Friday, March 30, 2012

A Message from the Medicaid Chairperson Vern Smith: Update on the Supreme Court Hearings

Medicaid Chairperson Vern Smith comments on this week’s Supreme Court Hearings:

The Supreme Court arguments on Medicaid, and recent new rules on Medicaid eligibility, have highlighted both the complexity and the significance of the changes coming for Medicaid, and their implications for states and health plans.

A lot is at stake, the risks are high, and there is hardly enough time to prepare for the opportunities immediately ahead.

Across all states and Medicaid managed care plans, the keywords now are innovation, coordination, collaboration, quality improvement and performance. It is an exciting time to be involved with serving the health care needs of this population.

That is why I invite you to attend IIR’s 20th Annual Medicaid Managed Care Congress, April 30 – May 2 in Baltimore. I’ve had the privilege to chair this event for the past few years, and have seen it consistently bring together health plan leaders, state and federal officials, to share how they are addressing the most significant challenges in Medicaid.

When you download the agenda, you’ll see more than 45 exceptional speakers. There is plenty of time to interact with speakers and with more than 350 fellow participants with their own expertise in the world of Medicaid managed care.

This year I will moderate the annual State Medicaid Directors Panel, always a highlight of the conference, where we’ll focus on the top challenges state leaders are facing, and their strategies for addressing them.

Thank you very much, and I look forward to seeing you in Baltimore!


Vernon K. Smith, Ph.D.
Managing Principal

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Don’t forget, as a reader of this blog, when you register to join us at MMCC in Baltimore this April, use priority code XP1726BLOG to receive 25% off of the standard rate! If you have any questions or need any further information, feel free to email Jennifer Pereira.

Thursday, March 29, 2012

Affordable Care Act : Day 3

After three separate sessions this week, the decision concerning whether the Affordable Care Act is constitutional still remains, if congress proceeds with the individual mandate, and it’s found unconstitutional, where do the rest of the laws stand? Deputy Attorney General Edwin S. Kneedler argued, “if it were to fall only two other provisions of the law should follow suit and fall, as well.” Risk factors of insurance companies, and the effects of if the mandate did indeed fall were discussed at great length. All information has been submitted to the justices’ and they will come to a decision by June.
A second meeting was held during the afternoon to discuss the expansion of Medicaid. The matter of whether or not the states will be coerced to comply with the mandate was a concern because they will be relying on the government for initial funding when their program expands in 2014. By 2017 the state will be covering up to 5 percent of the cost of care. Expanding the bracket for both age, and income will make it possible for millions of Americans to receive coverage.

What are your thoughts? Do you think the affordable care act is constitutional? How do you think it will impact the Medicaid expansion in 2014?

Tuesday, March 27, 2012

Affordable Care Act : Day 2

Today the Supreme court met for the second time this week, regarding the issue of whether the Affordable Care Act is Constitutional. The arguments focused on the issue of regulating commerce. Justice Anthony Kennedy questioned whether this mandate would, “change the relationships status between the Government and U.S. Citizens.”

Many of the statements circling around the same subject matter of if the government can require us to purchase healthcare, what else can they require us to buy? The cost of healthcare was also a concern. Justice Ruth Bader Ginsburg also discussed,” the people who don't participate in this market are making it more expensive for those who do.” The third hearing will resume tomorrow morning, with a 90 minute debate in the morning regarding how effective the law will be and an hour in the afternoon discussing the expansion of Medicaid.

Should Americans be required to purchase health care or face a penalty? Do you believe Congress is out of its jurisdiction? Review today's hearing below and check back here for the latest news from Washington on this matter.

Listen to all hearings from Day 2 here.

Read transcript from Day 2 here.

Monday, March 26, 2012

Is the Affordable Care Act Constitutional? Supreme Court began hearings today

Today he Supreme Court heard the preliminary arguments for 90 minutes today on the whether or not the Affordable Care Act is constitutional. Most of the arguments focused on the Anti-Injunction Act of 1867.  This looks as to whether or not the US government can collect a penalty, forcing people to pay for insurance they don't necessarily want.  So, is this new provision a tax or a mandate?

