News you can use: August 16, 2017

As part of our mission to transform healthcare, we want to keep you informed of regular industry updates. News You Can Use provides a brief overview of relevant healthcare topics.

In this issue, we cover a Government Accountability Office (GAO) report concerning Medicare Advantage, a summit on behavioral health issues, an update on 2018 exchange issuers, and a funding response to the opioid overdose epidemic.

1) GAO pushes CMS for greater accuracy and timeliness
The U.S. Government Accountability Office (GAO) recently published a report describing several issues with the Centers for Medicare & Medicaid Services’ (CMS) efforts to ensure proper payments in Medicare Advantage. The report recommended that the CMS increase its accuracy in identifying contracts that have the greatest potential for improper payments recovery and improve timeliness in the risk adjustment data validation (RADV) audit process.

2) Summit to discuss behavioral health issues
The CMS Innovation Center is planning to discuss ideas for a behavioral health model that would improve access, quality, and cost of care for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries with behavioral health conditions. The Innovation Center is seeking public comment about this effort and, to that end, will host a one-day summit to further discussion on Friday, September 8, 2017.

3) Map projects insurance issuers’ 2018 participation
The CMS updated the Health Insurance Exchanges Issuer County Map in July. According to the update, 40 counties across the U.S. are projected to have no insurance issuer participation on the exchanges in 2018. This would mean that about 27,000 enrollees in these counties could lose coverage.

The update also projected that as many as 1,332 counties‚ÄĒmore than 40 percent of counties nationwide representing more than 2.3 million exchange participants‚ÄĒcould have only one issuer in 2018.

4) CDC helps fund fight against opioid overdose epidemic
The Centers for Disease Control and Prevention (CDC) announced the award of more than $12 million in July to 23 states and the District of Columbia to help recipients fight the opioid overdose epidemic. The funds will be used to strengthen prevention efforts and enable better tracking of opioid-related overdoses.

States can use the funds, available through the Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality (ESOOS) program, to help with the following:

  • Speed the reporting of nonfatal and fatal opioid overdoses and related risk factors
  • Share data with key stakeholders to prevent overdoses
  • Share data with the CDC to improve multistate surveillance of and response to overdoses



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