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OIG: Most states not doing enough to monitor Medicaid telehealth fraud for behavioral health services

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The report implies that states have very little idea about what is going on with their telehealth programs.

 
 

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 new survey of 37 states found that three didn’t know which Medicaid behavioral health services are offered via telehealth compared to in person, an Office of Inspector General report found.

Many states don’t monitor for telehealth fraud and fail to evaluate how telehealth has impacted patient access and care, a Department of Health and Human Services watchdog found.

The agency’s Office of Inspector General (OIG) released a report Tuesday that explored how states are evaluating the use of telehealth to treat behavioral health in Medicaid. While states have increasingly turned to telehealth during the COVID-19 pandemic, OIG found that a few don’t even know what services are offered virtually.

“As the nation confronts the psychological and emotional impact of COVID-19, the use of telehealth will be important in addressing behavioral health needs for Medicaid enrollees,” the report said.

Telehealth can be used to cover several behavioral health services such as mental health assessments and therapy. This reliance has increased since the pandemic that caused patients to stay home for fear of contracting the virus.

But the report finds states still have a way to go if telehealth flexibilities offered by the Centers for Medicare & Medicaid Services become permanent.

OIG spoke with Medicaid directors for 37 states that provide telehealth behavioral services.

RELATED: New House, Senate bills aim to make telehealth expansion permanent in Medicare, Medicaid

The agency found only two states have evaluated the effectiveness of telehealth on access to services for Medicaid enrollees.

One of the states found that 70% of enrollees who used telehealth for behavioral services resided in a rural area and would have to be transported a long distance to get care without it. Another found telehealth increased the types of providers beneficiaries could access such as psychiatrists, psychologists and nurse practitioners that specialize in mental health.

Only one of the 37 states evaluated the impact of telehealth on cost. It found that prior to the pandemic, telehealth generated $8,600 in savings for emergency room care avoidance in one managed care plan and $484,000 in reduced transportation costs for another plan.

OIG also found that three of the 37 states couldn’t say which services are provided to Medicaid beneficiaries via telehealth compared to in person.

“These states cannot do any analysis on the effects of telehealth, nor do they have the ability to perform basic monitoring and oversight specific to telehealth services, which are essential to ensuring the fiscal integrity of the Medicaid program and to protecting Medicaid enrollees,” the report said.

States are already providing a small amount of monitoring and oversight on telehealth. OIG found that 11 out of the 37 states perform monitoring and other actions to combat any fraud or waste in telehealth. But 23 out of the 37 states report fraud is a major concern surrounding telehealth use.

Even though Medicaid is a federal-state joint program, states are responsible for monitoring.

A few states told OIG it is difficult to verify that telehealth services are being provided appropriately.

States need to step up their efforts to evaluate and examine the impact of telehealth on their Medicaid programs, especially as flexibilities that emerged during the pandemic could be made permanent, OIG said.

“Evaluating the effects of telehealth on access, cost and quality of behavioral health services is particularly important in helping states make decisions about how best to use telehealth and about which populations benefit most from these services,” OIG said.

RELATED: Telehealth use drops for 3rd straight month as patients return to in-person appointments

An accompanying data brief from OIG (PDF) also found that states have had major challenges with implementing behavioral telehealth services. The brief looked at state challenges from January through February 2020 before the onset of the pandemic.

Most states reported multiple challenges with using telehealth, including a lack of training for providers and enrollees, limited internet connectivity for providers and enrollees, difficulties with providers protecting the privacy and security of enrollees’ personal information, and the cost of telehealth infrastructure and interoperability issues for providers,” the brief said.

The findings act as a clarion call to states to prepare for potential permanent expansion of telehealth after the pandemic subsides. States can decide how to apply telehealth in their Medicaid programs.

 
 

Clipped from: https://www.fiercehealthcare.com/payer/oig-most-states-not-doing-enough-to-monitor-medicaid-telehealth-fraud-for-behavioral-health

 
 

 
 

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New Hampshire Extends Partnership with Conduent to Maintain, Operate and Enhance Medicaid

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Conduent (nee Xerox, nee ACS) continues its now 16-year contract for the huge MMS contract in NH.

