Category: MM Curator

Posted on by

OHIO- Humana Healthy Horizons Commits $4.6 Million to Improve Health of Ohioans

MM Curator summary

[MM Curator Summary]: Humana is making donations to 8 different groups in the Columbus area, including food banks, BH providers, housing non-profits, and others.

 
 

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.

 
 

Community investments benefit eight organizations throughout Ohio

COLUMBUS, Ohio–(BUSINESS WIRE)–Humana Healthy Horizons, the Medicaid business of leading health and well-being company Humana Inc. (NYSE: HUM), announced today that it has invested $4.6 million to support community organizations in Ohio that share the company’s passion for overcoming public health challenges and improving the health and well-being of Ohioans.

“The Foodbank is thrilled to work on health equity with Humana. The funds from Humana will be spent providing services to food-insecure residents across the Miami Valley”

Tweet this

“We are committed to supporting the important work being done by these community organizations across Ohio to improve the lives of people in the communities we serve,” said Jeff Corzine, Regional President-Ohio Medicaid at Humana. “We’re investing in community programs that will have a lasting impact on improving the holistic health and well-being of all Ohioans.”

The investments are going to community partners helping parents, families and individuals in need, including new mothers and children, and assisting with housing security, health and wellness, education, work force development, food security and more.

“The Foodbank is thrilled to work on health equity with Humana. The funds from Humana will be spent providing services to food-insecure residents across the Miami Valley,” said Michelle L. Riley, CEO of The Foodbank, a Dayton-area organization serving the Miami Valley through food distribution. “Ensuring our most vulnerable populations have the resources needed for a healthy and happy life is critical for our community to thrive. We thank Humana for its insight and leadership as we work to eliminate hunger in our communities.”

The community partners receiving funds are:

  • The Foodbank
  • Greater Cleveland Food Bank, the largest hunger relief organization in Northeast Ohio
  • Mid-Ohio Food Collective, which provides food to people across 20 central and eastern Ohio counties
  • Volunteers of America Ohio & Indiana, which provides behavioral health services, support for veterans, reentry from the criminal justice system and housing
  • CHN Housing Partners, an affordable housing developer, housing services provider and residential lender
  • March of Dimes, which works to improve the health of mothers and babies
  • Ohio Academy of Family Physicians, a statewide professional association
  • Ohio University, based in Athens

“Connecting families to healthy and nutritious food is an important part of Mid-Ohio Food Collective’s mission,” said Matt Habash, president and CEO of Mid-Ohio Food Collective. “We are thankful to have support from Humana as we continue to work together to find innovative solutions to hunger.”

“With Humana’s support, we are able to reach more people with our signature programs as we work toward our goals of improving maternal health and pregnancy outcomes so more babies will be born full-term and healthy,” said Lisa Amlung Holloway, director of maternal infant health for the March of Dimes in Ohio.

In April 2021, Humana was selected by the Ohio Department of Medicaid (ODM) to deliver health care coverage to Medicaid beneficiaries who live throughout Ohio. When Humana’s program entry is implemented, Humana will serve adults and children across Ohio with the goal of helping them improve their health and well-being through a whole-person, value-based approach that goes beyond traditional clinical care.

Humana has a strong and steadfast commitment to Ohio. As of March 31, 2022, approximately 563,700 Ohioans have health coverage through Humana Medicare Advantage plans, Medicare prescription drug plans, commercial group health plans, and the TRICARE military health care program as administered by Humana.

Humana is proud to be a community partner in Ohio by addressing community and social determinants of health through its Bold Goal program. The Bold Goal is Humana’s population health strategy to improve the health of people it serves, and Cincinnati is one of Humana’s official Bold Goal communities.

In addition, throughout the pandemic, the company has stepped up to support people and programs working to keeping our communities safe and functioning, and to support vaccination efforts.

About Humana Healthy Horizons

Humana manages Medicaid benefits for more than 950,000 members nationally under the Humana Healthy Horizons™ brand, which reflects our expertise in managing complex populations, our commitment to creating solutions that lead to a better quality of life for our members, and our efforts to deliver human care that makes the healthcare experience easier, more personalized and more caring.

