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No Surprises (?) in the No Surprises Act
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Earlier this January, I had my yearly physical. After my visit, I paid my copay and went about my day, assuming that was the end. Then in May, I received a mystery bill of $200 for services rendered “by my provider.” What a surprise! Let’s talk about the absurdity of the No Surprise Act, shall we?
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Post-Public Health Emergency: Don’t Forget the Importance of Telehealth
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The COVID-19 Public Health Emergency (PHE) moved us to provide and receive telehealth services. As the PHE comes to an end, many of us are reluctant to give up the flexibilities and access telehealth providers to achieve and maintain health. This week, Principal Tina Simpson reminds us about our pre-COVID telehealth experience and advocates for continued (and maybe increased?) access through telehealth.
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North Carolina’s Tailored Plan: To Contract or Not to Contract
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Are you ready for North Carolina’s Tailored Plan contracting? If not, get a quick definitional run down of the Tailored Plans and key aspects of the program to help evaluate your contracting strategies and decisions. This is particularly timely because one key date is coming up very quickly – July 16, 2022 – providers must have executed contracts with Tailored Plans to be included in the initial beneficiary choice period.
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State Directed Payments: Part II– Medicaid Supplemental Payments
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In the second installment of the series on State Directed Payments, Sarah Jagger shares the good, the bad, and the really (really) stupid about Medicaid Supplemental Payments.
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State Directed Payments: Part I—Medicaid Financing 101
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Atrómitos Vice President of Operations, Sarah Jagger, kicks off a new 3-part series on Medicaid State Directed Payments. This first article provides an important primer on key constructs of Medicaid financing. And a brief introduction of state-directed payments that play an important role in state Medicaid financing strategies and are the focus of upcoming policy recommendations to Congress by the Medicaid and CHIP Payment and Access Commission (MACPAC).
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The Intersection of Quality & Value-Based Care
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Healthcare Quality Week highlights the importance of quality in the healthcare delivery system. Guest Author Lavondia Alexander with Evolve Health Strategists breaks down the basics of why quality is important, how it impacts payment models, and how you can begin improving your quality game.
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The Monop-sony-and–oly of Healthcare: A Call to Government Action
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According to an annual report by the AMA, competition within the health insurance market is decreasing. This week we explore what that means, how it impacts care delivery, and what actions are necessary to correct it.
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NC Medicaid Tailored Plans: We Gotta Get this Right
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North Carolina is poised to implement Tailored Plans, a new managed care program, that will serve as an integrated health plan for individuals with significant behavioral health needs and intellectual/developmental disabilities (I/DDs) next July. Reflecting on lessons learned from other states, DHHS has the opportunity to take action NOW to ensure provider, plan, and system readiness.
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The Affordable Care Act Lives to Fight Another Day
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Yesterday, the Supreme Court released its decision in California v. Texas, upholding the Affordable Care Act (ACA) against a challenge by Republican-controlled “Red States” and the Trump Administration.
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The New NC DHHS Foster Care Plan: What the Department, Plans, and Partners Must Do for Success
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Earlier this month, NC DHHS issued its latest Medicaid Managed Care Policy Paper describing a new element of Medicaid Transformation in the state: Intent to establish a specialized managed care plan for children in foster care. Here’s what you need to know.
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A Call to Understand and Expand Medicaid This Year
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In Atrómitos’ final article of 2020, we wrote about the need for 2021 to be the year we address the myriad wicked problems confronting our nation. In keeping with that theme and also given that the N.C. General Assembly has recently convened for its new session, we’re talking about Medicaid expansion.
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ICYMI: Big Changes Coming to NC Advanced Medical Home Program
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Last week, the North Carolina Division of Health Benefits (Medicaid) launched its Advanced Medical Home (AMH) Webinar series with North Carolina Area Health Education Centers (NC AHEC) to support providers in the transition to Medicaid Managed Care. Here’s what you need to know.
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U.S. Health Reform: A Century of Groundhog Days
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Months ago, when we started our series on the Affordable Care Act (ACA), we intended to acknowledge an important anniversary (the failure of the 2017 Republican Congress’ efforts to repeal the ACA). Fast forward six months and four articles later, and we are wrapping up the year along with this series; put it down to another thing that hasn’t gone exactly as planned in 2020.