 
 

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.

 
 

Company will continue to support Medicaid beneficiaries and providers with a range of services including online enrollment, eligibility verification and claims processing

Conduent will also upgrade technical capabilities of the Medicaid system to increase security and processing speed and provide cost efficiencies

FLORHAM PARK, N.J., Sept. 09, 2021 (GLOBE NEWSWIRE) — Conduent Incorporated (Nasdaq: CNDT), a business process services and solutions company, today announced it has extended its partnership with the New Hampshire Department of Health and Human Services (NH DHHS), serving as the exclusive provider of services to modernize the state’s Medicaid Management Information System (MMIS). Conduent will provide maintenance, operations and enhancements that support NH DHHS’s ability to serve approximately 220,000 beneficiaries and process more than 15 million claims annually.

In addition, the company will upgrade the state’s MMIS to a virtualized environment, while increasing system security, reliability, scalability, and performance. 

Since 2005, Conduent has provided solutions to the NH DHHS to enhance the effectiveness, coordination and delivery of numerous initiatives that embody the agency’s mission to facilitate whole-person care. The company will continue to serve as fiscal agent for the state’s Medicaid program, providing online enrollment, eligibility verification and claims processing to help 30,000 providers meet the medical, behavioral and social needs of people across New Hampshire.

“This award demonstrates our strong MMIS expertise, and the trust NH DHHS has placed in us to help the state move its Medicaid program forward for the future,” said Pat Costa, President, Government Healthcare Solutions at Conduent. “Our team is committed to the department’s effort to bring about new technologies and efficiencies that will ultimately benefit providers and beneficiaries across New Hampshire.”

The contract renewal for MMIS maintenance, operations and enhancements, which is valued at approximately $206 million, includes a five-year base term plus a five-year option to extend until 2031.

Earlier this year, Conduent announced a related contract to help the state comply with the federal Interoperability and Patient Access Final Rule. That project provides Medicaid beneficiaries with improved, secure access to their personal health information, enabling them to make more informed healthcare decisions.

With 50 years of experience in the government health and social services industry, Conduent supports more than 41 million customers annually with various government health programs and other eligibility services. For Medicaid, Conduent supports systems in 23 states, Puerto Rico and Washington, D.C., and it has facilitated federal MMIS certifications in 14 states.

About Conduent Conduent delivers mission-critical services and solutions on behalf of businesses and governments – creating exceptional outcomes for its clients and the millions of people who count on them. Through process, technology, and our diverse and dedicated associates, Conduent solutions and services automate workflows, improve efficiencies, reduce costs, and enable revenue growth. It’s why most Fortune 100 companies and over 500 government entities depend on Conduent every day to manage their essential interactions and move their operations forward.

Conduent’s differentiated services and solutions improve experiences for millions of people every day, including three out of every four U.S. insured patients, 10 million employees who use its HR Services, and nearly 18 million benefits recipients. Conduent’s solutions deliver exceptional outcomes for its clients, including $16 billion in savings from medical bill review of workers compensation claims, up to 40% efficiency increase in HR operations, up to 27% reduction in government benefits costs, up to 40% improvement in finance, accounting and procurement expense, and improved customer service interaction times by up to 20% with higher end-user satisfaction. Learn more at https://www.conduent.com.

Media Contacts: Sharon Lakes, Conduent, +1-214-592-7637, sharon.lakes2@conduent.com

Investor Relations Contact: Giles Goodburn, Conduent, +1-203-216-3546, ir@conduent.com

Note: To receive RSS news feeds, visit www.news.conduent.com. For open commentary, industry perspectives, and views, visit http://twitter.com/Conduent, http://www.linkedin.com/company/conduent or http://www.facebook.com/Conduent.

Trademarks Conduent is a trademark of Conduent Incorporated in the United States and/or other countries. Other names may be trademarks of their respective owners.

 
 

Clipped from: https://www.bakersfield.com/ap/news/new-hampshire-extends-partnership-with-conduent-to-maintain-operate-and-enhance-medicaid/article_9e52249b-50c0-586f-b2a2-95a32707b1f8.html

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Texans on Medicaid can now use Uber for non-emergency medical appointments

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Uber just added millions of new customers in TX 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.

