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NE- Gov. Ricketts Presents 2021 Medicaid Provider Awards

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Nebraska providers are recognized for their impact on Medicaid members.



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.


Media Contacts:  

Taylor Gage, Governor’s Office, 402-471-1970

Barb Tyler, Dept. of Health and Human Services, 402-471-3486


Media Release:

Gov. Ricketts Presents 2021 Medicaid Provider Awards




From left to right: (DHHS CEO Dannette R. Smith, DHHS Director of Medicaid and Long-Term Care

Kevin Bagley, Dr. Sami Webb, Gov. Ricketts, Dr. Paula Harre)


LINCOLN – Today, Governor Pete Ricketts; Dannette R. Smith, CEO of the Department of Health and Human Services (DHHS); and Kevin Bagley, Director of the DHHS Division of Medicaid and Long-Term Care, honored four doctors with Nebraska Medicaid Provider awards.  The awards recognize outstanding providers within Heritage Health Adult, Nebraska’s Medicaid program.


“The winners of the Nebraska Medicaid Provider Awards delivered great customer service and responsibly stewarded taxpayer dollars,” said Gov. Ricketts.  “They help deliver on DHHS’ mission to help Nebraskans lead better lives.  Thank you to each of the award winners for your contributions to improving services for the people of Nebraska.”


Gov. Ricketts awarded one winner from each of the managed care organization (MCO) networks and dental plan.  The MCOs are UnitedHealthcare Community Plan of Nebraska, Nebraska Total Care, Healthy Blue of Nebraska, and MCNA Dental.  Award recipients were selected for having demonstrated exceptional care to the Medicaid population and measurable contributions during the pandemic through their clinical practice.  Winners were nominated from within each of their respective organizations. 


“We are extremely grateful to our Medicaid providers who help their fellow Nebraskans live better lives,” said Director Bagley.  “During a difficult year, these providers went above and beyond in providing excellent service to our Medicaid members.  These awards recognize their contributions to the Medicaid program and their commitment to improving the health of their community.”


The honorees of the Nebraska Medicaid Provider Awards are:


Dr. Kris McVea: Nominated with honor by Healthy Blue of Nebraska, Dr. McVea is passionate about the patients that both she and her team care for.  Her suggestions and input have been invaluable, not only at OneWorld in Omaha where she serves as Medical Director, but also as an advocate for all Medicaid members in Nebraska.  Dr. McVea has been an active member of her MCO quality improvement committee, and she also has led her team in pursuing quality metrics and goals for her clinics.  Her dedicated approach combines her pediatrics and epidemiology/public health training.  Dr. McVea uses data to drive quality health outcomes, but her dedication to the care of her patients is where she thrives.  During the coronavirus pandemic, she helped push drive-through immunization clinics onsite at OneWorld.  She also helped her team nimbly move to telemedicine visits on short notice to meet the needs of members.


Dr. McVea received her undergraduate degree from Stanford University and her medical degree with distinction from UNMC.  She then earned her M.P.H. in Epidemiology from the University of North Carolina.  Currently, she serves as a Graduate Faculty Member at the University of Nebraska Graduate College in Omaha.  Last year, she was awarded both the Public Citizen of the Year from the National Association of Social Workers, Nebraska Chapter, and the Nebraska Medical Association’s Distinguished Service to Medicine honor.


Dr. John Tubbs: Nebraska Total Care (NTC) identified Dr. John Tubbs from Stuart, NE, as its nominee for the Governor’s Medicaid Award.  Dr. Tubbs graduated from Ross University School of Medicine and completed his residency in Family Medicine at Creighton University School of Medicine.  After he completed his residency in 2002, Dr. Tubbs went into practice at Midtown Family Practice in Omaha.  In 2005, he and his wife, Erica, chose to move to Northeastern Nebraska to provide medical care to a more rural population.  They have clinics in Stuart, Atkinson, and Bassett and are enjoying the opportunity to continue offering quality medicine to the communities.


Dr. Tubbs is the winner of the NTC 2020 Physician Summit Award, which is presented to a doctor within the organization’s statewide network.  The award honors the provider who has produced the highest Healthcare Effectiveness Data and Information Set (HEDIS) quality scores across multiple key measures.  Dr. Tubbs has been a provider in NTC’s network since the plan’s inception on January 1, 2017, and he has demonstrated a commitment to delivering high-quality services and meeting rural health needs for the Medicaid members in his communities.      


