-
Over the past 12 months, Ohio Medicaid has seen a 9% increase in enrollment, totaling 168,000 additional individuals on the program. Interestingly, though, 80% of that growth has been in the Healthy Families program, which covers parents, pregnant women, and children at low income levels.
-
When Michael P. Starkowski, commissioner of Connecti- cut's Department of Social Services, gave a recent presentation, a woman in a wheelchair approached him during a coffee break. She asked whether he had anything to do with Money Follows the Person (MFP), a Medicaid initiative that helps people transition from institutions to community living.
-
Oklahoma's Medicaid director, Lynn Mitchell, MD, says as of January 2009, the state's primary care case management (PCCM) program, called SoonerCare Choice, in which 423,000 Oklahomans participate, had "further embraced the patient-centered medical home principle, and we did that as a request from our providers. We feel that this will take even a further benefit to our members."
-
A small but committed number of state Medicaid programs are setting out to enhance their primary care case management programs (PCCM) that link beneficiaries to primary care providers (PCPs) and pay providers for a core set of care management activities.
-
Cost-containment programs targeting high-need, high-cost Medicaid populations now have more information to work with. Researchers from the Hamilton, NJ-based Center for Health Care Strategies analyzed prescription drug use in addition to diagnostic claims in the October 2009 report, "The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions." Here are key findings resulting from the addition of pharmacy data to the analysis:
-
How effectively does the Medicaid Statistical Infor- mation System (MSIS), the only nationwide Medicaid eligibility and claims information source, detect fraud, waste, and abuse? Not very, according to a new report which found the MSIS failed to capture data elements that can assist in fraud, waste, and abuse detection.
-
You might receive a citation from the U.S. Occupational Safety and Health Administration if you fail to assess respiratory hazards related to 2009 H1N1, don't use various methods to reduce employee exposure or fail to consider respirators other than N95s when there is a shortage.
-
Is your patient access staff familiar with federal requirements for giving patients information on how to file complaints or grievances?
-
The Medicare Secondary Payer questionnaire is not complete. The Medicare number is missing from a replacement plan. The subscriber name or date of birth is a mismatch. An account has incorrect insurance coded for third-party liability.
-
Does an individual have flawless references and impressive skills? That doesn't matter much if his or her service skills are lacking.