The new rulereinterprets obesity as an eligible medical conditionfor which weight-loss drugs would be included under Medicare Part D coverage for those with a body mass index of 30 or higher. The new rule would not include coverage for weight-loss drugs for the ...
Fee-for-service Medicare has a lot of influence over the health insurance industry and U.S. healthcare at large, if only for its massive amount of spending and enrollment. The federal program represents the largest payer in the country, accounting for21% of the total national health expenditur...
Objective.—To compare preventive screening for children in Medicaid managed care (MMC) with children in Medicaid fee for service (M-FFS) in private and institutional settings.Methods.—The sample included randomly selected institutions and private practice physicians in New York City. Within setting,...
This info-graphic illustrates how the “provider fee” scam operates. The net result of all this is a nightmare for federal taxpayers, but states also are losing out when you consider the long-run consequences. And that’s even true with the Medicaid expansions contained in Obamacare, which ...
Finally, while these analyses document performance problems in Medicaid managed care, no similar information is available on care provided through traditional fee-for-service Medicaid. For example, it is not known whether enrollees served by Medicaid health plans are receiving better or worse care than...
Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html Centers for Medicare and Medicaid Services (CMS). Aligning quality reporting programs at CMS. Retrieved from https://www.cms.gov/eHealth/ListServ_AligningQualityReporting.html Centers for Medicare and ...
The Access NPRM prioritizes payment rate transparency. If the rule is finalized, states must make all fee-for-service (FFS) Medicaid payment rates public and accessible on a state website. Similar to the managed care provision, states would also have to report their state Medica...
I think a lot is haphazard under fee-for-service and I think there's a lot that can be gained with better care coordination.” (P19, Plan administrator). “So [with managed care], every client has an individualized treatment plan and we try very hard to make sure that the needs of ...
The study's implications for positive social change include information that could help lead to better decisions about the viability of community health organizations in a fee-for-service environment, higher quality services for clients being served, and more efficient and effective use of tax payer ...
To examine the impact of a mandatory managed care behavioral health program on utilization and cost of alcohol treatment services for high-risk Medicaid patients.Pre-post nonequivalent comparison group design to compare managed care clients with fee-for-service (FFS) clients in terms of behavioral ...