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Tech huge IBM has develop into a leader in demonstrating true-world purposes of blockchain technology. The enterprise has already implemented blockchain-based mostly options to music meals provide chains and to be certain ethically sourced minerals.
IBM continues to collaborate with a few main companies to remedy complicated business challenges through its blockchain network. introduced nowadays, IBM analysis is partnering with The Freshwater trust (TFT), a nonprofit working to protect and restore freshwater ecosystems, and SweetSense Inc., a company of low cost satellite tv for pc connected sensors, to pilot blockchain and IoT technologies for monitoring groundwater utilization in a single of the greatest and at risk aquifers in North the us.
The college of Colorado at Boulder will supply extra analysis guide for this venture, which is additionally being collectively funded with the aid of the Water basis and the Gordon and Betty Moore groundwork.
The task’s scientists and engineers will show how the blockchain and far off IoT sensors can accurately measure groundwater utilization transparently and in actual-time. The sensors will transmit water extraction facts to orbiting satellites and then to the IBM blockchain platform hosted within the IBM Cloud. The blockchain will list all information exchanges or transactions made in an append-simplest, immutable ledger. wise contracts will even be used once transactions are automatically executed when the conditions are matched.
The community will pilot the system in northern California’s Sacramento-San Joaquin River Delta, frequently spoke of because the “nexus of California’s statewide water device.” The river delta covers 1,one hundred square-miles, presenting water to the San Francisco Bay area and Southern California. It additionally helps dozens of legally included fish, plant and animal species. in addition, essentially seventy five% of this land is used for agriculture.
in keeping with a analysis venture in Kenya with USAID, the Millennium Water Alliance and different companions, they are actually making use of their knowledge in constructing determination assist systems for water administration for floor and groundwater statistics aggregation, workflow optimization and analytics to handle an identical challenges in California. With the addition of the blockchain, they will bridge important have confidence and transparency gaps making it viable to construct a sturdy, scalable and inexpensive platform for managing valuable groundwater substances anyplace on the earth”, noted Dr. Solomon Assefa, vice president, rising Market options and Director for IBM analysis, Africa.
The collaboration between the businesses all started in line with the Sustainable Groundwater management Act (SGMA), which become signed into California legislations in 2014. SGMA mandated the introduction of Groundwater Sustainability corporations (GSAs), native organizations that are answerable for making certain that regional groundwater resources are sustainably managed. The GSAs are answerable for establishing and imposing a plan to make their native groundwater usage sustainable by 2040.
In California and within the central Valley, one of the biggest impacts on their river situations is agriculture. here's a enormous agricultural location it's severely groundwater wired. This problem became dropped at attention in California when a multi-12 months drought resulted in an affect of over $three billion to the agricultural economic system. California then passed the SGMA, which for the primary time will modify groundwater pumping. Now, however, the State of California is attempting to investigate a way to share communal resources. As a non-earnings, they try to assist reaching these goals,” Alex Johnson, Freshwater Fund Director with TFT, informed me.
A Blockchain For Farmers, Financers And Regulators
right through the pilot, a web-primarily based dashboard will be attainable to farmers, financers and regulators, enabling all events to computer screen and song using groundwater. this could additionally assist display how sustainable pumping tiers can also be carried out throughout the buying and selling of groundwater use shares in the State of California. particular person clients who require groundwater amounts past their share cap could be able to “purchase” groundwater shares from different clients who don't require all of their give at a market-regulated rate.
based on Nathan Wangusi, desktop scientist for IBM research, Africa, researchers are establishing a concept for a “groundwater credit score,” so as to allow farmers to alternate water sources amongst each and every other.
