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Vorys Health Care Advisors

Category Archives: Managed Care

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Ohio’s Behavioral Health Redesign – Part 1

Posted in Behavioral Health, Managed Care, Medicaid, Physical and Behavioral Health Integration

Ohio’s behavioral health service delivery and payment systems are heading in a new direction. Over the next three years, we expect providers and service recipients to experience significant changes as alterations are made to the state’s determination of eligibility, authorized providers, covered services, and payment amounts and methods. This is the first post of a… Continue Reading

VHCA Webinar on New Medicaid Managed Care Rules

Posted in Behavioral Health, CMS, Health Care, Managed Care, Medicaid, Regulations

CMS recently proposed regulations regarding Medicaid managed care.  The proposed rule, which was released on June 1, offers the fist major update to Medicaid and CHIP managed care regulations since 2002 – in many ways, this update and modernization of the regulations is overdue.  In general, the proposal takes a big step toward aligning Medicaid and CHIP managed… Continue Reading

CMS to Study States’ Compliance With Medicaid Managed Care Actuarial Soundness Requirements; Early Reports “Troubling”

Posted in Managed Care, Medicaid

As recently reported in Modern Healthcare, the Centers for Medicare & Medicaid Services (CMS) have announced two initiatives that are likely to impact reimbursement to and operations of Medicaid managed care plans (MCPs). The first initiative is a study of the adequacy of how states set reimbursement rates for Medicaid MCPs.  Federal regulations require that… Continue Reading

The Centers for Medicare and Medicaid Services Issues Home and Community-Based Settings Toolkit

Posted in Managed Care, Medicaid

On March 20, 2014, the Centers for Medicare and Medicaid Services (CMS) posted a “Transition Plan Toolkit” to assist states in developing their Home and Community-Based Settings (HCBS) 1915(c) waiver and section 1915(i) state plan amendment or renewal application(s) so that they comply with new requirements in the HCBS Final Rule, released earlier this year…. Continue Reading