During more than two decades of serving people with Medicaid, Humana Healthy Horizons has developed a wide range of capabilities to serve children, parents, childless adults, and beneficiaries that are aged, blind or disabled. We integrate physical health, behavioral health, pharmacy, long-term care, and social services for a whole-person approach to improve the health and well-being of our members and the communities we serve.

Humana Healthy Horizons serves Medicaid enrollees through the following programs:

  • Medicaid Managed Care (MMC)
  • Managed Long Term Services and Supports (MLTSS)
  • Centers for Medicare and Medicaid Services (CMS) Financial Alignment Initiative Dual Demonstrations
  • Medicare Advantage Dual-eligible Special Needs Plans (D-SNPs) and Medicare Prescription Drug Plans (PDPs)

Humana Healthy Horizons is a Medicaid Product offered by affiliates of Humana Inc.

About Humana

Humana Inc. is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.

To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools – such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions – combine to produce a simplified experience that makes health care easier to navigate and more effective.

More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at www.humana.com, including copies of:

  • Annual reports to stockholders
  • Securities and Exchange Commission filings
  • Most recent investor conference presentations
  • Quarterly earnings news releases and conference calls
  • Calendar of events
  • Corporate Governance information

 
 

Clipped from: https://www.businesswire.com/news/home/20220615005259/en/Humana-Healthy-Horizons-Commits-4.6-Million-to-Improve-Health-of-Ohioans

Posted on by

HHS Extends American Rescue Plan Spending Deadline for States to Expand and Enhance Home- and Community-Based Services for People with Medicaid

MM Curator summary

[MM Curator Summary]: States now have until March 2025 to use the new HCBS monies under ARPA.

 
 

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.

 
 

States will have an additional year to use American Rescue Plan funds to strengthen the home care workforce and expand access to services 

Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is notifying states that they now have an additional year — through March 31, 2025 — to use funding made available by the American Rescue Plan (ARP) to enhance, expand, and strengthen home- and community-based services (HCBS) for people with Medicaid who need long-term services and supports. This policy update marks the latest action by the Biden-Harris Administration to strengthen the health care workforce, help people receive care in the setting of their choice, and reduce unnecessary reliance on institutional care.

“Everyone deserves the dignity to live in their own homes and communities, and the Biden-Harris Administration is committed to protecting that right,” said HHS Secretary Xavier Becerra. “Thanks to extended funding from President Biden’s American Rescue Plan, we are expanding home- and community-based services for millions of aging Americans and people with disabilities across the country. We are working hand-in-hand with states to ensure they have the time and support they need to strengthen their home care systems and workforce.”

“The Biden-Harris Administration is committed to expanding access to home- and community-based care for people with disabilities and older adults. Thanks to the American Rescue Plan, these additional funds will help people with Medicaid to live and thrive in the setting of their choice,” said CMS Administrator Chiquita Brooks-LaSure. “With this extension, we are addressing states’ concerns, giving states the time and resources to strengthen connections to care at home and in communities.”

The COVID-19 pandemic has exposed the risks of institutional and congregate settings for older Americans and people with disabilities, underscoring the urgent need to expand access to high-quality HCBS to improve outcomes for people who need long-term services and supports. HCBS allow millions of Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings.

As the primary funder of HCBS nationally, Medicaid plays a critical role in supporting states’ efforts to strengthen these services for their beneficiaries. Section 9817 of the American Rescue Plan provides states with a temporary 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for HCBS — an estimated $12.7 billion. As a result of the ARP increase in the federal matching rate on activities, states originally had a three-year period — from April 1, 2021 through March 31, 2024 — to use the available state funds, attributable to the ARP’s increased FMAP, on activities to enhance, expand, or strengthen HCBS in Medicaid. The extended timeframe, of an additional year, will help to facilitate high-quality, cost-effective, person-centered services for people with Medicaid. This will allow Medicaid beneficiaries to remain in the setting of their choice—whether it is their home or another setting—and remain a valued part of their communities.

