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- After more than two decades, SAMHSA and its Center for Substance Abuse Treatment (CSAT) is revisiting regulations governing opioid treatment programs (OTPs), as required by the 2023 Consolidated Appropriations Act passed by Congress. Read MoreIn Focus:Roundup:
Save the Date: HMA Spring Workshop on Implementing Value-Based Care
Alabama Receives Approval for Community-Based Mobile Crisis Services SPA
Arizona Requests Section 1115 Waiver Amendment to Raise CHIP Eligibility Threshold
California Governor Signs Bill to Simplify Billing, Increase Access for Medicaid School-based Health Programs
Florida Bills Would Remove Step Therapy Requirement for Medicaid Beneficiaries with Mental Illness
Georgia Legislators Discuss Coupling Full Medicaid Expansion, Relaxation of Certificate-of-Need Requirements
Idaho Releases MMIS System Integrator Technical Advisory Services RFP
Nevada Submits Section 1332 State Innovation Waiver Application For Market Stabilization, Public Option Program.
New York Essential Plan Expansion Implementation Delayed to April 2024
North Carolina Hospitals Will Receive $2.6 Billion As State Prepares to Start Medicaid Expansion
Tennessee to Renew Existing TennCare Medicaid Managed Care Contracts for Now
Wisconsin Insurers Fail to Meet Federal Access Standards for Exchange Program, Report Finds
Average Time Spent on Medicaid HCBS Waiting Lists Has Decreased Since 2021
ACA Exchange Enrollment Approaches 4.6 Million Through Three Weeks of Open Enrollment
Medicare, Medicaid Improper Payment Rates Driven by Documentation Errors in Fiscal 2023, CMS Finds
CMS Launches Medicare GUIDE Model Application
CMS Issues Proposed Rule to Ensure Network Adequacy Standards For State-run Exchange Plans
Humana, Cigna in Talks to Merge by End of Year
- This week, our In Focus section reviews a wide-ranging proposed rule issued by the Centers for Medicare & Medicaid Services (CMS) on November 6, 2023. Read MoreRoundup:
HMA Report Shows First-of-Its-Kind Actual Comparisons of State-by-State Medicaid Disenrollments vs. Projections
Medicaid Eligibility Redeterminations News: Arkansas, Idaho, Florida, Iowa, Kentucky, Maine, Maryland, Mississippi, Nevada, Texas, Washington
Idaho Legislative Task Force Agrees State Should Stick with Medicaid Value Care Organizations
Indiana Submits 1915c Waiver Request to Transition Medicaid LTSS to Managed Care
Iowa to Award Medicaid Dental Services Contracts to Delta Dental of Iowa, DentaQuest USA
CareSource Names Chad Moore Kansas Market President
Missouri Extends Medicaid Postpartum Coverage to 12 Months
South Dakota Enrolls Less than 20 Percent of Eligible Medicaid Expansion Population
Tennessee Releases RFP for TennCare Select Prepaid Inpatient Health Plan for Children
States Expect Medicaid Enrollment Decrease, Spending Increase in Fiscal 2024, KFF Medicaid Director Survey Finds
Fourteen Insurers to Exit Medicare Advantage Markets in 2024, KFF Data Show
Centene Names Susan Smith as Chief Operating Officer
- This week, our In Focus section reviews several calendar year (CY) 2024 Medicare payment final rules that the Centers for Medicare & Medicaid Services (CMS) issued in recent weeks. Read MoreRoundup:
HMA Information Services Names Andrea Maresca as Managing Director
Arizona to Award $47.5 Million to HCBS Providers in Second Round of ARP Grant Funding
California Minimum Wage Increase for Healthcare Workers Estimated to Cost $4 Billion in Fiscal 2025
Florida Releases Comprehensive IDD Managed Care Pilot Program ITN
Idaho Health Data Exchange Lacked Accountability Measures, Report Finds
Iowa Releases Medicaid Quality Improvement Organization Services RFP
Missouri Disenrolls 52,000 Children From Medicaid During First Four Months of Redeterminations
Nebraska Medicaid Director Resigns
North Carolina Order Dissolves Sandhills Behavioral Management Entity, Consolidates Two Others
GuideWell Names Thurman Justice President, CEO of Triple-S Management
Medicare Advantage Plans Enjoy Higher Payments than FFS, MedPAC Reports
Medicaid Disenrollments Top 10 Million Following Redeterminations
Cigna Explores Sale of Medicare Advantage Business
