NPAG 2018 Recap

Excellus Blue Cross Blue Shield was pleased to host the 2018 National Plan Automation Group (NPAG) Conference in picturesque Lake Placid, NY. The event showcased 4 days of interactive sessions exploring opportunities in EDI, electronic payments, health records, “HEDIS,” and the past, present, and future of authorization transactions. While NPAG sponsored a progressive networking retreat, attendees took advantage of Lake Placid Golf Club, Ausable Chasm, and an adventurous BobSled Experience.

In case you were not able to attend, here’s our recap of what was discussed:

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CMS to accelerate Medicaid waiver process and allocate $8.6 million in funding to states to steady health insurance markets

The Centers of Medicare and Medicaid Services (CMS) revealed on August 16th, 2018 changes to the Medicaid Review Process, unveiling substantial reduction in approval times. The new updates will generate faster processing of state requests to streamline changes to their Medicaid program through the state plan amendment and section 1915 waiver review process. Less than 1 week following this move, CMS announced $8.6 million in funding to 30 states and the District of Columbia to help reinforce and stabilize corresponding health insurance markets under the Affordable Care Act (ACA).  

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MESC 2018 Recap

The annual Medicaid Enterprise Systems Conference (MESC) showcased 4 days of interactive sessions discussing health information technology, MMIS implementations, and Medicaid innovations. Set in the picturesque city of Portland, Oregon, the conference welcomed industry experts from all over the country. Day 1 set the tone by asking the audience: “What’s your next big idea in Medicaid?” All sessions to follow explored that overarching question.  

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Section 1115 Waivers: The effects of Medicaid expansion under the Affordable Care Act

To date, 33 states and the District of Columbia have expanded their programs, 8 utilizing a Section 1115 Waiver.  Another 17 are not currently expanding, however, their interest will soon be measured on ballots this Fall.   

Overall, the impacts have been significant; coverage, access to care, and delivery system reform have all seen changes. Medicaid expansion has positively affected utilization of services, the affordability of care, and financial security among the low-income population. According to Kaiser Family Foundation (KFF), Medicaid expansion states have also experienced significant coverage gains and reductions in uninsured rates – among the low-income population broadly and within specific vulnerable populations.  

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MESC 2018 Recap: Day 2

The annual Medicaid Enterprise Systems Conference (MESC) began day 2 with a deep dive into Machine Learning for Medicaid Payers and Providers, followed by sessions on successful modular MMIS implementations and best practices from state reuse initiatives, including that of New Jersey and Pennsylvania.

If you weren’t able to attend, check out our MESC recap of key takeaways.

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MESC 2018 Recap: Day 1

The annual Medicaid Enterprise Systems Conference (MESC) kicked off with a boom. Set in beautiful Portland, Oregon, the event welcomed the who’s who of Medicaid. Nearly 100 sessions are packed into 4 days of fun- filled announcements and discussions about Medicaid and where the industry is headed.

Day 1 rang in with an overarching theme: “What’s your next big idea in Medicaid?” If you weren’t able to attend, check out our MESC recap of key takeaways:

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CMS restores Affordable Care Act risk-adjustment transfers for 2017 benefit year

Yesterday, the Centers for Medicare and Medicaid Services (CMS) released a final rule designed to allow and reissue payments under the Affordable Act risk-adjustment program to balance the insurance market. According to CMS Administrator Seema Verma, “This rule will restore operation of the risk adjustment program and mitigate some of the uncertainty caused by the New Mexico litigation.”  

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Overview of the CMS 2018 Enrollment Manual

On June 25, 2018, the Centers for Medicare and Medicaid Services (CMS) released its 2018 Enrollment Manual. The manual offers 15 key highlights relating to several processes including auto reenrollment and non-renewal, reports such as the Batch Auto-Reenrollment (BAR) Progress Report, as well as updates on Enhanced Direct Enrollment (EDE), Marketplace premiums, and Medicaid.

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A closer look at the CMS decision to suspend risk adjustment payments

Earlier this week, the Trump administration announced it would be suspending more than $10 billion in risk adjustment payments to issuers. Since then, several issuers and analysts have come out against the decision, saying CMS had several other options it could have taken.  

According to the Centers for Medicare & Medicaid Services (CMS), the hold is due to a March court ruling and pending litigation. The case involved New Mexico Connections, a consumer operated and oriented plan (CO-OP), which sued the Department of Health and Human Services (HHS) over an alleged flaw in the calculation that favored larger issuers. The presiding judge, James Browning, ruled that HHS’ formula was not illegal but should be re-examined. A previous court ruling in Massachusetts upheld the federal program.  

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