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Weekly Medicaid RoundUp: Week of May 29th, 2017

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2rMf8Yi

For optimist readers- http://bit.ly/2rMjpuK

 

I SEE CHICKEN LITTLES (READ THAT IN HALEY JOEL OSMENT’S VOICE FROM THE 6TH SENSE)- For all those screaming that the Medicaid world is ending, please see my article last week “A Few Charts re AHCA and Medicaid” (http://bit.ly/2rM9Pbl). We were flying the plane 90 degrees straight up (into the white hot burning sun); now its tacking at about 87 degrees. If you are going to freak out about the “cuts” at least be honest and use the real numbers. Any corrections to my #s / charts much appreciated. Send me a note and I can send you the spreadsheet and we can revise together. It would be like a group project in highschool.

 

SEEMA SAYS- An interview with CMS chief Seema Verma came out this week in USA Today, which is pretty cool because the recently former acting CMS Admin Andy Slavitt (now turned townhall superhero/the Michael Moore of Healthcare) is sort of on staff at USA Today as well. So, balance I guess. Anyway, Seema says that whole state-fed partnership thing is really out of whack in favor of top-down D.C. bullying, and its time for the states to have some actual say in the program, even if it means occasionally going against the D.C. money dealers. Somebody pinch me.

 

SAGEBRUSH STATE SEEKS TO EXPAND- Mike Quixote, er I mean Sprinkle, submitted a bill to expand Medicaid in Nevada this week. Good luck, Mike. Let us know how it turns out!

 

AMERICA’S DAIRYLAND ASKS YOU TO PEE IN A CUP- Wisconsin legislators approved the Good Guvn’r Walker’s drug testing provision for Medicaid coverage this week. Now it just needs to get covfefe-ed by President Trump’s CMS Administration.

 

PRAIRIE STATE SLOWING DOWN MCO STRATEGY- Dems in Illinois passed SB 1446 to require the state to use the normal procurement process in its attempts to expand managed care. Seems current state DHS officials have been using a different process (but not a new one), and legislators think it should be more transparent.

 

THE MUSIC HAS STOPPED AND MEDSTAR DOES NOT HAVE A CHAIR- D.C. MCO awards are out, and MedStar (an incumbent with about 60k bennies) is on the losing list. Per the D.C. report, MedStar had 40% higher costs and a higher service denial rate. MedStar responded that their bennies needed more pharma, but it wasn’t enough to sway the judges. Winners include Trusted Health Plan, AmeriHealth Caritas, and Anthem. Congrats to all our colleagues in the winning MCOs.

 

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Let’s start the ticker and see who wins this week’s award.  Ronette Brown of Bristol, CT was convicted this week for $200k worth of bogus psych therapy. Barbara Wallace of Savannah, GA was sentenced to 41 months for stealing $948k from Medicaid. Her crime? Selling unnecessary medical shoes. Complementary Support Services of Minnesota settled its Medicaid fraud suit for $4.5M. CSS was a mental health provider that fabricated patient records to get paid. Sonia Ponce of Freeport, NY stole $75k by inflating home healthcare aide time sheets under the state’s Consumer Directed Health Program. Total taxpayer tab for this paragraph: $5.8M. CSS you win this 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 (Everything is sprouting!) and keep running the race (you know who you are).

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Medicaid Industry Who’s Who Series: Elena Nicolella

Medicaid Who’s Who: Elena Nicolella – Executive Director, New England States Consortium Systems Organization (NESCSO)

 

 

 

 

 

  1.  What is your current role and in what sector of the industry?

   A: The New England States Consortium Systems Organization is a private, non-profit whose mission is to support State Government Health and Human Service agencies meet their goals.  We focus on: providing training and resources related to Medicaid to State employees, pursuing multi-state procurements, and supporting the effective use of information technology to support the Medicaid Enterprise.

  2.  How many years have you been in the Medicaid industry?

 A. 20 years (yikes!)

  3.  What is your focus/passion? (Industry related or not)

   A: Supporting the delivery of publicly-financed services and supports in ways that are responsive to the needs of people as opposed to the requirements of specific programs.

  4.  What is the top item on your “bucket list?”

   A: Finish all the ironing.

  5.  What do you enjoy doing most with your personal time?

   A: Day trips around New England with the family.

  6.  Who is your favorite historical figure and why?

    A. She is only “historical” to me – but my grandmother.  She was a character!

  7.  What is your favorite junk food?

   A: Olneyville NY System Hot Wieners (it’s a Rhode Island thing)

  8.  Of what accomplishment are you most proud?

   A: Remembering to learn something every day.

  9.  For what one thing do you wish you could get a mulligan?

  A: So many….in general, implementing an initiative without deliberately taking the time to understand the impact on others.

  10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months? 

   A: As States hold their breaths waiting for the outcome of new health care legislation or regulation, I think it is important to take the time to understand, embrace, and fortify their core values and whether or not they are implementing their programs in service of those values.  This will help guide States’ responses to new mandates or opportunities.