Author Archives: Kurt Bratten

Applicability of Fraud and Abuse Rules to the Marketplace Clarified … Somewhat

One of the lingering questions about the Health Insurance Marketplace created under the Affordable Care Act is whether plans on the Marketplace are considered part of a Federal health care program, thus opening up potential liability under the Anti-Kickback Statute. … Continue reading

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New York and CMS Announce Partnership to Coordinate Care for Medicare-Medicaid Dual Enrollees

Today, CMS issued a Press Release announcing that it is conducting a demonstration project with New York State known as the Fully Integrated Duals Advantage (FIDA) demonstration.  Under this capitated demonstration, approximately 170,000 New Yorkers who are people eligible for … Continue reading

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Jason Helgerson Makes MLTC Encounter Data a Priority

At a Managed Care Policy Meeting held last week with managed care plans, New York’s Medicaid Director, Jason Helgerson, spoke about the importance for plans to submit timely and accurate encounter data.  He noted that managed long term care plan … Continue reading

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The MRT Affordable Housing Work Group Allocates $86 Million to Supportive Housing Initiatives

The Medicaid Redesign Team (“MRT”) Affordable Housing Work Group has allocated $86 million in 2013-14 to fund various supportive housing initiatives throughout the state. The Notice of Funding Availability is available here. Of this amount, $36.376 million is targeted to … Continue reading

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New York State Releases Funding RFP for Sandy Relief

The Office of Children and Family Services announced that funding is available under the Federal Social Services Block Grant for health and human service providers impacted by Superstorm Sandy.  In total, $200,034,600 in federal Superstorm Sandy Social Services Block Grant … Continue reading

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WellPoint Pays $1.7 Million to Resolve Alleged HIPAA Violations

The managed care company WellPoint Inc. has reached a Resolution Agreement with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) to settle allegations that it violated the Health Insurance Portability and Accountability Act of 1996 … Continue reading

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OMH, OASAS and DOH Unveil Behavioral Health Managed Care Update

Earlier this week a team from New York State’s Office of Mental Health (OMH), Office of Alcoholism and Substance Abuse Services (OASAS) and the Department of Health (DOH) presented a webinar describing progress made on managed care program design activities intended … Continue reading

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Medicaid Director Announces House Oversight Committee Interest in Managed Long Term Care

On June 20, 2013, at the Managed Care Policy Meeting, Jason Helgerson announced that the House Oversight Committee has asked CMS to investigate managed long term care plans related to the use and possible abuse of social day care programs … Continue reading

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New York Managed Long Term Care Enrollment Hits 100,000

At its recent meeting on June 13, 2013, the N.Y.S. Department of Health Medicaid Managed Care Advisory Review Panel (MMCARP) was updated about enrollment in Managed Long Term Care.  DOH staff announced that enrollment across the state in 3 types … Continue reading

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Health Planning Committee of the Public Health and Health Planning Council Proposes Significant Certificate of Need Redesign

The Health Planning Committee of the Public Health and Health Planning Council is proposing a significant Certificate of Need (“CON”) redesign. The Committee and Council are expected to make twenty-two (22) recommendations to the Department of Health next week, affecting … Continue reading

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