Eligibility Review of eligibility SPA to reduce income eligibility for Medicare Changes categories to determine Savings Program to federal minimum potential duplication with SPA to eliminate coverage for 19 & 20 year eligibility for tax credits olds beginning in 2014 SPA to reduce eligibility for parents from 200% Increased tests to 100% FPL Reduced eligibility periods for Program integrity Oversight through data Utilization of Recovery Audit Contractors initiatives review, survey & certification Centralized provider enrollment process Increased claims level analysis Centralized program integrity training across all Contracts with program pertinent agencies integrity vendors Annual audit review by external agency or contractor Ongoing review of Medicaid policy and procedure Federal partnership best practice implementation (except CMS best practice annual summary report) Review of repayments due upon TPL payment Reimbursement Expansion of list of hospital Implements federal minimum requirement for reforms acquired conditions (HAC) for HAC which reimbursement is barred MaineCare does not reimburse for readmits beyond CMS required within 72 minimum Not reimbursing for potentially preventable readmissions No reimbursement for elective C-Section before 39 weeks Provider taxes Bundled payments Value Based Measuring and reporting Patient Centered Medical Homes Purchasing comparative performance Accountable Communities Paying providers differentially Primary Care Provider Incentive Program on performance Designing health benefit strategies & incentives to encourage individuals to select high services and providers and better managed their health care Purchasing Managed Care PCCM Strategies Health Homes ACOs HIT Electronic health records Current MaineCare initiative Health information exchanges Managing Special Needs Plans (SNPs) Program of All-Inclusive Care of the Elderly (PACE)
Eligibility Changes Review of eligibility categories to determine potential duplication with eligibility for tax credits beginning in 2014 Increased tests Reduced eligibility periods for SPA to reduce income eligibility for Medicare Savings Program to federal minimum SPA to eliminate coverage for 19 & 20 year olds SPA to reduce eligibility for parents from 200% to 100% FPL Program integrity initiatives Oversight through data review, survey & certification Increased claims level analysis Contracts with program integrity vendors Utilization of Recovery Audit Contractors Centralized provider enrollment process Centralized program integrity training across all pertinent agencies Annual audit review by external agency or contractor Ongoing review of Medicaid policy and procedure Federal partnership best practice implementation (except CMS best practice annual summary report) Review of repayments due upon TPL payment Reimbursement reforms Expansion of list of hospital acquired conditions (HAC) for which reimbursement is barred beyond CMS required minimum Not reimbursing for potentially preventable readmissions No reimbursement for elective C-Section before 39 weeks Provider taxes Bundled payments Implements federal minimum requirement for HAC MaineCare does not reimburse for readmits within 72 Value Based Purchasing Measuring and reporting comparative performance Paying providers differentially on performance Designing health benefit strategies & incentives to encourage individuals to select high services and providers and better managed their health care Patient Centered Medical Homes Accountable Communities Primary Care Provider Incentive Program Purchasing Strategies Managed Care Health Homes ACOs PCCM HIT Electronic health records Health information exchanges Current MaineCare initiative Managing Special Needs Plans (SNPs) Program of All-Inclusive Care of the Elderly (PACE)
recommendation-report12-15-2012.docx