 
 

Uber said it aims to eliminate barriers to care for Medicaid enrollees as well as provide a more cost-efficient form of transportation.

 
 

A sign in the lobby of Uber’s Deep Ellum office on Jan. 27, 2020 in Dallas.(Juan Figueroa / Staff photographer)

Uber is now offering millions of Texans on Medicaid rides to and from non-emergency medical appointments.

Uber Health, the company’s health care division, launched the service officially this week thanks to a law the company helped pass in the 2019 legislative session. Uber worked with now-Speaker of the Texas House of Representatives Dade Phelan to pass legislation allowing ride-sharing companies to utilize the Medicaid program.

Uber says that rides for Medicaid enrollees will be priced the same as the company’s UberX service, and the health systems providing care can schedule transportation on a dashboard. It can also streamline those providers’ payments by combining charges for Medicaid patients into a single monthly bill.

 
 

There are nearly 4.4 million people in the state enrolled in Medicaid who will be able to use Uber’s on-demand ride sharing platform for medical visits. The service touts a more cost-efficient way to get patients to appointments, and one that helps health systems overcome a thorny barrier to providing care.

Transportation issues are cited as the reason nearly 6 million Americans miss medical care appointments each year, according to a recent American Journal of Public Health
study cited by Uber.

“Texas is ahead of the curve and helping serve their communities, and especially the Medicaid community, in what they’ve done allowing Uber to be a piece of the transportation,” global head of Uber Health Caitlin Donovan said.

Donovan joined Uber from the home health industry about four months ago. She said the realization that case managers she worked with were spending more than half of their time sorting out logistics like transportation for patients drove her to join the ride-sharing company.

 
 

Health care providers can utilize Uber Health’s dashboard to manage and schedule rides.(Uber Health)

The company has been piloting the service since June 1 when it was finally approved by the Texas Health and Human Services Commission. Uber had hoped to launch the HIPAA-secure service sooner but COVID-19 created delays, Uber spokesman Chris Miller said.

 
 

“The truth is that spending our money on a ride with Uber Health can be a more cost-effective use of our Medicaid dollars and allows us to cut down on fraud, waste and abuse while creating more equitable patient outcomes,” Phelan said in a statement. “We’ve already begun to see health care organizations in the state report a serious decrease in their no-show rates.”

Uber has already worked with legislators to change laws in Arizona, Indiana and Florida allowing it to provide rides for Medicaid users.

In the last year, Uber has also partnered with NimbleRx to launch an on-demand prescription delivery service in Texas. Uber Health was launched in 2018 with the goal of providing transportation services to the health care industry.

 
 

Clipped from: https://www.dallasnews.com/business/technology/2021/08/26/texans-on-medicaid-can-now-use-uber-for-non-emergency-medical-appointments/

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New York Ends Telehealth Waivers; Issues New Medicaid Guidance

 
 

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NY Medicaid has made permanent telehealth services that were temporarily expanded during COVID.

 
 

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 York’s telehealth emergency waivers have expired, according to a June 25, 2021 announcement issued by Governor Andrew Cuomo’s Office declaring the waivers (contained in Executive Orders 202 through 202.11 and 205 through 205.3) are no longer necessary. Concurrent with the Governor’s announcement, the New York State Department of Health issued a guidance document on the New York Medicaid program’s continued coverage of telehealth services for the duration of the federal Public Health Emergency (PHE). The guidance is designed to maintain the ability of Medicaid providers to use telemedicine and digital health to deliver health services for the remainder of the federal PHE. The guidance will remain in effect until the federal PHE expires or the Department of Health issues permanent Medicaid telehealth rules, whichever comes first. The guidance also may be a preview of additional guidance to be issued in the near future regarding telehealth in New York State beyond the Medicaid Program.

This article discusses the top five highlights in the New York Medicaid telehealth guidance.