This ARP funding allows states to identify and implement changes aimed at addressing existing HCBS workforce and structural issues. It will also help expand states’ capacity to provide critical services and meet the needs of family caregivers and people on HCBS waitlists. Moreover, states can use these funds to tailor HCBS activities based on the needs and priorities of their residents. For example, states can use the funds to provide additional support to address the continued impact of the COVID-19 pandemic on individuals who need long-term services and supports, who are at higher risk for contracting COVID-19, and who might otherwise be in more costly nursing homes and other institutions instead of their own homes. Some states are also using the funds to increase pay and benefits for direct service workers, which many states were unable to do before the ARP funding increase due to funding shortages and restrictions.

Critical safeguards are in place through the ARP legislation and CMS’ guidance to certify that these funds are used appropriately. Between now and the March 2025 deadline, CMS will continue to monitor states’ progress and compliance to ensure funding is used to strengthen HCBS under their Medicaid program.

Additional information on states’ spending plans — including a recently updated infographic summarizing planned activities and key investments — can be found at Medicaid.gov https://www.medicaid.gov/medicaid/home-community-based-services/guidance/strengthening-and-investing-home-and-community-based-services-for-medicaid-beneficiaries-american-rescue-plan-act-of-2021-section-9817-spending-plans-and-narratives/index.html.

To review the guidelines for the use of the ARP funds, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/smd21003.pdf.

To review the State Medicaid Director Letter extending the spending deadline, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/smd22002.pdf.

###

 
 

Clipped from: https://www.cms.gov/newsroom/press-releases/hhs-extends-american-rescue-plan-spending-deadline-states-expand-and-enhance-home-and-community

Posted on by

Colorado’s Medicaid data on race and ethnicity deemed ‘poor’ quality by CMS

MM Curator summary

[MM Curator Summary]: The data can not be used for much; some call for a national survey to be done by CMS.

 
 

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.

 
 

 
 

 
 

 
 

Boram Kim | Jun 2, 2022 | Colorado

CMS recently released its assessments of states’ Medicaid administrative data and Colorado is one of 17 states where race and ethnicity data were of “high concern” due to missing beneficiary information.

 
 

 
 

 
 

The agency reported that the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) race and ethnicity data were missing for more than 40% of beneficiaries in Colorado.

 
 

(Source: CMS – Medicaid.gov)

 
 

CMS stated that these data were “unusable” in 5 other states and of “low concern” in 15 more.

The assessments were made based on the following criteria: (1) Percentage of beneficiaries missing race and/or ethnicity values in the T-MSIS Analytic Files (TAF) and (2) the number of race/ethnicity categories (out of 5) with a percentage point difference greater than 10 between the TAF and American Community Survey (ACS) data.

The Biden administration has made equity a central component of its policy agenda and health care disparities have been exacerbated and exposed by the pandemic.

Data on race and ethnicity for more than 90% of COVID-19 deaths reveals that the percentage of Hispanic or Latino, non-Hispanic Black, and non-Hispanic American Indian or Alaska Native people who have died (red bars) is higher than the percentage of these racial and ethnic groups among the total US population (blue bars).

 
 

(Distribution of COVID-19 deaths and population distributions by race and ethnicity. Source: CDC)

 
 

This disparity is even greater when the percentages are age-standardized (adjusted for differences in the age distribution across racial and ethnic groups).

In Colorado, Hispanic or Latino (+1.73 distribution gap in COVID-19 deaths vs. population), non-Hispanic Black (also a +1.73 gap), and non-Hispanic American Indian or Alaska Native people (+4.8 gap) also have a disproportionate burden of COVID-19 deaths among specific age groups across the lifespan—children, youth, adults, and older adults. The distribution gap in percentage of COVID-19 deaths vs. population for non-white Hispanics was -1.35. 

 
 

“Because with COVID-19, we discovered that people who are Black and brown were exposed to a high percentage of deaths, just based on a variety of different circumstances. Maybe they’re frontline workers, maybe it’s because of the environment that they’re living in—condensed quarters and those kinds of things,” said Sen. Rhonda Fields (D – Aurora), Chair of the Senate Health & Human Services Committee, speaking to the importance of the Colorado Health Equity Plan during a State of Reform panel discussion in 2021. 