Dr. Erica Peterson: Nominated by UnitedHealthcare Community Plan, Dr. Peterson is a pediatrician for Bluestem Health in Lincoln, where she has served as a provider since January 2012.  She is a member of the American Academy of Pediatrics and the Lancaster County Medical Society.  Dr Peterson earned her Bachelor of Science degree from the University of Nebraska-Lincoln and completed medical school at Duke University School of Medicine in 2000, with an emphasis on internal medicine and pediatrics.  Dr. Peterson also holds a Master of Public Health in Epidemiology from the University of North Carolina.


Dr. Peterson has been active with the National Association of County and City Health Officials Grantee for Breastfeeding Education and Support and served six years on Lancaster County Medical Society’s Board of Directors. 


Dr. Peterson is an advocate for the Reach Out and Read program, which champions the positive effects of reading daily and engaging in other language-rich activities with young children.  Dr. Peterson collaborated with the Lincoln Public Libraries and other donors to secure funding and books to give out to pediatric patient populations.  Dr. Peterson implemented the Pediatric Vision Screening tools to help identify sight problems with babies and children before they are identified by parents.


Dr. Peterson is committed to giving parents information and connecting them to local resources involving developmental promotion, early detection, and connection to community resources; this has allowed families to better understand developmental delay.  She has been a strong believer that utilizing Electronic Health Record (EHR) data leads to improved health outcomes.  The data has helped to improve the HPV vaccine numbers for boys and girls in the Bluestem Health clinics. 


Dr. Peterson has worked with staff to utilize Behavioral Health screening tools to identify postpartum depression, demonstrating that early identification gives pediatricians the greatest opportunity to have personal interaction with the infant and mother to appropriately screen and offer the most appropriate care.


Dr. Sami Webb: Nominated by MCNA Insurance, Dr. Webb is the only full-time resident orthodontist in Western Nebraska participating in the Medicaid program.  She has been in practice for 16 years in Scottsbluff, providing high-quality orthodontic care and serving the unique needs of children enrolled in the Nebraska Medicaid Program.  After earning her undergraduate degree at the University of Nebraska-Lincoln, Dr. Webb completed her Doctor of Dental Surgery (DDS) degree at the University of Nebraska Medical Center College of Dentistry.


A member of the Schulman Group, whose members represent the top two percent of orthodontists practicing in the United States, Dr. Webb has been recognized on multiple occasions for practice growth and innovative marketing efforts, served on several committees (including the New Membership Committee and the Steering Committee), and accepted appointment to the Board of Directors. 


Her practice, Webb Orthodontics, currently serves patients out of the Elite Health Center, a state-of-the-art medical office complex housing multiple dental and medical specialties and other businesses.  As a community leader, Dr. Webb is deeply committed to giving back to others both personally and through her practice, leading Webb Orthodontics to partner with organizations and key community stakeholders.  Since its inception, Dr. Webb’s practice has given $500,000 in sponsorships and donations to strengthen and support her community.  She and her team at Webb Orthodontics seek out opportunities to volunteer their time to help non-profit groups and work with area schools to provide on-the-job shadowing and internship opportunities for young adults who are interested in the dental profession.  They also participate in community events, providing free dental care and services to those in need.  Dr. Webb’s focus on community service and support, and her continuing dedication to serve those enrolled in Nebraska Medicaid, allow her to positively impact the lives of her patients, their families, and her community. 


Full video of today’s award ceremony is available by clicking here.  



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Home care in Ohio to see federal, state funding increases

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Home health providers will get rate increases for a 2nd year.


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.



For a very long time, as costs and understaffing increased, home and community-based services in Ohio pleaded with state lawmakers and governors to give them more Medicaid money to no avail.

Under Gov. Mike DeWine, the industry – adult day care, assisted living, home care and others offering less intensive alternatives to nursing homes – is finally seeing the needle moved.

“I want to give credit to the administration and to the General Assembly, because finally we have broken that cycle,” said Pete Van Runkle, head of the Ohio Health Care Association. “There was a 10-plus year cycle of no increases in assisted living reimbursement. Same was true with home care.”

Beginning in November, providers will see Medicaid reimbursement rate increases – albeit still not enough – for the second budget cycle in a row.

And with the COVID-19 pandemic worsening existing issues while highlighting more need for home-based care, significant federal COVID-19 relief funding is on its way. 

On the state level

Advocates say that aging in home is significantly less expensive and more accessible for disabled Ohioans, and safer than a skilled nursing facility, despite a history of fraud.

The average cost of care for in-home services can be $1,225 per month, said Beth Kowalczyk, policy officer for the Ohio Association of Area Agencies on Aging. Nursing facility care is estimated to cost $6,361 per month.

