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Medicaid is Toughest Insurer for Providers

Medicaid is the hardest insurer for providers when it comes to billing. Or so reports a new study published in the journal Health Affairs. According to this analysis, Medicaid claims take longer to file, are more likely to be rejected, more likely to be challenged, and take longer to be paid than Medicare and private insurance claims.  While the biggest problem is Medicaid fee-for-service claims, even Medicaid managed care claims pose more problems than Medicare and private insurance claims. This can pose a special challenge to urban safety-net hospitals because they care for so many more Medicaid patients than the [&hellip

Eat! You’ll Feel Better

And maybe need to spend less on health care. That is the lesson learned from a program in Massachusetts that provided home delivery of food to dually eligible Medicare/Medicaid recipients who were struggling with their meals. In a limited experiment, selected individuals received home delivery of food:  some received general meal deliveries while others received food tailored to their individual medical conditions.  The purpose:  address a major social determinant of health in this difficult-to-serve population. The result, according to a report published in the journal Health Affairs, was that Participants in the medically tailored meal program also had fewer inpatient [&hellip

CMS Proposes Easing Medicaid Access Requirement

Under a new regulation proposed by the Centers for Medicare & Medicaid Services, some states would no longer need to analyze access to care for their Medicaid population. In a newly proposed regulation, CMS calls for eliminating the need for such a review in states with a high degree of Medicaid managed care penetration – 85 percent or more – and under certain circumstances when they reduce payments to providers. According to CMS, existing regulations already enforce access requirements for Medicaid managed care plans, making a separate state obligation duplicative and unnecessary. A CMS news release accompanying publication of the [&hellip

Addressing Socio-Economic Challenges Through Medicaid Payment Policies

Amid the growing awareness of the impact of social factors on health, policy-makers are increasingly interested in finding ways to address those factors through state Medicaid programs. In a new blog post, the journal Health Affairs offers six ways for states to address social determinants of health through Medicaid managed care programs. classify certain social services as covered benefits under the state’s Medicaid plan explore additional flexibility afforded states through section 1115 waivers use value-based payments to support investment in social interventions use incentives and withholds to encourage plan investment in social interventions integrate efforts to address social issues into [&hellip

New Report Details Key Health Care Provisions in February Budget Bill

The Congressional Research Service has published a new report describing the health care-related provisions in the Bipartisan Budget Act of 2018 that Congress passed last month to fund the federal government. A major part of that law was the Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act, and the new report includes descriptions of the Medicare, Medicaid, CHIP, public health, and other health care aspects of the law. Go here to find the Congressional Research Service report Bipartisan Budget Act of 2018 (P.L. 115-123): Brief Summary of Division E—The Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act

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