The blockchain allows for visibility of water extraction and continues a good ledger on this, whereas helping with transparency and the means to exchange belongings. They at the moment are constructing a groundwater credit score, which is an asset-based mostly token that represents an quantity of water that a person has rights to. here's similar to an environmental credit score. for example, they presently have a project that makes use of plastic recycling as a tokenized credit score that can also be traded on a blockchain platform.”
as an instance, if a strawberry farmer is planning to take the season off to put together for an organic crop the following harvest, they can change or sell water credit on the blockchain to another farmer. Or, if due to a very dry season a vineyard realizes it is going to want additional floor water to stay away from dropping the old, the vintner can buy additional water shares, devoid of negatively impacting the aquifer.
moreover blockchain, the sensor technology supplied by SweetSense is a vital aspect for monitoring groundwater substances.
by remotely monitoring groundwater use by means of their sensors, we’re capable of support enhance and keep sustainable access to water resources for individuals, farmers, and cattle. The work we’re doing in Africa is without delay translatable to California, spoke of Evan Thomas, CEO of SweetSense and Mortenson Chair of world Engineering on the tuition of Colorado Boulder. Their analysis team on the university of Colorado will aid in modeling groundwater use during the sensor facts and satellite detected rainfall and climate correlations.”
SweetSense is currently monitoring groundwater for over a million people by the use of satellite networks in Kenya and Ethiopia and plans to scale to five million by means of the conclusion of the yr.
just The starting
whereas this pilot is an early example of the knowledge of those technologies, the groups at the back of the challenge also view it as an immense opportunity for future success.
“we are working in a free market space and the laws and necessities for floor water balance are handiest now being determined by using local jurisdiction in California. different western states are far in the back of, notwithstanding. They view this as a chance to reveal how issues can work if you follow them to a system with applied sciences like these,” spoke of Johnson of TFT.
Explaining blockchain technology to all the events involved remains a problem, however.
“We need to clarify to clarify what blockchain is, why it provides protection and sufficient transparency the place it will also be used for compliance. They deserve to reveal how this can assist farmers have a more resilient aquifer to pump water from, whereas having the flexibleness to change amongst their neighbors if a drought happens,” mentioned Johnson.
in addition, the success of this pilot is totally based on the technologies concerned.
the longer term success of those sustainability plans hinges on being able to tune and file groundwater use, and likely will additionally require a sturdy option to change groundwater shares as neatly” added Johnson. “Our strategic intent is to harness new technologies to enhance a equipment that makes getting groundwater extra sustainable, collaborative, accurate and clear process, which is why we're the usage of the blockchain. we've the venture crew and funding to do it, and a strong network of companions within the region which are open to an preliminary testing and constructing phase.”
February 01, 2019 - Cybersecurity, compliance, clinical equipment safety, and different urgent safety concerns will take core stage at the HIMSS19 annual convention, taking place February eleven-15 in Orlando, Florida.
during the conference, friends can seek advice from the HIMSS19 Cybersecurity Command middle on the Orange County convention core. internet hosting safety providers like Cisco, Clearwater, FairWarning, MimeCast, IBM safety, and a lot of others, attendees can consult with these booths for conversations around security and get solutions to one of the vital most urgent safety questions.
Attendees can verify their knowledge of user recognition, compliance possibility, cybersecurity modernization operations, and their cybersecurity knowledge with some of the trade’s leading safety experts. The cybersecurity showcase will remaining all week and will additionally cowl issues like cloud, fitness app safety, and a great deal greater.
The HIMSS19 pre-convention on February 11 will function an all-day Cybersecurity discussion board, covering navigate cybersecurity risks to the healthcare sector. Attendees will hear from leading safety professional Axel Wirth, Symantec Healthcare Architect, all the way through the hole keynote. He’ll provide insights on traits, a hit incident response, and greater.
The discussion board will additionally cowl a wide range of security themes including cloud safety and the NIST privacy framework.
examine more: The Hits and Misses of HHS Healthcare Cybersecurity guidelines
From compliance to medical machine security, the conference will host many security-based schooling periods so that it will provide attendees with insights from the security sector’s leading consultants. listed here are the safety shows no longer to leave out at HIMSS19.Compliance
To delivery, the office for Civil Rights Director Roger Severino will deliver attendees with an update on HIPAA compliance and enforcement efforts of the branch of fitness and Human features.
all the way through the session, an update on HIPAA Compliance and Enforcement from the HHS workplace for Civil Rights, Severino will share enforcement tendencies and movements, along with determining highest quality practices to ensure a firm continues to be HIPAA compliant.
As healthcare agencies consider imposing blockchain technology, security and compliance may still be a right precedence. in the session Blockchain privacy, safety, Compliance and law, attendees will hear from Microsoft, Sentara Healthcare, and Indiana school fitness protection leaders on a way to implement and use blockchain – while managing privateness, possibility and compliance expectations.
