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Janette Conway of Neighborhood Health Plan of R.I. Wins ACAP's "Making a Difference" Award

ACAP recently recognized Janette Conway, a housing specialist with Neighborhood Health Plan of Rhode Island, with the organization’s national “Making a Difference” Award. The award recognizes an employee at an ACAP-member Safety Net Health Plan who goes far beyond the boundaries of their job description in efforts to improve their community, support underserved populations, and fulfill community needs.

Ms.Conway is a Housing Specialist on Neighborhood’s nursing home transition team. She supports Neighborhood’s members as they transition to independent living from long-term care facilities, including forging connections with social services vital to their independence. Ms. Conway was singled out for the extraordinary lengths to which she will go in an effort to advocate for the members in her charge. Read more >  

ACAP Reacts to Updated Managed Care Regulations

In a recent statement, ACAP provided reaction to several aspects of recently-promulgated Federal regulations surrounding Medicaid managed care. The update is the first overhaul of such scope since 2003. 

"The way that health care is delivered and paid for has evolved substantially since the last overhaul of the Medicaid managed care regulations in 2003. The Centers for Medicare & Medicaid Services (CMS) has made a number of thoughtful modernizations to these regulations. While we are pleased with some of the changes brought about by this update, we believe significant room for improvement remains," said ACAP CEO Margaret A. Murray 

ACAP’s reaction includes specific notes on network adequacy and provider directories; quality measurement and reporting; establishment of a Medical Loss Ratio (MLR); the proposed 14-day period of fee-for-service (FFS) coverage for new enrollees, and more. Read more > | Summary of key provisions > 

New Report: 4 in 10 QHP Issuers Operate a Medicaid Plan in the Same State

A new ACAP analysis finds that of the 335 Qualified Health Plan issuers offering Marketplace plans in 2016, 137—or just over 40%—offer Medicaid managed care coverage in the same state. A closer analysis of the results, however, suggests that many individuals – even those residing in states with large numbers of overlap issuers – have limited access to plans that operate in both Medicaid and the Marketplace, as many overlap issuer plans are only offered regionally. 

Read the report >   Spreadsheet of QHP Issuers (Excel) >   Press release >

ACAP Applauds Preservation of Risk-Adjustment Fixes in Medicare Advantage Final Call Letter

ACAP CEO Margaret A. Murray made the following statement about the 2017 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter recently issued by the Centers for Medicare & Medicaid Services (CMS):

“With this final notice, CMS has addressed the flaw in its risk adjustment system that had led to systemic underpayments for health plans serving full-benefit dual eligibles—who are among the poorest, sickest, and most vulnerable Medicare beneficiaries.

“This fix will help Safety Net Health Plans and others to continue their mission to bring integrated services to full-benefit dual eligibles through coordinated, accessible, high-quality care—as is the intent of the Dual Eligible Special Needs Plan program as originally passed in the Medicare Modernization Act." Full statement >

39 Organizations Voice Support for 12-Month Continuous Enrollment in Medicaid, CHIP

Thirty-nine allied health organizations recently submitted a letter to leaders in the House and Senate urging them to pass legislation that would provide for 12 months’ continuous eligibility for Americans in the Medicaid and Children’s Health Insurance Programs (CHIP).  The legislation – H.R. 700 in the House, introduced by Reps. Gene Green (D-Texas) and Joe Barton (R-Texas), and S. 428, introduced by Sen. Sherrod Brown (D-Ohio) – addresses “churn,” a phenomenon where people with Medicaid and CHIP coverage lose their eligibility because of bureaucratic paperwork issues or short-term changes in income. Read the letter > | Press release > 

Medicaid Managed Care Is Accountable Care:
Reporting Prevalence by Program Type

Source: CMS Medicaid Managed Care Enrollment Reports, 2013 | see more >