Kentucky Cabinet provides updated information about KY HEALTH program

KY Health NoticeWe are still waiting for official word from the U.S. Centers for Medicare and Medicaid Services (CMS) about Kentucky Governor Matt Bevin’s Section 1115 waiver application proposal, known as KY HEALTH (Helping to Engage and Achieve Long Term Health).

In the meantime, the Kentucky Cabinet for Health and Family Services (CHFS) Department for Medicaid Services (DMS) has produced a “Kentucky HEALTH Quick Facts”one-pager for all Kentuckians. It is available online on the Kentucky HEALTH website under “additional information.” Also available online is the updated Kentucky HEALTH Overview Presentation and a quick reference Kentucky HEALTH Eligibility Summary.

 

 

Governor Bevin Requests Modifications to Kentucky HEALTH Proposal

KY Health NoticeOn Monday, July 3, Governor Bevin’s office formally issued a statement to the U.S. Centers for Medicare and Medicaid Services (CMS), requesting three modifications to the original 1115 Waiver request known as Kentucky HEALTH around three areas: Community Engagement, Member Disenrollment, and Presumptive Eligibility.

The proposed revisions do NOT propose any changes in benefits, cost sharing or delivery system.

There will be a voluntary 30-day public comment period, which will last until August 2 and include two public meetings – Friday, July 14, in Somerset and Monday, July 17, in Frankfort.

For more information, please check out the Kentucky Department for Medicaid Services (DMS) website.

 

Organization helps Americans understand what Medicaid is all about

commonwealth fund logoMedicaid now covers more than 73 million people, according to the U.S. Centers for Medicare & Medicaid Services (CMS), making it the nation’s largest insurer. Yet the program is not well understood by the public.

That’s why The Commonwealth Fund put together these five facts about Medicaid:

  1. Nearly 16 million people have gained Medicaid coverage under the Affordable Care Act’s expansions; most had previously been uninsured. A recent Commonwealth Fund survey found that about 60 percent of these newly insured adults were uninsured prior to gaining Medicaid coverage. Half were either uninsured for more than two years or never had coverage.
  2. Most people are satisfied with their Medicaid coverage. A recent Commonwealth Fund survey found that 88 percent of adults are satisfied with their new Medicaid coverage: 77 percent rate it as either good, very good, or excellent.
  3. Medicaid helps people get care and improve their health. About 70 percent of new Medicaid enrollees who’ve used health services said they would not have previously been able to access or afford their care. One study compared adults in two southern states that expanded Medicaid eligibility (Arkansas and Kentucky) to those in Texas, which did not. It found that people in Kentucky and Arkansas had greater access to primary care, were less likely to skip medications due to cost, were less likely to visit the emergency department, and were more likely to say they were in excellent health.
  4. Medicaid provides access to timely care. About two-thirds of adults with Medicaid coverage who tried to find a new primary care doctor found it very or somewhat easy to do so and 59 percent waited two weeks or less to see them.
  5. Medicaid provides comprehensive benefits and financial protection from large medical bills.

The mission of The Commonwealth Fund is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults. For more information, please click here.

 

Passport Health Plan named the Top Medicaid Plan in Kentucky by National Committee for Quality Assurance once more

Medicaid Rankings GraphicPassport Health Plan has once again been named the top Medicaid plan in Kentucky, rated a 4 out of 5 by the National Committee for Quality Assurance (NCQA) for the second straight year, according to “NCQA’s Medicaid Health Insurance Plan Ratings 2015-2016.”

Each year, NCQA provides updated ratings of health plans across the U.S. These ratings provide consumers with a more accurate picture of how health insurance plans perform in key quality areas. The ratings align with the U.S. Centers for Medicare & Medicaid Services (CMS) Star Ratings of Medicare Advantage plans and give unprecedented importance to health outcomes and consumer satisfaction.

“By focusing on member satisfaction, preventive services, and how we treat chronic and acute conditions, NCQA has once again reinforced what we have known to be true for a long time – Passport Health Plan is a leading model of collaboration and innovation in health care,” said Passport Health Plan CEO Mark B. Carter. “This recognition validates the great results as our staff collaborates daily with our provider partners every day to help Kentuckians live healthier lives.”

A complete list of the ratings can be found at www.ncqa.org/ratings. For more information, please click here.

