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From Medicare Advantage News - As part of an ongoing effort to regionalize Medicaid purchasing and provide Apple Health Medicaid beneficiaries with the full continuum of physical and behavioral health services through managed care by 2020, the Washington state Health Care Authority (HCA) has notified subsidiaries of Anthem, Inc., Centene Corp. and Molina Healthcare, Inc. of its intent to award Fully Integrated Managed Care (FIMC) contracts in the North Central Region. The new FIMC program includes a separate contract for behavioral health “wraparound” services, which are not traditionally covered under Medicaid managed care. Read more

From Health Plan Week - By partnering with local Blue Cross and Blue Shield carriers on Medicaid managed care business in states including North Carolina and Louisiana, Anthem Inc.’s Amerigroup unit gains robust local provider networks and brings operational know-how to the table in return, industry experts say. Amerigroup, with its national footprint in Medicaid, “brings operational competencies, while a local partner can bring the provider relations. That may work for a more potent combination,” says… Read more

From Health Plan Week - CMS said May 15 it intends to propose rules, taking effect Jan. 1, 2018, that would allow small employers in states with federally facilitated Small Business Health Options Program exchanges under the Affordable Care Act (ACA) to enroll directly with insurers offering SHOP plans or through agents and brokers. Employers would no longer enroll through HealthCare.gov’s portal. (Separately, CMS said May 17 it is “streamlining” the federal portal’s enrollment process for… Read more

From Medicare Advantage News - CMS’s annual report summarizing activities for the prior audit year — released several months earlier than usual — contained some “encouraging” results, such as improved performance in the Part D program areas of Formulary and Benefit Administration (FA) and Coverage Determinations, Appeals, and Grievances (CDAG), observed a CMS official who spoke during a May 11 session of the Medicare Advantage and Prescription Drug Plan Audit and Enforcement Conference. Read more

From Drug Benefit News - High drug prices have dominated headlines over the past couple of years, with a variety of factors contributing to the attention. All the hubbub has helped lead to some pushback on the state level, as well as by commercial plans, and such responses are likely to continue, according to Avalere Health speakers at an April 26 webinar titled Drug Pricing: Where’s the Future Headed? According to Caroline Pearson, senior vice president… Read more

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