News Briefs

✦ Oklahoma last month released a request-for-proposals from qualified insurers interested in participating in the state’s first managed Medicaid program. Beginning on Oct. 1, 2021, managed care organizations would coordinate medical, behavioral and pharmacy benefits for low-income adults (including the expansion population) and children in the new SoonerSelect program, while aged, blind or disabled enrollees and dual-eligible beneficiaries would remain in fee-for-service Medicaid for the time being. The Oklahoma Health Care Authority is seeking to contract with at least three MCOs to provide statewide coverage, and it expects to unveil awards in January or February. Visit www.okhca.org/soonerselect.

✦ CMS late last month released a series of Health Plan Management System (HPMS) memos aimed at clarifying various uncertainties related to the COVID-19 pandemic going into next year. In an Oct. 28 memo to Medicare Advantage organizations, Medicare-Medicaid Plans (MMPs) and Medicare Cost plans, CMS announced that fee-for-service Medicare will foot the bill for COVID-19 vaccinations administered in 2021. In a separate frequently-asked-questions document posted Oct. 15, CMS said MAOs, Part D plan sponsors and MMPs may not waive the Part B premium for an enrollee during the public health emergency, even though some MA plans during the current open enrollment period are offering “premium rebates” to cover Part B premium payments. And in a third memo dated Oct. 29, CMS notified plans that it will continue to use the 2020 audit protocols when conducting 2021 program audits. CMS had intended to use the updated protocols, which contained numerous changes, for the 2021 audits, but they are still awaiting OMB approval. View the HPMS memos archive at https://go.cms.gov/3oWvQya.

© 2024 MMIT
Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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