“We passed Senate Bill 181 to make sure that we create an equity lens and every department that reports to the governor, so that means labor, that means housing, that means public health, just everything everyone has to have a goal that addresses disparities as relates to health. So that’s important.” 

 
 

Medicaid enrollment forms pose race and ethnicity as optional fields for beneficiaries. Distrust over how agencies will use the information has prompted many enrollees to opt out of sharing this crucial health equity data.

Researchers at the University of Minnesota’s State Health Access Data Assistance Center have suggested three strategies to improve the country’s overall race and ethnicity data quality in the Medicaid program:

  • Communicate the importance of the data and how it will be used
  •  Work with community organizations to engage enrollees in improving data collection
  • Augment race and ethnicity data obtained via self-report with data from other sources such as vital records, EHRs, and other state-administered programs

According to a recent Health Affairs report, health policy experts suggest a national survey might be more effective at collecting better quality data and closing the gap on disparities.   

 
 

“A national Medicaid survey could help support more comprehensive monitoring of healthcare need relative to use, and if designed to oversample racial and ethnic minoritized populations, could also support more rigorous monitoring of quality of care and disparities within the program,” the report said.

 
 

CMS has not conducted a survey of Medicaid enrollees since 2014-2015, when the agency fielded its Nationwide Adult Medicaid Consumer Assessment of Healthcare Providers and Systems (NAM CAHPS).

The authors suggest expanding on existing infrastructure and investing in a national survey would improve the evaluation and advancement of health equity in the Medicaid program. 

 
 

Clipped from: https://stateofreform.com/featured/2022/06/colorados-medicaid-data-on-race-and-ethnicity-deemed-poor-quality-by-cms/

Posted on by

NC Medicaid bill causes stir over changes to how hospitals compete

MM Curator summary

[MM Curator Summary]: NC hospitals want the Medicaid expansion money; they do not want more competition under relaxed CON rules.

 
 

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.

 
 

 
 

Enlarge

The N.C. Department of Health and Human Services oversees the state’s certificate of need process for health care systems.

TBJ file photo

The North Carolina Senate passed a sweeping health care reform bill last week, and hospitals in the state have mixed feelings about it.

The wide-ranging legislation – known as House Bill 149 or Expanding Access to Healthcare – passed through the Senate nearly unanimously in a final vote Thursday that sends the package to the House. The bill would expand access to Medicaid to an estimated 500,000 North Carolinians, a move supported by the association that represents the state’s health care systems.

“North Carolina hospitals would see a reduction in uncompensated care by closing the coverage gap, which would have a particular impact on our struggling rural hospitals,” the North Carolina Healthcare Association said in a statement. “When hospitals provide care without adequate reimbursement, costs rise for everyone, including for those with insurance.”

But while the association backs this measure, it opposes changes to the state’s certificate of need (CON) law included in the bill. The CON law requires health care providers to receive approval from the state’s Department of Health and Human Services before acquiring, replacing or adding facilities and equipment – such as a new hospital or surgical center.

For instance, last year, UNC Health and Duke Health both submitted plans to add 40 acute care beds in Durham County. State regulators approved UNC’s proposal, and the health care system has since applied to further expand the project, but Duke continues to challenge the proposal.

Enlarge

The new UNC Rex Holly Springs Hospital

UNC Health

The association says the CON approach “right-sized healthcare resources in our state,” while controlling costs and making care accessible. But critics of the law argue that the process inflates heath care prices by limiting competition between providers.

The Senate bill reduces the number of projects that require a certificate of need. This includes removing the CON requirement for chemical dependency treatment facilities, ambulatory surgical facilities and magnetic resonance imaging (MRI) scanners.

A nonprofit called Affordable Healthcare Coalition of North Carolina says many of the reforms in the Senate bill will “increase access to new and better care.” The nonprofit describes itself as a group of businesses, organizations and individuals concerned about the increasing health care and prescription drug costs. Two members of its board of directors work for Blue Cross Blue Shield of North Carolina.

