From Medicare Advantage News - In what may be a preview of issues other states also will face as they expand Medicaid managed care extensively and quickly, the California state auditor (CSA) on June 16 severely criticized what both managed Medicaid plans and state agencies have done to ensure adequate provider-network access for beneficiaries. But the major state agency involved said only some of the criticisms are warranted. Read more
From Medicare Advantage News - A highly rated Medicare Advantage plan operator in Michigan has used an unusual partnership with five local nonprofit skilled nursing facilities (SNFs) and a local ambulance company to achieve large reductions in cost of care for about 300 of its complex chronically ill MA members. And based on the results and the need, Grand Rapids, Mich.-based Priority Health wants to boost the number of MA members in the program to… Read more
From Medicare Advantage News - Capital BlueCross benefited from two programs CMS began in 2014 to help Medicare Advantage and stand-alone Prescription Drug Plan insurers emerge from marketing and enrollment sanctions, a plan executive said at the agency’s annual MA and PDP audit and enforcement conference in Baltimore June 16. In an unusual joint presentation with CMS’s top MA enforcement official, Todd Shamash, vice president, legal and regulatory affairs at the Blues plan, emphasized that… Read more
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