Weekly Medicaid RoundUp: Week of August 7th, 2017

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2wO7zhZ

For optimist readers-  http://bit.ly/2wOp6GQ

RED AND WHITE SMOKE SEEN ON DAY 62 FROM THE TOWERS OF THE MCO NEGOTIATION COUNCIL- After a few months of dancing around the issue of insufficient rates in the press, Iowa officials and MCO folks are in closed-door sessions to figure it out. New price negotiations were expected to conclude in July, but now its looking like mid to late August. In addition to price it looks like plans may be asking for more control over care management and utilization. You know, the things they are on the hook for. The number 1 complaint I hear from plan clients is they are held accountable for things they are not allowed the tools to impact. Hear, here.


PLANS BICKERING IN THE MAGNOLIA STATE- Amerigroup and Mississippi True are protesting the late-June MCO awards. United, Magnolia Health and Molina all won another round on the MS Medicaid ride. Mississippi True is a new provider-sponsored plan arguing that the RFP requirements around experience were designed to lock out any bidders besides the incumbents. Three state lawmakers are petitioning the Governor to instruct the Caid agency to take another look. Its nice to see lawmakers take such an interest in the Medicaid procurement process. I am sure they are Medicaid experts with a lot of insight into who the Medicaid agency should select and how they should evaluate proposals.


TARHEEL STATE SUBMITS REVISED MANAGED CARE PROPOSAL- This one is from the new Guv (Cooper), updating the one from 14 months ago by the old Guv (McCrory). Right now its shaping up to be focused on integrating physical and behavioral health (makes absolute since given the efforts in the NC market in recent years), telemedicine (a bit of a surprise), opioids and care management. No word yet on whether The Good Guvnr Cooper is looking to horsetrade with CMS to expand Caid enrollment. Let’s get managed care in there first, fellas.


IOWA DID NOT COLLECT $700K IN RX REBATES. SUBTRACTS AMOUNT FROM NEXT SFY BUDGET REQUEST- Just kidding on that last part. Silly kids! Medicaid spending NEVER, EVER goes down. If it did, the pink elephants at the center of the earth’s core would stop marching and our planet would fall from its orbit and go hurtling into space and we would all die because the Republicans hate everybody and only Democrats are GoodPeople. At least that’s what General Spend-It-All in charge of the Resistance tells me.


WONDERS NEVER CEASE. NEW CLAIMS PAYMENT SYSTEM IN THE CENTENNIAL STATE BEGINS LIFE ON STATUS: SNAFU- Colorado’s new claims payment system (interChange- note the lowercase first letter, but the Capital letter in the middle of the name. That means its sophisticated.) is not a hit with providers (at least the ones being interviewed). According to them, claims that previously sailed through are now being rejected. Many providers are out a good bit of cash and have decided to stop taking any new Medicaid patients until the problems are resolved. In defense of the new system all providers had to re-enroll during implementation, and many of the problems are being seen with ones who failed to do so. Other interesting parts of this story: The vendor is DXC Technology, which I guess is maybe a new MMIS-ish vendor? And the contract is for $187M over 8 years. That has to be the cheapest claims payment system I have ever heard of – even when the price does double like we all know it will. Hear that sound? That’s the sound of change orders piling up on some project manager’s excel spreadsheet somewhere.

LOOK UP DUMPSTER FIRE IN THE DICTIONARY AND YOU WILL FIND A PICTURE OF THE ILLINOIS STATE BUDGET- Its just terrible. Terrible. The stories won’t stop. This week: 10 IL SNFs were allowed to continue their lawsuit against the state for not getting paid the correct rate for 4 years. IL NPR also ran a story about various pediatricians out hundreds of thousands of dollars as they wait for the state to pay.


AND APPARENTLY JAMES COMEY IS IN CHARGE OF THE IL MEDICAID PRESS OFFICE?  I can honestly say I have never seen this: There was a news story this week letting the world know that CountyCare is a winner in the IL MCO bids. All the other winners (and losers) will have to wait until later to find out the rest of the results. Appears there’s a leaker in IL someplace.


I WILL BE AT MESC NEXT WEEK, WILL YOU? If so send me a note and let’s meet up.

I WILL BE AT MHPA 2017 IN OCT., WILL YOU? You can check it out here – http://bit.ly/2twCi5L Every 100th registrant will get a free Medicaid Foundations Course registration (our online training course).

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph … Not enough space this week. Lots of fraudster goodies for you in the twitter feed, though.

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (practice your eclipse poses) and keep running the race (you know who you are).


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