Health care systems and hospitals in the state are “deeply concerned” about modifications to the CON law, according to the statement from the N.C. Healthcare Association.

“Modifying the current CON law would hurt the stability of rural hospitals by carving out elective and outpatient procedures which are the lifeblood of community hospitals, while allowing niche medical organizations without such federal regulation to cater to commercially insured patients,” the association said in its statement.

The association is also opposed to a part of the bill that regulates telehealth. The group said the legislation would make it “harder for providers to care for patients through modern technology.”

In addition to expanding Medicaid and reforming the state’s CON regulations, the bill includes protections against surprise medical billing. The legislation would require that patients receiving care at an in-network facility be informed ahead of time if some services or staff are out of their insurance network.

The legislation would also allow advanced practice registered nurses to provide medical services without a physician to supervise their work. The Affordable Healthcare Coalition of North Carolina says the change wouldn’t allow these nurses to perform services they’re not already performing. Instead, the bill would remove a requirement that these nurses meet with a supervising physician every six months.

 
 

Clipped from: https://www.bizjournals.com/triangle/news/2022/06/07/nc-medicaid-expansion-bill-includes-con-reform.html

Posted on by

NJ – Linden woman charged in a years-long Medicaid fraud scheme

MM Curator summary

[MM Curator Summary]: Leslie Lassen falsified eligibility information to hide her income and stole $350k in benefits in this member fraud.

 
 

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.

 
 

 
 

Leslie K. Lassen

An extensive investigation has led to the arrest of a Linden woman, Union County Prosecutor William A. Daniel announced Wednesday.  The criminal complaint comes as the result of a nearly two-year investigation led by Detective Alex Lopez of the Union County Prosecutor’s Office’s Special Prosecutions Unit.  Leslie K. Lassen, 39, was charged on May 23rd with one count of second-degree theft and two counts of third-degree tampering with records in connection with the scheme.

In June of 2020, the Prosecutor’s Office received a referral from the New Jersey Medicaid Fraud Division pertaining to the theft of Medicaid funds by Lassen, said Assistant Prosecutor Melissa Spagnoli, who is handling the case.  The exhaustive investigation that followed revealed that between January 2015 and December 2019, Lassen filed numerous falsified documents with Medicaid in which she under-reported her household income.  Based upon those fraudulent submissions, Lassen stole nearly $350,000 in public funds that she wasn’t entitled to.

 “I am grateful to the members of the Prosecutor’s Office’s Special Prosecutions Unit for their diligence and dedication throughout this investigation,” said Prosecutor Daniel. “Our commitment to stem a rising wave of fraud and financial crime — particularly that which targets public funds needed by our most vulnerable citizens — remains unwavering. 

Convictions on second-degree criminal charges are commonly punishable by 5 to 10 years and those on third-degree crimes can result in 3 to 5 years.

These criminal charges are mere accusations. Each defendant is presumed innocent unless and until proven guilty in a court of law.

 
 

Clipped from: https://ucnj.org/prosecutor/press-releases/prosecutor/2022/06/01/linden-woman-charged-in-a-years-long-medicaid-fraud-scheme/

Posted on by

FL – Prison Time Handed Down To Tampa Man Convicted Of Medicaid Fraud

MM Curator summary

[MM Curator Summary]: Josh Maywalt used his role as a medical biller to file false claims and send them to a bank account he owned. You lost $2M in tax dollars.

 
 

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.

 
 

Crime & Safety


Prosecutors said the fraud occurred when Joshua Maywalt worked as a medical billing company in Clearwater.

 
 

D’Ann Lawrence White,

Patch Staff

 
 

Posted Mon, Jun 6, 2022 at 11:33 am ET

 
 

Prosecutors said the fraud occurred when Joshua Maywalt worked as a medical billing company in Clearwater. (Shutterstock)

TAMPA, FL — A 42-year-old Tampa man has been sentenced to five years, five months in federal prison for health care fraud, aggravated identity theft, filing a false income tax return and failing to file an income tax return.

