Medicaid enrollees are having an increasingly difficult time locating providers to address their medical and behavioral concerns in a timely manner, including those enrolled in the Arizona Health Care Cost Containment System (AHCCCS).
An increasing number of enrollees are coming forward with stories that they have been unable to find...
A new study shows that the use of managed care organizations to cover long-term care services reduced the use of nursing homes, but patient needs were not the exclusive consideration for choosing support delivered in home- or community-based settings.
The study, published in the Journal of the American Geriatrics Society, analyzed...
Last Tuesday, the U.S. House of Representatives passed a budget blueprint that includes $880 billion in spending cuts for programs overseen by the House Energy and Commerce Committee. While the expectation is that cuts will impact Medicaid, there is little specificity on what they would mean for the program and the shape of the...Arizona News
As regulators make efforts to rein in prior authorization delays and denials by private insurers and Medicare Advantage (MA) plans, Medicare and Medicaid managed care organizations (MCOs) are also garnering scrutiny over denials and network adequacy.
A new consumer survey from Kaiser Family Foundation (KFF) found that roughly 60% of...Top of The Day
This week, the Medicaid and CHIP Payment and Access Commission (MACPAC) published an issue brief on regulations from the Centers for Medicare and Medicaid Services (CMS) on Medicaid managed care and directed payment arrangements.
The directed payment option is used by few states in order to require managed care organizations (MCOs) to...CMS Rules
Medicaid contracted managed-care organizations (MCOs) can spend up to 5 cents of every premium dollar on SDOH needs. The new guidance says Medicaid MCOs can also reduce health disparities and address unmet health-related social needs such as housing instability and nutrition insecurity by adopting in lieu of services and settings (ILOS)...Arizona News
AHCCCS is conducting a survey to determine the performance and responsiveness of its contracted managed care organizations to providers.
AHCCCS is asking providers who are contracted with the health plans listed below to complete a survey. The survey will be open from April 15, 2021 through May 17, 2021.
Arizona Complete...Arizona News
The Centers for Medicare and Medicaid Services (CMS) released a proposed rate increase of less than 1 percent on 2021 baseline payments for insurers managing Medicare Advantage (MA) plans. The proposal pales in comparison to the more than 2.5 percent increase plans saw this year, but the rate is set to finalize in April.
An...
The Trump Administration's rollout of its new Medicaid block grant policy, dubbed "Healthy Adult Opportunity" was met with backlash from House Democrats, who are moving to vote on a resolution next week that would disapprove the plan.
Block grants give states fixed federal grants to use toward Medicaid spending based on individual...
The Centers for Medicaid and Medicare Services' (CMS) new mandates issued on Monday is requiring states and Medicaid managed care organizations (MCOs) to make changes to their Medicaid drug utilization review program by the end of the year. The guidance includes setting prescription limits for all opioid drugs and monitoring...National News
A new analysis from the Association for Community Affiliated Plans (ACAP) focuses on new models implemented by safety-net plans and the best way high-quality coordinated care can be provided for individuals with substance abuse disorder (SUD).
Successfully managing the needs of people with SUD requires a high-level of comprehensive...National News
A study commissioned by the Association for Community Affiliated Plans (ACAP) looked at potential savings of Medicaid capitated care with national and state-by-state estimates.
Managed care is poised to become the dominant payment model for Medicaid, the report notes. In 2010, capitated managed care represented only a quarter of...