CNN points out that pointed out that Justice Ginsburg commented on the constitutionality of the provision to require the purchase of health insurance, "This is a suit that is challenging the 'must-buy' provision, and the argument is made that, if, indeed, 'must-buy' is constitutional, then these complainants will not resist the penalty. So what they're seeking is a determination that ... 'must-buy' is unconstitutional, and, if that's so, that's the end of the case. If it's not so, they are not resisting the penalty."

Read the full transcript of today's hearings here.
Listen to all of today's hearings here.

After looking over today's hearings, what do you think?  Is the ACA a tax or a mandate?

So what does this mean for Medicaid Managed Care? Should the court decide that the ACA cannot be challenged, some states and plans may have to hurry to prepare for various ACA upcoming deadlines, most notably Medicaid expansion going into effect in 2014. Other states and plans that have already started to prepare for Medicaid expansion will be in better shape, and will continue business as usual.

Tomorrow the court will look at whether or not the law’s health-insurance mandate fall outside the Constitution’s limit of congressional regulatory power to matters of interstate commerce? Check back here for the latest news from Washington on this matter.

Illinois planning big budget cuts to Medicaid

In what many states are trying to do in two years, Illinois is trying to do in one.  They goal is to cut $2.7 billion from their Medicaid spending budget next year.  The State Journal Register states that their initial plan is determine eligibility of participants, and remove those who don't qualify; rescind services that aren't required by the law and reduce the rates of doctors who service Medicaid.  The is acknowledgement form the government that cutting spending by that much in one year will be difficult, but they will proceed with their plan.

Illinois Governor Pat Quinn released in a statement:
"But we’ve gotten to the point where, despite the difficulty, we must try to make the program sustainable in order to keep providing other government services that are just as essential."

At the Medicaid Managed Care Congress this April 30-May 2, 2012, Pennsylvania, Nebraska, Georgia and Texas will be participating in the State Medicaid Directors Panel: Overcome State Budget Crises addressing the same issues that Illinois and many other states are missing.  As a reader of this blog, when you register to join us and mention code XP1725BLOG, you'll receive 25% off the standard rate.

What do you think?  What will be the biggest challenges to Illinois for cutting $2.7 billion from their Medicaid budget in one year?

Friday, March 23, 2012

Are You Ready for HHS's Final Rule on Medicaid Expansion?

HHS's final rule on Medicaid expansion was released on Friday, March 16, 2012. Based in part on feedback from more than 800 comments, the 268 page document provides tactical insight into managing the newly eligible population (most non-disabled adults under 65 up to 133% FPL) and simplifies the eligibility categories into 4 primary groups: children, pregnant women, parents, and the new adult group. It also seeks to modernize eligibility verification rules and ensure coordination across Medicaid, CHIP and Exchanges.

Click here to read the complete document.

It took HHS from August 2011 until March 2012 to get from draft to final.
Will your State and Plan be ready for the 2014 deadline?

YES! If you register today for the one event that gives you your best shot at being prepared for the 2014 deadline. Understand what you must do to get ready for real time eligibility approvals and multi-program coordination

Download the brochure to learn more about the agenda and the speakers.

The Medicaid Managed Care Congress is taking place April 30-May 2, 2012. As a reader of the Healthcare: From Policy to Practice blog, use priority code XP1726BLOG to receive 25% off of the standard rate! If you have any questions or need any further information, feel free to email or visit the webpage.

Wednesday, March 21, 2012

The Ruling on the Affordable Care Act Next Week

The healthcare industry is abuzz this week with the Supreme Court set to meet next week on the constitutionality of the Affordable Care Act. All over the internet, opinions and stories are bursting about why or why not they should find the law to be constitutional or unconstitutional.

Ruth Marcus of the Washington Post believes that the $116 billion spent by the US Government is all that needs to be said about why everyone should be mandated to have healthcare.

Vermont Public Radio profiles two hospitals in Miami - one private hospital and one public who has taken hits for those who are not insured in their area.  They look forward to the new ruling as a way to better staff their hospital and provide more care.

Bloomberg Business Week takes and in depth look on how the preceedings with the Supreme Court will go from who will be in the court room to hear the arguments to what will be discussed.

According to The Global Post, only 20% of Americans think the law is constitutional.

How do you think the Supreme Court will rule?