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Texas v. California and the Doctrine of Judicial Exhaustion
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Today we are, in remembrance of Thanksgiving Dinners’ Past, reminded of the wisdom of letting an argument go and turning to less fiery topics. We will focus on bringing us all back up to speed following the Supreme Court hearing in Texas v. California last week, and will provide our best assessment as to the Supreme Court’s decision in this matter (and when we can expect that decision).
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Medicaid Work Requirements: Who Exactly Are They Working For?
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This week all eyes were on the Supreme Court as it heard arguments in Texas v. California, a case that once again challenges the constitutionality of the Affordable Care Act (ACA). However, there is another case making its way to the SCOTUS that is also critically important to tens of millions of people: Alex M. Azar, II, Secretary of Health and Human Services, et al., Petitioners v. Charles Gresham, et al.
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Telehealth Series #4: Temporary Flexibilities in Telehealth Regulation: A Green Light to Adoption
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In healthcare, there are (almost always) going to be more questions than answers. Every so often there is an issue where the solution is transparent and compelling. However, telehealth is an example that falls into the more questions than answers category.
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Reflections on The Affordable Care Act and the Politics of Healthcare
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As may be expected in an election year in the midst of a pandemic (and following the recent death of Justice Ruth Bader Ginsburg and the precipitate nomination of Judge Amy Coney Barrett to the Supreme Court) health care reform remains front and center in the public debate. Here are our reflections on the ACA and the politics of health care.
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Untangling the Procedural History and Legal Arguments of Texas v. California
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This week, we dive into the case itself, which is now scheduled to appear before the Supreme Court on November 10th, one week after the November 3rd election. In this article, we examine the case’s complicated procedural history as well as its merits.
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Reflections on the Third Anniversary of Saving the Affordable Care Act
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The ACA, for all its imperfections has established a framework wherein private and public stakeholders can develop systems that enable for more efficient, equitable, effective, and sustainable care be delivered across our communities.
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COVID-19: Section 1135 Waiver Flexibilities to Support State and Provider Needs
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Shortly after the presidential declaration on March 13, the Centers for Medicare and Medicaid Services (CMS) announced a set of blanket waivers specific to the COVID-19 pandemic (COVID-19 waivers). Here’s what you need to know.
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NCDHHS Provides Policy Guidance On State-Funded Services
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On December 30, 2019, the Department released a Medicaid Managed Care Policy Paper outlining how its Behavioral Health and Intellectual/Development Disability Tailored Plans will be asked to operate State-funded Services.
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NCDHHS Seeks Comments On Changes to Value-Based Payment Program and Two New Accountable Care Organization Models by February 19
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On January 8, 2020, the Department released two Medicaid Managed Care Policy Papers that advance its design of the value-based payment program and incorporate two new Accountable Care Organization (ACO) models into the overall programmatic strategy for Medicaid Transformation.
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Our Perspective: North Carolina Medicaid Rollout Suspended
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On November 19, the North Carolina Department of Health and Human Services (NCDHHS) announced that the transition to Medicaid managed care would be indefinitely suspended. Here’s what you need to know and our perspective on the right path forward.
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Medicare 2020: Spotlight on Supplemental Benefits
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Medicare Open Enrollment is back with projected growth and premium reductions for the 2020 Medicare Advantage market. Here’s what you need to know about supplemental benefits and how it impacts beneficiaries.
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Budget Impasse Causes Delay in NC’s Medicaid Transformation
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On September 3, NCDHHS Secretary Mandy Cohen, announced that implementation of the state’s Medicaid Transformation would be delayed.
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CMS Releases State Guidance for Medicaid Implementation of SUPPORT Act
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States must amend their State Plan and receive CMS approval of the application for implementation of these DUR requirements.
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North Carolina Republicans Introduce Bill to Expand Medicaid
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On April 9, 2019, a group of House Republicans in North Carolina introduced House Bill (HB) 655 named the “NC Health Insurance for Working Families Act”. The bill mirrors “Carolina Cares” legislation that was introduced in the 2017-2018 legislative session.
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Opportunities for Behavioral Health Transformation: Making Change
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Over the past decade, public behavioral health systems across the country have undergone one transformation after another. As a result, providers and system stakeholders are often left feeling like just when one transformation finishes, it’s time to start over again.
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Medicare Advantage: Seeing the Value in Addressing the Social Determinants of Health
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Once a year, Medicare beneficiaries have the opportunity to renew their coverage or make changes to their Medicare enrollment. That can mean choosing to enroll in Medicare Advantage (MA), selecting a new MA plan, or opting for a different benefit package.