On December 8, the Centers for Medicare and Medicaid Services (CMS) posted preliminary guidance for the Medicaid work requirements mandated by the One Big Beautiful Bill Act (OBBBA), which passed into law on July 4 this year.
The law requires the creation of new rules by June 2026 and CMS notes in the guidance overview that further...White Papers, E books, Reports and more
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a new report demonstrating that Medicare Advantage (MA) and Medicaid managed care organizations (MCOs) coverage of behavioral health programs falls short of meeting enrollee needs.
The focus of the report was on network adequacy, which poses...Arizona News
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
Insurance company Centene defied the odds for the third quarter and overcame issues with Medicaid reimbursement for higher returns than investors had anticipated.
Centene reported $713 million in profit for Q3 on $42 billion in revenue, up from $469 million and $38 billion last year. Following the Medicaid redetermination period, more...Arizona News
This week, the National Committee for Quality Assurance (NCQA) announced a partnership with the Arizona Health Care Cost Containment System (AHCCCS) to support participants in the Targeted Investments (TI) 2.0 Program.
The partnership pledges to support health equity accreditation by addressing health disparities on the population...National News
A Republican-controlled Congress coupled with a second Trump presidency could spell Medicaid cuts and bigger barriers to Medicaid access.
After the second presidential debate, KFF couldn't help but notice that the future of Medicaid was never raised in a question to either former President Donald Trump or Vice President Kamala Harris....
The Issue brief defines prior authorization and how this process used by Medicaid fee-for-service programs and managed care organizations (MCOs) requires approval before providing specific items, services, or medications.
Prior authorization (PA) aims to prevent unnecessary utilization, limit improper, fraudulent, and wasteful...
The Biden administration finalized rules that would increase transparency and increase protections for Medicaid members in managed care plans. It also finalized the Ensuring Access to Medicaid Services Rule on Monday that requires home care providers to use a minimum of 80% of Medicaid payments to pay aides and nurses.
The new...CMS Rules
As states proceed with Medicaid redeterminations after three years of a pause on eligibility review, hundreds of thousands of Americans are losing insurance coverage, according to early data reports. The Centers for Medicare and Medicaid Services (CMS) are stressing the importance of limiting the number of lost enrollees and facilitating...National News
The public health emergency (PHE) related to the COVID-19 pandemic is currently slated to expire on April 15, but is expected to be renewed for an additional 90 days. State Medicaid programs are concerned that they will not be granted enough time to complete Medicaid enrollee redeterminations, which have been paused for the duration of...National News
The federal public health emergency (PHE) due to the COVID-19 pandemic is set to expire on January 16, 2022. Previously, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra extended the PHE during its prior three expirations under the Biden administration, but a lot of non-medical infrastructure for Medicaid...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...