There is a lot of work to be done as the ACA implementation begins and there is no better time or place than the Medicaid Managed Care Congress to meet with Federal and State Government Officials, Health Plan Leaders and Innovative Solution Providers to move into the era of reform implementation and Medicaid Modernization.  Join us at the Medicaid Manged Care Congress April 30-May 2, 2012, in Baltimore, Maryland to discuss the latest news and prepare for the changes in Medicaid.  As a reader of this blog, when you register and mention code XP1726BLOG, you'll receive a discount of 25% off the standard rate.

Tuesday, March 20, 2012

Medicaid Managed Care Congress Session Spotlight: Medicaid and Health Insurance Exchange Integration

There are a lot of people who are right on the border of qualifying for Medicaid, and there are a lot of questions about how they will manage people who may "churn" between Medicaid and Exchanges. For example, what if some weeks you work overtime and dont qualify for Medicaid and sometimes you don't work overtime and are eligible for Medicaid? They need to figure out a way to ensure continuous care--ideally, people could keep their same doctors so the care is continuous if they churn between medicaid and healthcare purchased through exchanges.  Also, some states are looking to have Medicaid offered through the same channel as Exchanges. I dont know if everyone is doing it, but ideally you would plug in your personal information and if you're eligible for Medicaid you could enroll in it through there.

The Medicaid Managed Care Congress' Panel Discussion Medicaid and Health Insurance Exchange Integration with a moderator from United Healthcare and representatives from Massachusetts, Michigan and Rhode Island will address these factors and more.  For more on the Medicaid Manged Care Congress taking place April 30-May 2, 2012, in Baltimore, Maryland, download the brochure.  As a reader of this blog, when you register and mention code XP1726BLOG, you'll receive 25% off the standard rate!

 John Kaelin, SVP,
Health Reform,
Featured Session: Medicaid and Health Insurance Exchange Integration
Featured Participants:
  • - Moderator: John Kaelin, Senior Vice President, Health Reform, UnitedHealth Group
  • - Julian J. Harris, MD, MBA, MSc, Medicaid Director, Executive Office of Health and Human Services, Massachusetts
  • - Amy Allen, Healthcare Reform Planning Director, Department of Community Health, Michigan
  • - Deborah Florio, Administrator, Center for Child & Family Health,Rhode Island Department of Human Services
About the session: Health Insurance Exchanges are a huge part of the ACA, and Medicaid’s integration with them varies by states. With a fast approaching 2013 deadline, states are scrambling to create regulations and guidance for plans. With approximately 80% of Exchange participants expecting to receive some sort of subsidy, Medicaid plans need to know how Exchanges will affect their current offerings. In this session, you’ll learn from states that are in various stages of creating Exchanges.
  • • Compare and contrast Medicaid enrollees and potential Exchange enrollees
  • • Identify how your plan will need to change to better serve additional members

Wednesday, March 7, 2012

Meg Murray on if there are specific areas where health plans need to expand their networks?

Recently, Meg Murray,CEO, Association for Community, Affiliated Health Plans, sat down with Medicaid Managed Care Congress director Sarah Gordon to discuss some of the biggest topics in the industry. 

Today, we feature Meg's answer to this question:

In general, are there specific areas where health plans need to expand their networks?

Her response:
We continue to hear about problems with the pediatric specialists. Dermatology is also one we often hear about. Of course the dental issues. I think everyone is very aware of the dental. As we move into the expansion population, a lot of this population coming on board are going to be people with significant mental health and substance abuse problems. That has continued to be a current concern of getting enough providers with those specialties. So, our plans are now actively looking at how they can enhance the network for adults, one. And then also for people with mental health issues.

Download the full interview at the MMCC Resource page.  Meg will be the moderator for the Health Plan CEO Panel: Ensure Member Access through Robust Provider Networks at this year's Medicaid Managed Care Congress taking place April 30-May 2.  For more information on the event, download the brochure.  If you'd like to attend, mention code XP1726BLOG when you register to save 25% off the standard rate!

Monday, March 5, 2012

How to Maintain Strong Medicaid Provider Networks to Prepare for 2014

Healthcare reform will have a dramatic impact on Medicaid eligibility by including adults at or below 133% FPL. Now is the time for Managed Care plans to evaluate their current networks to ensure they’re ready for the influx of new members in 2014. Not only will there be more lives to cover, it’s likely that the population will differ from the traditional Medicaid member, with more single young adults and more men.