1. Scope of Telehealth Services

  • Telehealth Definition: The term telehealth is broadly defined as “the use of electronic information and communication technologies to deliver health care to patients at a distance.” Medicaid-covered telehealth services include assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a Medicaid patient. During the PHE, “telehealth” includes telephonic, telemedicine, store and forward, and remote patient monitoring. The guidance uses the term “telemedicine” to denote two-way audiovisual communication.
  • Originating Site Restrictions: An originating site is where the Medicaid patient is located at the time health care services are delivered to him/her by means of telehealth. Originating sites during the PHE can be anywhere the member is located including the member’s home.
  • Distant Site Restrictions: A distant site is the site where the telehealth provider is located while delivering health care services by means of telehealth. During the PHE, any site within the fifty United States or United States’ territories, is eligible to be a distant site for delivery and payment purposes. This includes Federally Qualified Health Centers and providers’ homes.

2. Expansion of Eligible Providers

During the PHE, any provider authorized to deliver Medicaid billable services is eligible to provide services via telehealth, so long as the services are appropriate for telehealth and within the provider’s scope of practice. Providers must still comply with HIPAA and all other relevant privacy and security laws when delivering care remotely.

3. Consent and Recording

Providers must confirm the patient’s identity and provide the patient with basic information about the services the patient will receive via telehealth. The patient need not give written consent to telehealth services, but if verbal consent is given the provider should document this in the medical record. Providers cannot record telehealth sessions without the patient’s consent.

4. Billing Rules for Telephonic (Audio-Only), Asynchronous, and Remote Patient Monitoring Services

The Medicaid program will cover telephonic services during the federal PHE. Telephonic service is “two-way electronic audio-only communications to deliver services to a patient at an originating site by a telehealth provider located at a distant site.” The guidance provides detailed billing instructions and a 2-page table setting forth in detail the billing and coding rules, along with modifiers, for telephonic services. The guidance also expands and elaborates previous rules for billing and coverage of two-way audiovisual communication, store and forward, and remote patient monitoring.

5. Specialty Program Requirements Still Apply

The Medicaid guidance document applies to all Medicaid providers under the Medicaid FFS program and Medicaid managed care plan contracts. However, other State agencies have also issued their own separate guidance on telehealth standards and practice. If a provider’s specialty area renders them subject to licensure or registration with one of these agencies, those rules will apply in addition to the Medicaid reimbursement rules. The Office of Mental Health, the Office for People with Developmental Disabilities, the Office of Addiction Services and Supports, and the Office of Children and Family Services have issued their own guidance materials and regulations. Providers should review these carefully.

 
 

Clipped from: https://www.jdsupra.com/legalnews/new-york-ends-telehealth-waivers-issues-1855071/

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OHIO- Medicaid Contractor Data Breach Affected 334,000 Providers

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Maximus alerted Ohio, Maine and other states about the breach of its systems that occurred in mid-May.

 
 

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.

 
 

 
 

Maximus Corp. Says Personal Information Exposed in Unauthorized Access to App Doug Olenick (DougOlenick) • June 23, 2021    

 
 

Maximus Corp., a global provider of government health data services, says a data breach exposed the personal information of more than 334,000 Medicaid healthcare providers nationwide.

See Also:
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The company says in a statement provided to Information Security Media Group that on May 19, it discovered an unauthorized party had accessed one of its applications related to Medicaid provider credentialing and licensing with the Ohio Department of Medicaid between May 17 and May 19.

This incident did not affect patient or Medicaid beneficiary information. Some personal information about healthcare providers may have been impacted, including names, dates of birth and Social Security numbers,” the company states.

A breach notification provided to the Montana attorney general’s office says Medicaid providers’ Drug Enforcement Agency numbers also may have been exposed in the breach.

System Breached

In a filing with Maine’s attorney general, Maximus says 334,690 individuals were affected when one of the company’s external systems was breached. The notice states those affected will receive two years of free identity protection services through Experian.

In its statement provided to ISMG, Maximus did not supply a complete list of the states that were informed of the breach nor did the company offer details on the type of attack. The company says it began informing the individuals affected on June 18, along with filing formal data breach notifications with state officials where the victims are located.

As of Wednesday, the incident was not yet listed on the Department of Health and Human Services’ website that offers a tally of major health data breaches.