Yet for many years, Medicaid reimbursement for home-based care has not come close to meeting the actual costs, groups have said. A nursing visit that costs $95 on average is reimbursed at $54, said Lisa Von Lehmden Zidek, with the Visiting Nurse Association of Ohio.

The gap widened more when the pandemic increased costs and wages.

“The other home care agencies are simply not accepting Medicaid patients. They’re not taking on the financial loss,” Zidek told lawmakers last week. “Only the agencies that will take Medicaid are getting flooded with even more Medicaid referrals.” 

People have to be turned away, leading to more stress on nursing facilities where COVID-19 issues for congregate settings are well known, say home health care advocates. Those on Medicaid, who are low-income or disabled and stand the most to benefit from at-home care, lose out.

Long-term trends estimating a greater share of Medicaid folks to receive in-home care instead of in a facility are only adding to the pressure.

Almost 200,000 Ohioans on Medicaid are enrolled in a home and community-based services program as of June, per state data. Upwards of 60% of individuals with Medicaid coverage are choosing home and community-based settings. 

Increases in reimbursement rates can make a dent into that cycle. In 2019, Ohio committed to giving 3.25% increases for just two home-health programs as well as some more money to the direct care workforce.   

This year, all home and community-based health programs are set to see a 6.1% increase in rates in November. That’s estimated to be more than $57 million coming in, with at least $20 million of that from the state, according to the Legislative Budget Office. 

But to really address the issue, it’ll take more than continually increasing reimbursement rates, said Joe Russell, executive director of the Ohio Council for Home Care and Hospice. He’s advocating that care underMedicaid gets paid more like Medicare is in the state.

Medicaid reimburses on a “fee for service” model. If a direct care nurse visits a home for just 15 minutes, for instance, the home care agency gets reimbursed lower than if the nurse had visited for 45 minutes.

Under Medicare’s “pay per visit” model, the amount is the same no matter the length of the visit. That gives a lot more flexibility for home care providers, said Russell.

“Tracking the amount of time a nurse is visiting is a regulatory burden,” he said. “It costs the same amount of money to send a nurse no matter the length of the visit.”

Federal help

The federal government, recognizing the importance of home care in light of the COVID-19 pandemic, is also beefing up cash to the sector through the American Rescue Plan Act.

The temporary 10% bump in the federal share of Medicaid funding for home and community-based health care means that Ohio will get a total of $460 million between April of this year and March of 2022.   

The state has until March 2024 to use that additional money to make changes to the home-health system. While one-time, immediate needs from the coronavirus will be considered, the goal is to pinpoint more sustainable, long-term investments, Ohio Department of Medicaid Director Maureen Corcoran told lawmakers.

Providers in home care are eyeing the federal money and have already submitted feedback to the department on how to use that funding.

While most are looking at using money from increased reimbursement rates to help agencies make ends meet, they want to dedicate much of the federal aid to improve wages and work conditions for direct care workers, said Jordan Ballinger, policy director for Disability Rights Ohio, part of the Ohio HCBS Coalition.

“They’re making $12 an hour and Ohio’s estimated $13 an hour is what meets basic needs,” he said. “I think we should go above and beyond basic needs for these direct care workers.”

Workforce development is also another big priority, with issues exacerbated by the pandemic. Videk said since the beginning of 2020, around half of visiting nurses have left.

She told lawmakers she was thinking of hopefully using some of the federal money to create a program targeting students to thinking about becoming at-home providers, paired with tuition reimbursement.

“If we have a stream of employees coming through the organization that are basically raised by our organization, four years out from now I don’t believe we’re going to have the shortage that we have,” she said.

The Medicaid department released a vague, initial plan in June that outlined eight categories for potential projects, from workforce development to telehealth. The agency is in the process of incorporating feedback to create a more detailed plan.

Even with all the anticipated financial help, problems plaguing home health care are likely here to stay for now.

“Over the past 10 years, we have shifted from a crisis in this workforce and provider rates to really an emergency,” said Ballinger. “We’re going to continue to take hits on our HCBS system.” 

Titus Wu is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.


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Akron Children’s creates new company to care for 100,000 Medicaid patients

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A children’s hospital is starting a Medicaid ACO for children.


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.


Akron Children’s Hospital is creating a new subsidiary to help coordinate and improve overall care of 100,000 Medicaid patients in a 13-county region. 

The new company called the Akron Children’s Health Collaborative will be what’s called an accountable care organization or ACO.

