Gainwell Technologies’ Post

With Medicaid’s shifting tides, where should provider organization executives focus on preparing for the future? #Performance measurement and #management, integration #strategies, and nimble decision-making are keys to success. Read more: https://lnkd.in/d55Dkrqx To get an executive perspective of the #Medicaid landscape, our team compiled an overview of Medicaid service delivery and #financing at the national level. Become an OPEN MINDS Circle Member to view the full report: https://lnkd.in/dZtjs6kF

Time to step up #oversight efforts, to ensure states compliance with MH/SUD parity requirements. In the latest episode of "When the regulator needs regulating" - U.S. Department of Health and Human Services (HHS) #oig Found Centers for Medicare & Medicaid Services #cms did not ensure that selected States complied with Medicaid managed care #mentalhealth and#substanceusedisorder MH/SUD parity requirements. For all eight States reviewed, State contracts with #medicaid MCOs did not: 🤷🏾♀️Contain required parity provisions by the compliance date 🤷🏾♀️Conduct required parity analyses (five States), 🤷🏾♀️Make documentation of compliance available to the public by the compliance date (eight States). Moreover, all eight States may not have ensured that all services were delivered to MCO enrollees in compliance with MH/SUD parity requirements. Specifically: 🤷🏾♀️MCOs applied financial requirements (two States); and 🤷🏾♀️quantitative treatment limitations (six States) for MH/SUD services that were more restrictive than those for medical/surgical services in the same classifications Additionally, States also imposed nonquantitative #treatment limitations (eight States) on MH/SUD benefits that were not comparable to, or were more stringent than, those for #medical #surgical benefits in the same classifications.

The mPulse team is headed to Charm City next week for AHIP's Medicare, Medicaid, Duals, and Commercial Markets Forum. Come visit us in the exhibit hall and don't miss our session on Wednesday in Holiday 1, Level 2 where Lisette Roman and I will be sharing best practices for digital engagement powered by predictive analytics! #DSNP #medicareadvantage #medicaid #digitalengagement #machinelearning #conversationalai #predictiveanalytics #memberexperience #cahps #hedis

Are you aware of the power of Medicaid planning? It's not just about healthcare—it's about safeguarding your hard-earned assets for the future. If you or a loved one have questions or are navigating this complex process, our expert team can guide you, ensuring your long-term care needs are met while protecting what matters most. Don't wait until it's too late—let's start planning today! Call us at 816-601-1234 or visit www.completelawkc.com to schedule a consultation. #WhatToKnowWednesday #EstatePlanning #Medicaid #AssetProtection #CompleteLawKC

Time to step up #oversight efforts, to ensure states compliance with MH/SUD parity requirements. In the latest episode of "When the regulator needs regulating" - U.S. Department of Health and Human Services (HHS) #oig Found Centers for Medicare & Medicaid Services #cms did not ensure that selected States complied with Medicaid managed care #mentalhealth and#substanceusedisorder MH/SUD parity requirements. For all eight States reviewed, State contracts with #medicaid MCOs did not: 🤷🏾♀️Contain required parity provisions by the compliance date 🤷🏾♀️Conduct required parity analyses (five States), 🤷🏾♀️Make documentation of compliance available to the public by the compliance date (eight States). Moreover, all eight States may not have ensured that all services were delivered to MCO enrollees in compliance with MH/SUD parity requirements. Specifically: 🤷🏾♀️MCOs applied financial requirements (two States); and 🤷🏾♀️quantitative treatment limitations (six States) for MH/SUD services that were more restrictive than those for medical/surgical services in the same classifications Additionally, States also imposed nonquantitative #treatment limitations (eight States) on MH/SUD benefits that were not comparable to, or were more stringent than, those for #medical #surgical benefits in the same classifications.

Since the 1960s, Medicaid has provided health care coverage for low-income people across the United States. But do you know when to “spend down” extra assets to meet the applicable Medicaid limit set by each state? Learn about this and more on our weekly blog post! https://lnkd.in/enhVR7sQ #medicaid #MedicaidSpendDown #medicaidplanning #medicaidtips

🌟 Today's strategic discussion: @MHPA's president and Congressman Gus Bilirakis from the House E&C Committee discussed the importance of Medicaid and its crucial role in our healthcare system. We share a commitment to collaboration. #MedicaidForward #PartnersInCare #Medicaid #MedicaidLeadership 🤝 On both sides of the aisle, we find strong support for Medicaid managed care. #MedicaidAdvocacy #FL12

Delivering the right care, in the right setting, at the right time is key to creating affordability, sustainability, and patient-first care.

Sellers Dorsey Managing Director, Leesa Allen, was highlighted in a recent Fierce Healthcare article where she shares her insights on the newly released CMS Medicaid Managed Care Rule. With deep experience and expertise as a former state Medicaid Director, Leesa provided her thoughts around the challenges #Medicaid agencies will face in bringing #managedcare contracts and agency operations into compliance with the new rule. Click here to learn more and read the full article: https://hubs.li/Q02v334B0

New Medicaid managed care federal rules released last week strengthen managed care access standards, including establishing national maximum wait times for routine primary care, OB/GYN, and behavioral health appointments. Managed care is the most common delivery system for Medicaid. Most states (42, including DC) use comprehensive managed care plans to provide care to most of their Medicaid enrollees. Roughly 3 out of 4 Medicaid enrollees receive care through managed care organizations and payments to these organizations account for over half of total Medicaid spending. Five publicly traded firms – Centene, UnitedHealth Group, Anthem (renamed “Elevance” in 2022), Molina, and Aetna/CVS – account for half of managed care enrollment. Historically, states have had broad flexibility in defining and enforcing network adequacy standards for managed care organizations. Under the new federal rules, states will be required to monitor and enforce key standards for improving access to care. These rule changes will be implemented over time and may have significant implications for states, plans and enrollees. #rafaelgonzalezesq #cattiegonzalezpllc #medicare #medicaid #secondarypayer #ahigherstandardinmspcompliance https://lnkd.in/g3MU2S6