Attendees will also learn the way blockchain works as a security device, alongside other mechanisms to mitigate chance around breaches, DDoS, and other security incidents.
examine greater: HSCC Releases Joint medical gadget security Lifecycle tips
all through Streamline charge Card industry (PCI) Compliance in a diverse hospital atmosphere, attendees will study an often not noted risk enviornment: fee card program security. Leaders from Bon Secours health gadget and Coalfire, a protection enterprise, will tackle protection issues around the tech, including assessing gaps and settling on commonly omitted areas of development.vendor management
most likely one of the crucial famous themes at HIMSS19 may be dealer management: knowing the possibility and mitigating prison chance amongst disparate companies.
In Assessing When a vendor’s protection Incident Is a Breach attendees will hear from safety leaders from CynergisTek and the institution of Iowa round the way to check even if a safety incident of a company affiliate is usually a reportable breach. more importantly, they’ll outline the roles compliance, privacy, in-residence guidance, and safety play in that assessment.
further, attendees will learn to determine the questions they’ll should ask enterprise friends in the experience of a safety incident, including choosing the extent of records compromise.
visitors hoping to gain insight into constructing security into vendor relationships and contract management may still plan to attend the session, Proactive and Preventative dealer safety management. An Indiana school health protection leader will explain both the complications and necessities around vendor management classes for clinical devices and the way to proactively improve supplier relationships.
study greater: Credential Compromise good purpose of Phishing assaults in 2018
lastly, two safety leaders will define the criminal concerns around disparate companies all over the session, Let's Get precise: targeting felony possibility and probability Intelligence. Attendees will gain knowledge of gold standard practice records protection software building among companies through possibility assessments and utility particular protection necessities, together with prison risk method method and probability intelligence consolidation.medical gadget security
scientific equipment safety will be a well known theme throughout HIMSS19 to handle some of those concerns.
all the way through comfortable medical machine Procurement, a protection chief from Deloitte will discuss the contractual duties in constructing protection into the purchase and implementation of those contraptions. Attendees will learn the vital steps to buying the secure gadgets and the most advantageous method to reducing possibility to patients.
all the way through Mitigating the subsequent generation of risk: linked devices, IBM leaders will exhibit the need for an built-in protection application inside a company, by way of contrasting IT administration procedures to related medical devices. In response, they’ll additionally talk about how businesses can determine the areas for improvement across the administration and protection of linked contraptions.
extra, attendees will learn how to build a programmatic strategy to managing the safety of these instruments and the benefits of an end-to-end method of securing IT property together with devices.
The session attack Modeling and Mitigation thoughts for Networked clinical contraptions will construct on that approach, through outlining the vulnerabilities posed by means of these instruments and explaining a way to observe probability modeling frameworks and vulnerability scanners to medical gadgets.
finally, the FDA’s Suzanne Schwartz, MD will co-existing with MITRE right through the session clinical equipment Cybersecurity Incident Preparedness/Response. Attendees will hear the challenges corporations face responding to a medical machine impacted by way of a cyberattack, the need for collaboration around these hazards, and approaches businesses and producers can bolster device cybersecurity incident and response.hazards to Healthcare
protection leaders from Google Cloud, Nextgen Healthcare, and at ease-24 will supply an replace on the cybersecurity hazards to the healthcare sector, while sharing with attendees the role culture performs in a holistic protection method right through Reactions from the container: Cybersecurity. Attendees will additionally learn easy methods to take lower back to their organization to create a more resilient security environment.
