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From Health Plan Week - The “final frontier” of untapped membership is how one industry insider describes the dual-eligibles market. And now is the time many health insurers are seeking to win a slice of the richly reimbursed niche. With more than 9 million duals in the country, a series of reform law-funded demonstration programs for those eligible for both Medicare and Medicaid benefits have started or will soon. Read more

From Health Plan Week - After getting reassurance from CMS that no delay in implementation of the new International Classification of Diseases, 10th Edition (ICD-10) coding protocol would occur this year, health insurers were sideswiped not by the agency, but by the U.S. House of Representatives when on March 27 it passed unrelated legislation that includes a one-year delay of the revised code set. The Senate is expected to approve the bill on March 31. If… Read more

From ACO Business News - North Carolina Gov. Pat McCrory (R) hopes to use a combination of existing accountable care organizations and new ACOs to serve most of the state’s Medicaid population in a plan he estimates could save $1 billion over five years, in part by requiring the ACOs involved to accept downside risk. The program, which was unveiled in late February and still needs approval from state lawmakers, replaces McCrory’s original plan to implement… Read more

From Medicare Advantage News - An indicator of the future direction of programs for Medicare-Medicaid dual eligibles could come soon when CMS will decide whether to approve a Michigan proposal that would keep behavioral health care separate from physical health care despite the goal of integrated care (MAN 11/21/13, p. 6). When Michigan selected eight health plans for its duals initiative last November, the state said it was in the process of “finalizing” its Memorandum… Read more

From Drug Benefit News - A new report from a coalition of stakeholders suggests that a considerable portion of hospitals enrolled in the 340B Drug Pricing Program provides a negligible amount of free or reduced-price care to indigent, uninsured patients. This report, which was partly funded by PBMs, adds to the growing body of analysis questioning whether hospitals that qualify for special drug pricing under the federal program are actually using the savings for their… Read more

From Report on Medicare Compliance - Hospitals and their attorneys may be so deep in the weeds when analyzing financial relationships that they don’t realize the fundamental flaws, said a top official from the HHS Office of Inspector General. Sometimes there’s a failure to see “the flashing yellow warning signs on the anti-kickback and Stark roads” because people get tunnel vision about whether compensation arrangements with physicians can be shoved into an exception to the Stark self-referral… Read more

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