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Managed Care Archive – August 2012

A Few Words about the State Plan Approval
August 31, 2012

Attention: Medicaid Managed Care in NH has not been approved.

The NH media today is writing news reports based on two press releases, one from the Governor’s office and one from the Speaker’s office. The press release from the Speaker says that the recent action of CMS “…will allow DHHS to begin enrolling individuals in the managed care program”: Unfortunately, this statement is not accurate.

A large amount of hard work, negotiation and state and federal approvals must take place before that statement is true. For more information…

The State Plan has been Approved by the Federal Agency

Governor Lynch announced today that the federal Centers for Medicaid & Medicare Services has approved New Hampshire’s plan to implement Medicaid managed care across the state. For more information…

The State Plan (SPA) is the officially recognized document describing the nature and scope of the State of NH’s Medicaid program. As required under Section 1902 of the Social Security Act, the plan was developed by our state and approved by the CMS. Essentially, the plan is our state’s agreement that it will conform to the requirements of the Social Security Act and the official issuances of the CMS. Plan changes are submitted by the state to CMS as State Plan Amendments (SPAs). For more information…

Overview of NH Medicaid Care Management Information Sessions

NH Department of Health and Human Services has just posted the overview and content of the statewide information sessions held throughout the summer of 2012. Information covered during the sessions was on Step 1 of the new Medicaid Care Management program scheduled to launch at the beginning on 2013. For more information…

Network Adequacy

In implementing Step 1 of the managed care process, there are concerns reported about the hospitals in NH and their willingness to sign on with any of the managed care organizations (MCO’s). The department could not answer whether or not all three MCO’s have approved language for the subcontracts with providers.

Boston Medical Center opens New Hampshire office as Well Sense Health Plan

Boston Medical Center HealthNet Plan has named its new arm to the north. The Medicaid plan will operate in New Hampshire as Well Sense Health Plan, one of three insurers selected by health officials in that state to manage coverage for low-income and disabled residents. For more information…

State of Kansas “KANCARE” Section 1115 demonstration application has been approved by CMS

August 21, 2012

The State of Kansas, Department of Health and Environment, received approval from officials at the federal Center for Medicare and Medicaid Services for a Section 1115 demonstration waiver. This authority will fundamentally reform Medicaid in Kansas to improve outcomes and establish financial responsibility.

For more information…