“Because the unauthorized activity was detected at a very early stage, Maximus believes our quick response limited potentially adverse impacts. This incident did not affect any other Maximus servers, applications or customers,” the company says in its statement. It says it has no evidence the attackers have misused any of the information.

Maximus, which is based in Reston, Virginia, is an administrator of Medicaid enrollment broker services. The company says it answers more than 7 million Medicaid-related calls per month. It handles similar services in Australia, Canada, Italy, Saudi Arabia, Singapore, South Korea, Sweden and the U.K.

Other Recent Healthcare Incidents

Healthcare providers and their third-party suppliers have been targeted by cybercriminals in increasing numbers.

In a recent data breach notice, Attleboro, Massachusetts-based Sturdy Memorial Hospital said that on Feb. 9, it identified a security incident that disrupted the operations of some of its IT systems affecting about 57,400 people. The hospital reported paying a ransom in exchange for promises by the attackers to destroy stolen data.

On Monday, Reproductive Biology Associates , an Atlanta-based clinic operator, and its affiliate, MyEggBank North America, reported their systems were hit by a ransomware attack in April. The clinic operator says it regained control of its network and data after contacting the attackers.

 
 

Clipped from: https://www.govinfosecurity.com/medicaid-contractor-data-breach-affected-334000-providers-a-16929

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Illinois Selects CNSI to Support Ongoing Medicaid Modernization Efforts

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CNSI has won the IL MMIS contract.

 
 

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.

 
 

CNSI to Assist with Claims and Encounter Data Processing, Managed Care Coordination, and AWS Cloud Migration

MCLEAN, Va., June 8, 2021 /PRNewswire/ — CNSI, a leading provider of innovative, healthcare technology-driven products and solutions that improve health outcomes and reduce healthcare costs, announced today that Illinois has selected CNSI’s Medicaid Management Information System (MMIS) for core claims processing, encounter data processing, and MC-Track® managed care coordination platform. CNSI will also support Illinois’ MMIS migration to the Amazon Web Services (AWS) secure public cloud to power their infrastructure, become more agile, and lower costs. The Centers for Medicare & Medicaid Services (CMS) approved the four-year contract, which includes CNSI’s Fast Healthcare Interoperability Resources® (FHIR) based interoperability solution.

The Illinois Department of Healthcare and Family Services (HFS) is responsible for providing healthcare coverage for adults and children who qualify for Medicaid. Illinois’ medical assistance programs, consisting of Medicaid and numerous other associated health and human services programs, provide comprehensive health-care coverage to about 3.2 million Illinoisans.

“The state of Illinois is dedicated to creating a more efficient, accountable and integrated healthcare system, and providing better quality care and positive outcomes for our customers,” Illinois Department of Healthcare and Family Services Director Theresa Eagleson said. “CNSI’s partnership helps us avoid significant loss of time and inefficiencies as we work to modernize our 35-year old payment system and allows us to better focus our resources on connecting the Illinoisans we serve with quality care and services.”

Todd Stottlemyer, CEO of CNSI, added, “We have expanded the CNSI modular product suite to encompass claims and encounter data processing for care provided in a multitude of settings – each with their own data interoperability nuances. Illinois’ adoption of FHIR-based standardization will reduce the work required to implement, track, and report on health quality measures – all part of their long-term vision for growth and scalability.”

Central to the Illinois MMIS contract, CNSI received the top overall score in the 2020 NASPO ValuePoint™ multi-state evaluation of MMIS Claims Processing and Management Services.

 
 

Clipped from: https://www.prnewswire.com/news-releases/illinois-selects-cnsi-to-support-ongoing-medicaid-modernization-efforts-301307542.html

 
 

 
 

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New Hampshire Selects Conduent to Provide Medicaid Beneficiaries with Improved Access to Healthcare Information

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Conduent wins new contract expansion in NH to facilitate more member access to their own data.

 
 

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.

