MCOs

News & Analysis as of

HFS Issues Clarification on MMAI Program

On August 8, 2014, the Illinois Department of Healthcare and Family Services (HFS) issued a three-page memo to long term care nursing home providers clarifying several issues regarding participation in the Medicare/Medicaid...more

Battle Over Cost of Drugs Ratchets Up

The battle over the rising costs of drugs, fueled by Gilead’s Hepatitis C drug Sovaldi that costs $84,000 for a 12 week treatment regimen, intensified this week. Critics of the cost have taken to referring to the drug as the...more

What the WTP? The Rise of Merger Simulation in Hospital Transactions

If you are a health system or hospital thinking about a potential transaction and your lawyers haven’t spoken with you about hospital merger simulation, then maybe you should be talking with someone else. What is...more

MCOs Terminating Providers and Restricting the Freedom of Choice of Providers for Medicaid Recipients: Going To Far?

Who remembers Dennis Kozlowski? He is the former CEO of Tyco International, and his net worth is estimated at $600 million. However, his residence? A mansion? On his own island? Nope. He is currently serving 8.33 to...more

Alabama Medicaid: The Move To A Managed Care Program (Part I)

On May 17, 2013, Governor Bentley signed into law Act 2013-261, Ala. Code §§ 22-6-150 et seq., which changes the Alabama Medicaid system from a fee-for-service to a managed care program (the "Act"). This historic legislation...more

The Current Intersection of Antitrust and Managed Care

This article provides a summary of key healthcare antitrust developments in 2013, highlighted by two important Supreme Court decisions: - In FTC v. Phoebe Putney Health System, Inc.,133 S.Ct. 1003 (2013), the Court...more

To Terminate or Not to Terminate: Provider Exclusion Laws and Why They Matter

A robust, quality network of providers is essential to the operation of any managed care organization (MCO). Credentialing, quality of care, or other legitimate business concerns frequently require an MCO to evaluate removal...more

2013 Healthcare Year In Review

Bob Dylan's quote from 1964 -- "The Times They Are A-Changin" -- could equally apply to the healthcare industry in 2013. This was the year that the Affordable Care Act ("ACA") came into full public view with the start of the...more

The Future of NC Medicaid Behavioral Health: Will We Soon Be Down to Eight MCOs? Two More Monkeys Jumping off the Bed?!

Remember the song “10 Little Monkeys Jumping on the Bed?” Ten little monkeys jumping on the bed. One fell off and broke his head. Mama called the doctor and the doctor said, “No more monkeys jumping on the...more

Is Sec. Aldona Wos Challenging the Goliath - Like MCOs? Will She Win?

I attended a Women in Leadership conference the other day. The keynote speaker asked for us to come up with a one sentence mantra or mission statement that we would use to describe our purpose in life. I had never thought...more

DHHS’ Robotic Certification of MCOs…So Stepford-ish!

Senate Bill 208, Session Law 2013-85, requires the Secretary of the Department of Health and Human Services (DHHS) to conduct certifications to ensure the effectiveness of the managed care organizations (MCOs), and the first...more

Protests Of The Medicaid Managed Assistance ITN Recommended Awards

Pursuant to Section 409.966, Florida Statutes, traditional Medicaid services are to be provided to Florida recipients through a limited number of Managed Care Organizations ("MCOs") in the 11 Regions of the state. The Agency...more

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