An insider’s guide to managed care contract exclusions
By
Susie Mix
Dec 18, 2023
There’s a key question more providers need to know the answer to: What is a contract exclusion? A contract exclusion details the medications and treatments that are not included in the levels of a managed...
Yo, I’ll tell you what I want, what I really, really want
By
Steven Littlehale
Oct 14, 2022
It’s a curious day when I lift a lyric from the Spice Girls to title an article. The Spice Girls’ first single, “Wannabe,” was released in 1996 and rocketed to the top of the British singles chart....
Providers question managed care admissions in wake of denials
By
Danielle Brown
Jun 22, 2022
With denials on the rise, some long-term care providers are questioning the worth of admitting residents covered by managed care plans because they doubt they’ll be reimbursed for their services.
Also in the News for Wednesday, March 31
Mar 31, 2021
‘Pain champions’ in nursing homes spur better adoption of guidelines: study … State leaders gut proposed visitation law before passing it … Legal scholars want investigation into investigator of...
The 21st Century SNF: two paths forward
By
Anne Tumlinson
Jun 11, 2018
Many industry experts believe skilled nursing’s current marketshare challenges are temporary — that SNFs only have to hang on until demographic shifts kick in. But I worry about this strategy.
AHCA: Managed care transparency needed
By
Tim Mullaney
Oct 01, 2014
The government should collect and release more claims information from managed care plans, the nation’s largest long-term care provider association stated in a recent letter to Senate leaders.
Increase managed care transparency, long-term care providers urge Senators
By
Tim Mullaney
Aug 18, 2014
The government should collect and release more claims information from managed care plans, the nation’s largest long-term care provider association stated in a recent letter to leaders of the Senate...
Federal government needs to boost Medicaid managed care oversight, GAO says
By
Tim Mullaney
Jun 20, 2014
The government’s oversight of Medicaid managed care organizations is not strong, even though these entities cover about 50 million people and are growing rapidly, according to a recently released...
Data mandated for dual eligibles outlined as states move to managed care
By
Elizabeth Newman
Jun 10, 2013
Dual eligible managed care plans involved in an upcoming Centers for Medicare & Medicaid Services demonstration project will need to submit data in a variety of areas, the agency explained in a draft statement...
Florida’s Medicaid HMO program could lead to ‘granny dumping’
Jun 16, 2011
A lesser known provision of Florida’s newly adopted Medicaid reform law includes an incentive for health plans that can reduce the number of seniors in nursing homes, according to Florida elder law...