An ACO is a “partnership between doctors, hospital and other health care providers that work together to offer high quality care at a lower cost and directly with insurers,” said Kris Grayem, Akron Children’s vice president of population health. 


The first contract for the new company is with CareSource, the largest insurer of Medicaid-covered children in the state. The collaboration will begin Oct. 1. 

Akron Children’s is in negotiations with the other Medicaid managed-care insurers for children in its 35-county coverage area to create similar collaborations, hopefully within the next six months to a year, said Shawn Lyden, Akron Children’s chief strategy officer. 

This will be Children’s first foray into an ACO.

Instead of getting paid every time a child covered by CareSource is seen at the hospital or at Children’s physician offices,  Children’s will receive a set amount of money per CareSource enrollee per month, according to Grace Wakulchik, Children’s Hospital president and CEO. 

With those funds, the company is “entrusted to use to care for these group of Medicaid children,” Wakulchik said. “The thought being with our excellent clinical coordination systems, we can coordinate that care better so that those kids get better front-end care. So we manage their health better so there aren’t those adverse expensive hospitalizations. 

“We want to intervene early. We want to coordinate your care. We want to have the best possible outcome and so that’s the risk we are taking by accepting this per member per month amount that we will be able to manage that care better for those families,” she said. 

Akron Children’s officials declined to share financial details of the contract. 

How does the Akron Children’s Health Collaborative work?

Currently, the hospital loses money on each Medicaid patient, Wakulchik said.  

“We’re hoping by managing kids getting preventive care, dental care and other care, we’ll be able to manage their care when it costs less not only to us but to keep the kids healthier,” she said. “In the long run, I don’t know this will be as profitable per se, but hopefully we won’t lose as much money.” 

About 42% of the 100,000 children who will be part of this new care model are currently Akron Children’s patients and already get some of the holistic care through the hospital’s population health efforts, which started in 2017, Lyden said.  

For instance, Children’s already has been helping with other social barriers to health care —such as transportation needs, food insecurity and housing needs — for its existing Medicaid patients, said Grayem. 

But 58% of children covered in the new collaborative have primary care physicians who are independent practitioners or aren’t affiliated with Children’s. The monthly money Children’s collaborative will get can be used for some of those same social barriers for all covered children in the plan, according to Lyden and Wakulchik. 

Part of the model will be partnering with those providers to engage them in the proactive care of the children. Those independent practitioners still have their contract with CareSource and also will receive an incentive from Children’s ACO company to work together. 

An example, Wakulchik said, is “say we have a pathway that helps asthmatics stay out of the hospital. We’re not just going to use that for patients we serve in Akron Children’s. We want to work with our community partners and they will use them in their practice to help keep them healthier.” 

Medicaid is Akron Children’s single largest payor, accounting for 53% of total charge, Lyden said. 

“This is a ripe area for us to get involved in this accountable care population health,” he said. 

Akron Children’s has been working with a network of independent physicians and federally qualified health centers to set up the collaborative and also will have five members on the collaborative board, Wakulchik said. 

In a statement, CareSource Ohio Market President Steve Ringel said “CareSource’s history is built on breaking down the barriers of health care to increase access to seamless high-quality cost-effective care. 

“Our partnership with Akron Children’s Hospital will continue to support our youngest members and their families in northeast Ohio.” 

13 counties covered

The collaborative’s CareSource contract will cover 13 counties: Summit, Stark, Portage, Wayne, Medina, Ashland, Carroll, Holmes, Tuscarawas, Trumbull, Mahoning, Columbiana and Huron. 

There are still another 120,000 Medicaid-covered children in the 13 counties with other insurers that are not yet covered under this new model, Lyden said.  

Akron Children’s currently has a 35-county service area and will consider opportunities to expand the collaborative in future years, he aid. 

The new model is not a “patient-steering mechanism” to try to get more patients to Akron Children’s facilities, Wakulchik said. While she would like it if working with more community partners would involve better access to Akron Children’s facilities, the collaborative would be responsible for children’s care in the program anywhere they go. 

“They can go anywhere they want,” Lyden added. “They could go to Columbus and it’s still on our nickel. It still comes out on our fixed payment.” 

Said Grayem: “The main thing is we want to improve the health of kids by focusing on quality and improving health equity for better outcomes.” 

 Beacon Journal staff reporter Betty Lin-Fisher can be reached at 330-996-3724 or Follow her @blinfisherABJ on Twitter or To see her most recent stories and columns, go to


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Medicaid Cost of Incomplete Payment Eats Into Physician Reimbursement

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Doctors get their claims denied by Medicaid more than 6x vs commercial payers.