 
 

Company’s solution to help the state coordinate medical services while empowering patients to make more informed healthcare decisions
 

Contract enables New Hampshire to comply with a new federal regulation on Interoperability and Patient Access

FLORHAM PARK, N.J., June 02, 2021 (GLOBE NEWSWIRE) — Conduent Incorporated (Nasdaq: CNDT), a business process services and solutions company, today announced a contract from the New Hampshire Department of Health and Human Services (NH DHHS) to provide Medicaid beneficiaries in the state with improved, secure access to their personal health information, enabling them to make more informed healthcare decisions. The company’s solution will improve how information is exchanged between payers, providers and patients, as well as support efficient care coordination.

Through a web portal developed by Conduent, beneficiaries will have the ability to locate healthcare and pharmacy providers in their network, as well as seamlessly and securely review their information and share it with various providers. The contract also brings New Hampshire into compliance with the Interoperability and Patient Access Final Rule, a federal regulation put into effect by the Centers for Medicare and Medicaid Services. The rule, finalized in 2020, is expected to have a major impact nationally on the future of healthcare, making health information more easily available to patients and allowing them to safely share their data.

The contract marks an expansion of Conduent’s support for NH DHHS, a client since 2013. The company currently provides the department with claims processing and provider services for New Hampshire’s Medicaid program, as well as management of its Medicaid Management Information System (MMIS), which processes more than 15 million claims annually.

“We’re proud to continue supporting New Hampshire with innovative and efficient solutions for its Medicaid program,” said Pat Costa, President, Government Healthcare Solutions at Conduent. “Our team is dedicated to helping both patients and healthcare professionals in the state access critical health information that improves patient outcomes.”

With 50 years of experience in the government health and social services industry, Conduent supports more than 41 million customers annually with various government health programs and other eligibility services. For Medicaid, Conduent supports systems in 23 states, Puerto Rico and Washington, D.C., and it has facilitated federal MMIS certifications in 14 states.

About Conduent
Conduent delivers mission-critical services and solutions on behalf of businesses and governments – creating exceptional outcomes for its clients and the millions of people who count on them. Through our dedicated people, process and technology, Conduent solutions and services automate workflows, improve efficiencies, reduce costs and enable revenue growth. It’s why most Fortune 100 companies and over 500 government entities depend on Conduent every day to manage their essential interactions and move their operations forward.

Conduent’s differentiated services and solutions improve experiences for millions of people every day, including two-thirds of all insured patients in the U.S., 10 million employees who use its HR Services, and nearly 18 million benefit recipients. Conduent’s solutions deliver exceptional outcomes for its clients, including $17 billion in savings from medical bill review, up to 40% efficiency increase in HR operations, up to 27% reduction in government benefits costs, up to 40% improvement in finance, accounting and procurement expense, and improved customer service interaction times by up to 20% with higher end-user satisfaction. Learn more at www.conduent.com.

Media Contact:
Neil Franz, Conduent, +1-301-820-4324, neil.franz@conduent.com

Investor Relations Contacts:
Giles Goodburn, Conduent, +1-203-216-3546, giles.goodburn@conduent.com

Note: To receive RSS news feeds, visit www.news.conduent.com. For open commentary, industry perspectives and views, visit http://twitter.com/Conduent, http://www.linkedin.com/company/conduent or http://www.facebook.com/Conduent.

Conduent is a trademark of Conduent Incorporated in the United States and/or other countries.

Clipped from: https://finance.yahoo.com/news/hampshire-selects-conduent-medicaid-beneficiaries-124500854.html

 
 

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New House, Senate bills aim to make telehealth expansion permanent in Medicare, Medicaid

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Bills have been introduced to continue the telehealth expansions under the pandemic both for Medicare and pediatric 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.

 
 

 
 

New bills introduced in the House and Senate signal Congress’ intent to make telehealth flexibilities in Medicare and Medicaid permanent after the pandemic ends. (Getty Images)

A pair of bills recently introduced in the House and Senate aim to ensure that a boom in telehealth use during the pandemic does not go away.

A House bill introduced Monday and a Senate bill introduced Tuesday both aim to make certain telehealth flexibilities permanent for Medicaid and Medicare beneficiaries.

