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State Health Watch Archives – January 1, 2010

January 1, 2010

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  • New resources will combat major weaknesses in Medicaid fraud detection

    How effectively does the Medicaid Statistical Infor- mation System (MSIS), the only nationwide Medicaid eligibility and claims information source, detect fraud, waste, and abuse? Not very, according to a new report which found the MSIS failed to capture data elements that can assist in fraud, waste, and abuse detection.
  • Fiscal Fitness: How States Cope: Ohio Medicaid faces steep growth; strives to protect access

    Over the past 12 months, Ohio Medicaid has seen a 9% increase in enrollment, totaling 168,000 additional individuals on the program. Interestingly, though, 80% of that growth has been in the Healthy Families program, which covers parents, pregnant women, and children at low income levels.
  • New data help Medicaid target high-need, high-cost populations

    Cost-containment programs targeting high-need, high-cost Medicaid populations now have more information to work with. Researchers from the Hamilton, NJ-based Center for Health Care Strategies analyzed prescription drug use in addition to diagnostic claims in the October 2009 report, "The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions." Here are key findings resulting from the addition of pharmacy data to the analysis:
  • PCCM programs can achieve cost savings, if significantly enhanced

    A small but committed number of state Medicaid programs are setting out to enhance their primary care case management programs (PCCM) that link beneficiaries to primary care providers (PCPs) and pay providers for a core set of care management activities.
  • Oklahoma Medicaid reports on recent changes to its PCCM program

    Oklahoma's Medicaid director, Lynn Mitchell, MD, says as of January 2009, the state's primary care case management (PCCM) program, called SoonerCare Choice, in which 423,000 Oklahomans participate, had "further embraced the patient-centered medical home principle, and we did that as a request from our providers. We feel that this will take even a further benefit to our members."
  • Equal footing needed with community-based services for LTC

    When Michael P. Starkowski, commissioner of Connecti- cut's Department of Social Services, gave a recent presentation, a woman in a wheelchair approached him during a coffee break. She asked whether he had anything to do with Money Follows the Person (MFP), a Medicaid initiative that helps people transition from institutions to community living.
  • Industrial hygiene group says N95s the right call

    The American Industrial Hygiene Association (AIHA) has issued a position statement on H1N1 pandemic influenza A that endorses and reiterates the key findings of an Institute of Medicine panel that recommended N95 respirators for health care workers. Key points stressed by AIHA include: