Reimbursement

Massachusetts has finalized a memorandum of understanding with the Centers for Medicare & Medicaid Services (CMS) to test the federal agency's capitated financial alignment model for Medicare-Medicaid dual eligible beneficiaries.

Pennsylvania is considering HIX options amid HHS's deadlines. New Jersey lawmakers have passed HIX legislation that has some insurers concerned, and the D.C. exchange wants to be the only venue for small biz and individual plan sales.

A nonprofit in Ohio has been awarded a $129 million loan from the Centers for Medicare & Medicaid Services (CMS) to run a Consumer Oriented and Operated Plan (CO-OP).

Flexing its muscle with the healthcare buying power of 1.4 million employees, Wal-Mart last week announced it was contracting with six healthcare organizations nationwide to provide its health plan covered employees with no out-of-pocket costs for specific heart, spine and transplant surgeries.

Flexing its muscle with the healthcare buying power of 1.4 million employees, Walmart last week announced it was contracting with six healthcare organizations nationwide to provide its health plan-covered employees with no out-of-pocket costs for specific heart, spine and transplant surgeries.

Pennsylvania backs off co-payment plan; Texas investigates dental fraud; Alaska to study costs of Medicaid expansion in this week's Medicaid Digest.

State Medicaid directors are caught in the vice grip of competing interests driven by the looming election, lean state budgets, uncertainty about expansion caused by the Supreme Court health reform decision and the threat that Congress will cut the health program to help balance the federal budget.  

Not surprisingly, only about 10% of firms with fewer than 200 workers take advantage of self-insurance -- and almost no very small groups (fewer than 50 workers) use the product. It just isn't worth it for these small employer groups to take the risk that they will either have too many claims or very big claims from their workers -- that is what insurance companies are for.

Private health insurance exchanges are sprouting up and established ones want to grow, challenging state-based HIXs and expanding the retail insurance market.

The Medicare program could save billions in the next decade if care models are restructured says a newly released analysis commissioned by a nonprofit, national consortium of home healthcare organizations.