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.


One-quarter of Medicaid claims result in a denial of payment for at least one service included in the claim compared with just 7.3% of claims submitted to Medicare and 4.8% of claims submitted to commercial insurers

One-quarter of Medicaid claims result in a denial of payment for at least one service included in the claim compared with just 7.3% of claims submitted to Medicare and 4.8% of claims submitted to commercial insurers, according to National Bureau of Economic Research study published in July.

Abe Dunn, Ph.D., the study’s lead author and an economist in the Bureau of Economic Analysis in the Department of Commerce, and his colleagues set out to examine and quantify the “administrative frictions” in claims for medical services.

They came up with a statistic they call the cost of incomplete payments (CIP), which comprises forgone revenues when a claim is denied and the costs associated with the back-and-forth of trying to get payment. Their research shows that CIP eats up 17.4% of the contracted fee of a typical Medicaid visit, 5% of a Medicare fee and 2.8% of commercial insurance fee.

“These are significant losses — especially for Medicaid, which offers physicians much lower reimbursement rates than other insurers in the first place,” they wrote. Medicaid’s high CIP is, they argue, tantamount to a tax on physician revenues.

Dunn and his co-authors say their research opens up another avenue to reducing inequality in healthcare.

“Without expanding eligibility or raising reimbursement, improving Medicaid claims administration could help make healthcare for low-income Americans more similar to Medicare or employer-sponsored healthcare,” they said.


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NC Medicaid providers to be reimbursed for COVID-19 vaccine counseling

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Providers will now be paid to answer questions for patients about the vaccine.


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.


RALEIGH — To help Medicaid beneficiaries get the accurate information they need to make an informed decision about getting the COVID-19 vaccine, the North Carolina Department of Health and Human Services will reimburse Medicaid providers for providing counseling on the benefits of COVID-19 vaccination.

 NC Medicaid providers can now be reimbursed for up to 15 minutes for preventive medicine counseling and/or risk factor reduction intervention provided to an individual related to COVID-19 vaccination when provided to Medicaid beneficiaries. Many children do not yet qualify for the vaccine, but their family members do. Parents or guardians of children receiving Medicaid — even if they are uninsured — can also receive counseling from their child’s doctor. Medicaid providers will be reimbursed for this counseling as well. 

“It is our hope that other payers will adopt this additional reimbursement to acknowledge the time and effort front line practices are investing so that more COVID-19 vaccine makes it to North Carolinians before flu season arrives,” said Dr. Shannon Dowler, Chief Medical Officer of Medicaid at NCDHHS. 

Research done nationally and in North Carolina shows medical professionals are one of the top trusted sources for information about COVID-19 vaccines. With many North Carolinians still having questions about the vaccines, the additional payment for counseling will support health care providers in taking the time needed to understand a patient’s concerns and answer their questions.

NCDHHS has a toolkit to help health care providers promote vaccination within their practices. Healthcare providers are encouraged to use the materials to encourage patients to get vaccinated. 

There is increasing urgency for people to get vaccinated against COVID-19 as the more dangerous new Delta variant is rapidly spreading in the United States, including in North Carolina. The Centers for Disease Control and Prevention classified the Delta variant as a “variant of concern” because it spreads faster than current COVID-19 variants. Early data have also shown a possible increased risk of hospitalization in people infected with the Delta variant. The currently available COVID-19 vaccines are the best protection against the virus and its variants.

More information is available in the special bulletin about NC Medicaid’s new reimbursement code.


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Federal Incentive Program Fails to Motivate Many Medicaid Providers

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60% of providers did not participate in the Meaningful Use program after the initial larger payouts were made to them.


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.



Florida has distributed roughly $100 million to Medicaid providers that ultimately did not demonstrate they used electronic health records (EHR) in a meaningful way after collecting first-year financial incentives, according to a study by researchers at Florida Atlantic University.

The first-of-its-kind study, published in the ScienceDirect journal, was designed to quantify the rate of provider participation beyond the initial incentive of up to $21,250.

To improve the quality of care and reduce health imbalances in patients receiving Medicaid, the Health Information Technology for Economic and Clinical Health Act began in 2009, encouraging healthcare providers to convert their medical records to an electronic version. The program provides incentive payments for certain providers to use the technology.

After the first-year incentive, providers can earn up to $8,500 annually in the subsequent five years if they attest to Meaningful Use (MU) status, which is using certified EHR or software to boost efficiency, safety and quality of care.