Edelman will latest the session You’ve experienced an information Breach—Now What? A crisis Simulation recreation, with the intention to supply attendees with actionable guidance on how to in the reduction of the influence of security incidents. Attendees will profit figuring out on client preferences and expectations in the experience of breach, along with how healthcare corporations should adapt to meet rising threats.linked Articles linked supplies check in to obtain their e-newsletter and entry their materials
You can not detect What You can't See: Illuminating the total Kill Chain
There are bold cell utility administration platforms (MAM) obtainable. In some situations, this functionality is delivered in standalone MAM structures. In others, it comes as a module in a broader suite of features. In either case, the projects MAM performs are essential.
it is convenient to wander away in acronyms and details, spoke of Scott Lawrence, the vp for efficiency and Analytics for consulting enterprise AOTMP, a telecom administration and working towards enterprise. "First, the platform have to be intuitive and easy to use. organisations don't have time to work out how MAM utility is supposed to work," wrote. "second, and maybe extra vital, is the provider and help provided with the aid of the vendor. there is nothing greater irritating to an enterprise when they are unable to unravel their concerns or get answers to questions in a well timed manner.”greatest MAM equipment and proprietorsPulse comfortable's Workspace
The platform offers simplified, at ease entry with single signal-on (SSO) and certificate-based mostly authentication offers speedy application entry. purposes will also be curated by community and may be pushed to clients in a mandated vogue or downloaded at their comfort. equipment container protection for iOS and Android comprises encryption of all facts, managed records sharing between apps, on-demand VPN, policy-based mostly break up tunneling and enterprise wipe.
See consumer reviews of Pulse relaxed WorkspaceManageEngine cellular device supervisor Plus
The platform enforces facts loss prevention with customizable corporate protection guidelines that comfy cellular information when it's at leisure, in use and in transit. It secures sensitive enterprise facts, including assistance it is kept on misplaced or stolen gadgets.
The platform combats shadow IT by using managing and distributing each in-house and store apps to employee- and company-owned contraptions. It manages app licenses and controls app updates to be sure instruments are provisioned with the necessary apps. It checks, schedules and deploys OS updates in keeping with organizational necessities.
The platform automates device provisioning and access controls by means of setting up computerized enrollment to deliver cell instruments beneath management before unboxing them. as soon as enrolled, the platform auto-assigns gadgets to groups according to inside departments. safety guidelines, access controls, and apps associated with these groups can be instantly applied to these gadgets.
See person stories of ManageEngine cellular gadget managerIBM MaaS360 with Watson
The platform contains a leading container app solution for relaxed productivity that is deployed in most extremely regulated environments. Alongside its container, MaaS360 also presents id and entry administration with single signal-on and conditional entry capabilities out of the container. With Watson, MaaS360 consultant offers true-time possibility insights and counseled remediation path.
See consumer experiences of IBM MaaS360Arxan
The Apperian MAM aspects private business app stores, relaxed app distribution and app safety and administration guidelines. All are supported through Arxan's platform-as-a-provider offering, which enables for extensibility, automation and customization.Appaloosa save
The strategy is a native app store with "silent" example, replace, wipe and quick deployment.
See consumer reports of AppaloosaSOTI MobiControl
The platform can silently install, replace or eliminate apps on contraptions in accordance with no matter if a licensed user of the equipment has been granted entry to the app. it could combine with the Apple App shop or Google Play store to set up apps which have been authorized or purchased by the firm. a third means is to implement DLP to disable sharing of data inside a managed application to an unmanaged application similar to an individual’s own DropBox account.
See consumer experiences of SOTI MobiControlMicrosoft Intune
Multi-id, Selective Wipe (available handiest via iOS and Android platforms). users can open internet links securely via Intune Managed Browser app and app insurance policy policies.
See person reports of Microsoft IntuneMobileIron
The excellent features are a rich set of safety policies, passwordless authentication, and a robust app discovery adventure for the end person.
See consumer studies of MobileIronexact mobile utility management (MAM) device evaluation Chart
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Thursday, February 7, 2019
The Centers for Medicare and Medicaid Services (CMS) recently released several significant Medicare Advantage (MA) and Part D guidance documents outlining new Center for Medicare and Medicaid Innovation (CMMI) programs and proposed MA and Part D program changes. These new participation options and proposals, summarized in greater detail here, would give MA and Part D plans greater flexibility to customize and tailor their benefit packages to differentiate their products from competitors.IN DEPTH
The Centers for Medicare and Medicaid Services (CMS) recently released several significant Medicare Advantage (MA) and Part D guidance documents outlining new Center for Medicare and Medicaid Innovation (CMMI) programs and proposed MA and Part D program changes. A consistent theme throughout the new guidance is the agency’s emphasis on expanding flexibility and encouraging innovation in the MA and Part D programs. These new participation options and proposals would give MA and Part D plans greater flexibility to customize and tailor their benefit packages to differentiate their products from competitors, for example.