U.S. District Judge Mary S. Scriven also ordered Joshua Maywalt to forfeit $2,257,029.86 and real property at 5346 Northdale Boulevard in Tampa, which can be traced to proceeds of his crimes.

Maywalt pleaded guilty on Dec. 1.

Find out what’s happening in Tampawith free, real-time updates from Patch.

According to court documents, Maywalt worked as a medical biller at a company in Clearwater that provided credentialing and medical billing services for its medical provider clients. In this capacity, Maywalt had access to the company’s financial, medical provider and patient information.

Maywalt was assigned to a Tampa Bay area physician’s account and was responsible for submitting claims to Florida Medicaid Health Maintenance Organizations for services rendered by the account to Medicaid recipients.

Find out what’s happening in Tampawith free, real-time updates from Patch.

According to prosecutors, Maywalt abused his role as a medical biller by wrongfully accessing and using the company’s patient information and account identification number to submit false and fraudulent claims to a Florida Medicaid HMO for medical services which were not actually rendered.

Maywalt also altered the “pay to” information associated with the HMO’s payment processor so the payments for the non-rendered medical services were sent to bank accounts under Maywalt’s control.

Prosecutors said Maywalt also signed and filed a false federal income tax return 2019 which substantially understated his income and reported only his employment wages, and not the money he was depositing into his bank accounts as a result of his fraudulent activities.

In addition, prosecutors said Maywalt failed to file federal income tax returns for 2017 and 2018.

“Health care industry professionals are required to follow Medicaid rules and accurately bill for services that are actually provided. Fraudulently billing Medicaid for personal gain cheats millions of people who fund the program and contributes to the soaring cost of health care,” said Omar Perez Aybar, special agent in charge with the Department of Health and Human Services. “Working closely with our law enforcement partners, we will continue to pursue those who exploit government health care programs.”

“Joshua Maywalt had no concern for anyone except himself. He exploited the personal information of medical patients, fraudulently billed services on behalf of a local physician and then cheated the U.S. tax system for his own personal gain,” said Brian Payne, special agent in charge of the IRS Tampa Field Office. “In the end, committing fraud doesn’t pay. In this case, it resulted in a five-year prison sentence and a multimillion dollar forfeiture order.”

Clipped from: https://patch.com/florida/southtampa/prison-time-handed-down-tampa-man-convicted-medicaid-fraud

Posted on by

NY: Dansville doctor settles Medicare, Medicaid fraud allegations

MM Curator summary

[MM Curator Summary]: James Sakr stole $600k with a services not provided scam for ENT procedures.

 
 

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.

 
 

A Livingston County physician has agreed to pay more than $600,000 to resolve allegations that he fraudulently billed Medicare and Medicaid from 2014 through 2019.

U.S. Attorney Trini E. Ross said James A Sakr, an ear, nose and throat doctor with an office in Dansville, will pay $602,661.61 under an agreement announced Tuesday.

Prosecutors alleged Sakr billed the federal programs for procedures he did not perform or failed to document in patient records.

“The resolution of this case holds Dr. Sakr accountable for his actions and requires him to return the money he should not have received from Medicare and Medicaid,” Ross said. “Our office will continue to root out fraud in federal healthcare programs and hold those who defraud the public accountable.”

The civil settlement includes the resolution of claims by Dr. Lee M. Mandel under the whistleblower provisions of the False Claims Act. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. Mandel will receive a share of the settlement.

David M. Coriell, assistant U.S. attorney  for the Western District of New York, handled the case.

Officials said the U.S. Attorney’s Office coordinated with the U.S. Department of Health and Human Services Office of Inspector General and the New York State Attorney General’s Office Medicaid Fraud Control Unit.

Follow Neal Simon on Twitter @HornellTribNeal. To get unlimited access to the latest news, please subscribe or activate your digital account today.

 
 

Clipped from: https://www.eveningtribune.com/story/news/2022/06/07/dansville-doctor-settles-medicare-medicaid-fraud-allegations/10002382002/

Posted on by

Ohio House approves bill allowing doula services to be covered by Medicaid

MM Curator summary

[MM Curator Summary]: HB 142 moves forward the effort to use non-traditional providers to improve maternity outcomes.