Providers are not required to participate in consecutive years and are not penalized if they do not achieve MU even after collecting the first-year incentive. Many Medicaid providers (57 percent) discontinued participation after collecting their first payment, conservatively totaling approximately $100 million, the researchers said.  

“So about six out of 10 Florida Medicaid providers have basic EHR systems that cannot function in ways that can positively impact patient care,” said Judith P. Monestime, D.B.A., an instructor in FAU’s College of Business and the lead author of the study. “This is concerning because advanced EHR functions – such as Meaningful Use – are necessary precursors to address unmet socioeconomic needs to reduce health disparities. Not meeting these needs leads to higher healthcare costs fueled by a cycle of emergency room readmissions.”

In conducting the study, Monestime, Katherine Freeman, Ph.D., and Pierre K. Alexandre, Ph.D., used 2011-2018 records from the Florida Medicaid Promoting Interoperability program, formerly the Electronic Health Record Incentive program.

“The study was significant for many reasons,” said Alexandre, an associate professor and director of management programs in the College of Business’ Health Administration department. “It tells you that the incentive program, although it had the best of intentions, may not have done enough for certain providers to make it worth continuing in the program.”

Providers often did not continue with the program because the incentive dropped by 40 percent after the first year, and they were not able to continue receiving necessary technical assistance, the researchers said.  

The study found that pediatricians accounted for the largest percentage of providers achieving MU (65 percent) while dentists had the lowest rate (7 percent).

The researchers also noted that 58 percent of providers practicing in rural areas achieved MU compared with 42 percent in urban areas.

“Ultimately, efforts to improve health outcomes, reduce costs, and increase health equity for underserved populations through advanced EHR functions have stalled,” the study stated. “These results may provide timely information on the merits of further legislative efforts to increase MU and promote health information exchange.”



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This state is strongly considering a 10% Medicaid pay boost, and officials likely will dictate precisely how providers spend it

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NJ and other states are considered upping nursing home rates, but want to see it tied to increased wages.


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.



New Jersey’s governor has proposed a 10% Medicaid pay increase for nursing homes, with the kinds of strings attached that providers might ultimately view as needed lifelines.

Gov. Phil Murphy (D) is touting plans to spend $134.4 million next year to improve wages for direct care staff in nursing homes. But of the targeted 10% increase in the Medicaid nursing facility rate, facilities would be required to spend at least 60% to boost wages, while the rest would have to be used toward statewide infection control requirements. 

Murphy’s spending plan, which could be amended or replaced by the state legislature before passage next month, also includes $30 million to fund annual direct-care minimum wage increases.

“The committed workers showing up daily to care for some of our most vulnerable deserve to know they’re valued and supported,” Human Services Acting Commissioner Sarah Adelman said in a statement Tuesday.

Unlike many states grappling with their budget process, New Jersey has come through the pandemic on relatively solid financial footing, which the governor acknowledged while outlining the broader budget earlier this year. Murphy’s new support for long-term care staff would be funded without a tax increase.

Trending in other states

Provider associations in other states also are clamoring for Medicaid increases, and several have said they’d be willing to accept restrictions like the ones Murphy is proposing.

In March, LeadingAge Texas President and CEO George Linial said low Medicaid rates were a major contributor to nursing home staff turnover. He has advocated for a link between provider reimbursement increases and wage hikes.

“We really want any increase in Medicaid rates to be tied to staff wages and benefits,” Linial told McKnight’s Long-Term Care News at the time. “We definitely know that we need more funding, but there has to be accountability for that.”

While states including Florida and Pennsylvania have proposed flat (or lower) Medicaid funding for next year, others are joining New Jersey in considering more funding for nursing homes.

Maine leaders Tuesday held a hearing to consider a bill that requires the state to reconsider the base rate for its MaineCare Medicaid program every two years, which would enable the state to support providers in giving frontline workers raises.

Following up on recommendations from a long-term care task force, the bill would require direct care workers across the long-term care spectrum to be paid at least 125% of the minimum wage, which hit $12.15 per hour as of Jan. 1.

The bill also charges state officials to “take into account” costs of providing care and services, such as training requirements; quality and safety standards; future increases in the minimum wage; earned paid leave; electronic visit verification; and “other costs that are not provided for in the current reimbursement.”


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Medicaid transportation program failing by the thousands in Indiana

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Southestrans is struggling to deliver member trips in the Indiana market.


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.


SOUTHERN INDIANA (WAVE) – It’s the part of healthcare that should be the easiest.