CMS proposed these policy changes in the following guidance documents:
Read on for a summary of the agency’s new programs and proposals.Supplemental Benefits for Chronically Ill Enrollees
The Bipartisan Budget Act of 2018 amended the Social Security Act to allow MA plans to offer chronically ill enrollees supplemental benefits that are not primarily health-related. The Draft CY 2020 Call Letter proposes criteria to govern which members CMS would consider “chronically ill” and therefore eligible for these benefits. Specifically, this guidance clarifies the first of three statutory criteria, which requires members to have one or more comorbid and medically complex chronic conditions that are life threatening or that significantly limit the overall health or function of the enrollee. The member must also have a high risk of hospitalization or other adverse health outcomes and require intensive care coordination to satisfy the remaining statutory criteria for the supplemental benefits.
With respect to the first statutory criterion, CMS proposes to consider members “chronically ill” if they have one or more of the 15 conditions listed in existing CMS guidance applicable to Special Needs Plans. This list was developed in 2008 and has not been updated since. In connection with this list of 15 conditions, CMS states that in future years it will convene a technical advisory panel to provide periodic updates, and requests comments as to whether MA plans should have flexibility to go beyond this list and make these eligibility determinations themselves.
Regardless of whether CMS finalizes the use of a defined list to satisfy the first criterion, the agency expects MA plans to develop and document their own processes to identify which members are chronically ill and thus eligible for the expanded supplemental benefits. Further, CMS reiterates that a member request for a supplemental benefit will be treated similarly to requests for other benefits; therefore, a request for a supplemental benefit may be considered a request for an organization determination and, as a result, a challenge to such a determination will be processed as an appeal.
Another factor that may add complexity to member appeals is the ability of MA plans to vary benefits for different members within chronic condition groups. The MA uniformity rules are waived for these supplemental benefits, so MA plans may offer the benefits to individual members based on whether they are likely to benefit from the service or intervention, instead of offering the same benefits to all members with a particular chronic condition. This is a key distinction from the targeted supplemental benefits that MA plans have been able to offer since the beginning of 2019, which can be targeted at members based on condition but cannot be further targeted based on other factors. CMS has also requested comments on whether MA plans should be able to condition the receipt of supplemental benefits on financial need.New CMMI Model for Part D and Updates to MA VBID Model
On January 18, 2019, the CMMI announced a new payment model for Medicare Part D—the Part D Payment Modernization model—as well as updates to the existing MA VBID model. Both of these models are voluntary and will run from contract years 2020 through 2024.Part D Payment Modernization Model
The new Part D Model will allow for (1) enhanced risk sharing between Part D plans and CMS, and (2) the creation of new flexibilities and incentives for plans, providers and beneficiaries to choose lower cost drugs. Both standalone Part D plans and MA-Part D (MA-PD) plans may participate in the new model.
Plans that participate in the Part D Model will assume greater risk in the catastrophic phase of Part D than traditional Part D plans. CMS will calculate the shared savings or losses owed to or by the plan for a given contract year by retrospectively establishing a spending target benchmark. CMS will set the benchmark at the amount of the federal reinsurance subsidy (80 percent of the Part D catastrophic phase costs after rebate) that CMS projects Part D plans would receive if they were not participating in the model. Plans with federal reinsurance subsidy spending that is lower than the benchmark will receive performance-based payments that are based on the total amount of savings; plans with federal reinsurance spending that is higher than the benchmark will owe 10 percent of the difference back to CMS. CMS will calculate savings or losses at the parent organization level.