“The pandemic has created challenges for everyone, but it’s also shown us that technology can provide safe and dependable communication between patients and their doctors,” said Rep. Jason Smith, R-Missouri, one of the co-sponsors of the House bill alongside Rep. Josh Gottenheimer, D-New Jersey. “Innovations including telehealth and audio-only capabilities will improve efficiency, reduce costs and increase access to healthcare providers.”

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At the onset of the pandemic, the Centers for Medicare & Medicaid Services waived key barriers to telehealth use, enabling providers to offer audio-only telehealth services and ensuring that originating site requirements were removed. The new flexibility helped greatly expand the use of telehealth as providers could get Medicare reimbursement and help patients scared of going to the doctor’s office or hospital for fear of contracting COVID-19.

But the telehealth flexibilities will only last through the extent of the COVID-19 public health emergency, which will eventually lapse as the pandemic gets under control.

RELATED: 1 in 4 Medicare patients used telehealth during peak of pandemic with majority using only telephones: KFF

CMS officials have said that they need Congress’ help to make the flexibilities permanent.

The House’s Permanency for Audio-Only Telehealth Act would enable audio-only telehealth services for Medicare enrollees.

The legislation would also remove geographic and originating site restrictions to ensure that Medicare beneficiaries’ homes can be telehealth originating sites for audio-only services.

The Medical Group Management Association applauded the legislation.

“During the COVID-19 pandemic, audio-only visits have provided a lifeline to patients who are unable to attend visits in person or participate in telehealth visits due to lack of broadband access or necessary equipment to facilitate the visits,” said Anders Gilberg, MGMA’s senior vice president of government affairs.

The bill builds on similar legislation introduced in the House in March that would enable audio-only telehealth services for Medicare Advantage plans. Currently, providers can offer telehealth services under MA plans but only if they involve a video component.

Congress is not just looking at how to expand access to telehealth for Medicare.

Sens. Tom Carper, D-Delaware, and John Cornyn, R-Texas, introduced legislation on Tuesday that seeks to increase telehealth access for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries, according to a report in Politico.

RELATED: Top health experts talk telehealth regulation, health inequality

The legislation would require the Department of Health and Human Services (HHS) to give guidance to states to increase telehealth access for CHIP and Medicaid. This would include outlining what services can be reimbursed by telehealth.

The bipartisan nature of both the House and Senate legislation underscores the likelihood they could get through Congress and signed into law.

HHS Secretary Xavier Becerra has repeatedly underscored the need for legislative help if the boom in telehealth wants to continue.

“COVID has taught us so much,” Becerra said during his confirmation hearing in February. If we don’t learn from COVID how telehealth can save lives then we are going to be in trouble.”

Clipped from: https://www.fiercehealthcare.com/payer/new-house-senate-bills-aims-to-make-telehealth-expansion-permanent-medicare-medicaid

 
 

 
 

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New partnership will connect Medicaid members with free cell phones

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Priority Health in Michigan is leveraging the new federal EBB program to provider members with cell phones and data plans.

 
 

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.

 
 

DETROIT — A new partnership will help connect Michigan Medicaid members with free cell phones and monthly service.

Priority Health announced Wednesday that its partnering with FeelSafe Wireless, a Michigan-based wireless company.

The initiative was created to help connect Medicaid members with underlying health conditions connect with their health care provider.

Priority Health says FeelSafe Wireless will offer free, name-brand smartphones and free monthly service to qualifying individuals. The service consists of 1,000 free minutes, 500 texts and 4.5 gigabytes of data per month.

FeelSafe Wireless will also be participating in the new Federal Communication Commission’s Emergency Benefit Broadband Program, which was designed to help households struggling to pay for internet service during the coronavirus pandemic.

For the temporary EBB program, FeelSafe Wireless will offer unlimited talk, text and 15 gigabytes of additional data monthly. Priority Health says lifeline benefits are available to those who use government programs like Medicaid or Supplemental Nutrition Assistance Programs (SNAP).

Medicaid members can learn more or enroll in the program online.
 

Clipped from: https://www.fox17online.com/news/local-news/new-partnership-will-connect-medicaid-members-with-free-cell-phones

 
 

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How are procurement decisions on solutions for state Medicaid agencies made?