 
 

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.

 
 

 
 

KAMPUS

/

Shutterstock

Pregnant woman and doula at home.

A bill to expand access to doula services is moving to the Ohio Senate after receiving a near unanimous vote out of the Ohio House.

Doulas are professional labor assistants who work with pregnant people to provide physical and emotional support throughout pregnancy, labor, and postpartum.

The proposed law, HB142, would allow Medicaid coverage for doula services.

In their support, Republican and Democratic lawmakers in the House emphasized the important role doulas can play for safe and healthy child births.

Rep. Juanita Brent (D-Cleveland) said doulas can act as an advocate during the whole process of pregnancy – from doctor’s appointments through the first year of the baby’s life.

Brent said having a doula was once considered a commodity reserved for the wealthy, but allowing for Medicaid reimbursement can expand those services to more people.

“If we really want to fight infant mortality, if we really want to fight maternal mortality, maternal mobility, we need to make sure that everyone has access to doulas,” Brent said.

Brent noted the importance of providing more access to these types of services given the disproportionately high infant mortality rate for Black babies in Ohio.

Rep. Tom Brinkman (R-Mount Lookout) is a co-sponsor of the bill. Along with the health benefits, Brinkman pointed to the financial benefits of allowing Medicaid coverage for doulas.

“When we look at the cost effectiveness of doula care and the reduction of preterm birth and cesarean delivery, women who receive doula support had lower preterm caesarean birth rates than Medicaid beneficiaries regionally, and women with doula care had 22% lower odds of preterm birth,” Brinkman said.

The proposed expansion of Medicaid coverage for doula services has come at a time when Democratic and Republican lawmakers are locked in a heated debate over abortion rights. The U.S. Supreme Court is expected to make a decision – as early as this month – on a case that could overturn Roe v. Wade. If that 1973 landmark case is overturned, Ohio legislators could pass laws to ban abortions.

Brent, a supporter of abortion rights, noted the importance of providing services for healthy pregnancies if lawmakers block access to abortion.

“If Ohioans are being forced to have babies and that could be the law of the land – even though we’re fighting against that – then help make it easier for people to have babies. Particularly Black women who are disproportionately affected by this. Let’s make sure that people can have healthy deliveries and we can have healthy babies,” Brent said.

The bill is now in the Ohio Senate where lawmakers are not expected to reconvene the policymaking process until this fall.

 
 

Clipped from: https://www.wyso.org/local-and-statewide-news/2022-06-07/ohio-house-approves-bill-allowing-doula-services-to-be-covered-by-medicaid

Posted on by

U.S. Supreme Court rules in Florida Medicaid expense case

MM Curator summary

[MM Curator Summary]: SCOTUS ruled that states can recover lawsuit settlement monies for member care, even if the settlement designates it for future medical expenses.

 
 

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.

 
 

 
 

By Jim Saunders News Service of Florida

Updated June 06, 2022 1:55 PM

  •  

TALLAHASSEE

Nearly 14 years after a Lee County girl was catastrophically injured when she was hit by a truck, the U.S. Supreme Court on Monday said Florida’s Medicaid program can recoup a chunk of the money it paid for her initial care.

Justices, in a 7-2 opinion, sided with the Florida Agency for Health Care Administration in a case that drew attention from officials across the country.

The dispute stemmed from a November 2008 accident in which Gianinna Gallardo was struck by a truck after getting off a Lee County school bus. Florida’s Medicaid program paid $862,688 to cover initial medical expenses for Gallardo, who was 13 at the time of the accident and remains in a “persistent vegetative state,” according to the Supreme Court opinion.

Gallardo’s parents filed a lawsuit against the truck’s owner, its driver and the Lee County School Board and reached an $800,000 settlement. The settlement designated $35,367 for “past” medical expenses, with an unspecified amount earmarked for “future” medical expenses, according to the opinion written by Justice Clarence Thomas.

