HEOPS-Scientific Cowboys…

The Latest Managed Care News:


(07/28/2014) Link to TX Star Kids RFP – Are HCBS and DD Networks ready? Vendor Conference July 31, 2014: STAR Kids MCOs will customize and coordinate acute, behavioral, and long-term services and supports (LTSS) through an individualized planning and service design process. Through comprehensive service coordination, STAR Kids Members will receive services and supports tailored to their individual needs.

(07/28/2014) LA Medicaid RFP Due July 28, 2014 – Shared Savings Not Working: The Jindal administration announces big changes for Medicaid program. RFP expected Monday July 28, 2014.

The Jindal administration is moving toward a program in which the state pays premiums for a private health insurance program for two-thirds of the state’s 1.4 million Medicaid recipients. State Department of Health and Hospitals Secretary Kathy Kliebert announced the change Thursday. Kliebert said the move will provide for more budget predictability and increased savings while giving health plans more flexibility in services they can offer patients. “It was a decision based on the data we have … based on both cost and quality indicators,” Kliebert said.  Shared savings costs $13 more PMPM…  Read on…

(07/23/2014) Tennessee Sued – Lawsuit Claims Medicaid Application Process Too Hard:  Tennessee has been sued in a  lawsuit alleges that Tennessee makes it harder than any other state to enroll in its Medicaid program, called TennCare. The state has discontinued accepting applications in person at county offices and instead requires use of computer kiosks that connect people to healthcare.gov, making harder to enroll, according to the suit. The plaintiffs said that “thousands” of residents are applying every month and many are facing delays. Click to Read…

(7/15/2014) The Latest on MEDICAID – NASUAD July 2014 Medicaid Integration Tracker: Get the latest report from NASUAD the JULY  report summarizes state actions in managed care for people who receive Medicaid-funded Long-Term Services and Supports (LTSS), as well state initiatives relating to services for people who are dually eligible for Medicaid and Medicare.

(7/14/2014) Kentucky allows NPs to Practice without a Supervision Physician: Today, July 15, 2014 marks  a pivotal next step for Nurse practitioners and may impact activity in other states. Click for more…

(7/10/2014) Refinement of the ACA Marketplace Navigator Program:  The revised rule for the ACA Navigators was published in the Federal Register. Click for the rule… FYI: The 2015 HHS Navigator Grant RFP closed July 10, 2014. The next ACA Marketplace Navigator selections to be announced September 8, 2014.

(7/8/2014) 500 Billion $ Question – What’s Changing in Medicaid:  NAMD Executive Director Matt Salo shares the significant changes underway in the $500 billion Medicaid program, payment and delivery reform priorities of state Medicaid directors, and challenges faced by state Medicaid executives.


It’s not about activity, it’s about results. However results alone are not enough, in Drucker’s words: to be effective you must complete the right things. — Nancy C. Everitt

Latest News:

“Cowboys vs. Scientists”: HEOPS Sponsors Innovative Network Contracting Congress in Las Vegas February 25, 2010 (Las Vegas, NV) Approximately 100 delegates from many of the nation’s top health plans and key provider organizations met in Las Vegas for the inaugural 2010 Network Contracting Congress on February 25, 2010. This premier network contracting event was organized by Global Media Dynamics and sponsored by HEOPS.

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