- This week, our In Focus section reviews the Michigan Medicaid Managed Care Comprehensive Health Care Program (CHCP) request for proposals (RFP), which the Michigan Department of Health and Human Services released on October 30, 2023. Read MoreRoundup:
Alabama Releases Modular Electronic Visit Verification RFP
California Submits Section 1115 Medicaid Waiver Amendment to Provide Rental Assistance
Florida Legislators File Bills to Study Impact of Potential Medicaid Expansion on Individuals Aged 18 to 26
Georgia Bidding Conference for Medicaid Managed Care Contracts Is Attended by Several Health Plans
Georgia Democratic Leaders Call on Governor to Implement Full Medicaid Expansion
Mississippi Medicaid Managed Care Procurement Stalls Following Protests from UnitedHealthcare, Elevance
New Hampshire Providers to Receive Another Increase in Medicaid Payment Rates
Pennsylvania Bill Would Reinstate Medicaid Coverage of Most Dental Services
CMS Releases Final Rule to Increase Payments to ESRD Facilities by 2.1 Percent
Bright Health Group, Friday Health Plans Owe $1.1 Billion in Exchange Risk-Adjustment Payments
- This week, our In Focus section summarizes the Medicaid Long-Term Services and Supports (LTSS) Annual Expenditures Report, which the Centers for Medicare & Medicaid Services (CMS) released on October 17, 2023 Read MoreRoundup:
Arizona Releases Fee-For-Service Pharmacy Benefits Management Services RFP
Arkansas Releases Medicaid Enterprise Systems Independent Verification, Validation Services RFP
Arkansas Releases Medicaid Dental Services RFP
California Enacts Bills to Improve Treatment of Individuals with Mental, Behavioral Health Disorders
Colorado Individual Plan Rates to Rise 9.7 Percent in 2024
Florida Announces List of Bidders for Statewide Medicaid Managed Care ITN
Florida Releases ITNs for 6 Behavioral Health Managing Entity Regions
Georgia Pathways to Coverage Medicaid Expansion Enrollment is 1,343 Through September
Medicaid Eligibility Redeterminations News: Iowa, Kentucky, Louisiana, Maryland, Michigan, Pennsylvania, South Dakota
Maryland Cannot Document Receipt of Federal Funds, Shows $1.1 Billion Deficit in Medicaid Clearing Account, Audit Shows
New Jersey Enacts Medicaid Rate Increase for Reproductive Health Care Providers
New Mexico Releases Closed Loop Referral Service RFQ
Pennsylvania Expands List of Medicaid Providers Eligible to Provide Street Medicine Services
Previous Direct Contracting ACO Model Saved Medicare $371.5 Million in 2022
UPMC, Washington Health System Sign Merger Agreement
- This week, our In Focus section highlights a white paper that Wakely, a Health Management Associates company, released in October 2023, “Cut to the Point: A Summary of 2024 Star Rating Cut Point Changes”. Read MoreRoundup:
Arizona to Release Medicaid PBM RFP ‘in the Coming Weeks’
Medicaid Eligibility Redeterminations News: Arizona, Florida, Georgia, Mississippi, North Carolina, Texas, Wyoming
Florida Launches Dental Provider Incentive Program
Minnesota Eliminates Parental Fees for Medicaid Coverage of Children With Disabilities
Nevada Governor Proposes Exchange Reinsurance in ‘Revision’ to Public Option Law
New York Medicaid Spending Exceed Expectations, Report Finds
North Carolina Receives Final Federal Approval for Medicaid Expansion
Oregon Announces 3.4 Percent Increase in 2024 Capitation Rates for Medicaid Coordinated Care Organizations
Oregon Releases RFP to Expand PACE Services
Long-term Services, Supports Spending Falls as Percentage of Total Medicaid Expenditures, CMS Reports
State Medicaid Programs Disenroll 8.8 Million Beneficiaries During First 6 Months of Redeterminations, KFF Finds
Alignment Health, Walgreens to Jointly Market Medicare Advantage Plans in 2024
- This week, our In Focus section reviews the Florida Statewide Medicaid Prepaid Dental Program invitation to negotiate (ITN) released October 6, 2023, by the Florida Agency for Health Care Administration (AHCA). Read MoreRoundup:
Medicaid Eligibility Redeterminations News: Alabama, Alaska, Arizona, Arkansas, Florida, Maine, Missouri, New Mexico, Oregon, Texas, Wyoming
Arizona Receives Five Bids for Medicaid Managed Long-term Care Contracts
