By
This article will explore Medicaid expansion during COVID-19. We all know that COVID has uprooted our lives. Telehealth is the new post-COVID norm, whereas it was in infancy pre-COVID. Perhaps the pandemic has spurred on Medicaid expansion as well. I would be remiss if I did not mention that increased…
By
And then there were 12: Medicaid expansion, COVID-19, and the SDoH Elections in Missouri last week moved that state into the expansion fold. Voters approved creating a state constitutional amendment opening Medicaid eligibility to healthy adults, as of July 2021. This win was a big one, given strong opposition from…
By
Telehealth and Medicaid eligibility nuances are expected to be future hot topics of RAC and MAC audits. Someday, around a campfire, we will tell our grandchildren that we survived COVID-19. Without question, the two biggest healthcare exceptions in the time of COVID are expansion of telehealth and mandatory expansion of…
By
Your governor is now in charge of when you go back to work. Now would be a good time to comment on President Trump’s recent announcement of reliance on state’s rights, and how his recent stance may impact your state’s Medicaid program. Have you ever wondered: seriously, what is the…
By
340B Health president was a recent guest on Monitor Monday. The following are edited remarks of her presentation.  2019 was another very busy year for people involved in the 340B drug pricing program. And it marked the end of a remarkable decade of progress and challenges. One of the most…
By
EDITOR’S NOTE: Virginia Gov. Ralph Northam, along with six managed care organizations (MCOs), have been named as defendants in a federal lawsuit filed on Sept. 25, claiming that more than a dozen of the state’s Medicaid behavioral and mental healthcare providers had their agreements terminated by the MCOs without cause.…
By
There are resources available to help prevent wrongdoers from successfully targeting vulnerable patient populations. A dirty little secret of the long-term care industry is that the problem of identity theft arises more often than is reported.  In all fraud, there is the fraud triangle. The triangle sides are pressure, opportunity,…
By
The recent study was commissioned by the American Hospital Association and the Federation of American Hospitals. A report released last week found that the federal government has reduced Medicare and Medicaid payments to hospitals by nearly $253 billion, through 12 different legislative actions since 2010. $253 billion.   Two quick…
By
Although capped, more plaintiffs are expected to be included in a second lawsuit. EDITOR’S NOTE: Virginia Gov. Ralph Northam, along with six managed care organizations (MCOs), have been named as defendants in a federal lawsuit filed on Sept. 25, claiming that more than a dozen of the state’s Medicaid behavioral…
By
To understand the difference it is helpful to know the regulatory hierarchy. Last week’s article describing how Local Coverage Determinations (LCDs) are not binding prompted a question: what about National Coverage Determinations (NCDs)?  Are NCDs afforded more weight than LCDs? The answer is a resounding “yes.” NCDs are binding, but…