READ MORE: Fla. program that shirked duty to help kids with brain injuries could face a costly reckoning

Citing a formula in state law, the Agency for Health Care Administration, which runs most of Florida’s Medicaid program, said it was entitled to recoup $300,000 of the $800,000 settlement. But attorneys for the Gallardo family argued that the state should not be able to recover money earmarked for future medical expenses.

The Supreme Court, however, upheld a decision by the 11th U.S. Circuit Court of Appeals that backed the state.

“Under [a section of federal law], Florida may seek reimbursement from settlement amounts representing ‘payment for medical care,’ past or future,” Thomas wrote in a 16-page opinion joined by Chief Justice John Roberts and Justices Samuel Alito, Elena Kagan, Neil Gorsuch, Brett Kavanaugh and Amy Coney Barrett.

But Justice Sonia Sotomayor, in a dissent joined by Justice Stephen Breyer, wrote that the majority opinion “is inconsistent with the structure of the Medicaid program and will cause needless unfairness and disruption.” Sotomayor also wrote that Medicaid “is not a loan.”

“If a Medicaid beneficiary’s financial circumstances change and a beneficiary gains the ability to pay for his or her own medical expenses, the beneficiary is not obligated to repay the state for past expenses, no matter the magnitude of the change in circumstances,” the dissent said. “Rather, the ordinary consequence is that the individual simply becomes ineligible for benefits moving forward.”

Gallardo has continued to receive Medicaid benefits. Sotomayor wrote that money from the legal settlement was placed in what is known as a “special needs trust,” which can pay expenses not covered by Medicaid.

The U.S. Department of Justice lined up with the Gallardo family at the Supreme Court, while 14 states and groups such as the National Conference of State Legislatures backed the Agency for Health Care Administration.

This story was originally published June 6, 2022 11:59 AM.

 
 

Clipped from: https://www.miamiherald.com/news/health-care/article262202387.html

Health Care


 

Posted on by

Colorado expands Medicaid access to undocumented pregnant people and their babies

MM Curator summary

[MM Curator Summary]: Add Colorado to the list of states using 100% state money to cover non-citizens but calling it Medicaid.

 
 

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.

 
 

 
 

Pregnant undocumented immigrants and their children will be eligible for Medicaid starting in 2025 under a bill signed by Gov. Jared Polis Tuesday. 

Sponsors of HB22-1289 are aiming to close gaps in healthcare access for immigrants. 

“Expanding health-care coverage to all children, pregnant and postpartum people, regardless of immigration status, is fundamental to correcting the root causes of health inequities in Colorado,” said Rep. Serena Gonzales-Gutierrez in a statement. “This law will be life-changing for undocumented children and pregnant people who call Colorado home and deserve to have access to the healthcare they need.” 

Under the law, pregnant undocumented people who would otherwise qualify for Medicaid and the Children’s Basic Health Plan, or CHIP, would be provided full health insurance coverage for up to a year following a child’s birth. Undocumented children will be eligible until they turn 18.  

Healthcare advocates praised the passage of the bill. Yesenia Beascochea, a community organizer with Center for Health Progress, has been fighting for a bill to expand healthcare eligibility since 2015. She said it will help address persistent health issues undocumented people face.

“COVID allowed us to see a side that a lot of people turn their eyes on,” Beascochea said. “The undocumented population, including children, including babies, including senior citizens, were not able to access healthcare the way that the rest of us did.”  

In addition to the Medicaid expansion, the bill immediately expands healthcare benefits for all enrollees. Medicaid and CHIP members will have free access to lactation supplies and support services, like breast pumps. 

“There’s a huge shortage of baby formula,” Beascochea said. “This is gonna be a huge help for all those parents who are new parents and can’t find formula.”

Beginning in 2024, a special enrollment period will open for pregnant people, who can sign up for benefits as soon as they find out they’re expecting. The Department of Health Care Policy and Financing will also be tasked with expanding outreach to eligible people. 

The change is expected to cost the state $26 million per year by 2025.

 
 

 
 

Clipped from: https://www.cpr.org/2022/06/07/colorado-expands-medicaid-access-undocumented-pregnant-people/