The Health Plan CEO Panel at the 20th Annual Medicaid Managed Care Congress will discuss how you can provide high quality care to new members through robust provider networks. Join our distinguished CEO speakers Paul Rothman, President, Prestige Health Choice; Jay Feldstein, MD, Regional President, AmeriHealth Mercy; Al King , CEO, Amerigroup Tennessee; and Meg Murray , CEO, ACAP, who will share their strategies to maintain and expand networks amidst state rate cuts by identifying network gaps and leveraging technology to expand network coverage.

Find out more about session and the rest of the program by downloading the brochure.

For a preview the event, download the exclusive podcast “Ensure Member Access through Robust Provider Networks” featuring ACAP’s CEO, Meg Murray discussing network expansion. Download the podcast here.

The Medicaid Managed Care Congress is taking place April 30-May 2, 2012. As a reader of this blog, you can use priority code XP1726BLOG to receive 25% off of the standard rate! If you have any questions or need any further information, feel free to email

Thursday, March 1, 2012

Who can you meet at the GP Summit this month?

In just two weeks the Government Programs Summit will bring together hundreds of drug pricing and compliance executives from dozens of pharmaceutical and generic companies eager to get the most comprehensive, up to date information on the reimbursement programs affecting your business.

Here's who has registered to join us:

340B Prime Vendor Program/Apexus * Acorda Therapeutics * Afaxys Inc * Akin Gump Strauss Hauer & Feld * Akrimax Pharmaceuticals LLC * Allergan Inc * Alliance Life Science Consulting Group * Alvogen Inc * American Pharmaceutical Association * Amneal Pharmaceuticals * Amylin Pharmaceuticals Inc * Apexus * APP Pharmaceuticals * Aptalis Pharma * Aurobindo Pharma USA * Azur Pharma * Banner Pharmacaps Inc * Baxter International Inc * Bayer HealthCare * Bristol Myers Squibb Company * Brookings Institution * Cangene BioPharma * Celgene * Centers for Medicare & Medicaid Services * Cephalon Inc * CIS * CMS * Compliance Implementation Services * Cornerstone Biopharma Inc * Daiichi Sankyo * daVIZta Incorporated * Department of Health & Human Services * Dey Pharma LP * EDS * Eisai Inc * Eli Lilly & Company * Endo Pharmaceuticals * Ernst & Young * Forest Laboratories * Fresenius Medical Care * Galderma Laboratories * Gilead Sciences Inc * Government Pricing Specialists * HighPoint Solutions * Hospira Worldwide Inc * HP Enterprise Services * HP NC Medicaid * HRSA Office of Pharmacy Affairs * Huron Life Sciences * Impax Laboratories * Janssen * Jazz Pharmaceuticals Inc * JHP Pharmaceuticals LLC * Johnson & Johnson * Kadmon Pharmaceuticals * LEO Pharma Inc * Loma Linda Univ Med Ctr * McKesson Packaging Services * Medicis Pharmaceutical * MLEE Consulting * Model N * Mylan Pharmaceuticals Inc * National Association of Chain Drug Stores * Navigant Consulting * Nephron Pharmaceuticals Corporation * Novartis Pharmaceuticals Corporation * Office of Pharmacy Affairs HRSA * Optimer Pharmaceuticals * Perrigo Pharmaceuticals * Pfizer * Procter & Gamble * Purdue Pharma * Revitas * Sanofi Aventis * Shire Pharmaceuticals * Sigmapharm Laboratories, LLC * Sigma-Tau Pharmaceuticals Inc * Sunovion Pharmaceuticals * Takeda Pharmaceuticals North America * Teva Pharmaceuticals * Triax Pharmaceuticals LLC * UCB Pharma Inc * Upsher Smith Laboratories * Vertex Pharmaceuticals Inc * West -Ward Pharms * Zydus Pharmaceuticals USA

For more information on the event, download the brochure.  The Government Programs Summit is taking place March 14-16, 2012, in Baltimore, Maryland. For an exclusive discount of 25% to join us at the event, join the Government Programs LinkedIn Group. If you have any questions, feel free to email Jennifer Pereira.