AL Medicaid Agency Awards TC Significant Contract Amendment

 

The State of Alabama is leveraging both the Affordable Care Act (ACA) regulations and the A-87 exception to create a single centralized eligibility system to replace multiple antiquated less functional systems. This approach will lower costs to both the state and its federal partners while improving the experience for users as well as creating a more flexible, easily configurable system. This expanded effort for the AL eligibility system will impact 12 legacy systems. [More]

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Categories:Technology Consulting

 

CMS Issues Bulletin to States Re: Medicare-Eligible Medicaid Enrollees

 

On January 23, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a bulletin to states entitled, “Enrollment and Retention Flexibilities to Better Serve Medicare-Eligible Medicaid Enrollees.” It is noted in the bulletin that when Medicaid enrollees in the new adult low-income group become eligible for Medicare, they lose eligibility for that category of Medicaid. [More]

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Categories:Health and Human Services

 

HHS Outlines Research on Substance Abuse Treatment

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) released a bulletin on January 26, 2015 which outlines scientific evidence on treatment models and Medicaid coverage options for youth with substance abuse disorders. [More]

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Categories:Health and Human Services

 

Hawaii DHS Extends PCG Technology Consulting's IV&V Contract through December 2015

 

In 2012, the Hawaii Department of Human Services (DHS) decided to replace its legacy Medicaid eligibility system with a solution to modernize its system and support the Affordable Care Act requirements. The first phase of the project, known as the Kauhale (Community) Online Eligibility Assistance (KOLEA) project, went live on Oct. 1, 2013 when the state converted a majority of the Medicaid functionality from the legacy system to KOLEA. [More]

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Categories:Technology Consulting

 

U.S. Supreme Court Hears Oral Arguments on Whether Medicaid Providers Can Challenge a State’s Reimbursement Rates

 

On January 20, 2015, the U.S. Supreme Court heard oral arguments on whether the Supremacy Clause of the U.S. Constitution granted a state’s Medicaid providers a private right of action to challenge a state’s reimbursement rates. The Supremacy Clause generally is invoked when a federal law and a state law on the same subject collide with the federal law prevailing. [More]

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Categories:Health and Human Services

 

Indiana Wins State Health Plan Approval

 

The Centers for Medicare and Medicaid Services (CMS) notified the Indiana Family and Social Services Administration (FSSA) on January 27, 2015 that CMS has approved FSSA’s “Healthy Indiana Plan 2.0”. Indiana’s plan is designed to improve access to preventive care, encourage healthy behaviors, and promote greater efficiency in the health care delivery system. The CMS approval includes waivers of federal Medicaid requirements in eight major areas, including waivers related to charging enrollment premiums and enrollee co-payments on covered services. [More]

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Categories:Health and Human Services

 

Federal District Court Judge Rules FL Medicaid Program Violates Federal Laws

 

On December 31, 2014, Judge Adalberto Jordan of the U.S. District Court for the Southern District of Florida ruled that Florida’s Medicaid program violated federal laws, including those pertaining to the EPSDT program and the requirement in 42 U.S.C. section 1396a(30)(A) that providers be sufficiently compensated to ensure access by Medicaid recipients to services equal to others in the same geographical area. [More]

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Categories:Health and Human Services

 

CMS Withdraws Its Free Care Policy

 

In a December 15, 2014 letter to state Medicaid directors, the Centers for Medicare and Medicaid Services (CMS) issued new guidance withdrawing its long-standing free care policy. Historically, with the exception of IEP/IFSP services, CMS refused Medicaid payments to school districts for covered services provided to Medicaid-enrolled students if the school district provided the services free to other students (called the “free care policy”). [More]

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Categories:Education

 

CMS Issues Final Rule Re: Hospital-Specific Limitation

 

In the December 3, 2014 Federal Register (79 Fed. Reg. 71679), the Centers for Medicare & Medicaid Services (CMS) issued a final rule authorizing a service-specific basis for defining the uninsured, for the purpose of determining the hospital-specific limitation on disproportionate share hospital (DSH) payments. Under section 1923(g) of the Social Security Act, DSH payments to hospitals are limited to the uncompensated costs of providing hospital services to individuals who are Medicaid eligible or have no health insurance (or other source of third party coverage) for the services furnished during the year. [More]

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CMS Proposes Changes in Medicare ACO Rules

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published proposed rules in the December 8, 2014 Federal Register on accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) under section 3022 of the Affordable Care Act (ACA). Under the MSSP, Medicare providers and suppliers that participate in a qualifying ACO receive traditional Medicare Part A and Part B fee-for-service payments, the ACO drives collaboration, and the ACO has an opportunity to earn “shared savings” bonus payments for each ACO “performance period” if it achieves MSSP savings targets and performance standards under quality measures for that period. [More]

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Categories:Health and Human Services