CMS also plans to roll out tools for beneficiary use, including a Part D Rewards and Incentives program, that will help beneficiaries understand their options (for example, generic versus brand name options that are clinically equivalent) and out-of-pocket costs, and help them become more active and engaged consumers. In addition, plans will be able to propose drug utilization management techniques to encourage the use of lower priced drugs without impeding beneficiaries’ access to medically necessary drugs.MA VBID Model
CMS announced the national expansion of the MA VBID model, which first launched in 2017 in a limited number of states. Similar to the proposals regarding supplemental benefits for chronically ill beneficiaries described above, participating VBID MA plans enjoy additional flexibility with respect to benefits, such as reduced cost sharing or additional benefits for beneficiaries with particular health conditions. Beginning in 2020, the VBID model will be available to MA plans in all 50 states and territories, as well as to Regional Preferred Provider Organizations, Chronic Condition special needs plans (SNPs), Dual-Eligible SNPs and Institutional SNPs. For MA plans that apply and are approved by CMS, the 2020 VBID model will further enhance flexibility in several ways:
MA plans that apply to CMS by March 1, 2019, may seek to participate in one or more of the interventions described above. All MA plans that choose to participate in any of these interventions will also be required to offer wellness and health care planning.Part D Mail Order Auto-Ship
The Draft CY 2020 Call Letter would allow mail order pharmacies to auto-ship refills to members. Since the 2014 contract year, CMS has required Part D plan sponsors (other than non-employer group waiver plans (EGWPs)) to obtain member consent prior to shipping each refill prescription. CMS proposes that, for the 2020 contract year, Part D plan sponsors would be permitted to auto-ship refills of drugs that a member has been on for at least four consecutive months. The Draft CY 2020 Call Letter outlines CMS’s expectations regarding any auto-ship program, including the following:
The proposed change in policy follows CMS’s requests for comments in the Draft CY 2019 Call Letter on the current auto-ship restrictions that were adopted in 2014. Since the 2014 policy was initially announced, CMS has created a limited exception for auto-ship of initial fills for all Part D plans and a broad exception for EGWPs permitting auto-ship of initial fills and refills. The requirements CMS has proposed for auto-shipping are similar but not identical to the current exceptions to the auto-ship prohibition. For example, CMS does not currently limit auto-ship of refills by EGWP sponsors to drugs that a beneficiary has taken for four months, and does not currently require two reminders in advance of each refill.EGWP Buy-Down of Part B Premiums
CMS proposes permitting EGWPs to use a designated portion of their capitated payments to buy down the Part B premium, as individual market MA plans have been able to do. CMS formerly prohibited the practice for EGWPs both because of certain CMS operational limitations and because EGWPs could not distinguish the respective portions of their payments for basic benefits versus rebates. However, CMS was convinced to propose changing this policy after receiving feedback from stakeholders that the policy “hinders [EGWPs’] ability to function in the market and unnecessarily restricts their benefit offering beyond what was intended in its implementation.” If the proposal is finalized, EGWPs that choose to take advantage of this option will be required to comply with uniformity of benefit rules and apply the buy-down consistently to every enrollee in a particular plan. EGWPs will also be subject to the same buy-down maximum as individual market MA plans.Risk-Based Contracting for Pharmacy Benefits
CMS requests comments on “the barriers, feasibility, and benefits/drawbacks” of including the cost of Part B and D drugs in MA plans’ risk arrangements with non-pharmacy providers (e.g., physician groups or accountable care organizations) in a request for information set out in the Draft CY 2020 Call Letter. CMS appears to be interested in facilitating the inclusion of these Part B and Part D prescription drug costs in provider risk arrangements based, at least in part, on the statutory prohibition on Part D plan sponsors requiring pharmacies to take on insurance risk. By giving non-pharmacy providers a financial incentive to manage prescription drug costs, including physician-administered drugs, CMS hopes that MA plans and Part D plan sponsors will be able to “drive down the cost” of such drugs.Updates to MA Risk Adjustment Payment Condition Count Model
CMS has proposed to move forward in 2020 with the Payment Condition Count model it initially proposed in the CY 2019 Advance Notice Part I. This model includes a coefficient for a variable that counts the number of conditions that a beneficiary has, which stems from the 21st Century Cures Act mandate to “take into account the total number of diseases or conditions of an individual enrolled in an MA plan.” Under the proposed model, each condition will have two impacts on the beneficiary’s risk score. First, it will affect the coefficient for the specific condition. Second, it will affect the coefficient for a variable that counts the number of conditions the beneficiary has.