 

Governor Bevin officially submits Kentucky HEALTH 1115 waiver proposal to federal government

kyhealthGovernor Matt Bevin has officially submitted the comprehensive “Kentucky HEALTH” proposal – which would transform Kentucky’s Medicaid program – to the U.S. Centers for Medicare & Medicaid Services (CMS).

According to a news release, the Cabinet for Health and Family Services (CHFS) announced a comprehensive Section 1115 waiver application proposal for Kentucky that is Helping to Engage and Achieve Long Term Health (HEALTH) as a first step towards the implementation of the plan.

The full Kentucky HEALTH Waiver is available for review by clicking here, and the official federal comment period is expected to begin in early September.

CMS rates hospitals based on safety and performance; no Kentucky hospitals earn top rating

CMS logoThe U.S. Centers for Medicare and Medicaid Services (CMS) released its Overall Hospital Star Ratings this week, rating 3,662 U.S. hospitals from one (low) to five (high) stars to give consumers a simple measure of hospital quality.

Each hospital’s rating is based on 64 measures of safety and performance in seven categories: mortality, safety of care, readmission within 30 days, patient experience, effectiveness of care, timeliness of care, and efficient use of medical imaging.

“These easy-to-understand star ratings are available online and empower people to compare and choose across various types of facilities from nursing homes to home health agencies,” Dr. Kate Goodrich, director of Medicare’s Center for Clinical Standards and Quality, said Wednesday on CMS’s official blog.

Of the 94 Kentucky hospitals that CMS evaluated, 82 were rated, and 12 did not have enough data to generate a rating.

No Kentucky hospital earned a five-star rating.

Sixteen hospitals got four stars:

  • Baptist Health Lexington
  • Baptist Health Louisville
  • Casey County Hospital in Liberty
  • Clark Regional Medical Center in Winchester
  • Flaget Memorial Hospital in Bardstown
  • Greenview Regional Hospital in Bowling Green
  • Hardin Memorial Hospital in Elizabethtown
  • Harrison Memorial Hospital in Cynthiana
  • Marcum and Wallace Memorial Hospital in Irvine
  • Methodist Hospital in Henderson
  • Pineville Community Hospital
  • Joseph Martin
  • Elizabeth Fort Thomas
  • Elizabeth Medical Center North in Edgewood
  • TJ Health Columbia (now only a behavioral-health facility)
  • Twin Lakes Regional Medical Center in Leitchfield

The majority of the Kentucky hospitals rated earned three stars. Twelve hospitals got two stars, while two hospitals – University of Louisville Hospital, where a recent state inspection found problems with nursing, and Lake Cumberland Regional Hospital in Somerset – earned just one star. A comprehensive list of Kentucky hospital CMS ratings can be found by clicking here.

Nationally, CMS gave five stars to 102 hospitals, four to 934 hospitals, three stars to 1,770 and one star to 133. Many hospitals did not produce enough data in the measured areas to warrant a rating.

 

Federal government issues new managed-care standards for Medicaid, CHIP

CMS logoThe U.S. Centers for Medicaid and Medicare Services (CMS) has set new standards for Medicaid private insurance plans, which apply to insurers operating as so-called Medicaid middlemen in 39 states and Washington, D.C., and the Children’s Health Insurance Program (CHIP).

Each state, including Kentucky, runs its own program, although the federal government pays most of the cost. Private insurers now provide coverage to about two-thirds of the more than 70 million Medicaid recipients, and the rules had not been updated for more than 10 years, according to an Associated Press article.

“A lot has happened to health insurance coverage through Medicaid over the past several years as millions more people have gained coverage because of the Affordable Care Act: The federal government and the states have sought to strengthen the program’s focus on the consumer, the delivery of high quality care, and providing greater access points, and on developing a modern set of rules,” wrote Andy Slavitt, acting administrator of CMS, with Vikki Wachino, director for the Center for Medicaid and CHIP Services at CMS, in a blog post  announcing the final rule.

“Today, we’re taking a next step in that work today by finalizing a long-anticipated rule that updates how Medicaid works for the nearly two-thirds of beneficiaries who get coverage through private managed care plans. These improvements modernize the way these managed care health plans operate so that Medicaid and CHIP continue to provide cost-effective, high quality care to consumers,” they wrote.

The regulation is more than 1,400 pages long, and it will take time for states, consumer advocates, and insurers to assess all its implications.

According to an article in Morning Consult, “Wachino described it as having four parts: It will enhance delivery system reform, strengthen consumer experience and protections, strengthen the integrity of the program, and align the rules across different insurance programs.”

