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Category Archives: Medicaid

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Date Nears for States to Implement CMS Access Rule

Posted in Access, CMS, Health Care, Medicaid, Regulations

On January 4, 2016, the Center for Medicare and Medicaid Services (CMS) implemented sweeping new requirements for ensuring access to specific categories of Medicaid services. The final rule, released on November 2, 2015, and titled Medicaid Program; Methods for Assuring Access to Covered Medicaid Services, creates a very important vehicle for beneficiaries, service providers, their… Continue Reading

Multi-system youth: the need for additional and coordinated services

Posted in Behavioral Health, Care Coordination, Child protection, Medicaid, multi-system youth, Wrap-around

“Multi-system” youth are children and adolescents served by multiple public systems, including state agencies providing both financing and direct services in the areas of: Child protection, Health care (often through Medicaid), Juvenile justice, Intellectual and developmental disabilities, Behavioral health care (both mental health and addiction services), Child care, and Education. Multi-system youth have complex needs that cannot… Continue Reading

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

Court Ruling On Companionship Services Exemption

Posted in Medicaid

Recent federal court action ensuring that employers may continue to take advantage of minimum wage and overtime exemptions for companionship services protects providers of home and community-based services (HCBS), at least for the time being. As this Vorys, Sater, Seymour and Pease health care alert indicates, the ruling means that employers of direct care workers… Continue Reading

Ohio Receives $75 Million State Innovation Model Grant from CMS

Posted in Medicaid, Uncategorized

The State of Ohio has earned a $75 million implementation grant to continue work already underway to reform health care delivery and payment. The Centers for Medicare & Medicaid Services (CMS) announced earlier this week state recipients of second round funding for payment and system reform initiatives. Ohio is included in the list of winners,… Continue Reading

Corcoran Participates in Cincinnati Edition Panel on Health Insurance Marketplace Open Enrollment

Posted in Affordable Care Act, Medicaid, Presentations

Maureen Corcoran, President of Vorys Health Care Advisors, participated on Monday’s live Cincinnati Edition panel on 91.7, WVXU in Cincinnati.  Maureen and Cara Stewart, Health Law fellow with the Kentucky Equal Justice Center, and Kathryn Keller, Interact for Health Vice President for Policy and External Relations, spent nearly 40 minutes discussing with host Mark Heyne… Continue Reading

With a Year to Spare, Ohio Rebalances Spending on Long-Term Services/Supports

Posted in Medicaid

The Ohio Department of Medicaid recently announced that its work to rebalance spending on long-term services and supports in favor of home- and community-based services has hit an important milestone one year ahead of schedule.  In June 2013, Ohio was awarded $169 million in additional federal Medicaid matching funds as a result of the state’s… Continue Reading

So you graduated from high school, now what? It’s time to think about how you’ll get your health insurance.

Posted in Affordable Care Act, Medicaid

As recent high school graduates spend summer dreaming about the beginning of their college careers, it’s unlikely that many are thinking about how they are going to get their health insurance. But they should not throw caution to the wind; according to federal law, college students, like most other adults, are required to have health… 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

Is One Brand of Medicaid Expansion Waiver Better than Another?

Posted in Affordable Care Act, Health Care, Health Care Reform, Medicaid

Different strokes for different folks as the old adage goes.  This saying, however, is particularly true when you look at the states that have chosen to expand their Medicaid programs under the Affordable Care Act (ACA) through waivers. States do not have to seek a waiver from the federal government in order to expand their… Continue Reading

New York State’s Budget Relies on Federal Medicaid Money –Expecting an Answer from CMS Soon

Posted in Affordable Care Act, Health Care, Health Care Reform, Medicaid

In 2012, New York Governor Andrew Cuomo submitted to the federal Centers for Medicare & Medicaid Services (CMS) an amendment to New York’s existing Partnership Plan 1115 waiver that sought to “redesign” the state’s Medicaid program.  The amendment proposed to reinvest $10 billion of the $17 billion in savings the state anticipated it would achieve… Continue Reading

Federal Budget Agreement Delays Medicaid DSH Cuts

Posted in Affordable Care Act, Medicaid

Section 1204 of the federal budget agreement, HJ.Res.59, delays the Medicaid Disproportionate Share Hospital (DSH) payment reductions included in the Affordable Care Act (ACA) for two years.  As originally contemplated in the ACA, the DSH reductions were to have become effective in October 2013.  Instead, the budget agreement delays the reductions until October 1, 2015, but doubles… Continue Reading

