- New CMS guidance for Medicaid managed care medical loss ratio calculations
By Paul R. Houchens, Ian M. McCulla, Amber Kerstiens | 06 June 2019
The May 15, 2019, Informational Bulletin from the Centers for Medicare and Medicaid Services focuses on the responsibilities of a subcontractor in providing data and the proper accounting of subcontractor payments for purposes of medical loss ratio reporting.
- Medicaid adult dental reimbursement
By Joanne E. Fontana, Catherine E. Lewis, Tory Carver | 09 May 2019
This paper explores the relationships among a state’s adult Medicaid dental benefit, provider reimbursement, and dental care utilization rates.
- HHS’s proposed modification of pharmacy rebate safe harbors
By Christine M. Mytelka | 22 March 2019
This paper focuses on potential implications of the proposed modifications to safe harbor regulations for state Medicaid agencies and the Children’s Health Insurance Program.
- Webinar: Seven key challenges for Medicaid states considering alternative payment models
By Rebecca L. Johnson, Anders Larson, Zach Hunt | 28 February 2019
Webinar Agenda
Attribution
Claims volatility
Risk adjustment
Alignment with managed care
Quality metrics
Service carve-outs
Variation in benefits and coordination with other payers
Download the webinar slides
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- Evaluation of State Medicaid Scorecard Data
By Andrew Dilworth, Paul R. Houchens | 26 February 2019
An analysis of the recently announced Centers for Medicare and Medicaid Services Medicaid and Children’s Health Insurance Program Scorecard with a primary focus on the Scorecard’s State Health System Performance quality metrics.
- Pathways to Success MSSP final rule: Financial benchmark
By Jill S. Herbold, Cory Gusland, Charlie Mills, Matthew J. Kramer | 22 February 2019
This paper discusses the changes to the financial benchmark methodology that measures the gross savings or losses of an accountable care organization under the Medicare Shared Savings Program.
- An end to manufacturer rebates as we know them today?
By Deana Bell, Jennifer Carioto, Matthew Hayes | 15 February 2019
The proposed rule to make drug manufacturer rebates no longer protected under the Anti-Kickback Statute has broad impacts to federally funded prescription drug programs, especially Medicare Part D.
- Pathways to Success MSSP final rule: Winners and losers
By Anders Larson, Cory Gusland | 14 February 2019
This paper examines the Medicare Shared Savings Program’s (MSSP) final rule from the perspective of different accountable care organization (ACO) situations to help readers understand how the MSSP rule might affect different ACOs.
- Changing the rebate game: A primer on the HHS proposed rule to shift drug rebates to POS
By Maggie Alston, Carol Bazell, David R. Mike | 08 February 2019
This paper discusses the implications of recently proposed rebate regulation to various Medicare Part D program stakeholders.
- Seven key challenges for Medicaid states considering alternative payment models
By Anders Larson, Rebecca L. Johnson, Zach Hunt | 29 January 2019
This article focuses on some of the challenges that Medicaid payers (including states and managed care organizations) face when trying to establish alternative payment models with providers.