California Enacts Law Advancing State Toward Universal Healthcare System Such as Single-payer
Idaho Medicaid Value-based Care Organizations Ask State to Stick with Current Model
Kentucky Reports Savings Following Removal of PBMs from Medicaid Program
Nevada Extends Deadline for Medicaid Managed Care RFI
New York to Launch Medicaid Social Care Networks to Address Health-related Social Needs
Dual Demos in New York, Ohio, Washington Show Mixed Results, CMS Reports
Cigna Purchases Digital Health Company Bright.md
- This week, our In Focus section reviews the KanCare Medicaid capitated managed care request for proposals (RFP), released October 2, 2023, by the Kansas Department of Health and Environment and Department for Aging and Disability Services. Our second In Focus Read MoreRoundup:
Alaska Pauses Procedural Medicaid Disenrollments
Florida Agencies to Report on Medicaid Redeterminations to State Senate
CareSource to Partner with Pediatric Care Provider to Bid on Florida Medicaid Contract for Children, Teens with Special Needs
Illinois Head of Healthcare, Family Services to Step Down
Indiana Drops Molina from Medicaid MLTSS Contract
Indiana Medicaid MLTSS Contracts to Begin July 2024
Indiana Awards Hoosier Rx Program Contracts to Three Companies
Iowa to Develop HCBS for Children With Severe Behavioral Health Needs in Lawsuit Settlement
Elevance, Blue Cross Louisiana Withdraw Merger Application
Louisiana Lawmakers Push to Reexamine Medicaid Technology Contract
Michigan Releases State Action Plan to Improve Birth Outcomes
North Carolina Medicaid Expansion to Launch on December 1
Ohio Estate Recovery Program Recovers Less Than One Percent of Fiscal 2023 Medicaid Costs
Oklahoma Receives Federal Waiver Approval Enabling Transition to Medicaid Managed Care
Texas Implements Vendor Contracts for Medicaid FFS Prior Authorization, Enrollment, Other Functions
CMMI Value-based Models Result in $5.4 Billion Increase in Federal Spending, Report Finds
Carlyle Group in Talks to Acquire Majority of 2 Medtronic Medical Device Businesses
- This week, our In Focus section reviews the new States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model, which the Centers for Medicare & Medicaid Services (CMS) Center for Medicaid and Medicare Innovation (the Innovation Center) announced on Read MoreRoundup:
Help at Home to Cease Operations in Alabama
Arkansas Working Group Makes Recommendations Aimed at Improving Foster Care System
Florida Delays Bidding for Medicaid Managed Care Contract
AmeriHealth Caritas Names Melody Bonomo as Florida Market President
Medicaid Eligibility Redeterminations News: Florida, Kansas, Louisiana, Mississippi, Nevada, North Carolina, Texas, Virginia
Nebraska Launches Program to Enroll Inmates Nearing Release in Medicaid
Nevada Medicaid Plan Aims to Improve Maternal Health-related HEDIS Scores
New Mexico Seeks Public Comments on Section 1115 Waiver Renewal Application Addendum
North Dakota Seeks Public Comments on IDD HCBS Waiver Renewal Application
Utah Considers Carve Out of Medicaid ACO Pharmacy Benefits to Fee-for-Service
Vermont Releases HCBS Business Supports RFP
NCQA Includes Equity Measure in 2023 Health Plan Quality Ratings
CVS Health/Aetna Promotes Mark Santos to Head of Medicaid
- This week, our In Focus section reviews the New Hampshire Medicaid Care Management (MCM) request for proposals (RFP), which the state’s Department of Health and Human Services released on September 8, 2023. Read MoreRoundup:
California Medicaid Director Jacey Cooper Is Leaving to Join CMS
District of Columbia Receives Approval for Community-Based Mobile Crisis Services SPA
Florida Renews Medicaid Utilization Management Contract with Acentra Health
Hawaii Receives $4 Million Project LAUNCH Federal Grant to Improve Children’s Behavioral Health
Michigan Expects Medicaid Community Health Worker Benefit to Impact 50,000 Residents If Approved
BCBS-NC Names Angela Boykin CEO of Medicaid Plan
Oregon to Seek Federal Approval for Basic Health Plan
Pennsylvania to Review Rates for Providers Serving Individuals with Intellectual Disabilities, Autism
CMS to Lower Cost of 34 Prescription Drugs Beginning October 1
Walmart May Buy Majority Stake in ChenMed
