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Member news: Modern Healthcare profiled CareOregon’s innovative health resilience program, which partners specialists with high-risk Medicaid patients to address social determinants of health in an effort to reduce costs and improve care.
Stymied by debates over Medicaid and opioid funding, GOP considers move forward to vote on ACA repeal
Republican Senators have been negotiating, but have yet to draft a bill that can gather the 50 votes needed to pass the Senate. Senators are debating many issues, but Medicaid funding has been a key sticking point. Moderates are reluctant to make sweeping changes to the program, and Senators from states hit by the opioid crisis are worried cuts could jeopardize state efforts to address the epidemic. The Senate may vote on the bill soon even if Republicans don’t have enough support to pass the legislation in order to put the issue to rest for the legislative year.
Ways and Means Chair pushes CSR subsidies
Rep. Kevin Brady (R-TX), Chairman of the House Ways and Means Committee, is calling on his colleagues to authorize CSR subsidies to stabilize the market and ensure affordable rates in 2018. Congress had previously sued to stop the subsidies, and the Trump administration has not committed to continuing the subsidies.
CMS paid out more than $700 million in bonuses to unproven or false applicants
HHS Office of Inspector General (OIG) found that CMS improperly paid $729 million over three years in Medicare bonuses for an electronic record keeping incentive program. The payments went to physicians who had failed the requirements or could not prove they had met the requirements for the bonus. The OIG has recommended CMS review incentive payments and recoup erroneous payouts.
Switching jobs may be tougher with ACA repeal
The repeal of the ACA may make it harder for employees to change jobs. The ACA provided employees with increased flexibility when searching for employment by ensuring health care benefits. Repealing the ACA could mean ending provisions protecting pre-existing conditions and essential health benefits, which means extensive health coverage could again become a hiring perk for employers.
KFF report provides insight into effects of Medicaid cuts
The Kaiser Family Foundation has released an analysis of which states would be most impacted by the changes to Medicaid included in the House health care bill. The analysis notes all states would face challenges in responding to cuts, but identifies 11 states as being particularly vulnerable.
Medicaid managed care programs face challenges
More than 55 million people are members of Medicaid managed care organizations, but companies have lost millions since the program began in 2016. Modern Healthcare has released an infographic highlighting key Medicaid managed care data points, including the fact that 77% of Medicaid enrollees are in managed care as of 2014.
Oregon health care startup under investigation
Zoom, a health care startup based in Oregon, is facing allegations of retroactively falsifying medical claims to avoid paying into the ACA risk adjustment program and save money. The company now faces an FBI investigation. If the claims are true, it could be warning sign that the program is vulnerable to abuse or fraud.