Ohio Supreme Court Upholds Medicaid Expansion

Posted in Behavioral Health, Medicaid

The Ohio Supreme Court issued a decision today confirming the constitutionality of the state’s decision to expand the Medicaid program through an action of the Controlling Board.  The Court rejected a constitutional challenge made by six legislators. In November, our colleagues at Vorys, Sater, Seymour and Pease filed an amicus brief on behalf of Advocates for Ohio’s… Continue Reading

Mental Health Parity Requirements and Medicaid

Posted in Behavioral Health, Medicaid

The U. S. Department of Health and Human Services announced on Friday final regulations implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).  The MHPAEA is intended to align insured health care benefits for mental and substance use disorders (M/SUD) with those for medical and surgical care…. Continue Reading

Ohio Clears Path to Medicaid Expansion

Posted in Medicaid

The Controlling Board today approved a measure that will allow the State of Ohio to spend federal-only funds to extend Medicaid coverage in Ohio beginning January 1, 2014.  As we reported in earlier posts, the Centers for Medicare & Medicaid Services recently approved the state’s request to amend its Medicaid State Plan to cover an… Continue Reading

The Governor’s Big Play: Pushing Ahead on Medicaid Expansion

Posted in Affordable Care Act, Behavioral Health, Health Care, Health Care Reform, Medicaid

By Sylvia Brown and Former State Senate President Tom Niehaus Anticipation is building as the battle over Medicaid expansion moves to the unlikely arena of the state Controlling Board. On Monday, October 21 at 1:30 p.m., Governor John Kasich will try to make good on his promise to take whatever action within his power to… Continue Reading

Vorys Health Care Advisors and Truven Health Analytics Co-Author SAMHSA’s “Medicaid Handbook: Interface with Behavioral Health Services”

Posted in Behavioral Health, Medicaid

Maureen Corcoran, president of Vorys Health Care Advisors (VHCA), and Daphne Saneholtz, senior advisor with VHCA, partnered with John Easterday, Ph.D. and Truven Health Analytics to author a Medicaid handbook for the federal Substance Abuse and Mental Health Services Administration (SAMHSA).  The handbook, titled “Medicaid Handbook:  Interface with Behavioral Health Services,” provides readers with an understanding of… Continue Reading

Health Insurance Options in 2014

Posted in Affordable Care Act, Health Care, Health Care Reform, Medicaid

In a recent post, we discussed the insurance mandate itself.  That is, the requirement that most people have health insurance beginning in 2014 or face a financial penalty.  We also briefly mentioned the insurance options that will be available to you in order to fulfill this requirement.  They are— Have employer-sponsored insurance Be covered by… Continue Reading

CMS Addresses DSH Cuts; Impact on States That Do Not Expand Medicaid Remains Unclear

Posted in Affordable Care Act, Health Care, Health Care Reform, Medicaid

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that cuts federal payments to hospitals for uncompensated care.  What still remains unclear, however, is how these cuts will impact states that do not expand their Medicaid programs. The Affordable Care Act (ACA) requires significant cuts to Disproportionate Share Hospital… Continue Reading

HPIO Resources on Medicaid Expansion in Ohio

Posted in Affordable Care Act, Health Care Reform, Medicaid

The Health Policy Institute of Ohio (HPIO) has recently added to its collection of Medicaid resources a brief focused on projected new employment and new local general sales tax revenues due to Medicaid expansion.  Governor Kasich’s budget proposal includes language expanding Medicaid eligibility up to 138% of the federal poverty level, or $32,499 for a… Continue Reading

VHCA Webinar: How the Governor’s Executive Budget Impacts Providers

Posted in Medicaid

Vorys Health Care Advisors professionals, Maureen Corcoran and Daphne Saneholtz, along with Vorys attorney Suzanne Scrutton, will present How the Governor’s Executive Budget Impacts Providers 12 pm – 1 pm (Eastern time) on February 21. The presentation will discuss: Impact of the following on providers: Budget proposals affecting the behavioral health, developmental disability, child welfare,… Continue Reading