But for many in Indiana, it has become the toughest.

“I have been fighting this fight for two years,” former social worker Erin Stennett said, fighting back tears. “This could be anybody’s loved ones, and it’s not right, it’s just not right.”

This isn’t a story about the rigors of chemotherapy, radiation, or surgery. This is a story about the overlooked act of just getting to the doctor.

“I know there’s a lot of people now who have died over not being picked up,” Theresa Pate said. She is married to a man who relies on Southeastrans to get to important medical appointments.

For people who are poor, have disabilities, or are medically fragile in Indiana, getting to the doctor is often impossible.

“I have Spina Bifida, hydrocephalus, asthma, COPD, diabetes,” Medicaid patient Holly Cunningham said. “I’ve been left high and dry numerous times. I can’t even tell you how many times where I have been left, or they showed up two hours late, or not showed up at all. Probably 30, 40, 50, I mean over the course of the last three years, I can’t even count.”

She’s talking about Southeastrans, the Georgia-based company that got a four-year, $128 million contract with Indiana’s Family and Social Services Administration to take over the system of rides to medical appointments for Hoosiers on Medicaid. Southeastrans was given an F rating by Indiana’s Better Business Bureau. For others the grade is more like incomplete because they keep getting canceled or stood up.

“You think you have a ride scheduled with a transportation company, and then a lot of times they will not show up,” Stennett said. “They will cancel last minute. They are late. They may take you to your appointment and then you don’t have a ride home.”

In Stennett’s tenure as a social worker, she said she could write a book about what happened to her clients. Her book would be non-fiction, and filled with horror stories about what happens to people right after they have to cancel important appointments.

“She received a call saying, ‘We’re sorry we could not find you a ride,'” Stennett said, recalling one of her clients. “She called me Monday morning in tears, ‘Erin I don’t know what to do.’ She was put in ICU in kidney failure. She spent at least a week in the hospital and never went home again. Within three weeks she was gone and died. I was heartbroken.”

To get a better idea of how often riders are stranded, WAVE 3 News Troubleshooters analyzed the state medical transportation reports. The most recent one filed, from November, showed 2,900 trips not provided because no provider was assigned, and 116 cases of providers no-showing. In October, 3,446 trips were not provided because no provider was assigned and there were 150 provider no-shows.

Theresa Pate, whose husband is non-verbal after a stroke, said the complaint investigations mean nothing because, she said, Southeastrans lies in their reports. She cited one instance where Southeastrans no-showed her husband and then claimed the driver was the one stood up.

“No, I said, ‘You weren’t at my house because the home healthcare aid was standing there watching,'” Pate said, adding that when she filed a complaint with the state about it, she said they followed up one lie with another one. “When I sent the complaint to the state, they tried to say they transported him to that appointment the next week, that they came and got him and took him to that appointment.”

So, what did Southeastrans have to say about all this? Its Indiana director never responded to WAVE 3 News’ phone messages or emails. WAVE 3 News also requested an interview with Indiana’s FSSA in March, and even submitted questions at their request. Weeks later, WAVE 3 News received a statement from spokesman Jim Gavin, who wrote there are “supply challenges when it comes to the network of transportation providers available to serve the increased member demand.”

Gavin also wrote that while Medicaid ridership has increased to more than 65,000 per month, the drivers network is 1,650. The numbers of no-shows and cancellations were apparent. What’s harder to determine are the numbers of people who’ve gotten worse or died as a direct result of missing scheduled appointments.

“Has your health ever suffered immediately after one of these times where you had to get to the doctor but they left you?” WAVE 3 News asked Holly Cunningham.

“Yes my shunt failed a couple years ago,” she said. “I used to see a neurosurgeon and they were supposed to be transporting me to Norton Emergency room and they didn’t show up.”

Added Pate: “A friend of mine said her friend was supposed to have had two rides from them. But they canceled on her and just a few weeks later she passed away for an undetected heart condition and she told me I swear if she had gotten to the doctor they would have caught this.”


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Colorado Lawmaker Takes Action After a Business Owner Loses Nearly $50,000 Over Two Emails Lost In Spam Folder: ‘This is Nuts’


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A Colorado Medicaid provider lost $50,000 because emails from the state audit team went to spam.



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.


DENVER (CBS4) – The state clawed back nearly $50,000 from a Colorado small business owner after she failed to respond to two notices for an audit. She says the emails went to her spam folder.