Our clients are often challenged by understanding state information technology or other solution procurements: How they work, the timing of the opportunities, who the incumbents are in the space and what relationships and strategies matter in developing opportunities to win state Medicaid business.

Reading Time: 5 minutes

Intended Audience: Information Technology or Solution Business Development or Governmental Affairs Team Members in HHS solution vendors companies

Key Topics: Pre-proposal work, RFIs and RFQs, RFPs, Sole Source Procurements

 Pre-Proposal Work

This is the most often ignored or least understood aspect of Medicaid and Health and Human Services procurements at the state level. Opportunities to engage the potential customer before an active procurement are critical in understanding the pain points, opportunities and key decision maker needs within a state agency.

Making contact with the agency you expect to procure needs to be done strategically and in a manner that positions the vendor well for future competitive opportunities. Having an opportunity for the potential customer to see what your solutions can do for them before drafting a procurement can also assist in a favorable outcome.

Leveraging partners who have existing contracts in the state can assist in this effort. Also, providing thought leadership in topics related to your solutions can establish your brand in the minds of potential customers.

Work that can be accomplished before a procurement officially becomes available but is often left until after the fact includes: developing a win strategy, assessing potential competitors for strengths and weaknesses and identifying a price to win strategy.

Requests for Information or Requests for Qualifications

If a Request for Information or Requests for Qualifications is released as part of the procurement process, vendors should also take full advantage of that opportunity to craft the future procurement to benefit their solutions. Requests for Information or Requests for Qualification are often issued by state Medicaid or Health and Human Services agencies to answer particular questions about the solutions that are in the marketplace and to help them identify landmines that could cripple a potential procurement by eliminating or scaring off potential vendors.

Vendors should always respond to RFI and RFQ opportunities that impact procurements in which they are interested. This is yet another opportunity to get your vendor name in front of the potential decision makers, orient them to your solution, potentially impact a future request for proposal or begin convincing a state that your solution is unique and should receive sole source consideration.

Requests for Proposal

Responding to a request for proposal is a significant effort. Most procurements from state agencies now involve weeks of staff time in responding to functional requirements as well as statements of experience, references and pricing. Recently, we are also seeing acknowledgement from state agencies that change management is a crucial component of any potential change in solution, particularly technology solutions. We are also seeing pricing structure mattering almost as much or more than the actual cost of a solution. It is essential for vendors to understand that how their pricing is structured could be a disqualifying factor for a Medicaid or Health and Human Services agency. Knowing how state budgets work, the cycles, funding sources and variability of state funding structures is often underestimated as a concern. Some customers will see an advantage in a per member per month structure while others will prefer an annual fee.

Sole Source Procurements

There are certain states and types of procurements that are favored to be procured under “sole source” language, which can eliminate any competition. Getting into a relationship that convinces a state Medicaid or Health and Human Services agency that you are the only vendor able to meet their needs is certainly advantageous to the vendor, but is not always the best situation for taxpayers and ultimately, even for the state Medicaid or health and human service agency users.

How You Can Capture Opportunities With State Medicaid and Health and Human Service Agency Procurements?

Besides your own research into this topic, there are a few key tactics that can help you overcome some common challenges related to Medicaid and HHS procurements. We provide this type of assistance to our vendor clients, and are happy to have a conversation anytime. If our services and expertise are a fit for your needs as you develop or execute your strategy, engaging with us is a simple process. If we are not the right fit, we are happy to make a referral to another firm who may be.

  1. Develop a competitor analysis and win themes that differentiate you in the space- Who are your competitors? What do their solutions offer that yours do not? What do you offer that your competitors do not? What makes your company unique in this space? What do your competitors emphasize in their marketing materials? Which features make your solution unique?
  2. Strengthen your business development process to begin well before a procurement hits the street –  The pre-proposal release window is the most important part of the process to invest in. There are key best practices you can add to your capture process that are customized to this space. 
  3. Develop pricing models that fit the needs of states and still allow your solution to be profitable – The way you present pricing can often make the difference in a win or a loss. If possible, start by identifying competitor pricing and the typical pricing models for a given state Medicaid and Health and Human Services agency.