MA plans must consider the important implications of this new model. First, the model increases the additional value of each diagnosis identified and submitted—and increases the consequences of omitting a diagnosis—because each diagnosis is factored in the model twice. Second, it may make it harder to predict risk scores and make the bidding process more complicated. As CMS noted, the “incremental predicted expenditure for a given HCC [Hierarchical Condition Category] is dependent on the number of conditions the beneficiary may have, regardless of what those conditions may be.”
CMS asserts that it does not have a choice in whether to implement a revised model. The Social Security Act requires that the revised model be phased in over three years, with full implementation by 2022. CMS proposes to calculate risk scores used in payment year 2020 by blending (at 50/50) the risk score calculated with the new model and the risk score calculated with the 2017 CMS-HCC model.Encounter Data
CMS proposes to increase the weighting of encounter data from 25 percent to 50 percent. The transition from Risk Adjustment Processing System (RAPS) data to encounter data began in 2016 and was initially scheduled to be complete in 2020. CMS has delayed the transition amidst concerns in the industry and from the US Government Accountability Office regarding the accuracy and reliability of encounter data. As proposed, the encounter data score would use diagnoses from encounter data and fee-for-service claims, would continue to be supplemented with RAPS inpatient records, and would be calculated using the new Payment Condition Count model. The RAPS score would use diagnoses from RAPS and fee-for-service claims and would be calculated using the 2017 CMS-HCC model.Star Ratings Measures Appeals Auto-Forward (Part D) and Appeals Upheld (Part D)
CMS proposes to remove the two Part D appeals measures from the Star Ratings beginning with the 2020 measurement year (which will affect the CY 2022 Star Ratings). These measures evaluate the timeliness of processing coverage determinations and redeterminations and the rates at which appeals are upheld. However, CMS has expressed concerns that the measures are not statistically reliable because, among other issues, they rely on Part D plans to identify untimely cases and send them to an Independent Review Entity. CMS requests comments on whether the two Part D measures should remain on the Display Page. CMS also reminds Part D plans that Part D appeals will continue to be monitored through program audits, annual reporting requirements and other monitoring activities, and that the agency will continue to take action to address noncompliance.Provider Directory Accuracy
Like the annual Call Letters for the past several years, the Draft CY 2020 Call Letter includes a discussion of provider directory accuracy audits. In prior years, CMS emphasized the consistently high rates of provider directory inaccuracies and warned that the agency may take enforcement action for the most egregious instances of noncompliance. CMS recently concluded the third round of provider directory audits and, in keeping with its Call Letter warnings, the audits resulted in a combined 18 Notices of Non-Compliance, 15 Warning Letters and 7 Warning Letters with a Request for a Business Plan. In the current Draft CY 2020 Call Letter, CMS does not warn MA organizations about potential compliance actions, and the overall tone seems to signal that the agency may take a more collaborative approach to working with plans to address what the agency acknowledges is a “complex problem.”Part D Risk Corridors
Although CMS has the authority to widen risk corridor thresholds, after evaluating risk sharing amounts for 2008–2017 and finding that they have varied significantly from year to year and between Part D sponsors, CMS proposes leaving the risk corridor parameters unchanged for 2020.Addressing the Opioid Crisis
Addressing the opioid crisis remains a priority for the US Department of Health and Human Services. The Draft CY 2020 Call Letter contains several policies that continue to address this problem. For example, CMS is encouraging plans to reduce beneficiary cost-sharing for naloxone to treat overdose, and reminds MA organizations that medically approved non-opioid pain management can be offered as a supplemental benefit. CMS also proposes to advance opioid-related measures through the Star Ratings process.
This article was co-authored by Mara McDermott, Vice President at McDermott+Consulting.
Alaska is significantly behind on approving Medicaid applications, and in some cases applicants are waiting for months.
As of Jan. 29, Alaska had a backlog of 15,639 cases of new applicants or renewals on the books. About two-thirds of those, or 10,200 cases, were filed in 2018. The average wait time to be approved is currently 55 days, according to Clinton Bennett, the media relations manager for the Alaska Department of Health and Social Services.
That’s the average, but not everyone is waiting that long, he wrote in an email.
“Cases that are tagged as emergent, involve a pregnant woman or adding a newborn to any case are being processed on average within 2 days,” he wrote.
