State Medicaid agencies are increasingly turning to managed care organizations (MCOs) to cover more Medicaid enrollees, including those with complex needs. The ongoing shift from a fee-for-service payment model to a value-based payment model at the health plan and provider level puts even more importance on Medicaid managed care procurement strategies and approaches.
This webinar, drawn from the SHVS resource for states, Value-Based Purchasing for Managed Care Procurements: A Toolkit for State Medicaid Agencies, highlights key activities for state Medicaid agencies as they tackle managed care procurements. The webinar emphasizes the link between a state’s value objectives, RFP development, and model contract oversight. Beth Waldman and Mary Beth Dyer from Bailit Health discuss key steps and timelines for procurements, as well as important steps to take once contracts are in place to ensure a strong partnership between state Medicaid agencies and the health plans with which they contract. States with recent procurement experience will offer lessons learned from their own procurements.
Kim Hamilton, Director of the Managed Care Plan Division at Michigan Department of Health and Human Services shared with SHVS the provider survey implemented in Michigan and referenced during the webinar.
On September 8, the Department of Homeland Security (DHS) issued a final rule on the “Public Charge Ground of Inadmissibility,” regarding DHS’ authority to refuse a noncitizen’s application for admission or application for visa adjustment (including receipt of a green card) on grounds that they are “likely at any time to become a public charge.” This expert perspective provides an overview of the final rule.
This expert perspective provides an overview of the eligibility and enrollment proposed rule released by CMS on August 31 and details how the proposed rule seeks to strengthen existing eligibility, enrollment, and renewal operational processes in an effort to close gaps in coverage and extend best practices identified by CMS and states in the course of preparing for unwinding the federal public health emergency (PHE). Comments on the proposed rule are due no later than November 7, 2022.