Some States Complain Medicaid Rule To Assess Enrollees’ Access To Care Is Too Burdensome
States with at least 90 percent of beneficiaries in managed care, like Florida, say there's no point in spending the time to conduct the assessment of its Medicaid population. “We have a tiny fee-for-service population,” said Justin Senior, deputy secretary of the Division of Medicaid in Florida at the 2016 Medicaid Health Plans of America last week, according to Modern Healthcare. “We're having to do as much work under the access rule as we are to comply with the managed Medicaid rule. It doesn't make any sense.” News outlets also report on Medicaid developments in Nevada and Utah.
Modern Healthcare:
States Say Medicaid Provider Access Rule Is Ineffective And Burdensome
Last year, the CMS finalized a rule requiring states to assess how easy it it is for fee-for-service Medicaid beneficiaries to receive primary care and pre-and post-natal obstetric services and see specialists and behavioral health experts, among other services. The CMS felt that there are adequate provider network standards for managed-care beneficiaries so they are excluded. ... States with at least 90% beneficiaries in managed care, like Florida, say there's no point in spending the time time to conduct the assessment of its Medicaid population. In the final access rule, the CMS estimated it could take states as long as 15,000 hours to develop the plans. (Dickson, 9/29)
Reno Gazette-Journal:
Saint Mary’s, Health Plan Of Nevada At Odds Over Medicaid Coverage Once Again
The fight between Saint Mary’s Health Network and Health Plan of Nevada is on once again following disagreements regarding payment. Saint Mary’s says it informed HPN earlier this month that it will stop accepting its HPN Medicaid plan unless ongoing issues are resolved by Oct. 9. Saint Mary’s accused HPN of not upholding its end of their contract agreement. If issues are not resolved, Saint Mary’s will stop accepting HPN Medicaid, Senior Dimensions and HPN commercial products on Oct. 19. Saint Mary’s also said that it will continue to accept patients using fee-for-service Medicaid products as well as Medicaid Amerigroup. (Hidalgo, 9/29)
Salt Lake Tribune:
Utahns Likely Won’t Be Able To Sign Up For Medicaid Expansion On Jan. 1
Utahns eligible for the state's small-scale Medicaid expansion plan, even if it is approved by the federal government, likely will be unable to enroll in the program on the estimated Jan. 1 start date. The plan, projected to cover 9,000 to 11,000 people, recently underwent federal public comment. It targets childless adults who are chronically homeless, involved in the justice system or in need of mental-health or substance-abuse treatment. It also expands coverage of low-income parents with dependent children previously not covered by Medicaid. (Stuckey, 9/29)
Bloomberg:
Medicaid Expansion Will Drive Affordability, Insurance Leader Says
Medicaid expansion will force the U.S. to address the cost of health care, health insurance trade association chief Marilyn Tavenner said Sept. 28. “Medicaid is going to become the bigger issue [from the] affordability perspective,” said Tavenner, president and CEO of America’s Health Insurance Plans (AHIP), who spoke at the McKesson Health Solutions Conference in Orlando, Fla. She said she would like to see the 19 states that haven’t yet expanded the health-care program for low-income people under the Affordable Care Act do so, and doing that would likely be more difficult if Republican nominee Donald Trump is elected president than if Democratic candidate Hillary Clinton is elected. (Hansard, 9/28)