OIG Finds Inappropriate Service Denials by MAOs

An Office of Inspector General (OIG) report determined that Medicare Advantage Organizations (MAOs) sometimes delayed or denied Medicare Advantage beneficiaries’ access to services, even though the requests met Medicare coverage rules. MAOs also denied payments to providers for some services that met both Medicare coverage rules and MAO billing rules. In the report, Some Medicare Advantage Organization Denials…

Webinar: Unleashing the Capabilities of MAOs to Deliver Health Innovation for Older Adults in Underserved Settings

  • Thursday, October 7
  • 2:30PM – 4:00PM ET

As part of a broader partnership, CMMI, the Office of the Assistant Secretary for Health (OASH) and the Administration for Community Living (ACL) are jointly sponsoring a webinar titled, Unleashing the Capabilities of MAOs to Deliver Health Innovation for Older Adults in Underserved Settings on October 7 from 2:30-4:00 PM ET to highlight the emerging, numerous opportunities for MAOs to support beneficiaries in more fully meeting their care needs and goals through novel approaches and services enabled by technology.

The webinar will provide an overview of the data supporting these opportunities and will include a panel of three speakers from payer organizations, each of whom will provide an overview of their experience and results in innovating in the use of technology to address unmet enrollee health needs.

Panelists include:

  • Mona Siddiqui MD, MPH, Senior Vice President for Enterprise Clinical Strategy and Quality at Humana, who will discuss Humana’s approach to the use of data and predictive modeling to proactively engage and provide care for the highest risk and most vulnerable populations;
  • John Wiecha, Medical Director, Senior Products Division at Point32Health, representing the newly combined organizations of Harvard Pilgrim Health Care and Tufts Health Plan will provide an overview of a recent pilot project to improve dementia care through a digital caregiver support program; and
  • Caesar A. DeLeo, MD, MHSA Vice President & Executive Medical Director Strategic Initiatives, Highmark Health Enterprise Clinical Organization, Highmark BCBS who will discuss Highmark’s experience with telemedicine to approach substance use disorders during the pandemic and results from a five-year data driven program addressing appropriate opiate prescribing through profiling and academic detailing.

The webinar offers attendees the opportunity to gain a better understanding of the evidence and potential of several technology-enabled services in improving access, quality and outcomes of care, including, importantly, for underserved populations and will provide MAOs with insights more broadly on the challenges and solutions in design, implementation and evaluation of innovative and technology-enabled service.

MAOs that are considering such innovations who may wish to target the use of technology-enabled and/or other services based on chronic illness and/or Low-Income Subsidy (LIS) status through the VBID Model are encouraged to attend.

CMS Releases List of MA Plans Offering Hospice under VBID Model in CY2022

On September 29, 2021, the Centers for Medicare & Medicaid Services (CMS) released the list of Medicare Advantage (MA) plans that will participate in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model during Calendar Year (CY) 2022, including those that will participate in the MA VBID Hospice Benefit Component, which began operation in January…

CMS Directs MAC Outreach to Hospices in MA VBID Demonstration Model Areas

Beginning on January 1, 2021, through the VBID Model, participating Medicare Advantage Organizations (MAOs) can voluntarily participate in the Hospice Benefit Component of the Model, according to a November 13 transmittal (10458/CR 12045) from the Centers for Medicare & Medicaid Services (CMS).  During CY2021, nine plans will test coverage of Hospice as part of their…