- 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.
- Critical Point Episode 8: Puerto Rico after the hurricane: Managing Medicaid in the face of a natural disaster
By Jose Carlo | 14 January 2019
Managing Medicaid in Puerto Rico after Hurricane Maria was part of Jose Carlo’s job, but it was also personal for the Milliman consultant.
- Medicaid’s winding path through Institutions of Mental Disease
By Christopher Kunkel, Catherine E. Lewis, Jie Savage | 19 December 2018
The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act provides a simpler way for states to include Institutions of Mental Disease facilities in their fee-for-service and managed care delivery models—a state plan amendment.
- Are you ready for New York State Medicaid value-based payment models?
By Brett Friedman, Rebecca L. Johnson, Howard Kahn | 08 November 2018
This paper provides a high-level overview of the New York State value-based payment models, discusses the opportunities and challenges for providers considering participation in them, and highlights the needs for sophisticated actuarial, financial, and legal expertise to address the inherent business, legal, and operational risks.
- Approved Medicaid state directed payments: How states are using §438.6(c) Preprints to respond to the managed care final rule
By Jim B. Pettersson, Ben Mori, Luke B.G. Roth, Jason A. Clarkson | 30 October 2018
This paper provides a background on state directed payment arrangements based on our review of §438.6(c) “Preprints” and supporting documentation for arrangements approved by the Centers for Medicare and Medicaid Services as of August 15, 2018.
- Medicaid managed care financial results for 2017
By Jeremy D. Palmer, Christopher T. Pettit, Ian M. McCulla | 04 June 2018
This report summarizes the calendar year 2017 experience for selected financial metrics of organizations reporting Medicaid experience under the Title XIX Medicaid line of business on the National Association of Insurance Commissioners annual statement.
- Medicaid buy-in: Section 1332 Innovation Waivers, state options, and top ten considerations
By Paul R. Houchens, Christine M. Mytelka, Susan Philip | 11 May 2018
Medicaid buy-ins are currently getting states’ attention.