Alaska has a fairly large Medicaid population with about 210,276 people enrolled in the Medicaid and CHIP programs as of October 2018, according to the Centers for Medicare and Medicaid Services.
That’s about 24 percent of the state’s total population, and up from 123,335 people enrolled at the end of July 2015, just before the Medicaid expansion took effect in the state.
Though it’s still a sizable backlog, it’s significantly down from the total in May 2018, when the Alaska Ombudsman’s Office published a report highlighting the difficulties in the Division of Public Assistance. At the time, the ombudsman noted a backlog of more than 20,000 cases, itself down from 30,000 in July 2017.
The eligibility staff couldn’t keep up, in part because of the increasing number of cases per worker — up 24 percent since the expansion in 2015 — and other types of applications for public assistance, such as food stamps, which began increasing during the height of the economic recession in July 2017.
The state practices pre-enrollment eligibility verification, Bennett said, meaning that eligibility systems or workers must verify income before approving someone to enter the program. The state cooperates with the federally facilitated marketplace, Healthcare.gov, to verify eligibility for low-income individuals. If Healthcare.gov is unable to determine eligibility, the state will take over from there.
The Legislature also passed a bill reforming the state’s Medicaid program in 2016. One of those requirements was to implement a new technology system. Changing over systems amid the increased volume after the expansion may have led to the backlog boom, said Tricia Brooks, a senior fellow at Georgetown University’s Center for Children and Families.
“I think that in Alaska, it was sort of a perfect storm,” she said. “… You have this new system coming in, (the state was) a late adopter of the Medicaid expansion, so you have this volume going on. The combination of those two going on is really tough, particularly when you’re in an environment where you’re changing the business rules.”
Alaska is one of a handful of states that have an extensive delay for processing applications, Brooks said. The federal standard is 45 days for non-disability Medicaid applications, and 90 days for disability Medicaid applications. That delay can mean that some go without coverage, and it makes things complicated for the administrators when some are renewals as opposed to new applications.
“Backlogs affect both new applications as well as renewals,” Brooks said. “If the state’s unable to keep up with renewals, they should not be automatically terminating someone because they’re not able to renew applications.”
The Republican Senate Majority, which backed the original 2016 Medicaid redesign legislation, is concerned about the eligibility backlog as well. Senate President Cathy Giessel, R-Anchorage, said the current process is weighing the state down and allowing some people who do not qualify to obtain coverage.
Other states dealing with a similar problem have hired third-party qualified contractors to screen applicants. Giessel said that’s a step Alaska should take, too.
The backlog can be frustrating for providers as well as for recipients, she said.
“I think it’s the frustration that any compassionate Alaskan has,” she said. “When they’re on waiting lists so long, it’s not compassionate. It’s not compassionate. They want to fix that. In addition, they know there are folks on the rolls that are not eligible, that shouldn’t be.”
The reform was a big request of the department, but it is making some progress and reporting savings, Giessel said.
There are still changes that could make things better such as moving regulations through that allow expanded coverage of services via telehealth and possibly breaking up the Department of Health and Social Services into smaller departments, allowing for more efficient management, she said.
Two bills prefiled for the 2019 session propose adding work requirements for certain eligible adults. Giessel said that’s one other item the Senate is considering in the wake of Medicaid expansion, to encourage able-bodied adults on Medicaid to work.
“Am I personally happy with the way Mediciad reform is going? It’s slow,” she said. “It’s very much like the glaciers in Alaska. They’re there, but moving very slowly.”
To reduce the backlog in Alaska, Brooks pointed to a number of steps other states have taken, including the step Giessel mentioned to hire a third-party contractor to verify eligibility. Another way, which has been encouraged by CMS, is to use eligibility data from the SNAP program to determine eligibility for Medicaid. Most people who qualify for SNAP also qualify for Medicaid, Brooks said.
Another logjam in the system can be as simple as people calling the Division of Public Health to check the status of their application. That takes staff time to answer the phones. One way to address that problem is to launch online account that allow people to check the status of their applications online, Brooks said.
The majority of states have now done that, she said.
“Online accounts really improve the efficiency of the eligibility operations,” she said. “I think there’s been less trouble with the online accounts than there have with the underlying eligibility rules engine. It is a way to offload some of the work volume.”
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