Nicole Schiavone (credit: CBS)

Nicole Schiavone, owner of Wildflower Assisted Living, has cared for people with brain injuries for 15 years. Most of them are Medicaid recipients, so when the state sent her an email last year notifying her of an upcoming audit she confirmed receipt and then waited for an email requesting documentation.

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“Then didn’t hear anything, and COVID hit and so I was like, ‘maybe they’re not doing them.'”

Turns out, she was wrong. The state sent two subsequent emails.

“The notice went into my spam,” said Schiavone.

By the time she found out, she was out nearly $50,000 after the state took the money back.

“I said ‘hey guys what’s going on? You have my phone number. You have addresses of all my locations as well as my billing address. You could have sent a letter.'”

Sen. Jeff Bridges was stunned.

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“I took a look at it, and said ‘yea, this is nuts. It has to get fixed.'”


(credit: Nicole Schiavone)

He introduced a bill that requires the state to notify Medicaid providers of an audit with an email, letter and phone call before recouping the money.

“For me this is about good government,” said Bridges. “Governments need to be accountable in order to have the trust of the people represent. This was brought to us. We said ‘you’re right this isn’t the way government should work,’ and here we are fixing it.”

While the bill fixes the notification system going forward, Schiavone is out of luck and out nearly $50,000.



“There’s no way in the Medicaid industry to make that money up.”

A spokesperson for the state department that oversees Medicaid says he was unsure if there were other providers who’d had similar experiences, but, he says, providers are notified of an audit via their preferred method of communication.

He says once the audit deadline has passed, the law requires them to recoup the money that’s unaccounted for, regardless of the reason.


The bill passed its first committee.


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Centers for Medicare and Medicaid Services guidance expands nursing home visits


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FL nursing home providers are determining whether the CMS or state Medicaid guidance applies.


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.


TAMPA, Fla. — The past year was one filled with isolation for Elyce Turba and her mother, a resident of a long-term care facility.

A few months ago, Turba said she got to see her mother in person again, though they still couldn’t touch. But this week, she was finally able to give her now vaccinated mother a hug after a year.

“It was just a joyous feeling at that point and also a very hopeful feeling. I thought maybe we’re coming to the end of this pandemic,” she said.

Last week, the Centers for Medicare and Medicaid Services released guidance, that though it has similarities to the state’s last order for long-term care facilities, it also expands indoor visits and touching.

The CMS guidelines still recommend physical distancing and outdoor visits when possible.

In the event of a new COVID-19 case, it recommends allowing visits to resume as long as facility-wide testing is complete and transmission is contained to a single area. If a resident is fully vaccinated, it says they can choose to have close contact with their visitor while wearing a mask.

The Florida Health Care Association, an advocacy organization, says it’s asked the state for future clarification. Nursing homes are regulated by both CMS and the Agency for Health Care Administration, though assisted living facilities are not regulated by CMS.

“We’ve informed our members and we’re guiding them that they should follow the stricter of the two regulations or the stricter of the two guidelines in this situation so that’s what they’ll be doing,” said the group’s director of communications, Kristen Knapp, noting facilities have been having families.

AHCA stated, “The recently released CMS guidelines support the approach Florida has taken to ensure that long-term care facilities encourage and enable families and compassionate care providers to visit residents, which we know is important to residents’ wellbeing. The Agency for Health Care Administration will continue to work with facilities to safely give residents and visitors greater freedom to spend more time with their loved ones.”

AHCA said there has been a 74% decrease in COVID positive residents of nursing homes and a 78% decrease in COVID positive residents of assisted living facilities in about the last month.

“The one thing that we’re seeing is that the vaccines are working. We’re seeing our positive cases decline so we’re all very hopeful. So I think you’re seeing that because you’re having those widespread vaccinations in our facilities as our numbers go down you know it gives us more opportunities to get back to normal,” said Knapp.

Knapp said they’re still working to educate staff, and looking at long-term strategies for vaccinations.

AHCA data shows 67.55 percent of nursing home residents and 92.65 percent of assisted living facility residents have received the vaccine.

Meanwhile, the agency says 35.15 percent of current nursing home staff and 39.67 percent of current assisted living facility staff have received the vaccine.

That number is concerning for Turba.

“I just really feel like as long as we can keep more people getting vaccinated and getting a vaccine that’s going to allow us all to go in and see people that we love to be around groups again so it’s not just those in the long term care but it’s for the benefit of all of us,” she said.

She’s hopeful in the future, people like hairstylists can also enter the facility. But for now, she’s smiling that they were able to hug.

“Well I’m hopeful it will help her to be able to feel that connection again and know that I haven’t abandoned her,” she said.

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