ACA RA Transfer Report – 2021 Benefit Year

CLICK TO VIEW INTERACTIVE VISUALIZATION Once again, the U.S. Department of Health and Human Services (HHS) reported that the risk adjustment program operated smoothly for the 2021 benefit year. For the seventh year, the risk adjustment program is working as intended by more evenly spreading the financial risk carried by issuers that enrolled higher-risk individuals…

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Dual Eligible Renewal Strategies

The U.S. Department of Health and Human Services (HHS) first declared a Public Health Emergency (PHE) in January 2020. Section 6008 of the Families First Coronavirus Response Act (FFCRA) as amended by the Coronavirus Aid, Relief, and Economic Security (CARES) Act provides states with a temporary 6.2 percentage point increase in their federal medical assistance…

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To Emergency and Beyond….

To Emergency and Beyond. From Pandemic to Endemic. Sounds like science fiction, but it is our reality and our future as we attempt to navigate through and beyond the COVID-19 virus our world has been plagued with for more than two years.   Record high Medicaid and CHIP enrollment During these two-plus years, enrollment in…

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Is Your Health System’s Referral Network Leaking Patients and Revenue?

A key objective for an integrated health system is to keep provider referrals within the system. Many of the financial, patient outcome, and quality assumptions about a health system depend upon keeping the system, well, “integrated.” Most health systems in the U.S. do a good job putting together the right mix of clinical capabilities, medical…

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Beyond the Z-Codes

Promoting Health Equity and Population Health Through Advancing the Use of Social Determinants of Health Data In the recently released  CY 2023 Medicare Advantage (MA) and Part D Proposed Rule (CMS-4192-P) CMS for the first time provides very specific guidance related to social determinants of health (SDoH). As a refresher, SDoH are the non-medical factors…

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Federal Poverty Guidelines 2022 Release and COVID Public Health Emergency Renewal

Payors and Providers wait for the release of the poverty guidelines each year to update patient financial assistance and eligibility information within their forms and systems. The 2022 Poverty Guidelines went into effect on January 12, 2022, and are now posted at https://aspe.hhs.gov/poverty-guidelines. Poverty guidelines are issued each year in the Federal Register by the Department of Health…

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ACA RA Transfer Report – 2020 Benefit Year

According to the U.S. Department of Health and Human Services (HHS), the risk adjustment program operated smoothly for the 2020 benefit year. The risk adjustment program is working as intended by more evenly spreading the financial risk carried by issuers that enrolled higher-risk individuals in a particular state market risk pool, thereby protecting issuers against…

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Government Healthcare: Strategizing Today for Success Tomorrow

The Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) both underwent a leadership change in 2021. Xavier Becerra was confirmed as HHS’ Secretary in March and Chiquita Brooks-LaSure as CMS’ Administrator in May.   CMS, an Operating Division of HHS, has oversight for what Brooks-LaSure calls “the…

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Weathering the Storm of Climate Change and Its Impact on Health Equity

News Flash! January through June 2021 was the eighth warmest such period on record according to the National Oceanic and Atmospheric Administration (NOAA). The other day my Amazon Show informed me about the melting ice in Greenland. The red tide algae bloom in Florida was hard to miss as the news reported disturbing images of…

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Medicaid Before, During, and After the COVID-19 Public Health Emergency

Remember when there wasn’t a pandemic? COVID-19 has rocked our world and has left its mark on a new generation. It has also shape-shifted the Medicaid program. States will need to figure out how to return Medicaid to the pre-COVID-19 program it was. What does that mean for payors, providers, and beneficiaries? This article takes…

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