Healt Plan Leaders’ Statements About VBC

“The patient-centered medical home has served as a catalyst and organizing philosophy to refine our state care delivery system. It has brought stakeholders from both the public and private sector together to organize around a philosophy of care delivery that brings value to our citizens. This model serves to create value in our health care system through improving the quality of care delivered to patients and maximizing the value of each health care dollar spent.”

NEW RULES:Bans on balance billing and out-of-network cost-sharing

Effective Jan. 1, 2022, Health Plan commercial members will be protected from balance billing after receiving emergency care and nonemergency care from certain out-of-network providers at in-network facilities. The No Surprises Act, which is included within the Consolidated Appropriations Act of 2021 (the CAA), provides the following:

Improving Payment Accuracy In Health Insurance Marketplaces

In all three countries studied, risk adjustment leaves some enrollees highly underpaid and others highly overpaid. In the U.S. exchanges, for example, one in a thousand enrollees were underpaid by more than $190,000, and one in a thousand were overpaid by at least $95,000 in 2017.

Biofourmis Launches Its Chronic Condition Management Platform

The Biofourmis Care platform currently supports five virtual care programs: heart failure, hypertension, diabetes, lipid management, and atrial fibrillation. The technology platform facilitates care coordination across care settings and provider organizations and supports user communications with the care team. Biovitals, the Biofourmis artificial intelligence-powered predictive analytics engine, analyzes the data from the consumer wearables.

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Nurse Practitioners Sentenced to Prison for Health Care Fraud

GREAT  FALLS – Two Montana nurse practitioners have been sentenced for conspiring to defraud Medicare of millions of dollars.  Chief U.S. District Judge Brian Morris sentenced Janae Nichole Harper, 34, of Kalispell, to 12 months in prison and Mark Allen Hill, 54, of Edinburg, North Dakota to 9 months in prison. 

Medicaid MCO Quality Ratings

https://www.kff.org/medicaid/state-indicator/medicaid-mco-quality-ratings/view/print/?currentTimeframe=0&print=true&sortModel=%7B%22colId%22:%22State%22,%22sort%22:%22asc%22%7D https://www.kff.org/medicaid/state-indicator/medicaid-mco-quality-ratings/view/print/?currentTimeframe=0&print=true&sortModel=%7B%22colId%22:%22State%22,%22sort%22:%22asc%22%7D NOTES Notes Data reflect NCQA’s 2019 ratings of Medicaid managed care plans. The...

Florida Law Reminder for Early Prescription Refills (Managed Care Plans)

​Tallahassee, Fla. – Following Governor DeSantis’ Executive Orders 21-150 and 21-151 in response to Tropical Storm Elsa, the Florida Office of Insurance Regulation (OIR) issued the following notice to all health insurers, managed care organizations and other health entities licensed by OIR.

FLORIDA: Policing Reforms to Reduce Violence Against Minorities Effective Immediately

House Bill 7051, the package of policing reforms negotiated this spring by members of Florida’s Legislative Black Caucus and Republican leaders, was signed into law late Tuesday by Gov. Ron DeSantis, along with 93 other approved bills. The reforms take effect immediately and would impact not only minorities but other people facing trouble with the law.

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