET) on 12/04/2022 of the announcement to receive consideration. The application process is as follows:

  1. To begin the application process, click the Apply button. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
  2. Follow the system prompts in USAJOBS to select your resume and supporting documents; review your application package; include personal information; and continue the application process in the USA Staffing agency site.
  3. Answer the questions presented in the online application and attach all necessary supporting documentation in USA Staffing.
  4. Click the Submit Application button prior to 11:59PM (ET) on 12/04/2022.
  5. After submitting an online application, you will be notified whether or not you are required to take additional online assessments through the USA Hire Competency Based Assessment system. This message will be delivered to you via email notification. The email may be routed to your “Spam” or “Junk” folder.
  6. If you are asked to take the USA Hire Competency Based Assessments, you will be presented with a unique URL to access the USA Hire system. Access to USA Hire is granted through your USAJOBS login credentials. Be sure to review all instructions prior to beginning your USA Hire Assessments. Click here for Computer System Requirements.
  7. Note, set aside at least 3 hours to take these assessments; however, most applicants complete the assessments in less time. If you need to stop the assessments and continue at a later time, you can re-use the URL sent to you via email and also found by clicking the Track This Application link located in the application record in your USAJOBS account.

To update your application, including supporting documentation, at any time during the announcement open period, return to your USAJOBS account (https://my.usajobs.gov/Account/Login). There you will find a record of your application, the application status, and an option to Edit My Application. This option will no longer be available once the announcement has closed.


To verify the status of your application both during and after the announcement open period, log into your USAJOBS account: https://my.usajobs.gov/Account/Login. All of your applications will appear on the Welcome page. The application record in your USAJOBS account contains a Track This Application link that provides information regarding the documentation you submitted and any correspondence we have sent related to this application, including the invitation to take the USA Hire assessment. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.


Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.
 

Read more

Agency contact information

CMS TABG DCO A2

Email

TABG_DCOATeam2@cms.hhs.gov

Address

Office of Legislation
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

Based on your application and your responses to the application questionnaire, you may be presented with instructions on how to access the USA Hire system to complete the online assessments. The online assessments must be completed within 48 hours following the close of this announcement. You will have the opportunity to request a testing accommodation for the assessment should you have a disability covered under the Americans with Disabilities Act (ADA).


Your assessment results will be kept on record for one year and used toward future positions for which you might apply that require the same assessments.


Read more

Posted on by

Health Insurance Specialist (Program Policy). | Centers for Medicare & Medicaid Services

Clipped from: https://www.linkedin.com/jobs/view/health-insurance-specialist-program-policy-at-centers-for-medicare-medicaid-services-3382766213/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Duties

 
 

  • Evaluate and analyze the impact of new or revised changes to legislation before the Congress pertaining to any CMS program.
  • Conduct analysis of policy issues and topics by researching background information, the origin of laws, and the intended impact in order to make effective policy recommendations.
  • Work with the CMS Office of Legislation and related Congressional committees and staff in performing an impact analysis or mark-up of various Congressional options before the committees.
  • Provide technical assistance, consistent with program expertise and experience, other Federal agencies staff, State agencies and private sector organizations.
  • Develop and review health care policies and legislation in order to draft related policy documents, regulations, procedures and guidance to states.
  • Prepare all forms of written correspondence regarding program policy related activities and Medicaid issues to the public, Congressional staff, industry contacts, and State representatives.

 
 

Requirements

 
 

Conditions of Employment

 
 

  • You must be a U.S. Citizen or National to apply for this position.
  • You will be subject to a background and suitability investigation.
  • Time-in-Grade restrictions apply.
  • This is a remote position; however, the position reports to a CMS Office on a periodic basis. Requirements to report to the office will vary and can be discussed at the time of interview.

 
 

Qualifications

 
 

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT.


Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.


In order to qualify for the GS-13, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-12 grade level in the Federal government, obtained in either the private or public sector, to include: (1) Conducting analysis of national health insurance program policy issues in order to propose policy modifications; (2) Developing regulations, manuals, program guidelines, program memoranda, policy letters, and/or instructions to communicate health insurance program policies; and (3) Presenting recommendations and conclusions based on analysis and evaluation of health insurance programs that describe feasible options and/or the consequences.


Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.


Time-in-Grade: To be eligible, current or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.


Click The Following Link To View The Occupational Questionnaire


Education


This job does not have an education qualification requirement.


Additional information


Bargaining Unit Position: Yes – American Federation of Government Employees, Local 1923


Tour of Duty: Flexible


Recruitment/Relocation Incentive: Not Authorized


Financial Disclosure: Not Required


To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce Executive Order 14043 Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a federal job announcement includes the requirement to be fully vaccinated against COVID-19 pursuant to Executive Order 14043, that requirement does not currently apply. Positions with vaccination requirements under authority(ies) separate and distinct from Executive Order 14043 will be clearly identified. HHS may continue to require documentation of proof of vaccination to ensure compliance with those policies. Health and safety protocols remain in effect, in accordance with CDC guidance and the Safer Federal Workforce Task force. Consistent with current guidance, workplace safety protocols will no longer vary based on vaccination status or otherwise depend on the availability of vaccination information. Therefore, to the extent a job announcement states that HHS may request information regarding the vaccination status of selected applicants for the purposes of implementing workplace safety protocols, this statement does not currently apply.


Remote-Out Positions at CMS: This is a remote position; however, the position reports to a CMS Office on a periodic basis (e.g. 1-2 times per year). Requirements to report to the office will vary and can be discussed at the time of interview. As such, your pay will be based on your home address. For more information on locality and pay scales, please


The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy.


  • A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding.


Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.