The changes start to take effect next Jan. 1, and will take years to fully put into place.

 

Healthcare Providers Prepare for New ICD-10 Code Sets this Week

ICD-10 LogoHealthcare providers around the country have been preparing for this Thursday, October 1, when the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets.

ICD-10 consists of two parts:

  • ICD-10-CM diagnosis coding, which is for use in all U.S. health care settings.
  • ICD-10-PCS inpatient procedure coding, which is for use in U.S. hospital settings.

ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims:

  • Claims for services provided on or after the compliance date should be submitted with ICD-10 diagnosis codes.
  • Claims for services provided prior to the compliance date should be submitted with ICD-9 diagnosis codes.

The U.S. Centers for Medicare & Medicaid Services (CMS) has created a special website called RoadTo10.org that bills itself as the “one-stop source for all things ICD-10.”

Also, for any provider in the Passport network who has questions about the ICD-10, you can contact Provider Services at (800) 578-0775, or contact your provider relations specialist. To see other “eNews” mailings that get shared with providers, please click here.

 

Passport Health Plan Again Named the Top Medicaid Plan in Kentucky

NCQA ratingsPassport Health Plan has been named the top Medicaid plan in Kentucky with a 4-star Medicaid health plan rating by the National Committee for Quality Assurance (NCQA), according to “NCQA’s Medicaid Health Insurance Plan Ratings 2015-2016.”

Each year, NCQA provides updated ratings of health plans across the U.S. These ratings provide consumers with a more accurate picture of how health insurance plans perform in key quality areas. The ratings align with the U.S. Centers for Medicare & Medicaid Services (CMS) Star Ratings of Medicare Advantage plans and give unprecedented importance to health outcomes and consumer satisfaction.

Passport Health Plan was the only Kentucky Medicaid plan to receive a four-star rating.

“By focusing on clinical quality, member satisfaction, and Accreditation Survey results, NCQA has reinforced something that we have known to be true for a long time – Passport Health Plan continues to be a leading model of collaboration and innovation in health care,” said Passport Health Plan CEO Mark B. Carter. “This recognition is validation of the great results as our staff and our provider partners work every day to help Kentuckians live healthier lives.”

A complete list of the ratings can be found at www.ncqa.org/ratings. The searchable database provides a detailed view of each plan’s ratings in consumer satisfaction, prevention, and treatment. Passport received top scores in several categories, including rating of care, adolescent immunizations, and asthma control.

National Committee for Quality Assurance (NCQA) is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA’s HEDIS® is the most widely used performance measurement tool in health care. NCQA’s website  contains information to help consumers, employers and others make more informed health care choices.” To see the full list of this year’s Medicaid ratings, go online to healthinsuranceratings.ncqa.org/2015/search/Medicaid.

To see the official press release about this, please click here.

 

Medicare and Medicaid Celebrate 50 years of Protecting Americans’ Health

For NowThis year, the U.S. Centers for Medicare & Medicaid Services (CMS) is commemorating the 50th Anniversary of the Medicare and Medicaid programs. On July 30, 1965, President Lyndon B. Johnson signed into law legislation that established the Medicare and Medicaid programs, and for the last half-century, these programs have been protecting the health and well-being of millions of American families, saving lives, and improving the economic security of our nation.

According to the official CMS website, though Medicare and Medicaid started as basic insurance programs for Americans who didn’t have health insurance, they’ve changed over the years to provide more and more Americans with access to the quality and affordable health care they need.

“The 50th anniversary of Medicare and Medicaid provides an important opportunity for us to reflect on the critical role these programs have played in protecting the health and well-being of millions of families,” said Andy Slavitt, acting CMS administrator. “Today, Medicare and Medicaid are creating a health care system that is better, smarter, and healthier – setting standards for how care is delivered. As we take a moment to reflect on the past five decades, we must also look to the future and explore ways to strengthen and improve health care for future generations.”

As part of this anniversary celebration, CMS will be highlighting people, places, and progress that represent the Medicare and Medicaid programs as we know today through daily facts and posts on Twitter (@cmsgov) and Medicaid.gov.

Also, CMS is engaging in conversations with beneficiaries, providers, and health experts, and has invited the public to participate in this celebration by sharing stories of how Medicare and Medicaid have made a difference. Stories can be shared at http://www.medicare.gov/anniversary/share-your-story.html. In late July, regional CMS offices will host public events in addition to a national event in Washington, D.C.