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- September 10, 2015
Ensuring that Assessment Tools are Available to Enrollees
Read moreThe amount of Medicaid services for enrollees, particularly home and community based services, is increasingly being determined through prior authorization processes that use assessment tools and clinical coverage criteria. These assessment documents may not be made available to the enrollee. However, Medicaid law and due process call for disclosure…
- August 31, 2015
Step Guide to Reviewing Your State’s 2017 Essential Health Benefits Benchmark
Read moreIntroduced by the Affordable Care Act, Essential Health Benefits (EHB) are a set of ten health care service categories that certain health plans must cover. The EHBs are defined through a benchmark approach where states either select or get assigned a benchmark plan which serves as a reference plan…
- August 12, 2015
Health Advocate: Essential Health Benefits Overview
Read moreIntroduced by the Affordable Care Act, Essential Health Benefits (EHB) are a set of ten health care service categories that certain health plans must cover. In February 2015, HHS issued a Final Rule, which finalized changes to the EHB standard. This month's Health Advocate offers an EHB overview in…
- August 11, 2015
Model Medicaid Managed Care Contract Provisions: EPSDT Vision and Hearing Services
Read moreChildren enrolled in Medicaid are entitled to a comprehensive array of preventive and ameliorative care through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. As states have increasingly turned to managed care entities to fulfill their Medicaid administrative obligations, these companies are charged with affirmative duties to…
- August 5, 2015
State Medicaid Eligibility Policies for Individuals Moving Into and Out of Incarceration
Read moreConnecting individuals moving into and out of incarceration to health coverage may not only increase their access to care and improve their health status, but may also lead to state savings. Based on a review of state statutes, regulations, publicly available state Medicaid policies, and Medicaid managed care contracts,…
